Abstract
Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue that doctor and patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD.
Similar content being viewed by others
References
Alajouanine, T.: 1978, ‘Dostoiewski's epilepsy’, Brain 86(2), pp. 209-218.
Bear, D.M. and P. Fedio: 1977, ‘Quantitative analysis of interictal behavior in temporal lobe epilepsy’, Archives of Neurology 34, pp. 454-467.
Berrios, G.E.: 1984, ‘Epilepsy and insanity during the early 19th century. A conceptual history’, Archives of Neurology 41, pp. 978-981.
Bett, T.: 1990, ‘Pseudoseizures: seizures that are not epilepsy’, The Lancet 336, pp. 163-164.
Cassell, E.J.: 1991, The Nature of Suffering and the Goals of Medicine. New York/Oxford: Oxford University Press.
Charcot, J.M.: 1889, Clinical lectures on diseases of the nervous system, Delivered at la Salpetrière, 1872. Transl. by T. Savill, Vol. III. London: The New Sydenham Society.
Cirignotta, F., C.V. Todesco and E. Lugaresi: 1980, ‘Temporal lobe epilepsy with ecstatic seizures (so-called Dostoevsky epilepsy)’, Epilepsia 21, pp. 705-710.
Dam, M. and A.M. Dam: 1986, ‘Is there an epileptic personality?’, in M.R. Trimble and T.G. Bolwig (eds.), Aspects of Epilepsy and Psychiatry. Chichester etc.: JohnWiley & Sons, pp. 9-18.
Devinsky, O. and K. Thacker: 1995, ‘Nonepileptic seizures', in M.I. Weintraub (ed.), Neurologic Clinics, Vol. 13, No. 2 (Malingering and Conversion Reactions). Philadelphia etc.: W.B. Saunders Company, pp. 299-319.
Devinsky, O., F. Putnam, J. Grafman, E. Bromfield and W.H. Theodore: 1989, ‘Dissociative states and epilepsy’, Neurology 39, pp. 835-840.
Dostoevsky, F.: 1962, The Idiot. New York: The Modern Library.
Dostoevsky, F.: 1984, The Double. Two Versions. Ann Harbor: Ardis Publishers.
Eames, P.: 1992, ‘Hysteria following brain injury’, Journal of Neurology, Neurosurgery, and Psychiatry 55, pp. 1046-1053.
Fenwick, P.: 1981, ‘Precipitation and inhibition of seizures', in E.H. Reynolds and M.R. Trimble (eds.), Epilepsy and Psychiatry. London: Churchill Livingstone, pp. 306-321.
Foucault, M.: 1963, Naissance de la clinique. Une archéologie du regard médical. Paris: Presses Universitaires de France.
Freud, S.: 1985, ‘Dostoevsky and parricide [1928]', in A. Dickson (ed.), Art and Literature. The Pelican Freud library. Vol. 14. Harmondsworth, Middlesex: Penguin Books Ltd., pp. 437-460.
Gastaut, H.: 1978, ‘Fyodor Mikhailovitch Dostoevsky's involuntary contribution to the symptomatology and prognosis of epilepsy’, Epilepsia 19, pp. 186-201.
Gastaut, H., Y. Gastaut and R. Broughton: 1984, ‘Gustave Flaubert's illness: A case report in evidence against the erroneous notion of psychogenic epilepsy’, Epilepsia 25, pp. 622-637.
Girgis, M.: 1986, ‘Biochemical patterns in limbic system circuitry: Biochemical-electrophysiological interactions displayed by chemitrode techniques', in B.K. Doane and K.E. Livingstone (eds.), The Limbic System. New York: Raven Press, pp. 55-65.
Goddard, G.V.: 1983, ‘The kindling model of epilepsy’, Trends in the Neurosciences 6, pp. 275-279.
Goddard, G.V., D.C. McIntyre and C.K Leech: 1969, ‘A permanent change in brain function resulting from daily electrical stimulation’, Experimental Neurology 25, pp. 296-330.
Gowers, W.R.: 1994, Epilepsy and other Chronic Convulsive Diseases. Nijmegen: Arts & Boeve [reprint of the first American edition 1885].
Greaves, D.: 1988, ‘Sudden infant deaths: Models of health and disease’, Journal of Applied Philosophy 5(1), pp. 61-74.
Greaves, D.: 1998, ‘What are heart attacks? Rethinking some aspects of medical knowledge’, Medicine, Health Care and Philosophy 1(2), pp. 133-141.
Gulick, Th.A., I.P. Spinks and D.W. King: 1982, ‘Pseudoseizures: Ictal phenomena’, Neurology 32, pp. 24-30.
Hacking, I.: 1995, Rewriting the Soul. Multiple Personality and the Sciences of Memory. Princeton: Princeton University Press.
