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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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The rise of the green mayor – Sadiq Khan and the politics of clean energy

At an event at Tate Modern, Sadiq Khan pledged to clean up London's act.

On Thursday night, deep in the bowls of Tate Modern’s turbine hall, London Mayor Sadiq Khan renewed his promise to make the capital a world leader in clean energy and air. Yet his focus was as much on people as power plants – in particular, the need for local authorities to lead where central governments will not.

Khan was there to introduce the screening of a new documentary, From the Ashes, about the demise of the American coal industry. As he noted, Britain continues to battle against the legacy of fossil fuels: “In London today we burn very little coal but we are facing new air pollution challenges brought about for different reasons." 

At a time when the world's leaders are struggling to keep international agreements on climate change afloat, what can mayors do? Khan has pledged to buy only hybrid and zero-emissions buses from next year, and is working towards London becoming a zero carbon city.

Khan has, of course, also gained heroic status for being a bête noire of climate-change-denier-in-chief Donald Trump. On the US president's withdrawal from the Paris Agreement, Khan quipped: “If only he had withdrawn from Twitter.” He had more favourable things to say about the former mayor of New York and climate change activist Michael Bloomberg, who Khan said hailed from “the second greatest city in the world.”

Yet behind his humour was a serious point. Local authorities are having to pick up where both countries' central governments are leaving a void – in improving our air and supporting renewable technology and jobs. Most concerning of all, perhaps, is the way that interest groups representing business are slashing away at the regulations which protect public health, and claiming it as a virtue.

In the UK, documents leaked to Greenpeace’s energy desk show that a government-backed initiative considered proposals for reducing EU rules on fire-safety on the very day of the Grenfell Tower fire. The director of this Red Tape Initiative, Nick Tyrone, told the Guardian that these proposals were rejected. Yet government attempts to water down other EU regulations, such as the energy efficiency directive, still stand.

In America, this blame-game is even more highly charged. Republicans have sworn to replace what they describe as Obama’s “war on coal” with a war on regulation. “I am taking historic steps to lift the restrictions on American energy, to reverse government intrusion, and to cancel job-killing regulations,” Trump announced in March. While he has vowed “to promote clean air and clear water,” he has almost simultaneously signed an order to unravel the Clean Water Rule.

This rhetoric is hurting the very people it claims to protect: miners. From the Ashes shows the many ways that the industry harms wider public health, from water contamination, to air pollution. It also makes a strong case that the American coal industry is in terminal decline, regardless of possibile interventions from government or carbon capture.

Charities like Bloomberg can only do so much to pick up the pieces. The foundation, which helped fund the film, now not only helps support job training programs in coal communities after the Trump administration pulled their funding, but in recent weeks it also promised $15m to UN efforts to tackle climate change – again to help cover Trump's withdrawal from Paris Agreement. “I'm a bit worried about how many cards we're going to have to keep adding to the end of the film”, joked Antha Williams, a Bloomberg representative at the screening, with gallows humour.

Hope also lies with local governments and mayors. The publication of the mayor’s own environment strategy is coming “soon”. Speaking in panel discussion after the film, his deputy mayor for environment and energy, Shirley Rodrigues, described the move to a cleaner future as "an inevitable transition".

Confronting the troubled legacies of our fossil fuel past will not be easy. "We have our own experiences here of our coal mining communities being devastated by the closure of their mines," said Khan. But clean air begins with clean politics; maintaining old ways at the price of health is not one any government must pay. 

'From The Ashes' will premiere on National Geograhpic in the United Kingdom at 9pm on Tuesday, June 27th.

India Bourke is an environment writer and editorial assistant at the New Statesman.

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