Republicans for Satan. Health News and Information

Connie Mullens was an attractive woman in her early thirties. She appeared to have many of the things which would help to make a person happy: a loving spouse, a beautiful home, a good educational background, and a rewarding job. Yet before she came to the Ecology Unit, she was contemplating suicide. Mrs. Mullens had many illnesses and problems practically all her life, but was completely unhelped by conventional treatment. In fact, her health was endangered by being prescribed amphetamines. Clinical ecology helped her, in part by breaking her dependence on these drugs.

During her childhood, she had had many illnesses, some of them bizarre. She had had asthma so badly that her parents doubted at times that she would live. This problem went away after the family moved to a new house. In high school, she had frequent stomach problems, diagnosed as the result of a “virus.” One such “virus” lasted for over a year.

In college, she demonstrated superior academic ability, got straight A’s most of the time, and was elected to Phi Beta Kappa. Nevertheless, during this same period a curious sort of malaise started to creep over her, imperceptibly at first.

At times, especially in chemistry lab, she would feel a kind of euphoria. She was known as the chemistry class prankster and would devise complicated practical jokes to play on her instructors. Of course, this sort of behavior among college students is “normal” when looked at in isolation. It is only when seen in the context of her overall development, and the onset of her more serious symptoms, that it begins to take on medical significance. In retrospect, some of this behavior may have been a lesser stimulatory reaction (plus-one) to the presence of chemicals and natural gas (in the bunsen burners) in the classroom.

At the same time, Mrs. Mullens had an increasing number of bad days. On these occasions, she had headaches of ever-increasing frequency and intensity. On some days, she could not get out of bed, could not concentrate, and could barely stay awake. To combat these doldrums, she relied on junk food. She would drink cola beverages or eat chocolate and candy whenever she had to “cram” for a test. Every day she would go down to the drugstore and have a chocolate malt and a piece of pie, which seemed to temporarily relieve her tiredness and headaches.

Because she was, not surprisingly, overweight, she consulted an internist, who prescribed diet pills which contained amphetamines. “With these,” she later recalled, “I could leap tall buildings at a single bound.” She stopped taking them when she realized that she was becoming addicted.

Connie was married in college, but the marriage did not work out, This was mainly because of her irritability, she says. She would throw temper tantrums in the house, fling shoes at her husband, or force him to watch his favorite television shows with the sound off (she was very sensitive to noise). She kept on eating, too; her husband called her the “cookie monster” because of her insatiable sweet tooth.

By the time she reached graduate school, her problems were worse. She now had headaches once or twice a week, but each lasted a couple of days. She began to consult doctors, and each had a different diagnosis and solution. One internist, she says, prescribed twenty different pills, mostly amphetamines. She was instructed to try each of them in turn and keep a record of their effects. None of them did anything for her head pain.

She also saw an endocrinologist (hormone specialist), an otolaryngologist (ear-nose-and-throat specialist), and, of course, a psychiatrist. The psychiatrist analyzed her psyche in depth and at length. He came to the conclusion that, as an only child, she had had too much pressure put on her to achieve. In fact, except for her illnesses, she had had a particularly happy childhood. Her parents were both successful and well-educated and probably expected their daughter to be the same, but did not force her to emulate them in this regard.

Connie could not drive an automobile. If she attempted to she became confused and could not interpret traffic signs or even make sense out of a simple stop light. Rather than look for something in the environment (for example, automobile fumes) that might cause such a condition, the psychiatrist interpreted this problem as a psychological need for perfection. He recommended that she relax more.

After finishing graduate school, Mrs. Mullens undertook a job which brought her into contact with industrial chemicals. All of her symptoms worsened. She got married again and gave up the full-time job.

As bad as all these symptoms were, her condition took a sharp turn for the worse (from minus-two or -three to minus-four) when her new home was sprayed with powerful pesticides, inside and out. Winter came, and the gas-fired heater was turned on. Soon afterward she started to feel so weak that she could not get out of bed. She was depressed to the point of dwelling on suicide. Her new husband would come home each day and find her crying uncontrollably.

Her psychiatrist prescribed amphetamines again, this time for ten days, to bring her out of what he called a “short-term depression.” At the end of this period, she was worse and had developed a numbness in her fingers and a tingling in her limbs. To all of her other problems, she now added a fear of multiple sclerosis—an unfounded fear, it now appears.

When she was admitted to the Ecology Unit, her symptoms were particularly bad. The water fast accentuated her symptoms; she developed a terrible headache and cried almost continually at first. After a few days on the fast, however, she underwent a remarkable recovery. “I got completely better,” she recalls. “I became absolutely convinced that my problem was related to the environment.”

Mrs. Mullens reacted to most of the foods she was given. Some brought on arthritislike aches in her fingers and other joints. The worst food for her was beef. After eating a portion of beef, she told the nurse on duty that she wanted to kill herself. She wandered the halls, crying aimlessly. The next day she said that she felt as if she “had been run over by a bulldozer.”

All of her many symptoms were reproduced in several weeks of food testing. What is more, tests with chemicals in various forms showed that this patient had the problem of chemical susceptibility. Mrs. Mullens has made excellent progress in controlling her food and chemical difficulties. “In the real world we face serious problems,” she has said. For example, it is difficult for her to avoid all exposure to natural gas. The gas heater and range have been removed from her house, but she still runs into them in other peoples’ homes, as well as in stores. In certain shops, she becomes so irritable that she feels like strangling those who get in her way. It is only in gas-heated stores that she has this problem. Despite periodic setbacks, her mental state recently has been cheerful.

An understanding of the food and chemical problem has brought with it many rewards. But it also has added responsibilities. Once, when she was in a hospital for some physiological testing, a conventional doctor “caught” her making lists of her reactions to artificially colored and flavored medicine. He actually took papers which she had discarded out of the wastebasket, read them, and remarked, “I see that you are involved with your symptoms. You apparently want to be sick!” When she tried to reason with the man, who was a gastroenterologist, he said brusquely, “I have forty other cases in the hospital. I don’t need you.” To his amazement, she promptly checked herself out of the hospital.

Mrs. Mullens’ case thus represents both the triumph and the tragedy of treatment by the methods of clinical ecology. On the one hand, like many other patients, she was brought back from the brink of suicide by coming to understand the multiple environmental factors responsible for her reactions. She credits it with saving her life. Yet, on the other hand, the world itself sometimes seems hostile to this new approach. Much yet needs to be done to make the environment completely livable for the Connie Mullenses of this world.

