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Brendan’s fits seemed like epilepsy, until we looked into his emotional life

Dr Phil Whitaker’s Health Matters column. 

Daytime emergencies are always disruptive. Patients with appointments end up waiting for ages and colleagues have to squeeze extra people into already congested lists to deal with the backlog. So when a call from the son of the 70-year-old Brendan was put through in the middle of morning surgery, I took it with some foreboding.

“Dad’s having another fit,” he told me. “I was going to phone the ambulance but the hospital told us to ring you if it happened again.”

This struck me as unusual advice, so I speed-read the last hospital letter in his notes. Brendan had had three “blue-light” admissions with fits but the consensus was that they weren’t epilepsy. The provisional diagnosis was pseudoseizures and it was suggested that emergency admission would not be appropriate for future episodes. Brendan’s son sounded understandably stressed. I was going to have to visit.

Brendan was still fitting when I arrived – a bizarre pattern of involuntary writhing and inarticulate speech quite different to classical epilepsy. I was able to get him to co-operate with some instructions in the midst of it all, a finding also inconsistent with an ordinary seizure. I put the restive waiting room out of my mind and settled down to resolve the crisis by persistent reassurance.

Pseudoseizures – less pejoratively known as non-epileptic attack disorder, or NEAD – are a type of conversion illness: strange phenomena in which intolerable emotional stresses manifest as physical symptoms that don’t fit organic patterns. These include paralysis and mutism, as will be familiar to readers of Pat Barker’s Regeneration trilogy, which dealt with “shell shock” in First World War combatants.

In the months that followed, I got to know Brendan well. He’d never served in the military but his work with an international NGO had landed him in some sticky situations, including being held hostage at gunpoint during an African civil war in the 1970s. His personal life had been marred by tragedy; he’d fathered his son during an affair with a married woman, whom he described as the love of his life. She had died from cancer two years afterwards and her scandalised family had barred him from visiting her during her final months, so he never got to say goodbye.

Brendan is well educated and professed himself fascinated by my idea that his fits might be related to these past traumas. He is also pretty much the archetype of the stiff-upper-lipped Briton and was very polite in telling me he thought the whole thing was a load of bunkum. He undertook vast amounts of research, which reinforced his belief that he must have an unusual variant of epilepsy. His conviction wasn’t shaken by a second opinion from a nationally renowned neurological centre, or a fruitless trial of epilepsy medication.

The fits escalated, coming several times a day, disrupting life to such an extent that Brendan could barely leave the house. He started to fear that he wouldn’t be able to attend his son’s wedding the following year. He finally agreed to pursue psychological therapy, the only treatment to have any efficacy in NEAD.

The initial course was at a regional specialist centre in a nearby city. The approach was heavily behavioural, which Brendan experienced as deeply patronising. I was dismayed as relations between him and his therapists broke down. I began to worry that he would be among the two-thirds of NEAD patients unable to benefit from treatment.

Over the months, though, a bond of trust had developed between us, which must have played a part in his accepting my suggestion of a further referral to a national expert in NEAD psychological therapy at a hospital in a distant city – the funding for which I had to go to considerable lengths to secure.

Brendan’s son ferried him to and from the appointments over a 16-week period and to our delight, his fits – which had been going on for 18 months – gradually petered out. He eventually managed to witness his son, whose mother he had loved so much, get married. For all the disruption, I’m glad I went on that urgent home visit, which started Brendan and me on the long road to his eventual cure. 

This article first appeared in the 13 November 2014 issue of the New Statesman, Nigel Farage: The Arsonist

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What's to be done about racial inequality?

David Cameron's words on equal opportunities are to be welcomed - now for some action, says Sunder Katwala.

David Cameron made the strongest, clearest and most high profile statement about ethnic inequalities and the need to tackle discrimination ever yet offered by a British Prime Minister in his leader’s speech to the Conservative Party conference in Manchester.
“Picture this. You’ve graduated with a good degree. You send out your CV far and wide. But you get rejection after rejection. What’s wrong? It’s not the qualifications or the previous experience. It’s just two words at the top: first name, surname. Do you know that in our country today: even if they have exactly the same qualifications, people with white-sounding names are nearly twice as likely to get call backs for jobs than people with ethnic-sounding names? … That, in 21st century Britain, is disgraceful. We can talk all we want about opportunity, but it’s meaningless unless people are really judged equally”, said Cameron.
While the proof of the pudding will be in the eating, this was a powerfully argued Prime Ministerial intervention – and a particularly well-timed one, for three reasons.

Firstly, the Prime Minister was able to root his case in an all-but-universally accepted appeal for equal opportunities. It will always prove more difficult in practice to put political energy and resources behind efforts to remedy discrimination against a minority of the population unless a convincing fairness case is made that values cherished across our whole society are at stake. Cameron’s argument, that any party which tells itself that it is the party of the ‘fair chance’ and ‘the equal shot’ must have a response when there is such clear evidence of discrimination, should prove persuasive to a Conservative Party that has not seen race inequalities as its natural territory. Cameron argued that the same principles should animate responses to discrimination when it comes to race, gender and social class. Put like that, wanting job interviews to be fair – by eradicating conscious and unconscious patterns of bias wherever possible – would strike most Britons as offering as clear a case of the values of fair play as wanting the best baker to win the Great British Bake-Off on television.
Secondly, Cameron’s intervention comes at a potential "tipping point" moment for fair opportunities across ethnic groups. Traditionally, ethnic discrimination has been discussed primarily through the lens of its impact on the most marginalised. Certainly, persistent gaps in the criminal justice system, mental health provision and unemployment rates remain stark for some minority groups. What has been less noticed is the emergence of a much more complex pattern of opportunity and disadvantage – not least as a consequence of significant ethnic minority progress.

