Pseudoepileptic seizures are not 'fake' in the sense that the person is consciously pretending, but they do seem to be emotionally rather than biologically caused.
It was a bizarre mystery. Her brain had been observed, scanned, and measured. After much investigation, it was concluded that her unfathomable difficulty was psychological. But extensive cognitive behavioural therapy (CBT) had only made it worse.
Now, as this articulate, mature, and likeable 15-year-old girl sat with me and her mother, it was up to me to help her where so many had failed.
Not too long ago in one of our monthly members’ Q&A sessions, we had a question relating to pseudoepileptic seizures – fits and fainting spells that have no apparent somatic cause, but rather seem to be psychological in origin. (You can listen to this session or read the transcript below.)
Sometimes called psychogenic nonepileptic seizures, these are not ‘fake’ in the sense that the person is consciously pretending, such as might happen in Munchausen’s syndrome. But they do seem to be emotionally rather than biologically caused.
The unconscious mind can behave in ways that confuse and confound the conscious mind (and other people!).
As you’ll see (or hear), I’ve only ever come across one client who seemed to fit this diagnosis.
A miserable malady
Two years before she came to see me, Jess had been struck by sudden bouts of fainting. She’d fainted on a boat and fallen in a lake while on a school trip, having to be rescued from drowning. She’d fainted at school and fallen down some stairs. She’d fainted while playing netball, a sport she loved. Each time, her friends had said, she’d looked as if she were dead.
As I sat and listened, I was transported back to Sigmund Freud’s casebook. Freud’s patients always seemed to have bizarre, ‘hysterical bouts’ of insensibility.
Although, to be fair, neurological conditions like Tourette’s syndrome and epilepsy, poorly understood at the time, may have sometimes been assumed by Freud to be emotional symptoms of hysteria rather than organic disorders of the brain.1
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It got to the point where Jess needed special supervision at all times. No more school trips. No more going up flights of stairs on her own. No more beloved netball.
At first, her parents (and her doctors) had assumed this was an organic problem. She’d had a range of tests, including a PET scan and EEG. But nothing could be found. She was referred for CBT, but after months with no improvement – if anything, she seemed to be getting worse – her mother had brought her to me. Could I help her daughter stop fainting?
The first thing I wondered was whether there could be some kind of hidden benefit to these fainting fits, some secondary gain.
But she seemed genuinely to hate the frightening episodes and the stranglehold they had over her life, particularly at school.
So I got a bit Freudian…ish.
The mystery deepens… then disappears
What, I wondered, was the message of the symptom? What might her unconscious mind be trying to resolve?
“Do you ever faint at home, or when you’re away from school?”
“No,” she told me.
So she only fainted at school, or during school trips. Never at home. Had something happened at school? Something to upset her? No, she assured me, she loved school. She was popular and graced with being a star pupil both academically and athletically.
Then I asked her the question that would finally illuminate the whole matter.
The metaphorical mind’s role in creating somatic problems
“Did anything unpleasant happen around the time that the fainting began?”
She thought for a while. Eventually it was her mother that spoke:
“Well, you were very upset when Jeannie died. Remember? And, oh yes, when Spike died too.”
Now we were getting somewhere.
Jess explained to me that Jeannie had been a much-loved neighbour. She was 70, but seemed young and full of zest. One day my young client returned from school to the grave news that Jeannie had died suddenly while she was at school.
A few months later, Jess came home to more sad news. This time, the family dog, Spike, had been run over and killed – again while she’d been at school.
It was very soon afterwards that the fainting episodes – in which, you’ll remember, her friends had described her as appearing to be dead – had begun.
I asked her the usual questions to ascertain whether the trauma of those deaths was still ‘live’ within her. Did they – the moments when her father had informed her of these deaths – feel very recent and vivid and painful to recall? Yes, they did. When I asked her to rate how terrible these events were to recall, both were a 10 out of 10.
I used the Rewind technique to bring down the arousal around those memories.
So what happened?
Turning a corner
By the end of the session, Jess seemed much calmer when she recalled those memories. But would it be enough to stop the fainting? I wondered and waited for word. One week grew into six.
At last, her mother contacted me. The fainting had stopped. Just like that! I tried not to sound too surprised!
But I was surprised. And not just that a symptom of PTSD could have been so somatized. I was intrigued by how metaphorical it all seemed. A loved neighbour and a pet had died while my client had been at school, so her metaphorical unconscious mind had her ‘dying’ at school as a way of trying to resolve that trauma.
It’s incredible how so-called ‘somatic metaphors’ can arise in some clients. One man who constantly told me how his wife irritated him had unexplained neck pain. A ‘pain in the neck’ is, of course, an oft-used metaphor for someone/something being intensely irritating. (I guess his unexplained pain could have been in another region too!)
Now, I don’t know for sure that my young client’s mind was enacting death when she fainted. And actually, it doesn’t really matter.
What did matter was that the problem went away when her PTSD did.
But it’s interesting to reflect on the possibility that locked within (to use another metaphor!) some unexplained somatic symptoms are both purposeful behaviour (somehow trying to resolve trauma) and metaphorical enactment carried out not consciously, but by hidden parts of the mind.
To learn more about how to handle pseudoepileptic seizures, have a read (or a listen, by clicking on the link below) of my answer to one of our Uncommon Practitioners’ questions about pseudoepileptic seizures.
