While the experience is rare, it is not unique.  There are many who have described these spiritual seizures.  Perhaps the most verbal and most eloquent description comes from the great Russian author and epileptic, Fyodor Dostoevsky.  

” For several instants I experience a happiness that is impossible in an ordinary state, and of which other people have no conception.  I feel full harmony in myself and in the whole world, and the feeling is so strong and sweet that for a few seconds of such bliss one could give up ten years of life, perhaps all of life.

I felt that heaven descended to earth and swallowed me.  I really attained god and was imbued with him.  All of you healthy people don’t even suspect  what happiness is , that happiness that we epileptics experience for a second before an attack.”

  In fact, Dostoevsky himself stated the belief that Mohammed in his great vision of God must have had epilepsy because he recognized the experience.  Curiously, though he knew and recognized this event as a seizure, It did absolutely nothing to cast doubt on the singular spiritual reality of his experience.  Even though the seizure was an event happening within his brain, he was convinced that it was a physical event within his brain that gave him a very priveleged glimpse of the face of God.  Far from throwing doubt on God’s existence, this experience drove him forward in the face of all kinds of obstacles, trials and discouragement.  This siezure formed the absolute foundation of his faith.

     The folly of discounting subjective experience with a materialist explanation is that the impulses in the brain simply do not mean that what we are sensing from those impulses is in any way not real.  It would be silly to say that because you measure visual impulses in the occipital lobe as you look at an apple, olfactory impulses as you smell it, gustatory impulses as you taste it, that therefore the apple did not exist.  Similarly, Dostoevsky saw the ecstatic and profound euphoria he experienced preceding his siezures as an inborn gift that put him in touch with a higher truth that people cannot ordinarily experience. 

  Working in this same vein, the 1996 movie Phenomenon features John Travolta as George Malley, an ordinary man who develops a brain tumor that enhances and supplements his brain function rather than destroying it as an ordinary tumor would.   A neurosurgeon sees an opportunity to advance scientific knowledge by operation on his tumor in order to learn about brain function in a way that had never been done before, calling himself George’s ”biographer” in a sense.  George then point out that ” that isn’t me, it’s just my brain.”   

   The real challenge for any of us when we come to any profound experience or realization is to embrace it, to share it and to help others experience it as well.  What the fictional George had to offer was a glimpse of what was inside each of us, our true human potential.  While the story is fictional, the moral rings true.  We are more than our synapses and neuronal impulses.  These represent sensations, ideas, inferences and experiences of something more, something real and powerful, something central to our humanity. 

   So when an atheist lazily discounts religious experience and accounts of the divine as simply seizures, he is missing the point.  He is buying into an all to prevalent attitude that sees brokenness or dysfunction where true beauty and mystery might lie.   This theme is masterfully explored by author Mark Salzman, in his book, Lying Awake.   Based on a true story, he recounts the story of a Carmelite Nun who experiences the very seizures Dostoevsky describes, which drive her lifes choices to enter the sisterhood.  Over time these ecstatic visions are accompanied by a more and more severe headache, leading to the discovery that seizures are behind her experience with the divine.  The Nun is then given a heartbreaking choice, have her temporal lobe lesion removed surgically and cure her headache, losing a profound connection with God in the process, or to keep the connection, knowing her headaches may grow worse, and the episodes may eventually debilitate her.  Salzman makes a very strong case for the counterintuitive, that one could very reasonably choose to keep their seizures, seeing them as key to their sense of self identity and happiness.  That to lose her seizures would be to lose something wonderful and amazing.  Doubtless the New Atheist crowd would be stupefied at such a crazy idea.  Perhaps because they have already severed this profoundly human connection and experience from themselves, leaving them the poorer for it.

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     For over 20 years our country and its undying commitment to capitalism have tried desperately to slow mushrooming healthcare costs, and failed miserably. HMOs, Capitation, things that business was confident would succeed where those fiscally incompetent doctors failed, fell flat. Patients, it seems, did not tolerate their health and well-being treated as a business. I suppose business was part of the problem. After during WWII, with wages fixes and worker shortage, jobs starting sweetening benefits with healthcare and insurance to compete. It turns out patients and workers really, really like this system. It removes us from feeling any of the pain in our wallets with doctor visits and poor health.

Speaking in strictly capitalist, business terms customers were going to receive services from physicians, while a third party, insurance companies and businesses footed the bill. This removes some of the natural checks on inflation of cost. The patient and the doctor can now gang up on the third party payer, making control of spending difficult. So as an economist, obviously we just need to restore the marketplace, right?