In summary, it may be said that the concepts and techniques of ecologic mental illness are opening up new horizons for patients with the symptoms of depression and related psychiatric disturbances. In contrast to the longstanding artificial distinctions between physical and so-called mental illnesses, both physical and cerebral and behavioral manifestations of allergy/ecology represent different levels of reaction. At long last, large sectors of the field of psychiatry are yielding to medical management based on the demonstrability of cause and effect.

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There are few aspects of having epilepsy in adult life that cause greater distress than the necessary legal restrictions on driving. For some people owning and using a car is a hobby in itself—albeit an expensive one. Others, particularly those living in rural areas where public transport is limited or non-existent, find car ownership and driving necessary for shopping and social contact, and for getting to work. There are jobs such as delivery van driver in which driving is the sole function of employment, and any restriction on driving will cause the employee to lose his job.

This book may well be read in a number of countries, and the legal requirements vary from place to place. As an example, however, we consider the UK eligibility to hold a private (Group 1) driving licence in the UK, as determined by the Motor Vehicles (Driving Licences) (Amendment) (No. 2) Regulations 1994 which came into force on 5th August 1994. Epilepsy is prescribed for the purposes of Sections [92 (4) (b)] of the 1988 Road Traffic Act. The 1994 Regulations amended the 1987 Regulations (which specified a seizure-free period of two years) as follows:

‘An applicant for a licence suffering from epilepsy shall satisfy the following conditions, namely that he shall:

a) have been free from any epileptic attack during the period of one year immediately preceding the date when the licence is granted; or

b) have had an epileptic attack whilst asleep more than three years before the date when the licence is granted and shall have had attacks only whilst asleep between the date of that attack and the date when the licence is granted; and that the driving of a vehicle by him in accordance with the licence is not likely to be a danger to the public.. The purpose of clause (b) is to allow someone to drive who has established a long history of seizures whilst asleep without ever having had any whilst awake. It allows someone with continuing seizures only whilst asleep to drive, without requiring a period of one year free from such a seizure.

These Regulations are, we believe, a reasonable attempt to protect the public from the chances of meeting a driver who is briefly incapable of controlling his car because of a seizure. The Regulations are also fair to those with epilepsy insofar as they clearly state the circumstances under which they can drive.

What actually happens in practice? Take the example of a woman who has held a licence for several years, and then has two grand mal seizures at work within a month. Her family doctor or neurologist will explain that she is no longer eligible to hold a driving licence. It is not the responsibility of either doctor to inform the licensing authority of this, but a doctor will record in their notes the fact that they have explained the position to the patient. It is the driver’s responsibility to take action. Inside each UK Driving Licence is the statement that the ‘Drivers Medical Branch, Swansea SA99 ITU MUST be told at once if: you NOW have any physical or mental disability which affects your fitness as a driver or which might do so IN THE FUTURE’. The patient should write a brief note to the Drivers and Vehicle Licensing Authority (DVLA) at Swansea (the address above being sufficient) explaining the details and enclosing the licence, which will be acknowledged. No further action is necessary.

If all goes well for this woman, and she has no further seizures after the first two, she becomes eligible to hold a driving licence one year after the date of the last attack. She then completes an application form as usual. In Section 6d, or in a covering letter if there is insufficient space on the form, she writes briefly exactly what has occurred, refers to her earlier letter, states the date of her last seizure, and gives the name and address of her family doctor or neurologist to whom reference can be made. After a short interval, she will receive her new licence.

All this seems entirely straightforward, but we know that many people with epilepsy find the Regulations hard to accept. Doctors appreciate the difficulties that may be caused by giving up driving. Driving is usually an essential part of their work, so they do not have to make great leaps of imagination to realize the difficulties that a ban on driving may cause. Unfortunately the law does not take hardship into account. Doctors should, however, not only advise their patients of the law, but also, from their experience, advise patients how to cope with their changed circumstances. Doctors are in a position to influence decisions of employers about the nature of their patients’ work. They can write to the employer, with the patient’s consent, supporting a request for a change of job within the same company. In such a letter, a doctor does not necessarily have to say that the person has epilepsy, only that they are not able to drive for medical reasons, and not likely to be able to drive for some time. Such letters may well influence company decisions. We have known many examples of this. A travelling salesman has become a successful office-bound sales manager; a busy surveyor has taken on increased training responsibilities; and a delivery van driver has been employed within the factory making the goods he was previously delivering. Obviously such changes are easier within large organizations with their greater variety of jobs.

We usually advise people living in rural areas not to move house just because of their new inability to drive. If it seems likely that the seizures can be easily controlled, then it is probably better to cope somehow for the time necessary, rather than disturb the whole family’s way of life. The people with epilepsy are the only ones who can decide whether to move, but their doctors should give them sufficient information about the probability of seizure control to allow an informed decision.

Sometimes people with epilepsy will say that they consider it safe to drive as they always get a warning of their attacks. Leaving aside the legal point—that they are ineligible, and unfortunately their opinion does not count—we explain that the warning is the start of the cerebral events which form the early part of the seizure itself. The fact that to date the progression of the seizure discharge has been sufficiently slow to allow the subject to stop his or her car safely does not mean that this will always be the case. Such a person with epilepsy may well have a sudden grand mal seizure without warning.

Again, people with epilepsy may indicate that they consider it safe to drive, as all their seizures are small ones—perhaps temporal lobe seizures in which consciousness is disturbed in only a minor way. We have to say that the law does not distinguish between the various types of seizures. We also have to say that the next seizure may unfortunately be a grand mal one, and that in any event catastrophe is as likely to be caused by a momentary reduction of conscious awareness as by a major fit.

It is useless for the patient to say to his or her doctor that seizures always occur in the evening, or sometimes even: ‘I’ve never had one whilst driving’, as the next seizure may well be when he or she is in the driving seat.

Sometimes a patient may feel that the events which have led him to the doctor are not epileptic in nature. All a doctor can do in such circumstances is to disagree, and advise that the patient seeks a further opinion. As noted above, it is not a doctor’s responsibility to inform the licensing authority of a person’s epilepsy. It may be, however, that if a doctor is convinced of the diagnosis, and believes that there is a real risk to the public, and if the patient refuses to seek a further opinion, he or she may feel that responsibility to the public at large overrides responsibility to the individual patient.