Listen to Mark’s answer or read below
Hear the answer by clicking the play button below:
Or click here to download the clip to play later (you may need to right-click and select ‘Save As…’)
Question
I have a 26-year-old woman experiencing daily pseudoseizures, mild to extreme. They began three years ago, after she started counselling for childhood sexual abuse by her stepfather (between the ages of 10 and 15 after he split up with her mum. We’ve had one session, and I did very little except listen and do a gentle calming and relaxing hypnosis. She has had lots of therapeutic interventions with little relief, and hypnosis is, in her words, her “last hope”. Have you any experience with this? I’d appreciate your advice.
Mark’s answer
So pseudoepileptic seizures, as you know, seem like neurologically caused epileptic fits, but are seemingly caused by psychological factors. So, in the old days, at the beginning of psychoanalysis, with Freud and everything, all epileptic fits were seen as psychological, whereas the more we learned about physiology… the more we realized that lots of things can be neurological and not necessarily psychological, such as Tourette’s and so forth, although they have psychological impacts.
A pseudoseizure is basically a fit, or a seeming fit, that the person has; they’re not putting it on, but it seems like a genuine fit, and the person’s had electroencephalogram readings, EEG scans, done on the brain and there’s been no physical cause found.
Now the glaringly curious thing here with your client is that the seizures started happening after she started having counselling three years ago. So what was it about the counselling? We always need to ask, “When did these seizures start to happen?” So they didn’t start to happen when she was being abused; they started three years ago when she was 23.
I had one quite similar case to this, which was a 15-year-old girl who had been fainting, having fainting fits, but only at school. She had been having them for two years, since she was 13, and she was getting no seeming ‘benefit’ from them, because her friends were doing sleepovers and she couldn’t go on sleepovers, at playtime (recess) at school she couldn’t go upstairs because she had fallen down the stairs at one time and hurt herself after one of these fainting fits. So she was alone at playtime, because her friends were upstairs for some reason. She had been on a school trip and she’d nearly drowned on a lake because they had been on a boat and she had fallen in after fainting. So it wasn’t something that she seemed to be getting benefits for. She had had all the scans you could think of and nothing was found, and the experts were convinced it was nothing neurological going on here. She’d had a year of CBT therapy and she had said that had made it worse.
I asked her if anything else had happened at the onset of these fainting fits. She said nobody had asked her that before, which amazed me! I thought it was an obvious question. She said that actually, and her mother was there as well, and they both spoke a bit. She was extremely articulate, the 15-year-old girl. She said that she’d had this neighbour, this 70-year-old woman who was very vivacious and energetic and didn’t seem old, seemed very young, and was like a member of the family. When this girl had been at school one day, she came back and her father gravely told her that this neighbour had unexpectedly died and it was extremely horrible for this girl to hear. The fits didn’t start then, but about a month afterwards she came back from school (again, notice school is the unifying factor) and her father told her that the family dog had been run over and killed. After that, the seizures had started and she started fainting at school.
I asked her if these memories still really hurt to think about, and she said they did, and we rewound those memories so that she could think about them calmly and so forth. To my amazement (and you always have to pretend to not be amazed when you’re a therapist, you have to pretend that you absolutely expected it!) the fainting stopped.
So it seemed to be that on a metaphorical level perhaps she was acting out some kind of, you know, if you think about what fainting looks like, you’re falling, your eyes are closed, you’re insensible, you’re not there on one level. And it’s happening at school and nowhere else. And when she’d been at school these deaths had occurred, and her brain was trying to somehow process this trauma. I know this sounds a little bit ‘psychobabbly’! But once we’d resolved the trauma, she’d processed the trauma, then she no longer had to metaphorically and unconsciously enact those metaphorical deaths whilst being at school. It does seem to be the case that that’s what was going on.
Lots of cognitive behavioural therapy of just examining her thoughts all the time didn’t really cut it, because no one had even spotted (to my amazement) what was going on at the onset of the problem.
If we think about what happened to your client, a lot of counselling seems to be about getting people to talk and discuss their feelings, which is fair enough in lots of things, it can be valuable; but we know for severely traumatized people, who are about 25% of people who experience a traumatic incident, talking about it can be the last thing they need and can embed the trauma deeper.
So if we look at the metaphorical significance of having fits, or pseudo fits – and this is pure conjecture on my part – we see that during a fit someone is squirming, they could almost be avoiding something, they’re insensible to hearing other people’s point of view or responding to other people, communication usually, and it could be seen as an avoidance behaviour manufactured by the unconscious mind to not face something. Because if you’re severely traumatized by something, you don’t want to talk about it, because your amygdala will just kick off again, you’ll hypnotically regress to the trauma again. Someone who is severely traumatized cannot discuss it until they are detraumatized. So it may have begun when and if the counsellor was perhaps probing and asking about some of the traumas that happened to your client.
So you could ask what happened during the counselling, when these seizures started. What kind of thing was being discussed – without asking about painful things – but what were you touching upon (difficult things) with the counsellor? What were the circumstances surrounding the genesis, the beginning of these seizures? Then if you find, as I suspect you might, that the traumas are still live, that she hasn’t been detraumatized by any work that the counsellor did, then you could seek to gently decondition those memories using whatever method you know best – Rewind if you know it – but without her having to explore or recount those memories in detail to you at all, because you don’t need to know what happened in order to decondition a traumatic memory.
If you can successfully do this, then I strongly think the fits will ameliorate at least, or perhaps stop entirely.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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Notes:
- See Webster, R. (1995). Why Freud was Wrong. The Orwell Press.
