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Product reviews for Psychodynamics and Psychotherapy of Pseudoseizures
Dr Claire Isaac, Clinical Lecturer, Clinical Psychology Unit, Sheffield
I approached this book with a degree of trepidation. Being a scientist-practitioner with a background in cognitive neuropsychology I am relatively unfamiliar with and unsocialised into the field of psychodynamic psychotherapy. As a clinician working in the field of neuropsychology, however, I have a practical experience with the complex and puzzling phenomena of somatisation disorders and so was keen to expand my knowledge of this field.
The foreword, written by a neurologist and neuroscientist, provides an excellent introduction to the phenomenon of pseudoseizures and the diagnostic process involved in identifying this disorder. It captures well the difficulties and uncertainty inherent in the process. It also provides a good introduction to and overview of the methodology of the author. The book is based on the author's experience of treating and assessing patients with a wide range of presentations over a number of years. Thus adding a valuable longitudinal perspective.
The first section of the book is reproduced from a previous publication, which serves as an introduction to the classification identified by the author of posttraumatic pseudoseizure syndrome (PTPS) and developmental pseudoseizure syndrome. The former is characterised as a variant of posttraumatic stress disorder (PTSD), while the latter is postulated to arise from difficulty in negotiating the difficult life tasks that accompany development. This seems a valuable distinction and it is disappointing therefore that it is apparently not maintained throughout the rest of the book, which concentrates solely on the PTPS. The first section ends with treatment of pseudoseizure syndromes, a valuable section dealing with practicalities of treatment. I found the section on reconceptualisation of the nature of pseudoseizures particularly helpful. It is aimed at three categories of patients with PTPS ” those who have suffered sexual trauma, those who have suffered head injury or post concussion syndrome and those who have suffered a chronic life course.
The second section presents a second framework for understanding pseudoseizures based within the psychodynamic tradition. This framework is based on three approaches; psychoanalytic theory, object relations theory and self-psychology. This is a challenging section for those not socialised into the idiosyncratic style of psychodynamic writing and I found the “Points of organisation' section rather confusing and unhelpful in setting out the aims. Despite these difficulties the discussion is elegantly constructed and at points very illuminating and thought-provoking. To mention just two, there are particularly insightful parallels drawn with the concept of complicated mourning and the authors view of pseudoseizures as an ecosystem captures well the complex nature of the disorder. Throughout, the points of technique are practical and valuable.
Section three sets out a model of posttraumatic disturbance likely to occur in pseudoseizure patients. While I would not describe this as a model in the strict sense of the word, it does provide a helpful synthesis and a drawing together of the strands of the discussion. It also provides a summary and some useful additions.
Understanding psychogenic pseudoseizures is a vast and formidable challenge. This book presents a first step at simplifying this task, by providing a framework for understanding the phenomenon and providing a rationale for an approach to treatment. The author, with her vast experience makes an invaluable contribution to the field and to clinicians involved in the treatment of these patients.
For some, however, the nature of the framework will be problematic. There is a tension between psychodynamic theory and neuroscience. This would seem to be as much in the style of writing as it is in the actual content of the writing. Throughout the book there are numerous unreferenced claims. One important one is that pseudoseizures are in some way a “solution' to the patient's trauma. While I can accept that a dissociative experience is in some way protective, this is very different from the claim that it may go some way to resolving the traumatic experience. The question of whether these experiences, whether they be pseudoseizures in people with PTPS or flashbacks in people with PTSD, are purely pathological or rather go some way to resolving the trauma is an important one. It is also one that is the current focus of debate generally in the field of psychiatry/psychology in the UK. This is one illustration of the tension. There may be some psychodynamic theory which states that pseudoseizures are functional in this way, but the author does not reference it or assumes that the reader is sufficiently fluent in psychodynamic theory to accept it.
Likewise, many questions are left unanswered: throughout the book I was asking what is it that makes one person develop pseudoseizures in relation to trauma and another person a different somatic symptom? This question was finally addressed on page 235. It was a long time to wait but the answer, that it is unimportant in approaching treatment, was helpful. It would have been helpful for me if this point had been made earlier. These points of critique generally relate to style. A psychodynamic style may well be perceived as rather inaccessible in mainstream psychology. However, in the case of this book it is worth persevering with.