There are, however, circumstances in which the occurrence of epileptic seizures is not automatically associated with loss of eligibility to hold a driving licence. Clause (b) of the Regulations quoted states that an applicant shall ‘have had an epileptic attack whilst asleep more than three years before the date when the licence is granted and shall have had attacks only whilst asleep between the date of that attack and the date when the licence is granted’. There are some people, though not many, who only have fits during sleep; three years seems a reasonable period to allow one to see if that is the case. After that, even if attacks do occur in sleep and never whilst awake, a person can nevertheless drive.

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It is not sensible to be a steeple-jack or scaffolder if one has many seizures. But just what restrictions on employment should be applied to those with epilepsy?

First of all, there are the legal restrictions on driving. This may stop employment as a travelling representative, for example, but these Regulations have a wider effect in making travel to a job more difficult, especially in rural areas, however suitable that job may be.

Driving is the most obvious way in which a person with epilepsy can harm others, as well as himself, during a seizure. But there are occupations of heavy personal responsibility to others which those with uncontrolled seizures must not do. Surgery and nursing are obvious examples from our own health professions. The occupations of airline pilot, and bus, train, mass transit and crane driver, railway signalman, and merchant navy sailor, are other examples. The Armed Forces, fire, and ambulance services and Police also exclude those with continuing seizures.

In other jobs, there is no real risk to bystanders during a seizure, but there is a substantial risk of injury or death to the person with continuing epilepsy. The operation of heavy moving machinery, including agricultural machinery, work near conveyor belts, work at heights, particularly in the construction or electric power industries, and work underground or underwater should all be avoided. However keen the subject may be to take his own life in his hands, it is not fair to burden employers if there is a substantial risk of a mutilating or fatal accident.

One of the agonizing questions that people with infrequent seizures must ask themselves is whether to tell a potential employer about them. Obviously it is best if they do because the employer can take into account any remote risks about which the applicant is unaware. Employers can make an occasional allowance for rare but unexpected absences from work, and they can, in an informed way, cope with occasional seizures at work. The truth of the matter is that many employers reject those with seizures which are few and far between, or those who have had no seizures for some years, for jobs which carry virtually no risk to the person with epilepsy or to others.

Surveys of public attitudes towards those with epilepsy are in our view meaningless, insofar as potential employers may well make favourable remarks about the employment of a hypothetical person with epilepsy in response to an interviewer, because this is the polite and modern thing to say. However, it is their actual behaviour in hiring and firing that counts. A truer measure of the amount of prejudice against employing people with epilepsy would be to send round two personable young people with equal qualifications in response to 100 advertisements for a post as a secretary, for example. In half the interviews each applicant would indicate that they suffered from mild, well-controlled epilepsy. The success rate with and without revealing this information would be a fair guide to current prejudice against the employment of those with epilepsy. Unfortunately such a study would be unethical, insofar as it would waste the time and resources of employers. Nevertheless, we would be fascinated to know the answer!

Those with epilepsy intuitively know the likely result from the results of their own interviews. One survey of people with epilepsy in London showed that over half those who had two or more full-time jobs after the onset of epilepsy had never disclosed their epilepsy to an employer, and only one in ten had always revealed it. Furthermore, if seizures were infrequent or nocturnal, so that applicants considered that they had a good chance of getting away with concealment, the employer was virtually never informed. Whilst not condoning or encouraging dishonesty, the relative success of this policy can be judged by the fact that 74 per cent of the men of employable age with epilepsy were employed at the time of the survey, compared with 81 per cent of male workers of the same age group in the UK as a whole.

Whatever the policy about disclosure, applicants for a job will be more successful if they follow the general rules of taking care with their written application, taking trouble to inform themselves about the responsibilities of the post and about the employer, presenting themselves well at interviews, selling their ability to do the job, and convincing the prospective employer that they have an enthusiastic desire to work. What is absolutely disastrous is for frequent rejections to lead to the development of a chip on the shoulder, so that a potential employer is confronted by the attitude ‘I have epilepsy; you haven’t; you have a duty to employ me’. We have helped look after patients with seizures who succeed in presenting themselves and their epilepsy in such an unfavourable light that we feel there can be no strong motivation to obtain work.

Obtaining a job is obviously only the first step. Most of us want promotion up to the limits of our energies and capabilities, and here again epilepsy, even if well controlled, often spoils chances in life. It is difficult to measure the frequency with which those well qualified for promotion are overlooked, but one study found that the rate of dismissal following the onset of epilepsy was increased approximately sixfold.

There is another more subtle way in which epilepsy can hinder employment and promotion. The fear of encountering rejection, or the fear of leaving an established position with a tolerant employer may cause the people with epilepsy to deny themselves chances for betterment. Just as the employer may be prejudiced against ‘epileptics’ so may the epileptic be prejudiced against ‘employers’, believing them all to be lacking in understanding.

There may be an advantage in young people with epilepsy seeking a career in small organizations, where regulations for employment, sick leave, insurance, and pensions are flexible compared with those of, for example, the Civil Service.

As might be expected, if seizures occur frequently, one study showed that it was much more difficult to hold down a job. The study showed that a third of the unemployed were having generalized seizures monthly or more frequently, whilst only 2 per cent of those in work were suffering equivalently. Roughly the same proportions held true for partial seizures. Apart from seizure frequency, the main barrier to employment is lack of any special skill. One survey found, as could have been foretold, that virtually all those with frequent seizures and no special skills were unemployed. It is here that specialist advice from employment agencies should be sought.

In the UK the Employment Service provides a wide range of services to help people with disabilities to get and keep suitable employment. Most disabled people helped by the Employment Service are helped by general services. There is also a network of 71 Placing, Assessment, and Counselling Teams (PACTs) to help those people with disabilities who cannot be helped properly by the general services. This may include some people with epilepsy. People in PACTs are called Disability Employment Advisers (DEAs). The DEA can be contacted at, or through, the local Employment Service Jobcentre. It is not necessary to be registered as disabled to use most of the services provided through the DEA, though they may recommend registration. The Disabled Persons Register is a voluntary register of people who want to work, and are able to do so, but who have difficulty in getting or keeping suitable work because of their long-term health problem or disability. The Register is run by the Employment Service through its DEAs. All employers who have 20 or more workers have a duty, under the Disabled Persons (Employment) Acts 1944 and 1958, to employ a quota of registered disabled people, usually three per cent of their total workforce. Consequently a big firm is keen to employ someone capable of good work if they happen to be on the Register. Before registration, the family doctor or neurologist will, with the person’s consent, fill in a special form which provides basic information about the type and frequency of seizures, and any other associated disability.

