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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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Everyone's forgotten the one issue that united the Labour party

There was a time when Ed Miliband spoke at Momentum rallies.

To label the row over the EU at Thursday’s Labour leadership hustings "fireworks" would be to endow it with more beauty than it deserves. Owen Smith’s dogged condemnation of John McDonnell’s absence from a Remain rally – only for Corbyn to point out that his absence was for medical reasons – ought to go down as a cringing new low point in the campaign. 

Not so long ago, we were all friends. In the course of the EU referendum, almost all of the protagonists in the current debacle spoke alongside each other and praised one another’s efforts. At a local level, party activists of all stripes joined forces. Two days before polling day, Momentum activists helped organise an impromptu rally. Ed Miliband was the headline speaker, and was cheered on. 

If you take the simple version of the debate, Labour’s schism on the EU appears as an aberration of the usual dynamics of left and right in the party. Labour's left is supposedly cheering a position which avoids advocating what it believes in (Remain), because it would lose votes. Meanwhile, the right claims to be dying in a ditch for its principles - no matter what the consequences for Labour’s support in Leave-voting heartlands.

Smith wants to oppose Brexit, even after the vote, on the basis of using every available procedural mechanism. He would whip MPs against the invocation of Article 50, refuse to implement it in government, and run on a manifesto of staying in the EU. For the die-hard Europhiles on the left – and I count myself among these, having run the Another Europe is Possible campaign during the referendum – there ought to be no contest as to who to support. On a result that is so damaging to people’s lives and so rooted in prejudice, how could we ever accept that there is such a thing as a "final word"? 

And yet, on the basic principles that lie behind a progressive version of EU membership, such as freedom of movement, Smith seems to contradict himself. Right at the outset of the Labour leadership, Smith took to Newsnight to express his view – typical of many politicians moulded in the era of New Labour – that Labour needed to “listen” to the views Leave voters by simply adopting them, regardless of whether or not they were right. There were, he said, “too many” immigrants in some parts of the country. 

Unlike Smith, Corbyn has not made his post-Brexit policy a headline feature of the campaign, and it is less widely understood. But it is clear, via the five "red lines" outlined by John McDonnell at the end of June:

  1. full access to the single market
  2. membership of the European investment bank
  3. access to trading rights for financial services sector
  4. full residency rights for all EU nationals in the UK and all UK nationals in the EU, and
  5. the enshrinement of EU protections for workers. 

Without these five conditions being met, Labour would presumably not support the invocation of Article 50. So if, as seems likely, a Conservative government would never meet these five conditions, would there be any real difference in how a Corbyn leadership would handle the situation? 

The fight over the legacy of the referendum is theatrical at times. The mutual mistrust last week played out on the stage in front of a mass televised audience. Some Corbyn supporters jeered Smith as he made the case for another referendum. Smith accused Corbyn of not even voting for Remain, and wouldn’t let it go. But, deep down, the division is really about a difference of emphasis. 

It speaks to a deeper truth about the future of Britain in Europe. During the referendum, the establishment case for Remain floundered because it refused to make the case that unemployment and declining public services were the result of austerity, not immigrants. Being spearheaded by Conservatives, it couldn’t. It fell to the left to offer the ideological counter attack that was needed – and we failed to reach enough people. 

As a result, what we got was a popular mandate for petty racism and a potentially long-term shift to the right in British politics, endangering a whole raft of workplace and legal protections along the way. Now that it has happened, anyone who really hopes to overcome either Brexit, or the meaning of Brexit, has to address the core attitudes and debates at their root. Then as now, it is only clear left-wing ideas – free from any attempt to triangulate towards anti-migrant sentiment– that can have any hope of success. 

The real dividing lines in Labour are not about the EU. If they were, the Eurosceptic Frank Field would not be backing Smith. For all that it may be convenient to deny it, Europe was once, briefly, the issue that united the Labour Party. One day, the issues at stake in the referendum may do so again – but only if Labour consolidates itself around a strategy for convincing people of ideas, rather than simply reaching for procedural levers.