The doctors may accuse their patients of this, with or without, any basis. If this has happened to you, trust yourself. It is NEVER okay for a doctor to make that kind of an assessment without any basis, even if the doctor has a lot of experience and good intuition. Even a history of trauma, difficulty controlling seizures, and statistics are not enough for a doctor to make that kind of assessment.
Perhaps you have even had an abnormal EEG or VEEG that has documented your seizures, but for whatever reason the doctors are still questioning your symptoms or even calling your seizures something else like “complex migraines” [1] because you happen to have a common co-morbid neurological disorder called migraine. Alternatively, you may have been told that the study showed no abnormal activity at the time of the “seizure” or there were “no abnormalities” during the EEG or VEEG, which on its own does not indicate conclusively an episode of PNES. [2][3]
It is a very scary and painful experience to be controlled by seizures, particularly when you have no memory of the seizures happening, but others have witnessed the seizures, or you find some detail that helps you realize that you have had seizures. Many in the medical and mental health professions lack so much understanding about epilepsy and psychogenic non-epileptic seizures (PNES) that they actually do more harm to their clients who are already suffering.
Many of the so-called expert neurologists and other insurance-based mental health professionals will often tell you that your seizures are “psychological”, and that your seizures are unconscious and involuntary, but that your “prescription” to make the seizures stop is to receive the typical cognitive-behavioral therapy, which only focuses on changing specific thoughts and behaviors that are within your conscious awareness. That’s a major contradiction and it’s a clear indication that either he or she is only regurgitating what he or she has been told about PNES or he or she really believes that you are consciously aware and voluntarily able to stop your “psychological” seizures, which many don’t even like to use the term “seizures” as part of the PNES diagnosis.
Even though new medications and treatment options are being developed regularly for people with epilepsy, more than 1 in 3 adults who experience epilepsy live with uncontrollable seizures. The CDC reported in 2015 that the number may be even more with as many as 56% of adults with epilepsy, or more than 3 Million adults with epilepsy, still have active seizures. The number of people who have psychogenic non-epileptic seizures (PNES) is not known, but PNES may account for as many as 5 to 20 percent of people diagnosed with epilepsy. The good news is that help is available. With the help and support from someone who knows and understands epilepsy and psychogenic non-epileptic seizures (PNES), you can choose not to be controlled by your seizures anymore.
In session, we will first work towards identifying and understanding any unconscious psychological conflicts that may need attention. Psychotherapy techniques can help you to put new language and meaning to things that you were not able to do on your own, but we will work together to help you to do so and to find new, healthier ways of seeing your situation and living so that you are no longer controlled by your seizures.
My approach is carefully designed to promote healing and wellness. I have been able to help a lot of clients overcome unconscious conflicts, some of which result in physical manifestations of their distress. Some clients who have had seizures that started in childhood or after a trauma, stop having seizures after their first session with me simply because I have been able to identify the original cause of their unconscious anger. But, they have continued treatment to experience psychological healing and ultimately stopped taking anti-epileptic drugs.
For my clients who continue to have uncontrolled seizures, my approach is the same. I focus on helping them overcome unconscious conflicts. In some cases, if there are identifiable triggers, we have focused on reducing or managing those as well so that these clients can experience more independence and wellness. With some clients, I have used teaching and reasoning as a therapeutic intervention so that they learn to use their voice to advocate for themselves, so they can be heard, understood, or recognized in a particular relationship, including with their doctor, which often produces change in other areas of their lives. My approach to treatment is unique and specific based on the individualized needs of each and every client.
We don’t know, although it is believed that the cause is likely related to an unresolved unconscious conflict resulting from trauma. In other words, there’s likely some form of unresolved anger or resentment(s) that result in a type of conversion disorder, which is a physical manifestation of a psychological conflict(s) that are significant enough to lead to a psychiatric diagnosis.