The DEA may consider that a person with epilepsy may benefit from a course of vocational training, to equip him or her with a special skill not already possessed. For example, a nurse with frequent seizures might no longer be suitable for nursing, until the seizures were controlled, and the DEA might well advise that she or he take a course to encourage the development of business skills. This could be arranged through, and at the expense of, the local Training and Enterprise Council (TEC) (Local Enterprise Company (LEC) in Scotland). Training allowances may be payable. The DEA could put the client in touch with the TEC (LEC).

For those with frequent seizures, possibly in association with learning disabilities, the DEA may advise a job in Supported Employment, in which severely handicapped people work in a supported environment—either in a Remploy factory, a supported workshop run by a local authority or voluntary body, or in a supported placement in ordinary employment.

The DEA can also advise on the wide range of help which is available, where appropriate, through the new Access to Work Programme. Individuals can get up to £21 000 worth of help, over a five year period, to pay for things such as extra costs of travel to work for those who cannot use public transport because of their disability; vehicle adaptations; special equipment needed at work; adaptations to the employer’s premises; communication support for blind or deaf people at work; or human support. The DEA can also offer a weekly grant to an employer who provides employment on a trial basis to give a disabled person the chance to demonstrate that they can do the job.

There will always be a nucleus of people with epilepsy who are unemployed either temporarily or more or less permanently. The person who is capable of work but unemployed may, as time passes, become progressively more unemployable if not given occupation and support. It is here that local authority social workers DEAs, and epilepsy associations can help.

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Most children with epilepsy attend normal mainstream schools and can participate fully in the schools’ curricular and extra-curricular activities. This is the case even in children in whom the epilepsy is not fully controlled. It is important for the teachers and for the school doctor and nurse to know that a child has epilepsy—even if the child’s seizures are at the current time controlled. Teachers will then know what to expect and what to do if the child has a seizure. The teacher may also involve children in the class in the care of the child after a seizure; this is important for two reasons. First, it teaches children how to help someone in a seizure, and secondly—and perhaps more importantly—it shows children that there is no need to be scared or upset when someone has a fit. Hopefully, such activities may reduce, in future generations, some of the misunderstanding and social prejudice which surround epilepsy.

About one fifth of children with epilepsy are not able to attend a normal school. This may simply be because of different and frequent seizure types which are not fully controlled. However, the more common reason for these children not being able to attend a normal school is that they have additional problems, such as moderate or severe learning difficulties or physical handicaps (or both), as well as their epilepsy. Most of these children will attend special schools, usually within the local neighbourhood. In this situation in the UK, under the terms of the Education Act, the child will have an assessment or ‘statement’ made of his or her educational needs so that the most appropriate school can be found. This statement is based on reports from doctors (including the hospital doctor), teachers, clinical psychologists, therapists, and any other specialist who may have been involved with the child. The ultimate decision as to which school the child should attend rests with the parent.

Perhaps 1-2 per cent of all children with epilepsy may need to attend a school specifically established for children with epilepsy. These schools are usually residential or boarding schools, and the staff have special expertise in teaching children with epilepsy, in coping with their seizures, and in generally supporting them. One of the additional benefits provided by these schools is that they allow separation from the family. The benefit of this lies in the

over-protective attitude of many parents who do not allow their child the opportunity to participate in normal social activities. This clearly may not be in the child’s best interest with regard to either control of seizures or enabling the child to ‘grow’ into adulthood and to develop a degree of independence. The environment provided by these schools encourages self-reliance.

Occasionally, a child with epilepsy, although not having frequent seizures, may be doing badly in school. Rarely this is due to the fact that the child is experiencing many more absences or complex partial seizures. These may actually be first picked up by the child’s teachers. In these situations, an EEG may help to confirm that the child is experiencing frequent seizures. Another rare possibility—but one that is often put forward—is that the child’s poor school work is due to the effect of the anti-epileptic drugs. However, if the child is not excessively sleepy or drowsy, then it is most unlikely that the drugs are interfering significantly with school work. Exceptions include phenobarbitone and phenytoin, which may affect a child’s concentration and therefore their learning potential. In these situations the amount of drug in the blood may need to be checked. The most common reason for learning problems in a child with epilepsy is that the intellectual difficulty and the epilepsy share a common cause due to abnormal development of the brain or brain damage (for example, after meningitis or a head injury). In these situations, an educational psychologist will assess the child’s strengths and weaknesses and advice on the most appropriate school. Sometimes the cause of the child’s learning difficulties may be familial—that is, other family members show similar educational problems which has nothing at all to do with the epilepsy.

Children up until the age of 16 years are well cared for by society, educationally and medically. The difficult time comes after the age of 16 years—the ‘adolescent’ period which, brings changes in social, family, and educational life. This is often a difficult time of life, even for those who do not have epilepsy.

Many changes occur at adolescence which need to be coped with.

• The seizures may change in type, particularly if the epilepsy started at a young age. These changes may include more complex partial and generalized tonic-clonic seizures, and a reduction in absence and myoclonic (jerk) seizures.

• The anti-epileptic medication may have to change in order to maintain control of the epileptic seizures. This may mean a change in dose or even the introduction of different drugs.

• Young people may find it difficult to take their anti-epileptic drug regularly, or they may deliberately decide not to do so. This is more likely to occur in teenagers who have recently been diagnosed and who may find it difficult to come to terms with the diagnosis and need for regular treatment. This may be just one part of a general rebelliousness—against the condition, the treatment, the doctor, family and friends, even life itself. The best way of dealing with these understandable reactions is for the young person to talk about their epilepsy and all its associated problems. Friends may or may not be the easiest to talk to, but hopefully the young person will discuss his or her feelings with the rest of the family and with an understanding doctor.

