Table 2

Suggested actions and things to say for some further difficult moments in interactions with patients with dissociative seizures

Things to doThings to say
“So you are saying this is all in my head?”
  • Reflect on your own attitude towards dissociative seizures. If this is what the patient has heard, perhaps this is what you have said.

  • “I DO think that dissociative seizures are a problem in your head but I don’t think that you are making them up or putting them on deliberately.”

  • “You only have one brain. Your brain does not have separate sections for your mental or physical health. The brain matches the information it receives from your senses with emotions such as fear, happiness or disgust. Dissociative seizures can be triggered during this process.”

“But the psychiatrist has said I don’t have a mental illness.”
  • Chase correspondence relating to previous mental health contacts to find out what exactly the psychiatrist said.

  • Establish a working relationship with psychiatrists involved in patients’ ongoing care (by talking to them and copying letters).

  • “Many people who experience dissociative seizures also have mental health problems such as depression, anxiety of post-traumatic stress disorder but many other people don’t, and this does not mean the diagnosis is wrong.”

  • “I am not sure it really helps to think of dissociative seizures as a mental illness, I would explain them as a kind of reflex response to triggers inside or outside the body… .”

  • “Dissociative seizures can be triggered by emotions such as fear, shame, guilt, or sadness but it’s a bit like they happen instead of the emotion, and when the seizure is over, many people have no idea what initially triggered them.”

  • “Even if a psychiatrist has not identified another mental disorder, retraining your brain with psychological treatment can help.”

“I have had counselling already, but that’s all behind me now.”
  • Find out about psychological treatment and counselling services in your area, including services from the voluntary and private sectors.

  • “Counselling is not the same as psychological treatment. Counselling is about attentive listening, psychological treatment is about training the brain to do things differently. Also: the treatment dose needs to be right. Changing the way the brain does something takes time and effort. You will not be proficient at playing a musical instrument after five or ten lessons.”

“What good could talking do?”
  • Establish a contact with psychological treatment services so that you know what patients can expect.

  • Familiarise yourself with common psychotherapeutic approaches so you can explain them.

  • “Psychological treatment is not just talking. When physiotherapy has worked, it is because the therapist explained to you that you should do something slightly differently. You then practised and your pain or discomfort improved. Psychological therapy is similar. It encourages you to think a little differently about things that you are faced with, and through practice, you may learn to react differently to them.”

  • “You are not starting your dissociative seizures deliberately but you may be able to learn to stop them.”

“What about my benefits?”
  • Reflect why patients with dissociative seizures should be less deserving than those disabled by epilepsy, depression or post-traumatic stress disorder? What is the evidence that those with dissociative seizures are more likely to exaggerate their disabilities than those with neurological disorders with demonstrable structural or biochemical changes?

  • “Of course I very much hope that you are going to get better but benefits are based on your level of disability, not on what the causes of this disability are.”

“What about driving?”
  • “The risk of having a dissociative seizure while driving a car is very low.”

  • “However, if you have seizures that could affect your ability to control a car, for instance because they happen ‘out of the blue’, involve impairment of consciousness or the control of movement, it would not be safe for you to drive a car.”

  • “You should be able to drive again once the risk of you having a dissociative seizure has fallen to an acceptable level. You may learn to control your seizures more quickly with psychological treatment.”

  • “If you hold a Group 1 driver’s licence in the UK (to drive ordinary, non-commercial cars) you are deemed fit to drive when you have not had a dissociative seizure for three months.”