Encountering akathisia for the first time: a dance/movement therapist’s perspective

Hospital hallway, Laurel L. Russwurm

I first encountered akathisia during my dance/movement therapy internship at an inpatient psychiatric hospital in 2013. Nothing in my training had prepared me for this particular kind of movement distress.

In dance therapy, we view movement as deeply meaningful. We learn that health is reflected in our ability to access a wide range of movement expressions – the gentleness when handling something fragile, the strength needed for heavy objects, the playful flow when joking with friends, or the way we adjust our movements when addressing different audiences. We note preferences, but ultimately celebrate balance, flexibility, and agility in movement.

Then I met patients with akathisia.

What struck me most was the absence of meaningful choice in their movements. Many displayed what has been called the "Thorazine shuffle" – instead of standing still, they would step in place, shifting their weight back and forth endlessly. The jokey name belies the true experience of a nearly constant, tormenting inner sensation that couldn't be satisfied.

When I spoke with these patients, their distress was palpable. They described feeling trapped in their bodies, unable to find relief. The movements weren't expressions of their emotions or intentions – they were symptoms of something gone terribly wrong.

What disturbed me even more was the clinical team's response. Where I saw suffering, they saw a manageable side effect. The standard approach was simply to add another medication – propranolol, cogentin, or benadryl – to the regimen. When I'd check back with patients, they'd usually tell me these additions helped minimally, if at all. The profound discomfort remained.

When I reported this back to the medical team, I hit a wall. The consensus seemed to be that this was simply the cost of treating the "primary" condition. For people already experiencing paranoia or intrusive voice-hearing, this additional layer of suffering seemed particularly cruel.

In our dance therapy groups, I did notice some temporary relief. Group rhythmic action sometimes provided a brief respite from the discomfort of akathisia. The shared movement seemed to channel the restlessness into something momentarily meaningful. But as soon as the group ended, the distress would return.

The best I could do was educate patients about what they were experiencing and encourage them to advocate for themselves with their outpatient providers. Perhaps they could reduce their dosage, try a different medication, or explore non-medication approaches for their underlying issues.

Years later, this experience stays with me. When a body can't move in ways that express the self, something fundamental is lost. Akathisia isn't just a side effect – it's a profound disruption in a person’s self concept and relationships. It matters because movement is a main way that we communicate, self sooth, and connect with the world. Our ability to move in ways that reflect our intentions, emotions, and needs isn't a luxury – it's essential to our humanity.