• There are a number of educational possibilities beyond the normal school leaving age. Many young people with epilepsy will obtain higher qualifications at school and then obtain a place at college or university. It is important that college or university tutors and examiners are told about students who have epilepsy as this promotes and encourages increased awareness and understanding. Those students who live away from home in halls of residence or in rented accommodation should tell friends and college or university tutors.

• Most paediatricians would not think it sensible to continue seeing patients over the age of 16 years. Teenagers of 17 or 18 years have questions and needs that reflect his transition to adult life. All too often transfer from paediatric to adult services in poorly planned. The family doctor will continue his or her support, but consideration of course should be given to transferring care to a neurologist who has a special interest in epilepsy. A special clinic for teenagers with epilepsy has been established in Liverpool to ensure that there is a smooth handover of care from a children’s epilepsy clinic to an adult clinic, and in which the specific issues and problems of teenagers can be dealt with satisfactorily.

• There are many changes in life style at adolescence, with different interests and activities and different sleeping patterns, and it is known that deprivation of sleep and alcohol may precipitate seizures. These activities are important in developing independence and self reliance. There are few activities which young people with epilepsy cannot undertake.

An occasional drink containing alcohol is unlikely to be harmful. However, alcohol can make anti-epileptic medication less effective and may, in excess, bring on a seizure. It is important to get the balance right—and this applies to the correct amount of sleep and appropriate diet, as well as the amount of alcohol that is drunk. Medical research suggests that drinking more than two units of alcohol in less than 12-15 hours may significantly increase the risk of seizures in patients who have epilepsy (2 units = one pint of beer, lager, or cider, or 2 glasses of wine, or two measures (‘shorts’) of spirits such as whisky, rum, vodka, or gin).

• Contraception will also begin to emerge as an important issue during this time. The most effective form of contraception is the pill. The oral contraceptive pill does not make epileptic seizures more or less likely to happen and there is no reason why women with epilepsy cannot take the pill. Certain anti-epileptic drugs (except sodium valproate and the newer ones including vigabatrin and gabapertin) may reduce the contraceptive efficacy of the pill, resulting in an unwanted pregnancy. A contraceptive pill with a high oestrogen content may need to be prescribed, but other forms of contraception (condom or cap plus spermicide) should be considered.

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The subject of nutrition brought to light an interesting discovery. The doctors reported that infantile eczema was fairly prevalent among the affluent families of Nigeria, who live according to European standards, whereas among the natives who have held on to their traditional way of life it was rare or unknown. On the basis of this finding it can be concluded that the incorrect nutrition and living habits associated with our civilisation are contributory factors to the incidence of infantile eczema.

The statement, or rather claim, that infantile eczema is an allergy does not have much support. The search for an allergen or a specific antibody will probably have little success. So why not take advantage of a natural therapy that has proved to be simple and harmless in treating infantile eczema and which, in the end, does not offer just temporary relief but in many cases results in a complete cure?

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A year later the mother sent us the following brief note: ‘Last year you helped us cure our little girl’s cradle cap. Thank you ever so much.’

Another letter we received from a nurse reads:

‘At the moment I am looking after two children. The boy, now 15 months old, had cradle cap last year. You sent me a calcium complex (Urticalcin), Viola tricolor and whey concentrate. Thanks to your excellent remedies the condition cleared up within a fortnight.’

In this particular case, diluted whey concentrate (Molkosan) was used to dab on the rash. Excellent results have also been achieved by dabbing on Echinaforce, a fresh plant preparation made from Echinacea. Water and soap are quite unsuitable for cradle cap and must be avoided. Instead, use oil, preferably St John’s wort oil, to cleanse the baby’s skin. It is indeed good to know that cradle cap can be successfully treated with these natural remedies, sparing the children permanent harm.

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There are many ways of tackling or managing stress, and mastering these techniques inevitably pays off by promoting an antidepressant lifestyle. Improving interpersonal skills, for example, is one way of reducing the feeling that others are a constant source of unavoidable and uncontrollable stress. When I first began to supervise research assistants, I would observe that they often seemed harried and anxious. On one occasion, as a result of a shuffling of government personnel, a senior manager was temporarily assigned to me as a research assistant. I delegated several tasks to him and, after the first week of working under my direction, he asked to meet with me. He explained that the number of tasks I had assigned him were more than he was able to manage competently in the course of his working hours. Would I be good enough, he asked, to indicate to him my priorities so that if he was unable to complete all the tasks by the week’s end, only the least important task would remain undone. This research assistant taught me two invaluable lessons: Not only did I learn to become a better manager, to set priorities and be more realistic about what could be accomplished in the time available, but I learned how someone who is subordinate in an organization can politely set limits and manage his or her level of daily stress. If you are feeling under pressure at work, take some time to analyse the situation. Make a list of all the sources of stress and then try to figure out solutions to each of them. It is in the interest of the other parties involved to have these stresses resolved as well. Consider ways of presenting the problem to your boss, co-workers or even those working for you in such a way as to point out how it would be mutually beneficial if the stresses could be alleviated. For example, the final product might be superior, production might be more efficient, or the working environment more conducive to creativity or productivity. All of these goals can be legitimately presented as being in the interests of both workers and management.

Exactly the same principles apply in a marriage or other type of relationship, only more so. In these situations all parties involved usually have major investments at multiple, different levels. For example, in a marriage or relationship it is in both parties’ interests to get along, not only because it is more pleasant to do so, but also for the sake of mutual investments in the form of children and other common goals. Once again sources of stress can be identified and communicated to your partner, and if this is done in the right way the outcome can diminish levels of stress, relieve the tension in the relationship and promote an anti-depressant lifestyle. The key is always to present the situation as a shared issue which it would benefit both individuals to solve together. Let us say, for example, that a husband comes home from work and goes straight to the fridge for a can of lager, ignoring his wife in the process. She is bound to feel neglected, angry and perhaps depressed. At this point she has a choice. She can attack her husband for his callous and brutish behaviour or she can take a more collaborative approach. Attacking him may make her feel better in the short run but is bound to make the problem worse. A collaborative approach may have a better chance of working in the long run. This could involve: (1) empathy – ‘I understand that you are stressed and tired at the end of a hard day’; (2) communication of her feelings – T feel the same way after running after the kids all day’; (3) involving him in solving the problem – ‘Can you think of some way that we can unwind together?’; and (4) demonstration of what’s in it for him to do so – ‘so that we can support each other at difficult times and maybe even figure out a way of having some fun in the process.’ Obviously the way in which she chooses to handle the communication is likely to influence the outcome of the evening and either exacerbate or ameliorate her depression.

