"THE FALLING SICKNESS"

In ‘Julius Caesar’ William Shakespeare has depicted thus, The incident of Caesar’s Seizure,

CASCA : ‘He fell down in the market place, and foam’d at
Mouth, and was speechless.’

The noble Brutus : ‘Tis very like. He hath THE FALLING SICKNESS.’

RISE OF THE FALL

Epilepsy is caused by a temporary dysfunction of the nervous system; triggered by a normal focal activity in the brain. The activity could be localized or may spread over the entire cerebral cortex, resulting in a seizure; i.e. a fit or convulsions. The symptomatic manifestation of the abnormal focal activity could have a variegated from of presentation, a seizure or it could be an altered cognition, of the locally affected sensory field. One may hear noises or witness hallucinatory sights etc. It could be a kinetic, i.e. without any movements too!

In fact there is a wide spectrum of the affliction; depending on the site of origin of the disease, the severity, frequency, pattern and sometimes the presence of premonitory symptoms in epileptic attacks(termed AURA), etc.

ARRESTING IT

There are a number of causes for this malady. Functional causes and organic ones. Functional ones refer to a response to varied stimuli in the form of seizures. There is nothing wrong structurally or organically.

Treatment of petit-mal by anticonvulsant drugs is reasonably effective. The therapy has to be properly monitored and is fairly a prolonged one. The dose has to be enough to suppress fits, but regulated one to fall short of the toxic-dose.

The organic causes such as a tumor in the brain could be excised but it requires a prolonged medication post surgery. Surgery is also effectively employed to stereo tactically ablate (numb) the area which causes the abnormal focal discharge in brain.



RIGHT PERSPECTIVE

There are a number of misconceptions prevalent about the affliction of epilepsy; the MYTHS:

That, Persons with Epilepsy, PWEs for short; are not capable of any intelligent activity.

That, it is some occult phenomenon, some mystic experience or a condition which will cure by itself; e.g. after marriage a PWE spinster will get cured; etc.

That, it permanently and irretrievably impairs the cerebral function.

The fact is that except for the brief interlude of the epileptic fit, the PWE’s central nervous system functions normally. PWEs are definitely capable of intelligent economic activity; as “knowledge workers”.

LIVING THE DIGNITY

Take the case of Gopal who was a bright student and started getting fits, while in the final year of school. With proper medication his condition was effectively controlled. He studied his Law and later chose to specialize in Office Administration. He was being treated regularly for his epilepsy by an eminent specialist, who was monitoring his progress and condition. He desired to secure a good job without hiding the fat that he was a PWE. Innately a truthful person, he allowed his tact to prevail on his instinctive honesty.

He cleared the job tests and interviews with e reputed private sector Company and was selected as an Administrative Officer on his own merits. On receipt of an appointment letter he was rightfully jubilant but sought an additional interview with the employer. He explained at length the fact that although a PWE, has had in seizures lately. HE requested the employer to crosscheck on his condition with the specialist who was treating him.

Being an enlightened employer, Mr. Seth the Managing Director of M/s Seth & Wilson arranged a meeting of the specialist with the Company’s medical advisor. It is so transpired that Mr. Gopal hadn’t had a seizure for nearly an year. The seizures had a pattern of occurrence, i.e. only at late nights so far. The job was essentially in an Office, where late night working was not even a remote possibility. Employer concluded that the job be offered to Gopal.

Today, he is accepted by the colleagues, and is progressing famously well in his career. Most times confrontation halves the severity of a problem and running away from it doubles it.

PWEs BATTLING WITH IT SINGLY

There have been several cases of individuals who are employed in organized sector, as normal healthy ones initially, but develop epilepsy while in the employ. A peculiar situation crops up for the patient;

to start the curative process, immediately and discreetly

to hide the fact of his condition from employer and colleagues who may tend to treat PWEs differently

Continuously nurture the feeling of insecurity and anxiety about the chance occurrence of a seizure during office hours. Facing the STIGMA thereafter.

Worry about the wellbeing and economic dependence of the family members,

A feeling of inadequacy as a bread-winner to meet the demands of dependents.

How can one come unscathed out of all this? How can one face the employer and the colleagues? In our social pattern, a number of PWE, are still being treated by quacks and witch-doctors who subject them to inhuman treatment.

