Pseudo-Epileptic Seizures, edited by Lennart Gram, Svein I. Johannessen, Per Olof Osterman, and Matti Silanpaa
In many ways, this particular book gets off on the wrong foot and never manages to fully overcome a negative first impression. Part of the negative impression comes from the way that the authors deal with the definition of pseudo-epileptic seizures and the distinction made between such seizures and non-epileptic seizures. The authors tend to think that the Scandinavian experience is a worthwhile one (which is itself a dubious proposition) and seem more concerned about delegitimizing a whole class of seizures as being a physical condition and relegating it to the realms of psychosomatic diseases. While it is certainly true that a great many diseases have both physical and mental components, there is terrible damage done to people when they have health struggles and are told that the problem is all in their head, when there may indeed be reasons why unpleasant and stressful and traumatic life experiences may cause certain physical results for physical reasons, something that appears to be beyond these thick-headed writers. It is not difficult to realize that the attitude of people like those found in this book appears to have greatly hindered the understanding of the physical repercussions of issues with the brain and trauma for decades, all because some people did not want to consider such things to be real.
This book is a bit more than 150 pages and it is divided into fifteen papers by a variety of authors that talk about seizures, mostly to be found in children and the young in general, that are not from epilepsy nor from an obviously metabolic physical cause. The book begins with a list of contributors, as well as a foreword and and a preface. After this comes an introductory paper discussing terms and definitions that puts the book on the wrong foot (1). This is followed by a paper that seeks to compare and contrast epileptic and non-epileptic seizures (2). After this comes a paper on pseudo-epileptic seizures in children (3) as well as panic disorders and their diagnosis and treatment (4). This is followed by a look at aggression, rage, and epilepsy (5) as well as the link between sexual abuse and pseudo-epileptic seizures (6). This is followed by papers on Munchausen’s Disease by Proxy, which was all the rage in the early 1990’s when this book was written (7) as well as psychological aspects of treatment (8). This is followed by papers that discuss individualized treatment of seizures (9), psychiatric perspectives on treatment (10), treatment of pseudo-epileptic seizures in the community (11), and in general (12), as well as eclectic approaches (13), and a case history (14), as well as the Danish experience in such matters (15).
One area where this book particularly fails is that it does not demonstrate that the authors in fact know what they are talking about. All too often, the papers in this book seek to demonstrate that the authors are experts when in reality they largely failed to account for and respond to the physical realities for seizures that were outside of epilepsy and obvious physiological issues. And it is this blindness to the possibility that there were physical roots to what the authors are quick to label as false epilepsy rather than simply a different type of seizure that marks the authors as blind guides, and brings a certain amount of disrepute on the mentalizing and delegitimizing of physical diseases as being merely psychosomatic and carrying them with a certain degree of victim blaming. While this book is not a particularly wise guide to questions of seizures in themselves, it is at least instructive in demonstrating the tendency of people with a lot of education and self-professed expertise in mental health to frame health problems relating to the brain in such ways as preserve a space for themselves to be highly paid if not particularly helpful practitioners. The exercise is instructive in looking at the misguided sociology of psychiatry even if it fails as a guide to non-epileptic seizures.