What is Conversion as a Defence?
Conversion is a psychological defence mechanism where emotional conflict or distress is expressed through physical symptoms. These symptoms are not intentionally produced and cannot be explained by a medical condition, yet they are very real to the individual experiencing them. In psychodynamic psychotherapy, conversion is understood as the body speaking what the mind cannot yet tolerate or articulate, and can allow for distress to be displaced from conscious emotional awareness into somatic form.
Evening of Summer, Painting by Halfdan Egedius, 1893
This defence usually develops in contexts where emotional expression is constrained, unsafe, disallowed, or overwhelming. When feelings such as fear, anger, guilt, or grief cannot be consciously acknowledged, they may be converted into bodily symptoms such as paralysis, pain, sensory loss, or functional disturbances. Historically, conversion was closely associated with what was once termed hysteria in early psychoanalytic theory; however, contemporary psychodynamic psychotherapy understands conversion in a more precise and compassionate way, and recognizes it as an unconscious mind–body process rather than a label.
George Vaillant put conversion within his hierarchy of defences as a neurotic defence. From this perspective, conversion allows psychological conflict to be managed indirectly, and reduces conscious anxiety by shifting distress into the body. While this can temporarily protect the individual from emotional overwhelm, it can also limit insight and lead to significant impairment in daily functioning. Vaillant emphasized that, as with other neurotic defences, conversion represents a compromise between internal conflict and psychological stability.
Patagonian Landscape with Single Tree before Night Sky, Painting by Eduard von Buchan, 1832
In therapy, conversion may be observed when physical symptoms come up or worsen in response to emotional stressors or unresolved trauma. Individuals experiencing conversion symptoms are often deeply distressed and may feel invalidated if their symptoms are misunderstood as “all in their head.” Psychodynamic work emphasizes careful listening, compassionate responses, validation of the lived experience, and attention to the emotional and relational context when symptoms come up, rather than jumping to conclusions or reassurance.
Psychodynamic psychotherapy seeks to help individuals gradually reconnect bodily experience with emotional meaning. Through a safe and attuned therapeutic relationship, patients can begin to recognize and tolerate previously unacknowledged feelings, reducing the need for symptoms to carry psychological distress. As emotional awareness and integration increase, conversion symptoms often lessen in intensity or resolve, and allow for the individual to experience both mind and body as part of a more meaningful whole.