Spontaneous Trance as a Possible Cause for Persistent Symptoms in the Medically Ill

A 45-year-old female underwent pericardiectomy for recurrent pericarditis. Four years later, persistent, unexplained chest pain was seen as a “conversion” symptom and treated with hypnosis and psychotherapy. Improvement was noted in narcotic dependence and level of function but not in the complaint of pain or disability status. The roles of the patient's emotional arousal and the physician's words in the setting of acute illness are explored as contributing factors in the genesis of the persistent pain. The concepts of spontaneous trance, posthypnotic suggestion, and conversion are reviewed in the context of this case.