Most strikingly of all, in educational outcomes, historic attainment gaps between ethnic minorities and their white British peers have disappeared over the last decade. In the aggregate, ethnic minorities get better GCSE results on average. Ethnic minority Britons are more likely, not less likely, to be university graduates than their fellow citizens. 

As a result of that progress, Cameron’s intervention comes at a moment of significant potential – but significant risk too. Britain’s ethnic minorities are the youngest and fastest-growing sections of British society. If that educational progress translates into economic success, it will make a significant contribution to the "Great British Take-Off" that the Prime Minister envisions. But if that does not happen, with educational convergence combined with current ‘ethnic penalties’ in employment and income persisting, then that potential could well curdle into frustration that the British promise of equal opportunities is not being kept.  Cameron also mirrored his own language in committing himself to both a ‘fight against extremism’ and a ‘fight against discrimination’: while those are distinct challenges and causes, actively pursuing both tracks simultaneously has the potential, at least, depolarise some debates about responses to extremism  - and so to help deepen the broad social coalitions we need for a more cohesive society too.

Thirdly, Cameron’s challenge could mark an important deepening in the political competition between the major parties on race issues. Many have been struck by the increase in political attention on the centre-right to race issues over the last five to ten years. The focus has been on the politics of representation. By increasing the number of non-white Conservative MPs from two to seventeen since 2005, Cameron has sent a powerful signal that Labour’s traditional claim to be ‘the party of ethnic minorities’ would now be contested. Cameron was again able to celebrate in Manchester several ways in which his Cabinet and Parliamentary benches demonstrate many successful journeys of migrant and minority integration in British society. That might perhaps help to ease the fears, about integration being impossible in an era of higher immigration, which the Home Secretary had articulated the previous day.

So symbolism can matter. But facial diversity is not enough. The politics of ethnic minority opportunity needs to be about more than visits to gurdwaras, diversity nights at the party conference fringes and unveiling statues of Mahatma Gandhi in Parliament Square. Jeremy Corbyn’s first speech as Labour leader did include one brief celebratory reference to Britain’s ethnic diversity – “as I travelled the country during the leadership campaign it was wonderful to see the diversity of all the people in our country” – and to Labour bringing in more black, Asian and ethnic minority members - but it did not include any substantial content on discrimination. Tim Farron acknowledged during his leadership campaign that the Liberal Democrats have struggled to get to the starting-line on race and diversity at all. The opposition parties too will no doubt now be challenged to match not just the Prime Minister’s rhetorical commitment to challenging inequalities but also to propose how it could be done in practice.

Non-white Britons expect substance, not just symbolism from all of the parties on race inequalites.  Survation’s large survey of ethnic minority voters for British Future showed the Conservatives winning more ethnic minority support than ever before – but just 29 per cent of non-white respondents were confident that the Conservatives are committed to treating people of every ethnic background equally, while 54 per cent said this of Labour. Respondents were twice as likely to say that the Conservatives needto do more to reach out – and the Prime Minister would seem to be committed to showing that he has got that message.  Moreover, there is evidence that ethnic inclusion could be important in broadening a party’s appeal to other younger, urban and more liberal white voters too – which is why it made sense for this issue to form part of a broader attempt by David Cameron to colonise the broad centre of British politics in his Manchester speech.

But the case for caution is that there has been limited policy attention to ethnic inequalities under the last two governments. Restaurateur Iqbal Wahhab decided to give up his role chairing an ethnic minority taskforce for successive governments, unconvinced there was a political commitment to do much more than convene a talking shop. Lib Dem equalities minister Lynne Featherstone did push the CV discrimination issue – but many Conservatives were sceptical. Cameron’s new commitment may face similar challenges from those whose instinct is to worry that more attention to discrimination or bias in the jobs market will mean more red tape for business.

Labour had a separate race inequalities manifesto in 2015, outside of its main election manifesto, while the Conservative manifesto did not contain significant commitments to racial inequality. The mid-campaign launch in Croydon of a series of race equality pledges showed an increasing awareness of the growing importance of ethnic minority votes - though the fact that they all involved aiming for increases of 20 per cent by 2020 gave them a slightly back-of-the-envelope feel. 

Prime Ministerial commitments have an important agenda-setting function. A generation ago the Stephen Lawrence case opened the eyes of middle England to racist violence and police failures, particularly through the Daily Mail’s persistent challenging of those injustices. A Conservative Prime Minister’s words could similarly make a big difference in the mainstreaming of the issue of inequalities of opportunity. What action should follow words? Between now and next year’s party conference season, that must will now be the test for this Conservative government – and for their political opponents too. 

Sunder Katwala is director of British Future and former general secretary of the Fabian Society.