The Case of the Shaking Legs: Somatoform Dissociation and Spiritual Struggles

Abstract

Psychogenic non-epileptic seizures (PNES) are episodic behavior that resembles epileptic seizures but without epileptiform activity in the brain. They are expression of psychological conflict. From the perspective of theory, research, and clinical experience, many authors have conceptualized PNES as a kind of somatoform dissociation. This article presents a clinical case study of a young and very religious woman who suffered episodes of marked seizure-like movements in both legs. These episodes began when the time approached to keep her earlier commitment to dedicate herself to a nun’s life in a convent. While in psychotherapy, she revealed and deliberated tremendous spiritual struggle about keeping that commitment. She acknowledged great fear of rejection by her church, family and friends, if she chose to pursue, instead, her newfound desire for a mate and a family. Therapy helped Nancy with psychoeducation about PNES, gaining insight about her spiritual conflict, validation of her authentic desires and assertiveness training. It helped her reason with her family and friends for their approval and to begin dating. While taking those steps for resolution of her spiritual conflict and approached termination of therapy, Nancy’s episodes of PNES abated steadily. This case study illustrates that dissociative somatoform symptoms are manifestation of powerlessness to cope with grave danger, in Nancy’s case, danger of losing relationships she needed to live an authentic life. It also illustrates the effectiveness of psychotherapy that helps end that powerlessness.