All good things must come to an end.  I am in the midst of some major life changes right now, and have found my time and energy for blogging have vanished.  I have enjoyed pouring my soul out into the internet the past year and a half, but my schedule has become such that I am having to phase out my posting and blog maintenance.  I don’t know if this will change after we move,  or if the blogging bug will get me again, but for now this blog is on indefinite hiatus.  I just wanted to let my legions of faithful readers know (both of you!)

   Witnessing a seizure is a very frightening experience.  Parents who witness seizures in children fear for their child’s life.  It is extremely traumatic.  Even now, as a trained professional, knowing all the steps I could ever need to take care of the problem, I will feel my heart rate climb with a knot in my stomach as adrenaline starts to flood my system to this day.

      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.

Back in the day, I posted a video by a wacky group of harmonizing nurse anesthetists going by the name of the Laryngospasms.  Here is another of their fabulous repertoir, lamenting the pain of coming out of anesthesia.  Enjoy, as they report to patients everywhere, that waking up is hard to do.

The BBC has an  Interesting Article on how the economic crisis is leading to an emotional crisis in many men in the face of trouble providing for their families.  The report on a survey that found men are twice as likely currently to report having suicidal thoughts, half as likely to discuss their trouble with friends or family, and while experience mental health problems in roughly equal numbers with women, they go untreated far more often.

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.

People of my generation may remember Schoolhouse Rock, a collection of campy educational cartoon shorts from everything from history to government to math, to grammar and English.  Here is a reworking of the greatest of them all from my completely unbiased point of view, reviewing the greatest of the body’s organ systems, the Nervous system.

   The fourth ever edition of the Palliative Care Grand Rounds is up at the Medical Futility Blog, having grown by leaps and bounds since it started last January.    I am honored to have been included after a long carnival absence.

   Grand Rounds is up at first time host, Nursing Handover, where she does a bang up job with accompanying photos that almost steal the show from the wonderful posts. 

Surge X Periences has been posted at Other Things Amanzi with an equally impressive montage of African Wildlife to organize compelling tales of the OR.

   Also, check out the last editions of the Disability blog carnival and Change of Shift, while a bit older, are definitely worth the look if you missed them, and just think, more will be on the way shortly.