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Neurologist and UN at odds over mental health eeport

9 January, 2002

A Swiss neurologist has sharply criticised a United Nations agency for including discussion of epilepsy in last year's World Health Report, which focused on mental illness. A World Health Organisation (WHO) official responded by accusing the neurologist of stigmatising the mentally ill.

Le Temps calls the October report the first overview of mental illness around the world. In it, the WHO warned about the rising occurrence of mental illness and the rising costs associated with it and called for a new concept of mental illness, free of shame and stigma. Although the WHO said in the report that epilepsy is not a mental health problem, it included the disorder because of the ignorance and stigma that can surround it, similar to the reactions associated with mental illness. Hopitaux Universitaires de Geneve epilepsy chief Pierre Jallon called the inclusion "retrograde" and a "stab in the back."

"Epileptologists have been fighting for years to get patients, families, the public and other doctors to understand what epilepsy is - that is, a neurological illness," Jallon told Le Temps. "Now, just when we had left ignorance behind, we fall back into obscurantism. The WHO's report reduces epilepsy to its symptoms, to the attacks and convulsions that inspire fear, or to a death drive - because ill-informed people interpret the attacks as a sign of a mental anomaly. This report is like a work from the nineteenth century. It is like being in an underdeveloped region where the illness is still considered a contagious disease that is transmitted in saliva."

"This backpedaling is all the more incomprehensible because the WHO four years ago launched a campaign called 'Out of a Shadow,'" Jallon continued. "This worldwide sensitisation campaign, in which I participated, was aimed at freeing epilepsy from the shackles of ignorance and fear. Now the WHO is bringing epilepsy back into the psychiatric domain. It is maddening."

Report author and WHO mental health official Jose Manoel Bertolote called Jallon's criticism:

"The typical reaction of an academic living in a highly developed country"

In seeking to distance himself from mental illnesses, Bertolote said of Jallon "this neurologist stigmatises them, because he apparently considers them a despicable category. We have no neurological or psychiatric department at the WHO. We are a public health organisation whose goal is to better treat the ill. In many countries, epileptics are cared for - and well cared for, at that - in hospitals' psychiatric units. That is better than not being treated at all, which is unfortunately still the case for many patients."