It really depends on how one envisions healthcare. I can’t see going to the doctor or hospital the same as shopping for a new SUV, or getting cable TV. Our health is a fundamentally different thing, central to our quality of life, our independence, even the pursuit of happiness. Is it something people deserve or something we buy, dependent on our resources and wealth?

Without question it is dependent on our wealth to some extent, because it is creating a very real drag on our economy. Businesses have been weighed down with the cost of healthcare to the point where even the most heartless capitalist is demanding that the government do something to fix this mess. We spend more on healthcare by far than any other nation in the world. In spite of this, we have huge inequities in care with a mushrooming population of “working poor.”

These are people who have jobs and contribute to society, eliminating their eligibility for medicaid, but don’t have access or resources to get health insurance, so they go without. These people do take themselves out of the equation. The price checks work, as they stop seeing the doctor, that is until their uncared for hypertension, diabetes, cancer, lands them straight in the hospital desperately ill, devouring resources. But hey, a recent study actually showed this saves us money. We should just let them shorten their lifespan right?

You could even go so far as to say they deserve it for not taking care of themselves. If they just ate right they wouldn’t get hypertension or diabetes, right? Problem is fat, sugar, processed food are very cheap. Fresh fruit, vegetables, unprocessed grains are not so cheap and take time to prepare, time that could be spent working away at your minimum wage job to make ends meet. No, I am afraid blaming the poor has become an American pastime, one I am deeply ashamed of.

I have witnessed it firsthand. In medical school, our catholic hospital often received “patient dumps” from another large private hospital. These were medicaid patients, the cost of their care being eaten by the hospital. Medicaid pays substantially less than the actual cost of healthcare with the thought being that Hospitals and Doctors can take the hit as doing their share of charity work. This being the real world, the cost is passed on to everyone else through inflated costs to cover losses caring for the poor. These losses would be very manageable if the poor were evenly distributed among us, and everyone took in their share. Alas, the poor are concentrated in the inner cities, the victims of family flight to the suburbs, or in rural areas where the resources are scarce. We now have laws outlawing patient dumping and ERs everywhere are becoming the primary health care clinic for the poor. ER physicians are frustrated, burnt out and cynical. Many of them blog about it. Many of them grow contemptuous of those they care for. It is sad really.

The president recently stated that we actually have universal health care in this country. He was referring to our “safety net”, government and community hospitals. In fact all hospitals are now required by law to take care of everyone who walks through their doors, regardless of ability to pay.

I have spent a good portion of my training in county and inner city hospitals and I have seen our safety net in action. I have watched as a hospital has closed, causing an overflow of the poor to other hospitals. When the poor arrive in too large of numbers, the old patients get spooked. They equate care for the poor with substandard care. They leave and take their insurance with them. The end result is that, indeed, care for the poor becomes substandard. Morale in these hospitals is exceedingly low. They go bankrupt, they cut staff and wages to make ends meet, they outsource, then they die. All the while, patients with money cause the suburban hospitals to thrive, explode, and expand. This is what it means to make healthcare a commodity. This will destroy our “safety net.” This is a crisis.

A main argument I have seen on other blogs against a single payer system is that people will expect more, waste more and everything will cost more. They state that patients won’t tolerate the rationing of healthcare that a single payer system will require. Governments won’t control the spending because it is politically harmful. I agree. I can tell you right now, patients don’t tolerate rationing. We have a tiered system with quality going to the highest bidder. This is capitalism, welcome to America, right?

I just can’t embrace it. My stomach has turned watching the market in action as hospitals are destroyed and the face of the poor ground upon. The resources available to medicine are not unlimited. We do have to face this. Personally I believe a single payer system would at least be a huge improvement over the fractured system we have now. You could tax business what they are paying for healthcare right now, eliminate all the duplication of beauracracy in insurance companies and with the money you save, put it toward real quality that benefits everyone, all without raising costs, which you could fix with inflation adjustments to force economic responsibility. Since we spend twice as much on healthcare as any other nation, we would have the best system in the world instead of the most wasteful.

Realistically you would still have two tiers. The Uber rich, I am sure, would feel they wanted something better and would pay out of pocket to doctors that would only be too happy to oblige. If they pay taxes and foot the entire bill, I suppose it is only fair. They would be a definite minority. The important thing is that healthcare would become a resource that we share.

