Seizing Seizures, Converting Conversion And Attacking Agency

Foreword In my opinion those who first attributed a sacred character to this disease were the sort of people we nowadays call witch-doctors, faith-healers, charlatans and quacks. These people also pretend to be very pious and to have superior knowledge. Shielding themselves by citing the divine as an excuse for their own perplexity in not knowing what beneficial treatment to apply, they held this condition to be sacred so that their ignorance might not be manifest. By choosing suitable terms they established a mode of treatment that safeguarded their own positions. They prescribed purifications and incantations . Men in need of a livelihood contrive and embroider many fictions of all sorts with regard to this disease and many other matters, putting the blame for each kind of complaint upon a particular god . I do not believe that the so-called 'Sacred Disease' is any more divine or sacred than any other disease. It has its own specific nature and cause; but because it is completely different from other diseases men through their inexperience and wonder at its peculiar symptoms have believed it to be of divine origin . -Aristotle On The Sacred Disease. -

Introduction.

This paper aims to develop a clear language and a single pathology, in which to understand all seizures. The clear language will purge definitions of seizures which will be shown to be untenable. Post hoc, a phenomenological method will be adopted, which focuses on the experiences of seizures, and brackets the cause of symptoms which obscure and distort our understanding of the phenomena. This approach will be coupled with a Wittgensteinian approach; observing how the term seizure is being used. A suitable definition will be put forward based on this coupling. Symptoms held together by Wittgenstein`s ``family resemblance``, and not a Platonist ``essence``, will salvage the concept of a seizure which has variable effects, and is realised by many causes. Only then, will we focus on the cause(s) of seizures. A pluralistic pathology will be put forward, that admits that seizures can have differing causes. However, it will not admit differing causes of a differing nature, nor devoid itself of physicalist explanations in the absence of physical findings, nor will it appeal to God, or, to a Cartesian dualism propounded by Sigmund Freud. These notions are theoretical relics, and do not belong in our current conceptual framework of medicine and do not denote the causes of seizures. This new conceptual framework for classifying seizures will be called a pluralistic physicalist pathology (PPP). The novel PPP will be favoured, over a pathology which admits the mind is separated from the body, viz. psychopathology. Conversion disorder and other classifications which attribute symptoms to non-physicalist causes will be removed. However, this is not at the expense of psychological ,or social, theories if they admit physiological causes of all physiological symptoms. Consequently, in theory, it must be possible, if the PPP is correct, that there is potential evidence for a physical abnormality, be it structural or functional, that underlies seizures thought to b caused by non-organic stuff. Evidence does indeed lye, not in the not-too-distant-future, but in the not-too-distant-past. This paper concludes with a definition of seizures which can be used coherently across the sciences, in addition to, having collapsed the organic and psychological etiological distinction of seizures into a PPP. There will be some last thought on the relation between the phenomena of impaired agency in seizures and the PPP. This paper will begin with a brief history, language and pathology of seizures, to contextualise the discussion.

History and Language "The study of these terms is a fascinating revelation of the human mind struggling with the first stages of science building, when even the terms it needed did not yet exist, but had to be created, and we watch the process of their creation going on." -James Breasted, 1930 .

There are many terms which have been used to refer to the same/similar heterogenic manifestations, said to occur, in mind and/or in body. These heterogenic manifestations have been referred to as seizures, psychomotor seizures , epileptic seizures , hysterical seizures , psychogenic-seizures , pseudo-seizures , non-epileptic seizures , imitation seizures , dissociative seizures , spinal-cord seizures , and more. For now, I will refer to the heterogenic manifestations as just seizures. Seizures have been said to be characteristic of the following diseases/disorders: epilepsy , psychomotor epilepsy , genuine-epilepsy , pseudo-epilepsy , non-epileptic attack disorder , dissociative disorder, hysteria , pseudo-neurologic syndrome, hysterical neuroses, psychogenic disorder , conversion disorder (a type of somatoform disorder ), somatic symptom disorder , etc. Some of these terms refer to the same disease process, but have been conceptualised differently. Underlying all of this terminology is a history of ideas on the cause(s) of seizures which are exemplified in the following paragraphs. There is evidence that Ancient Egyptians thought that there existed two main causes of seizures. The Edwin Smith surgical papyrus (1700 B.C.), was said to have cast aside the magic and mysticism of their time, in favour of logic and deductive reasoning . Seizures appear in this text as possibly being due to a head injury . In the Eber Papyrus (1600 BC), Ancient Egyptians depicted other seizures could be caused by a wandering womb . Note, they had a natural pathological explanation in both cases. Conversely, in Ancient Greece, the pathology of seizures was under dispute. One theory was that seizures were caused by the gods, and nature . This view differs to that of the Ancient Egyptians, in that the former invokes a pathology that appealed to the natural and the supernatural, where the latter appealed to nature alone. In contradistinction with fellow Ancient Grecians, Hippocrates speculated that seizures were caused by the brain , and like the Ancient Egyptians, thought other seizures were caused by the wandering womb. Alas, medicine was set to revert back to the supernatural, as Europe entered the Dark ages, and people who suffered with seizures were deemed to be witches and burned. Marc Stiefel and colleagues claim however, that medicine was finally purged of supernatural influences with the dawn of the Renaissance, and Hippocratic teachings formed the basis of modern medicine . Indeed, in the late 1800`s, Jean-Martin Charcot, the Father of Neurology , distinguished seizures caused by the brain (called epilepsy), and seizures caused by the womb and the brain (called hysteria) , continuing a Hippocratic natural pathology, but conjoining seizures that were once thought to be caused only by the womb, with the brain. Yet, what Steifel and colleagues failed to note, were the influential theories of Charcot`s student, Sigmund Freud who embarked upon a pathology, that invoked the supernatural. Freud, subscribed to a binary pathology of seizures, meaning, not only were seizures distinguished by their cause, but by the nature of causality itself. Freud concluded hysterical seizures were caused by emotions and the unconscious mind (repressed energies and drives) and not organic brain abnormalities. Under Freud`s teachings, there are two pathologies for events that appear to look the same. An unconscious mind and not an abnormal brain account for certain seizures, and only an abnormal brain that accounts for others (in the case of Epielspy) . Here, we have a mind, severed from the brain. Contra- all the scientific evidence that conscious life and the brain are heavily linked together, some seizures are still held to be caused by non-organic phenomena. Psychogenic non-epileptic seizures, (PNES) are said not to be caused by ``abnormal electrical brain discharges``, but by ``psychological distress`` . People with these types of seizures, are not faking it , but neither is their brain or body determining it. Rather, it is something as intangible as the Gods invoked by Ancient Greeks. Advancements in technology, seemingly helped set this distinction in stone .