Narrative medicine: A communication therapy for the communication disorder of Psychogenic Non-Epileptic Seizures (PNES)

Title : Narrative medicine: A communication therapy for the communication disorder of Psychogenic Non-Epileptic Seizures (PNES)

Abstract:

Patients with psychogenic nonepileptic seizures (PNES), also known as Functional Seizures (FS), have involuntary paroxysmal episodes that resemble epileptic seizures but without organic etiology. Patients with PNES are frequently misdiagnosed and mistreated for epileptic seizures. 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. Many patients with PNES have a history of sexual, physical, or emotional abuse or other traumatic or overwhelming experiences. Some patients with PNES have been accused of faking symptoms or malingering, and stigmatized by health care providers, coworkers, family members, and others in society. Patients with PNES may have family histories of poor interpersonal communication and conflict resolution, with inherited codes of silence and shame concerning sensitive or traumatic subjects. PNES 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. Narrative medicine (NM) visits draw out the patient’s narrative of illness or injury and treatment in the context of their entire life story. The focus is to discover topics and areas in the patient’s narrative that the patient needs to explore. Narrative writing exercises have proven helpful for patients facing a variety of traumas and major stresses in situations similar to those faced by patients with PNES. NM sessions encourage patients to communicate more effectively about their unspeakable distress and reclaim their lives from the communication disorder of PNES. A case study illustrates NM applications to help a patient with PNES to communicate about a traumatic past that has been avoided and address psychogenic symptoms.

Biography:

Robert B. Slocum is the Narrative Medicine Program Coordinator at University of Kentucky HealthCare. He holds doctorates in law (Vanderbilt), ministry (University of the South), and theology (Marquette). He has experience in pastoral ministry as well as academic teaching and administration. He has taught undergraduate courses in religious studies and ethics. He is an Assistant Professor (voluntary faculty, Internal Medicine) at the University of Kentucky College of Medicine (COM). He teaches a fourth-year COM elective on the narrative basis for patient care and resilient practice. He is a member of the Hospital Ethics Committee. He is the author, editor, or co-editor of 14 books, including a journal of reflections. His 36 articles have appeared in theological or medical journals and as book chapters, and he has made presentations at more than two dozen theological and medical conferences. He has also published short fiction and poetry. He is interested in the clinical application of narrative and the significance of narrative for identity formation. He sees Narrative Medicine as a bridge between medical humanities and clinical practice.