The term that we now know as Psychogenic Non-Epileptic Seizures (PNES) was originally conceptualized by Sigmund Freud as “functional seizures”, which he called “hysteria” based on his work with women who had a history of abuse early in their lives. Jean-Martin Charcot explored it as a neurological process. Eighty percent of those with PNES in the general population are women. Twenty-five percent of those who are admitted to a seizure or epilepsy monitoring unit (SMU) or (EMU) are veterans. [5]
While there are a small percentage of people who “fake” or “exaggerate” their seizures, the mere suggestion that psychotherapy can help you heal or be more responsive to your medical treatments does not imply that I believe you are one of them. My belief in psychotherapy being beneficial in treating epilepsy and psychogenic non-epileptic seizures (PNES) is based on research and experience in treating clients who have experienced one or both. I personally believe that it’s unconscionable that physicians and others make certain kinds of statements to their patients, particularly in regard to psychogenic non-epileptic seizures because of the mortality rates of those who have that diagnosis. [6]
As a psychotherapist, my role is to help you to experience relief from your symptoms. The connection to the mind and body is one that I think we have a lot of “growing pains” to do in the field, so I don’t focus on whether the symptom is “psychological”. Rather, I focus on healing from a psychological and spiritual aspect, specializing in trauma and forgiveness. If you also experience relief of physical symptoms, which are also known as somatic, I view that as a bonus! Many of my clients have experienced that “bonus” and a general sense of wellness as part of their participation and completion of counseling or psychotherapy.
[1] If any physician, healthcare provider, or mental health professional uses the term migraine in the plural, as in by adding an “s”, when talking with you about migraine, you can be sure that he or she is either not paying attention or is not well-educated on migraine. Migraine is a neurological disease, like epilepsy, and when it’s discussed with a patient or client by someone who is familiar with it, it’s discussed in the context of the number of days per month, whereas epilepsy has a separate term called “seizures” that can be used in plurals and it is normal to ask how many “seizures” a person has had in the last month, week, or even day depending on the frequency. You would likely look at your doctor with confusion if he or she were to ask you about the number of epilepsies you’ve had in the last month, as an example. It’s equally important that a professional doesn’t call migraine, migraines, and that if he or she would like to use it in the plural context that he or she call it what it is, a migraine attack or migraine attacks.
[2] It’s important to note that you are relying upon people who are ‘interpreting’ the results of these EEGs and VEEGs. In many cases, these individuals are highly trained and interpret these results accurately. However, I am familiar with how medical records are not always documented accurately, for a variety of reasons and this is not always done with bad intentions. Whitehead, K., Kane, N., Wardrope, A., Kandler, R., Reuber, M. (2017). Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis. Clinical Neurophysiology Practice, Vol. 2, Pgs. 130-139, ISSN 2467-981X, https://doi.org/10.1016/j.cnp.2017.06.002
[3] Whitehead, K., Kane, N., Wardrope, A., Kandler, R., Reuber, M. (2017). Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis. Clinical Neurophysiology Practice, Vol. 2, Pgs. 130-139, ISSN 2467-981X, https://doi.org/10.1016/j.cnp.2017.06.002
[4] Epilepsy Foundation (2023). Drug resistant epilepsy. Retrieved on January 18, 2023, from https://www.epilepsy.com/treatment/medicines/drug-resistant-epilepsy<
[5] Bajestan, S., LaFrance Jr., W. (2016). Clinical approaches to psychogenic nonepileptic seizures. Clinical Neuropsychiatry, 14(4), 422-431. American Psychiatric Association Publishing. https://doi.org/10.1176/appi.focus.20160020
[6] Nightscales, R., McCartney, L., Auvrez, C., Tao, G., Barnard, S., Malpas, C., Perucca, P., McIntosh, A., Chen, Z., Sivathamboo, S., Ignatiadis, Jones, S., Adams, S., Cook, M., …, T. O’Brien (2020). Mortality in patients with psychogenic nonepileptic seizures. Neurology, 95(6), e643-e652; https://doi.org/10.1212/WNL.0000000000009855