DR. RICHARD BARNUM
BOARD CERTIFIED IN PSYCHIATRY AND CHILD PSYCHIATRY
Richard Barnum is a child and adolescent forensic psychiatrist. He directed the Boston Juvenile Court Clinic from 1982 to 2003, conducting evaluations of thousands of children and families involved in juvenile court. He was formerly on the faculty of the University of Massachusetts and Harvard Medical Schools, and has written on issues of forensic assessment of children and families and mental health concerns in the juvenile justice system. Since 2003, he has been in the private practice of psychiatry, providing consultation and treatment for children and families in community and residential settings. This work has included increasing involvement with children suffering from various hard-to-diagnose medical conditions.
Dr. Barnum's Communication Station
Abstract: Conversion Disorder (CD) is a diagnosis offered to explain signs and symptoms that do not correspond to recognized medical conditions. Pediatric patients with variable, vague, and multisystem complaints are at increased risk for being diagnosed with CD. Little is known about the impact of such a diagnosis. In making such diagnoses, it is likely that pediatric providers hope to encourage patients to access mental health care, but no basis exists to show that these diagnoses result in such access in any useful way. This article presents the case of a child with Ehlers-Danlos Syndrome, who had been previously (incorrectly) diagnosed with CD and referred for mental health care. It offers commentary based on interviews with other pediatric patients with similar experiences – conducted in collaboration with the Ehlers-Danlos National Foundation. These cases indicate that CD diagnoses can seriously undermine patients’ trust in doctors, and can create such defensiveness that it may interfere with (especially) patients’ abilities to engage with mental health services. Such interference is an important problem, if the diagnosis is accurate. But, in the (more likely) event that it is not accurate, this defensiveness can interfere with both important mental health care and further ongoing necessary medical care.