Beyond the medical encounter: can the free association narrative interview method extend psychosocial understandings of non-epileptic attack disorder?

Abstract

This exploratory interdisciplinary study was devised to explore how using the free association narrative interview (FANI) method might extend understanding of non-epileptic attack disorder (NEAD) within a psychosocial framework. NEAD is the medical definition of what can be described as embodied events that resemble epilepsy, but which are not associated with the abnormal electrical discharges in the brain found in epilepsy. They are the most frequent ‘functional’ disorder or medically unexplained symptom (MUS) seen by neurologists. While NEAD is associated with trauma, distress and negative life events, a significant minority of patients report no trauma history. The FANI method, we argue, produced narratives which shed light on events that patients have not acknowledged as traumatic, but which might be considered as such, and we explore what aspects of the method may facilitate this process. Previous work has highlighted that a diagnosis of NEAD is often experienced as deeply troubling and contentious to both give and to receive. We thus reflect on the need for patients to feel a sense of legitimacy and how the challenges of living with a NEAD diagnosis are negotiated. Drawing on the work of Benjamin (2004) on ‘thirdness’, we suggest that the FANI method can allow the research interview to become a space that facilitates novel ways of engaging around NEAD. We conclude that the method may be a powerful tool for studying NEAD, and that further studies should be undertaken using this approach since it may have broader utility in understanding the landscape of functional neurological disorders.