Part of the skill involved in such communications is picking the right time. A perceptive husband might recognize, for example, that the three days before his wife’s period are not the best time to discuss the large charges they have run up on the credit card. Conversely, an insightful wife learns to discern her husband’s moods and bides her time before discussing with him how she could use more help from him around the house or with the children.

It is also important to recognize that depression frequently causes stress in a relationship. This is of course an additional reason to treat the depression biologically. The partner of the depressed person often feels neglected. Feelings of depression can be contagious and there is a natural tendency to want to avoid a depressed person, which can isolate the person further and deepen the depression. There are some important pointers for the partner or family member of a depressed person to bear in mind. First, don’t take the depression personally. It is not your fault. Frequently the family member feels responsible for the depressed person’s mood, which makes him or her angry since at times nothing seems to cheer the depressed person up and there is a tendency for friends and family members to give up on the depressed person and withdraw. Second, it is not your responsibility to turn the depressed person’s mood around. You can and should be supportive. It is particularly worth trying to help your friend or loved one get appropriate assistance. But you cannot expect to have a direct effect on the other person’s mood. It is too much of a burden to place on yourself and is bound to leave you feeling resentful. Finally, don’t ignore the depressed person and enhance his or her sense of isolation. Do what you can to include the person in activities in a non-demanding way. For example, a husband might suggest going out to a restaurant for dinner with his wife, who may feel cheered up by the food, the setting and the friendly attention. On the other hand, suggesting that it might cheer her up to have guests over is unlikely to have its intended beneficial effect because of the demands this will place on her to perform and be sociable, which might be the last things in the world that she feels like doing.

There is a great deal that a depressed person can do to keep his or her loved one involved even while in a depressed state. Simply acknowledging the depression and its impact can be helpful. For example, a wife is likely to respond favourably to her depressed husband if he says T know I have been down and not much fun lately, but I am trying to turn things around as best I can. Thanks for hanging in there with me.’ The partner of a depressed person becomes starved for any positive feedback and comments such as this are generally greatly appreciated. Even if you are feeling sad and detached, as is often the case when one is depressed, it pays to make a point of expressing appreciation to your friend or loved one for gestures of kindness. It can be also useful to pinpoint specific things that your loved one can do that would make you feel better. This helps him or her to feel useful and counteracts the powerlessness typically experienced by those who surround and care about a depressed person.

So important are interpersonal skills in helping people overcome and avoid depression that an entire type of psychotherapy for depression, called Interpersonal Therapy, has been developed around these principles.

There are many types of stress other than interpersonal difficulties which may confront a depressed person and make matters worse. These include physical illness, financial difficulties and loss of a loved one. For all these different types of situations, help can be obtained from different types of experts, for example a sympathetic and competent doctor, a financial advisor or a religious or spiritual leader. A good doctor should not only provide specific help for symptoms but also comfort and reassurance. I have seen people in serious financial difficulty who have been greatly relieved after turning their affairs over to a debt counsellor or obtaining help and guidance from a financial planner. And innumerable people have been comforted and supported over the centuries by their priests, ministers or rabbis. Of course, caveat emptor applies whenever one turns to any guide or authority figure for help. Ultimately you have to be the judge as to whether a so-called expert is helping you or not. As always, stay tuned to your mood barometer to judge the quality of assistance you are receiving.

*68/75/2*

These are among the most troublesome and mistreated forms of environmental disease. In the following paragraphs, the overall scope of systemic problems related to the withdrawal stage will be surveyed and an overview provided of the complexity of the problem.

HEADACHE (MINUS-TWO REACTION)

The pain may be localized in one part of the head, or it may be generalized. It may occur with or without nausea, vomiting, visual disturbances, or muscle involvement. It can meet the classical picture of migraine, with visions of flashing lights, and a general malaise. It is frequently accompanied by blurring of vision, weakness of the limbs, or pains in the nape, shoulders, and upper back—for this reason headache qualifies as a systemic, not just a local, problem.

Sometimes a headache is followed by a period of relative good health in which no pain is present. This “breathing space” tends to occur in the earlier stages of the problem, however. As it develops, headaches tend to become increasingly common and more severe.

MUSCLE ACHES AND PAINS (MINUS-TWO REACTION)

Both fatigue and headache are commonly associated with myalgia, or muscle pain. The frequency of this association has led some doctors to refer to it as the “tension-fatigue syndrome.” While the term suggests that the syndrome is caused by psychological tension, it is most commonly related to food and chemical susceptibility.

Myalgia, although frequently centered in the nape of the neck, may involve many other muscles. Muscle spasms (such as torticollis, lumbago, and sciatica), muscle cramps, aches, pains and weakness, chest pains (through the involvement of muscles of the chest wall), and abdominal pains are all possible symptoms.

Ignorance of the allergic basis of these pains sometimes leads to incorrect diagnoses of pleurisy, appendicitis, and even heart attacks.

JOINT ACHES AND PAINS (MINUS-TWO REACTIONS)

Arthritis of all types, arthralgia (joint aches), joint swelling, and bursitis all frequently have an allergic basis and can be controlled through altering the environment, as the case histories will make clear.

fatigue (minus-two reaction)

By allergic fatigue is meant tiredness which is unrelieved by the customary, or even an excessive, amount of rest. Fatigue is possibly the most common systemic symptom caused by allergy.* Although there are many variations on this theme, fatigue resulting from food allergy is usually at its worst in the morning and gradually improves as the day advances. This is due to the daily schedule of the food addict. Allergic fatigue is associated with general weakness, drowsiness, and the sensation of heavy limbs. It is also frequently associated with other allergic responses, such as swelling, headache, irritability, and low levels of confusion and depression.

Fatigue caused by exposure to pollen and other inhalants is also known, but is usually seasonal and easier to recognize and control.

brain-fag or impaired thinking ability (minus-three reactions)

“Brain-fag” is a designation for a rather severe, but unfortunately common, condition. This is the minus-three category, and its symptoms are systemic, but predominantly “mental” rather than physical. Such patients suffer from mild depression, with sadness, moodiness, and sullenness; mental confusion and disturbed thinking; impaired memory and reading comprehension; minimal brain dysfunction; indecisiveness; mental lapses, including aphasia and blackouts; and, in general, the whole gamut of “neuroses,” hypochondria, and so-called psychosomatic illnesses.