There is a certain basic concept that we are beginning to forget in our society, the concept of common wealth. Way back in the days of print media, communities would pool their resources to build a collection of books we call a library. This was because information and education was felt to be mutually beneficial if shared. The poor can only benefit from learning. We all can gain more as a group, enriching the whole, than any of us can individually. This is a way the group can protect resources from individuals who would devour or horde them. It turns out that together we have much more than any of us could ever hope to acquire individually. This is the thinking behind public museums, national parks. These are something different than commodities. They are actual sources of well being. This is our true wealth, and it is shared.

The common wealth of America are habitats, ecosystems, languages, cultures, science, technology, schools, social and political systems, democracy. These are things often so basic we sometimes forget how much we have. They are things we all value together and are well worth fighting for. So is medicine a right, or a commodity dependant on resources and wealth? My answer has to be an unqualified yes, it’s both.

I believe, sincerely in the depths of my soul, our commonwealth has to include medicine. We need to protect it, not exploit it. I doubt any of us could calculate what exactly any of these things would cost on the open market. I think it is safe to say that taken together our common wealth’s value exceeds all we could ever own privately.

This is why collectively, we need to move to protect healthcare and medicine and distribute it among ourselves equally. Yes this means placing some trust in the government, which after all represents all of us. I am just enough of a hopeless optimist to suggest this is something we must fight for. In the end, I have to come down believing health care is a right, inextricably tied with life, liberty, and the pursuit of happiness. I leave you with this closing thought about what I believe society should and can be.

“We need to speak up, to say boldly why we fight for good schools, why we build houses for the homeless, why we protect open space, why we look after the ailing and the elderly, why we pay taxes without grumbling, why we honor government as a force for public good. In a society obsessed with competition, we need to say why we practice cooperation. In a culture addicted to instant gratification, we need to champion long-term healing and the welfare of coming generations.”

-Scott Russell Sanders

      So it’s not surprising that in the past, seizures were thought to be caused by demonic possession.  Many an epileptic in the middle ages were treated with exorcism.

Matthew 17:15- "Lord, have mercy on my son: for he is lunatick, and sore vexed: for ofttimes he afalleth into the fire, and oft into the water."

    More recently, many in the scientific world have tried to paint religion itself as founded on epilepsy and a diseased mind, as the religious experience of everyone from Mohammed to Joseph Smith have been ascribed to an epileptic fit.   Unfortunately, the EEG was not hooked up during said events, so the world may never know.  The insinuation and prejudice against the “diseased mind” are still very much at play in these modern science based accusations.  It seems we still want to call those we feel deluded possessed by our modern day demons.

(Note- see this post for an excellent recent excoriation of this mindset.)

   With the advent of modern medicine we have started to get a handle on what is happening in the brain during a seizure.  We know a little group of renegade neurons somewhere in the brain start a regular firing pattern that recruits more and more of the brain until the signal grows so strong it wipes out all regular brain activity.  The tendency for this to happen periodically is known as epilepsy.

    When interviewing the general public, however, an amazing amount of stigma remains in regard to epilepsy.   This has generally improved slowly over time.  In 1949, a Gallup poll revealed 57% of Americans thought epilepsy was a form of insanity, our own modern day equivalent of demonic possession.  By 1979, the percentage decreased to around 8%.  

     In 1949, only 45% of people thought an epileptic could hold employment.  Today 80% believe an epileptic can work.  Still, finding employment can be difficult when one in five potential employers thinks you are inelegible to start with.    In 1987, 92% of Americans were aware of epilepsy, a third of those surveyed thought epilepsy made other people think less of them or their families, and 12% thought people with epilepsy should never have children.

 Considering how most epilepsy is quite treatable and controllable, and not genetically acquired, that last statistic is one of the most troubling.   Even in our “enlightened” age, so many of us are troubled by the possessed.  Many don’t want to see them propogate their inferior genes, or trouble us in the workplace.

   Even worse is epilepsy as seen through the eyes of a child’s peer group.  In 2006, a study by C. Cheung in the Journal of Child Neurology found that when asked, most teenagers agreed that Epilepsy commonly causes mental handicap, frequently leads to self injury and death, that people often injure bystanders when having a seizure, and that persons with epilepsy are less honest, popular, fun, and adept at sports than other teens.

     In case you were wondering, all of these impressions are wildly exaggerated and not supported by reality.  The fact is any of us, in the right circumstances and conditions can have a seizure.    The dividing line between us and epileptics is actually that the seizures haven’t happened to “regular, healthy people” yet.  But don’t fear, epilepsy ocurrence spikes a second time after childhood in old age.   We all may get our chance. 