In summary, therefore, the author achieves her aim of examining the influence of trauma in the genesis of pseudoseizures and presenting the implications of treatment and she does this extremely well. It is perhaps unfair to expect an explanation grounded in empirical study. The phenomenon of pseudoseizures is, at present, impervious to neuroscience. The author has tackled the subject head-on via one of the few approaches that can deal with it and she should be congratulated for it.
The foreword, written by a neurologist and neuroscientist, provides an excellent introduction to the phenomenon of pseudoseizures and the diagnostic process involved in identifying this disorder. It captures well the difficulties and uncertainty inherent in the process. It also provides a good introduction to and overview of the methodology of the author. The book is based on the author's experience of treating and assessing patients with a wide range of presentations over a number of years. Thus adding a valuable longitudinal perspective.
The first section of the book is reproduced from a previous publication, which serves as an introduction to the classification identified by the author of posttraumatic pseudoseizure syndrome (PTPS) and developmental pseudoseizure syndrome. The former is characterised as a variant of posttraumatic stress disorder (PTSD), while the latter is postulated to arise from difficulty in negotiating the difficult life tasks that accompany development. This seems a valuable distinction and it is disappointing therefore that it is apparently not maintained throughout the rest of the book, which concentrates solely on the PTPS. The first section ends with treatment of pseudoseizure syndromes, a valuable section dealing with practicalities of treatment. I found the section on reconceptualisation of the nature of pseudoseizures particularly helpful. It is aimed at three categories of patients with PTPS ” those who have suffered sexual trauma, those who have suffered head injury or post concussion syndrome and those who have suffered a chronic life course.
The second section presents a second framework for understanding pseudoseizures based within the psychodynamic tradition. This framework is based on three approaches; psychoanalytic theory, object relations theory and self-psychology. This is a challenging section for those not socialised into the idiosyncratic style of psychodynamic writing and I found the “Points of organisation' section rather confusing and unhelpful in setting out the aims. Despite these difficulties the discussion is elegantly constructed and at points very illuminating and thought-provoking. To mention just two, there are particularly insightful parallels drawn with the concept of complicated mourning and the authors view of pseudoseizures as an ecosystem captures well the complex nature of the disorder. Throughout, the points of technique are practical and valuable.
Section three sets out a model of posttraumatic disturbance likely to occur in pseudoseizure patients. While I would not describe this as a model in the strict sense of the word, it does provide a helpful synthesis and a drawing together of the strands of the discussion. It also provides a summary and some useful additions.
Understanding psychogenic pseudoseizures is a vast and formidable challenge. This book presents a first step at simplifying this task, by providing a framework for understanding the phenomenon and providing a rationale for an approach to treatment. The author, with her vast experience makes an invaluable contribution to the field and to clinicians involved in the treatment of these patients.
For some, however, the nature of the framework will be problematic. There is a tension between psychodynamic theory and neuroscience. This would seem to be as much in the style of writing as it is in the actual content of the writing. Throughout the book there are numerous unreferenced claims. One important one is that pseudoseizures are in some way a “solution' to the patient's trauma. While I can accept that a dissociative experience is in some way protective, this is very different from the claim that it may go some way to resolving the traumatic experience. The question of whether these experiences, whether they be pseudoseizures in people with PTPS or flashbacks in people with PTSD, are purely pathological or rather go some way to resolving the trauma is an important one. It is also one that is the current focus of debate generally in the field of psychiatry/psychology in the UK. This is one illustration of the tension. There may be some psychodynamic theory which states that pseudoseizures are functional in this way, but the author does not reference it or assumes that the reader is sufficiently fluent in psychodynamic theory to accept it.
Likewise, many questions are left unanswered: throughout the book I was asking what is it that makes one person develop pseudoseizures in relation to trauma and another person a different somatic symptom? This question was finally addressed on page 235. It was a long time to wait but the answer, that it is unimportant in approaching treatment, was helpful. It would have been helpful for me if this point had been made earlier. These points of critique generally relate to style. A psychodynamic style may well be perceived as rather inaccessible in mainstream psychology. However, in the case of this book it is worth persevering with.
In summary, therefore, the author achieves her aim of examining the influence of trauma in the genesis of pseudoseizures and presenting the implications of treatment and she does this extremely well. It is perhaps unfair to expect an explanation grounded in empirical study. The phenomenon of pseudoseizures is, at present, impervious to neuroscience. The author has tackled the subject head-on via one of the few approaches that can deal with it and she should be congratulated for it.
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03/09/2004 01:00
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