Breaking the spell: Narrative Medicine applications for Psychogenic Nonepileptic Seizures (PNES). (March 2021)

• Record Type: Journal Article
• Authors: Slocum, Robert B.
• Is Part Of: Seizure. Volume 86(2021)
• Page Start: 96
• Page End: 101
• Publication Date: 2021-03
• Subjects: Psychogenic Nonepileptic -- Seizures (PNES) -- Conversion disorder -- Narrative Medicine -- Self-Identity -- Quality of life -- Resilience; Epilepsy -- Periodicals; Epilepsy -- Periodicals; Seizures -- Periodicals; Épilepsie -- Périodiques; Electronic journals; Electronic journals; 616.853
• DOI: 10.1016/j.seizure.2021.01.017
• Languages: English
• ISSNs: 1059-1311

Abstract

Highlights: Narrative Medicine (NM) seeks to help patients identify meaning and identity in the context of their life and challenges. NM provides space for the patient to explore thoughts and feelings in a guided conversation with a collaborator who listens attentively. NM is a communication therapy that engages the patient's life story and overwhelming experiences through interactive conversations and writing exercises. Patients may identify sources of strength, new insights during treatment, and hope for the future. Psychogenic nonepileptic seizures (PNES) may be understood in many cases as a communication disorder in which overwhelming distress is expressed somatically in a pathological way instead of an adaptive and verbal manner. A seizure-like event may provide distraction or escape from an overwhelming situation or experience but at a severe cost to the patient. NM can help patients communicate more effectively concerning the unspeakable distress of their traumas and overwhelming experiences. Patients can discover new perspectives and insights, leading to improved resilience and quality of life. Abstract: Narrative Medicine (NM) sessions draw out the patient's narrative of illness or injury and treatment in the context of the patient's whole life story. The focus is to discover topics and areas in the patient's narrative that the patient needs to explore. PNES may be understood in many cases as a communication disorder in which distress is expressed somatically in a pathological way instead of an adaptive and verbal manner. Patients with PNES are frequently misdiagnosed, and accurate diagnosis may be delayed for many years. PNES 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. NM sessions encourage patients to communicate more effectively about their unspeakable distress and reclaim their lives from the communication disorder of PNES. Narrative writing exercises have also proven helpful for patients facing a variety of traumas and major stresses in situations similar to those faced by patients with PNES. This paper is a narrative review with an illustrative case report indicating NM applications to help a patient with PNES to communicate about a traumatic past that has been avoided and address psychogenic symptoms.