  The vast majority of people are not killed or injured by their seizures.  Such events are rare.  Even more rare is being injured by standing next to someone with a seizure.  Yet, so many fear that the demons are contagious. 

  These teenagers considered Epilepsy as socially disabling as HIV infection or leukemia, ranking it worse than any condition other than Down syndrome.  It was considered worse than asthma, diabetes, migraines, or arthritis.   

  This percieved stigma aggravates real problems as a child ages.  Parents that fear their child is dying subtly lower their expectations for the child.  Very often, children with seizures acquire vulnerable child syndrome, even when their seizures stop and they go off of medications as they grow up. 

    The end result is that even in this majority of epileptics, devoid of medication or seizures for many years, unemployment is higher.  They are less likely to go to college than people of the same socioeconomic bacground and intelligence.  They are less likely to marry or have children  (silanpaa M, shinnar S, NEJM 1998; 38:708).   In the end, it seems those 12% who want to stop epilepsy gene spread and contact in the workplace are winning.  It is aggravating as a child neurologist to know that even when I have done my job and stopped the demons, the stigma continues to limit these children far beyond what their condition demands.  In the end, curing the disease is not enough.   The demons will continue to haunt them even after the body is healed.   My question is, whose demons are they, theirs or the rest of society?  It is evident to me that we are not as far beyond the superstition and misunderstanding of ages past as we would like to believe.

from Doonesbury, by Gary Trudeau

This is interesting to me for several reasons.  The suffering goes on largely in silence.  Men don’t use health care in general to the extent that women do and they absolutely don’t use mental health care to the same extent.  One could look at this as evidence that women in our society are oppressed, if it suited their purpose.  You could argue that men are healthier because they are more free from the trap of poverty and childcare.  You could also be dead wrong.  This is a perfect example of how using mental health statistics to prove an oppression argument only feeds the monsters of stigma and prejudice.

It is deeply ironic that refusing to get help is ever considered a show of strength.  The only strength I’m seeing is a two tons of stigma flexing its muscle with men everywhere bending to its will.   Unfortunately, in our society, to go to the doctor is to admit weakness and trouble coping, and to have weakness and trouble coping is to be less than a man.  Strangely, it is the need to be strong that causes and reinforces the depression, the problem aggravated by the need to avoid itself.

These are emotions I am far too familiar with.   I have a be strong, perfectionist trifecta going against me personally, with my gender, profession and faith.  I have ranted and raved about the Mormon angle of this prejudice in the past, so this time I’ll focus on the other two aspects.  If men are not allowed weakness, it goes double for physicians.  People are relying on us to function calmly and coolly, often in the face of dire emergency.

     To be mentally unwell as a doctor is to put the public in danger.  Currently I have the distinct privilege of turning over some very personal health information over to a state medical board all for the sake of protecting the public.  As the healers of and advocates for the sick and infirm, we cannot afford to ever join their ranks.  At least that’s the conventional wisdom.   Doctors cannot afford to have weakness.

Trouble is, we doctors do have weaknesses.  When an emotional or health problem can threaten a career, and when one’s identity is invested in that career and in providing for your family,  health or mental health issues become a dangerous secret. 

     Doctors face a tremendous amount of stress in their professional life, for exactly the reasons stated above.   Increased stress will lead to more depression.  We learn this in our own traning.  We also learn how to treat it, yet my own experience is that actually getting treatment for ourselves involves serious risks to our career.  

     This is the great secret.  Mental health stigma actually puts patients in danger by by shutting off the help required for good physician function.   In reality, getting help is the only responsible thing any of us can do.  Yet we raise the stakes for those who do to the point that it takes one collosal crisis for anything to be done.

   Western society is founded on a strong belief in the power of the individual.  The American dream is the idea that we can pull ourselves out of the very depths of poverty through sheer will and determination.   While this idealism is behind a lot of what America has achieved, we have lost something in the process. 

     Humankind is a social animal.  No man is an island.  Without some degree of shoring up each others weaknesses with other’s strengths, we are all lost.  This becomes very clear when we are all stressed at once by the same problem, as in a recession.  It is paradoxical how empathy and compassion often experience a groundswell in the face of hard times.

  In much the same way it is paradoxical how one can come out of a deep depression a stronger, more adjusted individual.   It took me near destruction from perfectionism to learn how to be better adjusted.   It is a destruction that would have been certain if I had not been forced kicking and screaming to the care of some of the most wonderful and compassionate individuals I could ever imagine.  It was in concession and defeat that I finally learned what it truly is to be a man.

HT: Amiedusfree

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