All of these problems can occur, but more commonly only a few of them are found in a single individual. The condition may get somewhat better for a while, or it may change back to a minus-two reaction (systemic and physical). But the general tendency is for it to linger or to get worse with the passage of time.

In a sense this is the most characteristic form of food and chemical allergy, for it represents the “bottom-of-the-barrel” for a great many advanced cases.

severe depression, with or without altered consciousness (M1NUS-three and minus-four reactions)

Depression straddles the fence between minus-three and minus-four reactions. In its most severe form, the patient experiences stupor, lethargy, and impaired responsiveness. Childish thinking, disorientation, amnesia, paranoid feelings, and even hallucinations may occur. Apathy, lethargy, and stupor are seen. The patient at this extreme level may lapse into a coma.

The minus-four stage also includes the various forms of “psychosis,” including manic-depressive disease and schizophrenia.

Most allergy patients never reach this extreme level of depression. However, once they do, it is difficult to treat them or even to obtain a history. In the latter stages of this kind of illness, a patient often cannot take care of himself and often cannot even give his correct name, much less a coherent history of his illness. The cause of the problem can usually be detected, but a great deal of family support is necessary for complete recovery. Schizophrenics who have become used to, and comfortable with, state welfare support or institutionalized care often make poor patients and may not be properly motivated to get better.

It should be obvious, then, that the scope of environmental disease is great. It includes many of the common chronic ailments which send people to doctors, although of course other causes of these ailments are also possible and should be investigated along with food and chemical susceptibility. It would be impossible in a book such as this to give a more thorough treatment of all of these syndromes. Instead, four common illnesses will be discussed at greater length below. The first is a physical ailment—headache—which is often erroneously diagnosed as psychosomatic in origin. The second is a physical, systemic illness—rheumatoid arthritis. The third is “brain-fag,” the most characteristic form of illness caused by food and chemical allergy. Finally, the most severe form of the problem, depression (which straddles minus-three and minus-four categories), is examined in greater depth.

The case histories in each chapter should add a human aspect to the rather bare bones of theory and show how even the seemingly incurable cases can be properly diagnosed and treated, and how many patients have been enabled to start leading normal lives once more.

*67/110/2*

The surgical treatment of epilepsy is becoming increasingly useful, particularly when the seizures are not controlled by anti-epileptic drugs. However, surgery must only be undertaken after a careful detailed assessment of the patient. This, and the operation, should only be carried out in recognized specialist centres. This is because both the assessment of the patient, and the operation itself involve expert and sophisticated procedures—and clearly surgery is an irreversible treatment.

Surgical treatment depends on two main principles or ideas. The first is that a local abnormal area of brain can be entirely removed, leaving behind only healthy, normal brain. The second is that the spread of the seizure discharge, can be prevented by cutting the nerve fibres which cause the discharge. Penfield and Rasmussen, two Canadian neurosurgeons, were the pioneers of surgery for epilepsy and much of the surgical assessment and treatment of patients today is based on their early work. One of the most important questions that must be answered before surgery can be considered is from where

precisely within the brain do the seizures originate. When the cause is a tumour or cyst, then this is relatively easy, but frequently the cause is an area of brain that developed abnormally in fetal life. The identification of the abnormal part of the brain relies upon magnetic resonance imaging, and the use of special electrodes to try and record or ‘capture’ the epileptic discharge. The scalp electrodes (used in a routine EEG) are not usually sensitive enough for this task, and so other electrodes, called depth electrodes, are frequently used. They are also called ‘sphenoidal’ or ‘foramen ovale, electrodes because this describes how they are placed close to the brain. Electrodes may even have to be placed directly on the surface of the brain, or, as fine silver needles, within its substance. Because these special electrodes are in very close contact with the brain, there is a much greater chance that they will pick up the epileptic discharge.

As well as these assessments, people being considered for surgery may also need detailed psychological evaluation, specifically to try and identify which side of the brain is responsible for language and memory, so that these areas are not damaged during the operation. Consideration must also be given to avoid operating in those parts of the brain responsible for movement—it would be unacceptable to stop the seizures at the expense of causing a paralysis on one side of the body (hemiplegia), which might result in losing the ability to walk or write.

Before a patient is considered for surgical treatment of their epilepsy, it must have been shown that the patient’s seizures could not be adequately controlled using anti-epileptic drugs. For how long a patient should not have been controlled is dependent on individual circumstances. It is unwise to operate too early, as the epilepsy might remit (stop) spontaneously, although this is unlikely in the difficult epilepsies. However, if surgery is delayed for too long, then this may limit the potential success of the operation, either because the patient has suffered irreversible educational and social consequences of repeated seizures, or because other parts of the brain which were previously normal may have developed abnormal foci of electrical activity as a result of the continuing activity of the primary focus. Generally speaking most patients with difficult, drug-resistant epilepsy are being considered for surgery too late; surgery can safely be undertaken in children—even young infants. Most specialists would now consider that if acceptable seizure control has not been achieved using optimal doses of anti-epileptic drugs after one to two years, then surgery should be considered as the next step in a patient’s treatment. It has been estimated that many patients in the UK might currently benefit from surgery, but only about 200 operations per year are at present being performed.

There are four types of surgical procedure that are currently undertaken:

• removing a large, identifiable lesion such as a tumour or cyst.

• removing an entire cerebral hemisphere. This is done when the whole of one side of the brain is abnormal, this being associated with a hemiplegia (weakness down one side of the body). The operation sounds dramatic, but is often successful leading to a complete resolution of seizures and, frequently, an improvement in the hemiplegia. Hemispherectomy is particularly useful in children with the Sturge-Weber syndrome.

• removing a small or large lesion which has been identified on the basis of detailed specialized EEG recording and imaging. This procedure is the one frequently used in temporal lobe epilepsy, where different parts and amounts of the temporal lobe are removed. Advances in imaging have led to the identification of subtle structural abnormalities in the temporal lobes, which are responsible for seizures.

