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Philosophy matters in brain matters (April 2013)

Markus Reuber, editor-in-chief, SeizureIntroduction from Dr Markus Reuber, editor-in-chief of Seizure

Seizure 22/3 has published Philosophy matters in brain matters (April 2013)

Despite the best efforts of many readers and of Seizures, there are still clear and surprisingly tribal borders between patients and doctors. Several recent studies examining communication between patients and doctors working in epilepsy clinics have demonstrated that, from the patients' (and the doctors') perspective, a distinction between them and us remains clearly evident [1, 2]. Perhaps it will always be so. Quite possibly the gap between the person who experiences the symptoms and the person who has spent many years learning to apply a "rational" explanatory framework to the patients' complaints and to turn them into medical categories which can be observed, studied and treated is one of the major achievements of modern medicine and one we should be proud of. However, this possibly necessary gap does not mean that doctors and patients should stop reflecting on their interactions, attempting to understand each other better and minimising the potential for miscommunication.

In this issue's Editor's choice, Siri Hustvedt shares her experience of being a patient with seizures and how she experienced the doctors she encountered [3]. Her account clearly demonstrates the gap between her experiences and the responses of her doctors and makes for an uncomfortable read.

Siri Hustvedt's seizures were thought to be "medically unexplained", and she also writes about another gap which shows little sign of disappearing: Despite its obvious logical and scientific flaws, dualistic thinking, the division of pathology of the mind and the body, continues to underpin current expert discourse about "psychogenic" disorders and recommendations for the explanation which health professionals should give to their patients.

Siri Hustvedt turns out to be one patient who would not be fooled by an explanation which cuts too many philosophical and biomedical corners. Probably like many others, she would prefer to be taken more seriously by her doctors. She wants them to admit what they don't know rather than present her with certainties, which simply cannot be right. She also challenges her readers to replace the mind/body split with a biopsychosocial understanding of disease which may be more complicated but which is also much more in keeping with our current understanding of how the brain works.

Siri Hustvedt gave this paper at an international ethics conference entitled "Brain Matters 3: Values at the Crossroads of Neurology, Psychiatry, and Psychology" organized by Paul Ford of the Cleveland Clinic Foundation. I am grateful that she has used the tools of her trade as a novelist and essayist, her impressive erudition and sharp intellect to help us reflect on what we think about our patients' symptoms and how we communicate with them.

[1] McCorry D, Marson T, Jacoby A. Understanding routine antiepileptic drug decisions: a qualitative analysis of patients' accounts of hospital consultations. Epilepsy Behav 2009;14: 210-4.
[2] Toerien M, Shaw R, Duncan R, Reuber M. Offering patients choices: a pilot study of interactions in the seizure clinic. Epilepsy Behav 2011;20: 312-20.
[3] Hustvedt S. Philosophy Matters in Brain Matters. Seizure 2013;22:169-173.

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