Dr. Selim Benbadis published an excellent editorial article in the Neuropsychiatry Journal this year in which he called out both the American Psychological and American Psychiatric Association for the absence of information about Psychogenic non-epileptic seizures (conversion disorders) they have on their sites. He pointed out that both associations have a plethora of mental health topics and diagnoses for which they provide facts. In fact, the APA-Psychiatric offers a total of 28 brochures none of which mention somatoform, somatization, conversion or factitious disorders! The APA-Psychological provides information on a total of 56 “psychological topics” with no mention of somatoform, somatization, conversion or factitious disorders! Dr. Benbadis calls this interesting omission by both APAs a reflection of an “ostrich policy.” (http://www.nonepilepticseizures.com/downloads/Neuropsychiatry%20on%20APA.pdf).
Do they doubt the psychological nature of psychogenic non epileptic seizures, do they feel it lies outside their scope of practice because it overlaps with “neuro,” are these patients scary because they are “too ill, or could it be guilt for having misunderstood and abandoned many of these patients in the past?”
All we need to do is to look at the history of psychology and psychiatry and we see it is built on the backs of these very same patients. Dr. Sigmund Freud, founding father of much of today’s psych theories, developed these very theories by working with patients who had psychogenic symptoms. Theories about the unconscious, conversion of psychic impulses into physical symptoms… But he then turned around and redefined the abuse these patients had suffered as “fantasies” because the very possibility of child abuse at that time was so strongly rejected. I recommend reading Jeffrey Moussaieff Masson’s book: The Assault on Truth: Freud’s suppression of the Seduction Theory. This single act of having abandoned these patients represented a second and even more profound form of abuse and betrayal.
I challenge psychiatry and psychology to make amends and rather than ignoring psychogenic conditions you give them the rightful place they deserve on your sites, in your literature, and in your day-to-day practice. Hiding your head in the sand only perpetuates the pain these patients suffer.
Dear Lorna,
Thank you for posting this article. As someone who has suffered from TLE and PNES for almost 40 years I have experienced a tremendous amount of, what I can only call “scorn” from the medical community at large. I have been, literally, laughed out of emergency rooms by misinformed physicians. The responsibility for educating them lies with the ones who know about these disorders – the psychiatrists, neurologists and psychologists. We are treated like lepers in an ancient civilation.
Mary, how are you living with these issues? Are you on disability? SS? Please let me know as my sister is going through a horrible time now and we just don’t know where to turn. thank you
Dear Mary, thank you for your brave comment.
Thanks, Mary for telling your story. You seem to be well in spite of all the ignorance out there. (You sound strong!) Sharon, my heart goes out to your sister. As far as the psychiatric communities goes, maybe people living with PNES are lucky that they are being ignored because of the incredible harm caused by psychotropic medications that, if there were any meds for this disorder, would be handed out like candy. People with psych Diagnosis and taking meds can expect to live 10 to 20 years less than the average person and experience a host of cognitive, behavioral, and physical illnesses and problems. That being said, Curt LaFrance MD in Providence, RI is making progress with cognitive behavioral therapy especially for people living with PNES. I have no idea who else in the psychology is addressing this issue with therapy. Does anybody have any experience with alternative natural therapies like essential oils?
I had one neuro drop me as a patient b/c of a speculated diagnosis of PNES. I have been diagnosed with PTSD after a history of sexual abuse.
I am afraid to talk openly with my new neurologist for fear of being left out in the cold again.
All the ‘professional’ message boards for physicians the members are critical and laugh it off.
Psychiatric disorders are no laughing matter and neither is the suffering that they can cause. I don’t feel safe being open and honest with my doctors for fear my AE meds will be stopped.