The role of doctor and patient in the construction of the pseudo-epileptic attack disorder

Abstract

Periodic attacks of uncertain origin, where the clinical presentation resembles epilepsy but there is no evidence of a somatic disease, are called Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEAD may be called a 'non-disease', i.e. a disorder on the fringes of established disease patterns, because it lacks a rational pathophysiological explanation. The first aim of this article is to criticize the idea, common in medical science, that diseases are real entities which exist separately from the patient, waiting to be discovered by the doctor. We argue that doctor and patient construct a disease, and that the construction of the disease PEAD includes many normative evaluations. The second aim is to provide insight into the suffering of patients with PEAD. We focus on three aspects of the patient, identity, autonomy and responsibility. We present some characteristic descriptions of (pseudo-)epileptic attacks by Fjodor Dostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosing PEAD reduces a meaningful life event into an insignificant, though intriguing, medical phenomenon, and that the patient will not benefit from being diagnosed as having PEAD.