• carrying out a disconnection procedure; this is to try and separate the focus (site of abnormal electrical activity) of origin of the seizure from other parts of the brain, by cutting the nerve fibres which allow the epileptic discharge to spread. Operations attempted have included division (cutting) of the corpus callosum. This is a large band of fibres which transmits electrical information from one hemisphere to another. A more sophisticated, technically difficult procedure (called subpial transection) appears to be more successful.

Overall, the results of epilepsy surgery are encouraging, as many as 60-70 per cent of people who have operations for epilepsy have no further seizures, whilst another 10-20 per cent are much improved. Patients undergoing a hemispherectomy or temporal lobectomy do better than patients who have a corpus callosotomy. For some patients who have had to live with uncontrolled seizures for many years, a cure of their epilepsy following surgery may come as something of a ‘shock’, requiring a major adjustment in their lives. These patients need careful and expert support and counselling.

It must be emphasized again that patients must be assessed carefully in specialist centres before undergoing surgical treatment of their epilepsy. No one person can have a guarantee that their seizures will stop.

*66/188/2*

Diane Witherspoon was in her early forties and had started having a problem with alcohol when she worked as a stewardess, more than a decade before. Her excessive drinking continued when she got an influential job in politics and became exacerbated when she got married and had a child. Within three days of giving birth, in fact, she got drunk, and, she says, remained intoxicated for most of the next three years.

This period of alcoholism was preceded, during her pregnancy, by a craving for sweets and a weight gain of sixty pounds.

During her three-year period of alcoholism, she drank a fifth of vodka a day. At times she became so nervous that she shook violently. The only way that she could relieve this shaking was to drink more vodka. She could no longer read, since she had “floaters” in the form of dots, threads, beads, and circles drifting across her field of vision. On one occasion, while bathing her child, she was overcome with uncontrollable rage at some meaningless remark and violently beat the youngster.

After living as a virtual recluse, she managed to drag herself to a local church and appeal to the minister for help. He referred her to Alcoholics Anonymous. AA exhorted her to abandon drink.

None of this seemed to help. She still had “cobwebs” in her head, nervousness, fits of anxiety, visual distortions, and “floaters.” And she still had a craving for alcoholic beverages.

Mrs. Witherspoon drank tea compulsively and began to suspect that it was not agreeing with her. She suspected the sugar she added to the tea, and so she eliminated it, with no beneficial effect. She then tried other beverages, such as herb tea and even plain hot water. Everything seemed to make her feel worse. Her psychiatrist predictably accused her of being “neurotic” about food. (It was not until she came to the Ecology Unit that she discovered that she was sensitive to all chlorinated water.)

A perceptive woman, she began to find clues of her food susceptibilities, although she had never heard of clinical ecology. After eating a salami sandwich once, she felt as if she were about to explode from nervousness. She waited a few days and then experimented by trying salami again. Again she experienced a nervous attack. She did this four times.

Having learned about clinical ecology through a lecture, she was admitted to the Ecology Unit. In her initial interview, she cried constantly and was in a state of nervous exhaustion. After a few days of fasting on pure water, however, she was symptom-free and almost euphoric. When she began to test various waters, in sequence, she had a serious reaction to one particular water. It turned out to be from Lake Michigan sources, the same kind she drank at home and out of which she had made her tea.

Upon testing she was found to have some degree of susceptibility to almost every food tested. We call such persons “universal reactors,” and they have a serious problem indeed. On her second morning, she was given pears for breakfast. “My mind closed down,” she later recalled, “and my brain was floating around as if on water. There was no way to lock it into place. I could not talk or converse. I could hear words coming out of peoples’ mouths, but I could not respond.”

Usually, but not always, one reacts most strongly to those foods which one eats regularly, more than once every three days. Pears were not listed among such foods in her history. Upon further inquiry, it turned out that she had had a pear tree in her backyard as a child and had eaten them compulsively and to excess at that time. It is entirely possible that this early, excessive exposure had left her with a fixed allergy to the fruit.

Her most dramatic reaction was to potato. She had finished her first boiled potato and was eating her second when, five minutes or so into the test, she crumpled over in agony. She later said that the pain was the worst she had ever experienced in her life, worse than her difficult childbirth.

When she left the hospital, Mrs. Witherspoon’s prescription was to avoid those foods to which she had the strongest reactions, try to find new, compatible foods, and eventually try to reintroduce some of her “failed” foods back into her diet. In her case, however, all alcoholic beverages were taboo, because she was susceptible to various components of all of them.

To summarize, the treatment of alcoholism by the methods of clinical ecology has been successful in many cases. It even has been possible to permit some alcoholic beverages, in limited amounts, to former alcoholics, provided they only take compatible beverages, in a rotated schedule. Whether this can be done depends on the individual nature of the case.

Alcoholics, like schizophrenics, need a supportive atmosphere in which to recover. If the family unit is still intact, the patient frequently does very well. But an alcoholic who has no family, and who eats in restaurants frequently, has a much smaller chance of making a full recovery through the methods of clinical ecology. The reason is that most American alcoholics are highly corn-sensitive, and there is some form of corn in almost every commercially prepared meal.

In order to go on this program, then, the reformed alcoholic must either make his own meals, according to his individual needs (as determined by food tests), or have someone with the necessary knowledge to prepare them for him. In practice, these needs could best be met inside a functioning family unit. The homeless alcoholic is likely to leave the Ecology Unit in decent shape, go out to eat, and immediately resume his addiction to com, wheat, or whatever was making him sick in the first place. This “up” phase may last an hour or two, as in the case of Mr. Parsons, before he starts to come down and experience a kind of “hangover.” The experienced alcoholic, however, knows very well how to ward off a hangover—and before long he is in a bar, drinking down his dose of corn or wheat in convenient liquid form.

Similarly, an alcoholic who has not worked out his food allergies along the lines indicated in this book has little chance of breaking the addiction for good, since he is constantly being restimulated by contact with the very foods which lie at the basis of his problem. It is as if a heroin addict were given a small amount of his craved substance just as he was trying to get over his addiction. Yet the alcoholic is unaware of the real nature of his craving and takes the wrong substance unintentionally. He is left with a constant craving for alcoholic beverages and must exercise extraordinary willpower to fight off his physiological need.

The safest course for anyone who fears alcoholism is not to drink more often than once every four days and only to drink those beverages (or eat those foods) to which he knows that he is not allergic.

*64/110/2*