Clinical-phenomenological signs of psychogenic disorders of stance and gait – Investigating the physical basis for movements perceived as theatrical using documentary reconstruction. A pioneer study with 10 patients

The understanding of clinical-phenomenological signs of motor conversion disorders (DSM-IV) has evolved profoundly since they were first conceptualized by Freud. Yet until today, no positive clinical signs exist to diagnose ICD-10 or DSM-IV, and there is no common terminology to describe these disorders. Instead, motor conversion disorders (MCDs) are often described using metaphorical language, including terminology from the field of theatre. The aim of this study is to develop a method that describes and assesses the movements of MCDs independently of subjective language. Such method should be able to identify the empirical reason for the past use of theatre terminology and should help in the development of a better defined medical terminology for MCDs. Ten patients with MCD were recorded on video during their medical examination. A qualitative method derived from the Documentary Method of R. Bohnsack was then used to analyze the physical movements of these patients. The method distinguishes information from three different levels of interpretation, which together allow the reconstruction of a sense-oriented typology („sinngenetische Typenbildung“). Results from this documentary reconstruction analysis support three hypotheses. (1) The nature of the physical movements of MCD patients is a reason for the usage of theatre terminology. (2) The nature of the physical interactions between doctor and patient may be an additional and perhaps stronger reason for the usage of theatre terminology. (3) Although the reconstructed typology does not point to a theatrical relationship between patient and doctor, the typology may indicate reasons for both patient and doctor to act as if in theatre. Taken together, the documentary reconstruction method appears to be a useful tool for analyzing MCDs in this pioneer study and may be used for a larger study in the future.

Key words

Conversion - Hysteria - Gait - Video Study - Documentary Method (Dokumentarische Methode) - Qualitative Movement Analysis