A patient in her mid-20's with an alleged idiosyncratic reaction to phenytoin (Dilantin) was studied by an objective double-dissociation method. Under carefully monitored conditions an iv saline placebo was administered. A variety of dose-dependent pseudoneurologic symptoms developed, including hysterical aphasia, pseudoseizures, and profound unresponsiveness. Optokinetic nystagmus, the visual threat reflex, corneal reflex, the auditory startle response, and responses to deep pain were completely lost. Despite the dramatic nature of symptoms, however, the EEG remained normal, and S responded to cues she overheard concerning her "drug" level. Later, no reactions occurred when, thinking it was something else, S actually received phenytoin. Hysterical aphasias and the implications for afferent theories of conversion reactions are discussed. A speculative model that pertains to dissociative phenomena (e.g., hidden-observer effect, selective awareness, and amnesia) and the controlled aspect of consciousness is suggested. (27 ref)

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