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A Proposed Theory on the Subject of Archie Kennedy's Seizures
by Keyanna

After careful study, I've decided that there is another possible diagnosis for Archie that is worth consideration, which is that he suffers from conversion disorder. Conversion disorder (which has also been called hysterical conversion or conversion neurosis) is a psychological disorder in which an extreme stress or trauma manifests itself in the form of physical symptoms, which cannot be accounted for from a biological standpoint. These symptoms can take different forms depending on the patient, but generally fall into one of three main subgroups: motor symptoms or deficits (such as paralysis), sensory symptoms or deficits (such as blindness), or seizures and convulsions (or, in some cases, a mix of these groups). Seizures caused by conversion disorder are commonly referred to as non-epileptic seizures (or NES). However, a diagnosis of conversion disorder as the cause of seizures does not necessarily rule out the possibility of epilepsy; indeed, it is estimated that between 10 and 58 percent of patients with non-epileptic seizures also have epileptic seizures.

The reason that I first came to consider conversion disorder as a possible explanation for Archie's condition was the singular nature of his second seizure in "The Duel" (which occurs during their mission to attack the French ship). As everyone familiar with the episode is aware, Horatio clubs Archie in the head with the tiller in order to silence him, and prevent the French from being warned of their presence. This action effectively ends Archie's seizure, leaving him unconscious and perfectly quiet. However, most seizures with a biological basis (such as epilepsy) continue whether or not the individual is conscious, and in many cases, cause unconsciousness by matter of course. If that particular seizure had been caused by epilepsy, Horatio's blow would not have changed the situation at all, unless he had struck with enough force to kill Archie. Now, I do not mean to argue that all of Archie's seizures must be a result of conversion disorder; it is extremely possible, as I have already stated, for him to have epilepsy as well, and the fact is that we really know nothing to either prove or disprove that hypothesis (with the exception of this particular instance). However, I feel that the highly specific nature of Archie's seizures (namely, the presence or reminder of Jack Simpson) supports the notion that a psychological condition may well be at work.

A side note on this issue is that the parallel incident in the books (depicted in the chapter "The Man Who Felt Queer" in Mr. Midshipman Hornblower) has a small but significant difference about it. The sailor who suffered a seizure is not knocked out until after the seizure has ended, and he becomes disorientated and confused, and begins calling out for someone named "Mary" (Archie, during his seizure, does yell "Maria" at one point), which is why he needs to be silenced. In that case, then, the problem of unconsciousness during a seizure does not arise, and it seems likely that the explanation of epilepsy is both logical and sufficient.

There are a number of other factors involved with conversion disorder which I believe also provide support for this theory. Firstly, conversion disorder patients often report negative life events prior to the onset of symptoms. This, in truth, is unverifiable, since we never learn when Archie's seizures began, but it is indeed possible to theorize that they did not develop until he began serving on the Justinian, something which may be construed from Clayton's remark during Archie's first fit (that we see): "They've started again. It's as I feared." Horatio asks Clayton, "What ails him?" and Clayton responds with a nod in Simpson's direction and the remark, "What ails us all?" He explicitly makes the connection between the return of Simpson to the midshipmen's realm with Archie's (apparently just-renewed) onset of symptoms.

Secondly, conversion symptoms are suggestible and may change or improve secondary to outside cues. The seizures had apparently stopped during Simpson's absence, if Clayton spoke accurately, and began again upon his return. A similar pattern is seen when Archie is transferred to the Indefatigable. We do not see or hear any indication that he has suffered from seizures during his time there, until Simpson returns to the picture. Later on, in "The Duchess and the Devil," when Archie experiences a seizure shortly after Horatio's arrival, he remarks, "I have not been troubled by [the seizures]. Not until you came." In this instance, Horatio is a reminder of past events, one which Archie is not prepared to deal with. However, following this instance, we have no further indications that Archie has had another seizure throughout the rest of the series.

Thirdly, patients with non-epileptic seizures have a high correlation with suicide ideation (39%), and suicide attempt (20%), as well as a high incidence of depression. Archie undeniably matches up on this count, from the his attempt to starve himself to death during "The Duchess and the Devil." Finally (and perhaps most controversially), NES patients frequently have a history of sexual abuse. This is, again, impossible to prove one way or the other, and is one of the most debated points in the series. However, if the allegations that some propose that Simpson was sexually abusing Archie are true, it lends further credence to a diagnosis of conversion disorder.

With regard to the characteristics of non-epileptic seizures themselves, they appear to be in most respects identical to epileptic seizures. During an attack, there is marked involvement of the truncal muscles with opisthotonos and lateral rolling of the head or body is present. All 4 limbs may exhibit random thrashing movements, which may increase in intensity if restraint is applied. Tongue-biting and incontinence are rare. These characteristics all seem to match up with Archie's seizures. One interesting and highly relevant point about NES is that the seizures do not occur when the individual is alone, or when they are asleep. On the one hand, it brings up the important fact that two of the three seizures we see Archie experience (the first and third), occur immediately following a nightmare. It could conceivably be argued either that he awoke from the nightmare and then immediately experienced a seizure, or that these specific seizures were indeed the product of epilepsy (to me, both ideas seem equally plausible). However, the fact that an individual who experiences non-epileptic seizures does not have them when he or she is alone provides support for this theory in light of the fact that Archie (by his own report) had not experienced seizures while imprisoned until the arrival of Horatio and Hunter. And, to restate my earlier point, the fact that seizures due to conversion disorder occur only when the individual is conscious lend support to the theory given the fact that Archie's seizure ended after he was knocked unconscious by Horatio.

Finally, an extremely important point which I wish to emphasize is that, in true conversion disorder, the symptoms which are manifested are not under the voluntary control of the patient. I think that most people would agree that it is utter folly to suggest that Archie's seizures are faked or deliberate. The fact that the physical symptoms found in conversion disorder have a psychological cause rather than a biological one does not by any means make them less serious or less "real." The symptoms of conversion disorder are caused unconsciously by a psychological trauma or extreme stress that the individual has no means of resolving (which, incidentally, makes it one of the few disorders for which a Freudian approach to therapy can be truly effective). That conversion disorder can often co-occur with similar symptoms which do have a biological basis, in my opinion, only emphasizes the importance that both problems be addressed with equal gravity. While I have no intention of discounting other theories as to Archie's various afflictions, I believe that there exists a strong base of evidence in support of him having conversion disorder, and so I humbly present this possibility for your collective consideration.

Sources:

"Conversion Disorder" by Susan Dufel, MD, FACEP, Program Director, Associate Professor, Department of Traumatology and Emergency Medicine, Division of Emergency Medicine, University of Connecticut School of Medicine (http://www.emedicine.com/emerg/topic112.htm)

"Conversion Disorder" DSM IV 300.11, UPCMD: Diagnostic Testing in
Psychiatric Disorders (http://www.upcmd.com/dot/diseases/01078/disorder_information.html)


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