Harrington, A.: 1989, Medicine, Mind, and the Double Brain. A Study in Nineteeth-Century Thought. Princeton: Princeton University Press.
Hippocratic Writings: 1978, Edited with an introduction by G.E.R. Lloyd. Harmondsworth: Penguin Books Ltd.
Janz, D.: 1994, ‘Anmerkungen zu Epilepsiegestalten bei Dostojewskij’, Rundbrief und Zeitschrift der Deutschen Sektion der Internationalen Liga gegen Epilepsie 7, supplement 2, pp. 15-17.
Kuyk, J. and L. Dunki Jacobs: 1994, ‘Pseudo-epileptische aanvallen (Deel I)’, Epilepsie Bulletin 22(4), pp. 99-103.
Kuyk, J. and L. Dunki Jacobs: 1995, ‘Pseudo-epileptische aanvallen (Deel II)’, Epilepsie Bulletin 23(1), pp. 3-5.
Lesser, R.P.: 1985, ‘Psychogenic Seizures', in T.A. Pedley and B.S. Meldrum (eds.), Recent Advances in Epilepsy. Edinburgh: Churchill Livingstone, pp. 273-295.
Liske, E. and F.M. Forster: 1964, ‘Pseudoseizures: a problem in the diagnosis and management of epileptic patients’, Neurology 14, pp. 41-49.
Mann, Th.: 1989, Bekenntnisse des Hochstaplers Felix Krull. Hamburg: Fisher Taschenbuch Verlag, 1989.
Meador, C.F.: 1995, ‘The art and science of nondisease’, New England Journal of Medicine 272, p. 92.
Nijhof, G. et al.: 1992, ‘Polyvalentie in opvattingen over de beheersbaarheid van epileptische aanvallen’, Medische Antropologie 4(2), pp. 225-235.
Polkey, C.E.: 1990, ‘Surgical treatment of epilepsy’, The Lancet 336, pp. 553-555.
Ramani, V. and R.J. Gummit: 1982, ‘Management of hysterical seizures in epileptic patients’, Archives of Neurology 39, pp. 78-81.
Reznek, L.: 1987, The Nature of Disease. London/New York: Routledge & Kegan Paul.
Sackett, D.L., W.M.C. Rosenberg, J.A.M. Gray, R.B. Haynes and W.S. Richardson: 1996, ‘Evidence based medicine: what it is and what it isn't’, British Medical Journal 312, 71-72.
Sartre, J.P.: 1971-72, L'idiot de la famille. Paris: Gallimard.
Scambler, G.: 1989, Epilepsy. London: Tavistock/Routledge.
Shen, W., E.S. Bowman and O.M. Markand: 1990, ‘Presenting the diagnosis of pseudoseizure’, Neurology 40, pp. 756-759.
Shorter, E.: 1995, ‘The borderland between neurology and history', in M.I. Weintraub (ed.), Neurologic Clinics, Vol. 13, No. 2 (Malingering and Conversion Reactions). Philadelphia etc.: W.B. Saunders Company, pp. 229-239.
Small, J.G., J.R. Stevens and V. Milstein: 1964, ‘Electroclinical correlates of emotional activation of the electroencephalogram’, Journal of Nervous and Mental Disease 138, pp. 146-155.
Taylor, J. (ed): 1931, Selected Writings of John Hughlings Jackson, Vol 1. London: Hodder & Stoughton.
Temkin, O.: 1971, The Falling Sickness. Baltimore: John Hopkins University Press.
Trimble, M.R.: 1981, ‘Hysteria and other non-epileptic convulsions', in E.H. Reynolds and M.R. Trimble (eds.), Epilepsy and Psychiatry. London: Churchill Livingstone, pp. 92-112.
Voskuil, P.H.A.: 1983, ‘The Epilepsy of Fyodor Mikhailovitch Dostoevsky (1821-1881)’, Epilepsia 24, pp. 658-667.
Weintraub M.I.: 1995, ‘Preface', in M.I. Weintraub (ed.), Neurologic Clinics, Vol. 13, No. 2 (Malingering and Conversion Reactions). Philadelphia etc.: W.B. Saunders Company, pp. xi-xii.
Zivin, L. and C. Ajmone-Marsan: 1968, ‘Incidence and prognostic significance of “epileptiform” activity in the EEG of non-epileptic subjects’, Brain 91, pp. 751-778.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dekkers, W., van Domburg, P. The role of doctor and patient in the construction of the pseudo-epileptic attack disorder. Med Health Care Philos 3, 29–38 (2000). https://doi.org/10.1023/A:1009921329444
Issue Date:
DOI: https://doi.org/10.1023/A:1009921329444