Title : Narrative medicine: A communication therapy for the communication disorder of Functional Seizures (FS) also known as Psychogenic Nonepileptic Seizures (PNES)
Abstract:
Patients with Functional Seizures (FS) (also known as Psychogenic Nonepileptic Seizures (PNES), have involuntary paroxysmal episodes that resemble epileptic seizures but without organic etiology. Many patients with FS have a history of sexual, physical, or emotional abuse or other traumatic or overwhelming experiences. FS is a communication disorder in which distress is expressed somatically in a pathological way instead of a healthy verbal manner. The patient’s body may seem to enact a communication of its own as the patient cannot or will not communicate directly about an overwhelming and unspeakable subject. Patients with FS are frequently misdiagnosed and mistreated for epileptic seizures. Accurate diagnosis may be delayed for many years. FS may cause severe disruption of the patient’s quality of life in terms of employment or schooling as well as relationships, and activities of daily living. Some patients with FS have been accused of faking symptoms or malingering, and stigmatized by health care providers, coworkers, family members, and others in society. Patients with FS may have family histories of poor interpersonal communication and conflict resolution, with inherited codes of silence and shame concerning sensitive or traumatic subjects. Patients with FS may have Post-Traumatic Stress Disorder (PTSD) as a comorbidity. They may have significant dissociation and inadequate emotional expression. Narrative Medicine (NM) is a communication therapy that draws out the patient’s narrative of illness or injury and overwhelming experiences through interactive conversations and writing exercises. NM provides space for the patient to explore thoughts and feelings in a guided conversation with a collaborator who listens attentively. NM is patient-centered and open-ended with focus on exploring topics the patient needs to discuss. NM seeks to help patients identify meaning and identity in the context of their lives and challenges. Unlike Cognitive Behavioral Therapy (CBT), there is no script or checklist for NM sessions. NM sessions are not confrontational. The “teller” and “listener” share a “dyadic” professional relationship that encourages trust and respect. This interactive process is dynamic and may take unexpected turns. Both teller and listener can be changed by an NM session. Patients can reflect on their difficult stories relative to their sense of identity, sources of strength, new insights, and hope for the future. Unstated or previously silenced concerns may be voiced by the patient. An unhurried context of trust where the patient is heard can encourage the patient to communicate about disturbing history and situations. NM helps patients work through the biographical disruption of their condition that may threaten their sense of an integrated and coherent self. Narrative writing exercises have also proven helpful for patients facing a variety of traumas and major stresses. A patient with FS who constructs a story (written or oral) about personal trauma or overwhelming stress can discover a narrative antidote to the communication disorder and inhibition of FS. The patient with FS can become the teller of the story who discovers hope by putting the unspeakable into words. Old taboos and codes of silence can be let go as the patient collaborates with an attentive NM provider. Finding words for difficult experiences and sharing the story can help patients process their thoughts and feelings to reintegrate traumas and other experiences relative to their sense of meaning, self-identity, beliefs, and goals. Difficult personal history cannot be changed, but the patient may come to see their challenges in a new light. Patients can begin to reclaim their lives from the communication disorder of FS and other functional disorders.
Audience Take Away Notes:
- This presentation will help the audience to understand the causes and symptoms of Functional Seizures (FS), and respond appropriately when encountering patients with PNES
- This presentation will help the audience to understand the need for Narrative Medicine (NM) interventions for patients with FS, and to make appropriate referrals for care with NM
- This presentation suggests future possibilities for research concerning the effectiveness of NM applications for patients with FS
