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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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On the important issues, Louise Casey all too often has little to say

Far from moving the debate on, this new report on integration adds little to the report I commissioned in 2001. 

For 15 years, “numerous government reports on community cohesion and integration have not been implemented with enough force or consistency” concludes Louise Casey’s review of  integration.  The government’s lukewarm response suggests their effort will be as “diluted and muddled” as all the rest.

There’s a deeper reason why governments shy away from the measures that are needed. The report's wealth of data sets out a stark if sometimes contestable picture of a divided society.  But no amount of data can really bring the lives of our fellow citizens to life. As the Brexit vote underlined, this is now a nation divided by class, geography, education, wealth, opportunity and race. Those divisions colour the way we live our lives, the way we see problems in society, the relations we have with others, and our political choices. The report, like many before it, stops short of setting out that reality. It’s easier to pretend that most of us pretty much agree on most things; but just few people don’t agree and they must be the problem. Predictably, much of the early coverage has focussed on the Muslim community and new migrants. If only it were so easy.

According to Casey “in this country, we take poverty, social exclusion, social justice and social mobility seriously” and we do it “across political divides”. Apparently “creating a fair, just society where everyone can prosper and get on” is a cornerstone of British values. Yet for page after page the report chronicles the serial failure of this benign consensus to tackle educational under-performance, and economic and racial disadvantage. If we all agree, how come we haven't done anything about it?

These problems are not certainly easy to solve, but more lip service is paid to tackling them than effort. The practical material issues documented here need addressing, but punches are pulled when hard answers are needed. Given the dramatic impact of mass migration on cohesion, is integration possible while current rates of immigration persist? Can we find the political will to tackle poverty and disadvantage when those who might benefit from the effort are divided against each other by suspicion, race, geography and values? After all, rather than progressive policies producing a cohesive society, social unity is the precondition for the introduction of progressive policies.

We don't actually actually agree on what our “fundamental values” mean in practice. We can all sign up to democracy and the rule of law, but as soon as those are put into practice – see the court case on Article 50 – we are divided. When judges are popularly seen as “enemies of the people” and a vote in an elected parliament as a threat to democracy, in what sense are law and democracy fundamental?

Casey usefully highlights how treating homeless families equally, irrespective of ethnicity and length of residence can create the perception that minorities are being favoured over long standing residents. Our differing views on what is “just” and how “fairness” are defined can tear us apart. Is it fair to favour the newcomer over the indigenous? Is it just to put length of time on the waiting list above housing need? We often don't even acknowledge the legitimacy of other points of view, let alone try to find common ground.

The continual invocation of Britain and British values lends an air of unreality to the report.  Most people in England include British in their identity, but Englishness and English interests are of growing importance. In a worrying development, some areas of England  may be polarising between a white Englishness and an ethnic minority Britishness. Integration won't happen without a shared national story that combines a unifying national identity with the acceptance that we all have more than one identity that matters to us. Ignoring the reality of complex and multiple identities closes off one essential way forward.

None of this means that the criticism of some reactionary and occasionally dangerous ideas and practices in the Muslim community should be ignored and not confronted. But in a country where the established church opposes homosexual relationships and praise for Vladimir Putin's Russia is now mainstream politics it is hard to believe that all our problems can be reduced to the behaviour of a minority of a minority community.

John Denham was a Labour MP from 1992 to 2015, and a Secretary of State 2007 to 2010. He is Director of the Centre for English Identity and Politics at Winchester University