“It’s Just a Cry for Help”
I just finished moving and ended up with a decent-sized stack of nursing journals next to my couch to catch up on—maybe 6 months’ worth of “stuff I need to read someday.” I flipped through the tables of contents to see where to start, and I noticed a trend in research and articles about psychiatric illnesses (including a range of conversion disorders and lesser-known anxiety disorders and phobias), self-harm, and substance abuse. A subtrend that stuck out to me is one that I, not the authors, categorize as “illnesses that make providers ignore the patient because they just want attention.” (One example of such an article is “Understanding psychogenic nonepileptic seizures” in the May 2012 American Nurse Today.)
This phenomenon bothered me even before I became a nurse because to me, it seemed as if someone went to all the trouble to fabricate sometimes dangerous or complex symptoms just to get attention, he or she most likely really needed attention of some kind, even if not the brand originally sought. “Just” a cry for help made little sense to me. A cry for help is a cry for help. Now that I have worked as an RN for several years, mostly in an ER, I understand the other side as well, the frustration at having to take time away from physically (sometimes critically so) ill patients to treat those who have either harmed themselves or have illnesses with no physical basis. It frustrates physicians, nurses, and patients to find no physical cause for “the chief complaint.” But just because there is no readily identifiable cause for the issue at hand does not mean that it does not exist or that it is not important or that it does not necessitate attention and treatment.
Apparently the appearance of all these articles indicates that other nurses also require some reminding of my pre–nursing career thoughts, eg, a cry for help means we need to help. The article I cited from American Nurse Today clarifies that the patients in question largely “don’t intentionally create or fake these symptoms.” I am anecdotally generalizing to patients who self-harm, drink too much, withhold their insulin, and so on when I make my next statement, but I really don’t think most of these folks are intentionally making themselves sick. Now, they may be engaging in volitional behavior that has predictable adverse effects to solve a problem, but that is not the same thing, and it does not mean they are fabricating symptoms to annoy medical personnel. They may be crying out for help because they need help.
When I think about it, conversion disorder must actually be fairly terrifying to a patient. Not only is something not working right, but they’re told basically that the cause is all in their heads. These psychogenic nonepileptic seizures (which most of us still know as “pseudoseizures”) are probably no picnic either; if you think you’re having a seizure, you most likely don’t care in the moment whether it’s caused by errant brain electricity or a psychological problem.
In general, all of the issues and complaints I’ve written about are probably not indicative that the patient is having a very good day to begin with. The last thing these patients need are providers who feel inconvenienced about people who are crying out for our help. Let’s help.
Tocco S. Understanding psychogenic nonepileptic seizures. Am Nurs Today 2012;7(5):8–10. ↩
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