The hapless family members and perhaps the patients too suffer the agony in the hope that a cure may materialize. In spite of the scientific and technological advance, in the medical field, these pre-historic methods still continue to be espoused by even prey to denied education and are less fortunate. They are an easy prey to such torturous ‘treatments’.

GRACEFUL COEXISTENCE

On account of the foregoing, if the social stigma which is attached to such patients is eliminated by conscious, continuous and enlightened efforts, PWEs can lead their painful life with dignity without withholding from the world the fact of the affliction. It is possible to control the condition and rehabilitate the PWEs, by offering them gainful employment. This will reassure them that Society is treating them as equals and they are not discriminated against.

A proper counseling by trained medical social counselors helps the patients get reassured about their usefulness to the society and restores their self confidence.

It is essential that the colleagues and the employers with the active help from the medical personnel understand the scientific/medical reasons for such seizures and explain to the co-workers that there is nothing wrong with the epileptics. It is a phase of a periodic disturbance in the nervous system. For a brief while the normal functioning is absent. For all the rest of the period, the individual is as normal as you and me. His creativity is in tact; his brain will function normally except for the moment of seizure. The peer group should ensure that such a confidence is given to the in suffering from epilepsy. Please don’t ostracize PWEs; as sub-normal.

SOME TIPS

A simple sympathy smothers the self respect of PWEs. Psychological problems are more difficult to digest. It is a common sight to note people addressing the afflicted, with a pseudo concern and in hushed voices. The occurrence of a seizure makes all friends avoid a PWE. A responsible participation in an economic activity gives an enormous joy to PWEs. They can convert their creativity, knowledge and productivity, into wealth. Giving them just some preoccupation to keep them gainfully employed is but the first step emanating from empathy. Treating them as equals calls for nobility.

The Services of a competent human services professional will help identity and sort the problems of rehabilitation; effectively.

INSTITUTIONALISED EFFORTS

The Indian Epilepsy Association is doing a splendid working the field of generating a public awareness and removal of misconceptions. A fund of information and guidance is available through the International Bureau of Epilepsy; IBE for short. IBE was established as an Organization for laymen and professionals concerned with the non-medical aspects of epilepsy, such as the social problems and public education. IBE provides assistance by offering international support by creating ways and means for a worldwide exchange of factual information and where possible by setting standards which provide an international policy focus and identity, for all persons with epilepsy.

Given the different cultural and educational backgrounds of the people at large, the responses to the PWEs vary largely.

A workshop was held in 1989 in New Delhi as a part of the International Epilepsy Congress under the auspices of IBE.

A CONFRONTATION IS THE HALF WAY TO SOLUTION

Hiding the condition can be dangerous to the individual and detrimental to the cause. Take the case of Sudhakar. He is a driver and used to have fits. He and his family members conveniently brushed it aside as the wrath of some village-deity & no medication was resorted to. He sought a job as a driver, and was given one by a private bus company; based on his experience and a driving license.

Unfortunately he had a seizure while in the driver’s seat. Luckily though, no damage occurred, since the seizure was, while waiting at the traffic signals. It caused quite a commotion though, in the busy streets and a lot of inconvenience; to all concerned. It costed Sudhakar his job which was a natural sequel to his keeping the problem under wraps. A proper and timely medication could have saved the situation. By shrouding in secrecy the problems don’t get solved.

BASIC SAFETY PRECAUTIONS

The precautions to be taken while employing a PWE are broadly as follows:

They should be offered work preferably in the General shifts, where, medical aid can be had, easily; if and when required.

They should not be made to work in hazardous situations, near unguarded machinery or near moving parts; and at heights.

Preferably engaged with a group of people so as they are not left alone; unnoticed.
driving of vehicles should be avoided

Cassius the wise Roman conspirator, the one with “a lean and hungry look” says,

CASSIUS: “No Caesar hath it not; but you and I, And honest Casca, we have ‘the falling sickness’ ”.


Be slightly changing the context, I would conclude, that the eminent ones in Society have to shoulder the responsibility to rehabilitate PWEs. If we shirk to willingly offer this help, we will be the ones who would display our “FALLING SICKNESS”.




Published in The Economic Times,20th May 1993, Thursday




M S RANADE

Chairman & CEOPlacewell Consultants,

Pune 411007

mranade@vsnl.com


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