Epilepsy Talk

Violence and Epilepsy | August 19, 2017

No question about it. Epilepsy’s been the victim of bad press since ancient Greece. There, it was sometimes called the “Herculean Disease” because Hercules was thought to have murdered his family in a fit of uncontrollable rage.

Two thousand years later, Michael Crichton wrote in The Terminal Man, “Epileptics are predisposed to violent, aggressive behavior during their attacks.”

Which didn’t exactly help.

In later editions of his novel, Crichton softened his stance with a postscript, but many physicians and laymen still truly believe that those with epilepsy are dangerous and potentially violent people.

British psychiatrist Henry Maudsley suggested that “whenever a murder occurs, without premeditation…we ought to look carefully for evidence of previous epilepsy.”

In the film “Deceiver,” a psychiatrist describes a person with epilepsy as “one of the most dangerous creatures on earth,” and recommends that police officers treat him as you would treat a strange dog in an alley, “don’t talk to him, don’t look him in the eye, and whatever you do, don’t touch him.”

Lovely. But they’re not the first to have these biased attitudes. (And they’re considered to be educated, “smart” men!)

Two schools of thought…

There’s a long-standing belief that temporal lobe epilepsy (TLE) is the epilepsy syndrome most often complicated by interictal (the time between seizures) cognitive and behavioral problems.

Criminologist Cesare Lombroso promoted the association of epilepsy with aggressive, sociopathic tendencies.

But modern research rejects the idea that having epilepsy makes you automatically prone to violence. However, studies do show increased violence among those with seizures as compared with those without seizures.

An international workshop found that aggressive acts “appeared suddenly, without evidence of planning, lasted an average of 29 seconds and occurred during partial complex seizures.”

They pointed out that the most important aspect to these acts is they were random and that the aggressive action was extremely brief.

Members of the workshop also determined that fear or an attempt at restraining the subject exacerbated these aggressive acts. (Hey, who would want to be pinned down, tied up or put in cuffs?)

They determined, that it would be “a near impossibility” for a person having a seizure to commit a directed act of violence.

While it’s true that compared with the general population, violent behavior occurs more often among those with epilepsy, seizures are most aggressive at the interictal stage, between seizures and can correlate with: frontal lobe deficits, neurotransmitter abnormalities, perinatal neurological damage and behavioral genetics.

Other biological aspects influencing aggressive behavior in epilepsy can be: male gender, psychopathology, low intelligence or cognitive deficits.

Also included are prior head trauma, or abnormal neurological studies, even medication side effects, and possibly the experience of child abuse.

Unfortunately, the interictal period comprises more than 99% of most patients’ lives, making this a continuing problem even though the seizures themselves are intermittent.

Clinicians need to be aware of the different relationships between epilepsy and violence, especially when choosing management with anticonvulsant medications, psychoactive drugs, or in some cases, surgery.

Because, the effectiveness of one may defeat the other.

So, it’s a real double bind.

And then there’s the debate of pre-existing psychosis versus psychosis being a by-product of seizures.

I don’t think anyone is going to win that debate, because each situation is entirely possible.

While “automatic” aggression is higher in those with epilepsy, the incidence and prevalence of psychosis and aggression in epilepsy, are still unknown.

The question is: what’s triggering what?

Besides, that kind of aggression isn’t really any different from the violent behavior of other patients who experience psychotic episodes because of other illnesses.

It’s not simply a matter of “A” (partial complex seizures) + “B” (the interictal stage) = “C” (aggressive acts and violence.)

You can have epilepsy and not be psychotic. And you can be psychotic and not have epilepsy. What’s so difficult about that?

But old biases die hard. And we still have a long way to go to prove to people who those with epilepsy aren’t crazy, aggressive or violent.

Only through education and awareness can we change those odious opinions.

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Resources:

http://jamanetwork.com/journals/jama/article-abstract/336801

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053027/

http://m.ehealthforum.com/blogs/colored_stone/the-link-between-epilepsy-and-aggression-b11140.html

http://www.epilepsy.com/learn/impact/moods-and-behavior/mood-and-behavior-101/aggression

http://www.neurology.org/content/73/21/1720.extract

http://www.sciencedirect.com/science/article/pii/S2213323213000224

http://www.neurology.org/content/73/21/1720

http://thenadd.org/modal/bulletins/v2n3a1~.htm

http://io9.gizmodo.com/was-michael-crichton-right-about-a-link-between-epileps-509012575

http://aibolita.com/nervous-diseases/2436-epilepsy-and-aggression.html

 


21 Comments »

  1. Interesting. One comment you made really hit home – getting cuffed. I remember the letter where Jamie said he woke up after a seizure to find himself cuffed and in leg restraints – because the guard was afraid for his safety. That is adding insult to injury.

    Like

    Comment by SonniQ — August 19, 2017 @ 3:33 PM

  2. For goodness sake, let stop repeating history. I am an epileptic, I volunteer, I am most of the time pleasant. Of course, every body including normal people get mad and frustrated. Let’s change the definition of an epileptic. A person that has epilepsy. People now a days, get to offended. I have had epilepsy all of my life, it does not bother me.

    Like

    Comment by Kathleen — August 20, 2017 @ 3:10 PM

    • Yes, I was teased through my childhood and yes, I am going through discrimination, right now. You know what, I am an adult, I am finding ways to handle it. It is very discouraging at time but I am an epileptic and I am proud of it! I would rather have it, than someone who couldn’t handle it!

      Like

      Comment by Kathleen — August 20, 2017 @ 3:15 PM

      • Wow Kathleen,
        I admire your positive attitude in dealing with epilepsy & the social stigma associated with epilepsy.
        Growing up with epilepsy might have strengthened your determination & will power to accept & fight back the ordeals associated with epilepsy.
        Some of us knew nothing about Epilepsy until being struck with strange conditions, ending up in hospital emergency rooms for seizures in adult age, we never had before.
        Feeling hostage to the mental, medical changes & unpredictable conditions we never had before, became like being robbed of the ordinary lifestyle we have been accustomed too for most of our lives.
        Therefore, for some of us the condition became a very difficult radical change to overcome.
        But, with very inspiring people like you sharing their experience, we’re learning that life is a whole lot bigger treasure to appreciate more than the ordeals of Epilepsy. Therefore, thank you for sharing your experience in dealing with epilepsy.

        Like

        Comment by Gerrie — August 20, 2017 @ 10:34 PM

    • That’s because you’re a compassionate and intelligent survivor.

      Like

      Comment by Phylis Feiner Johnson — August 20, 2017 @ 3:23 PM

  3. It has never happened to me. But there have been plenty of situations where I saw the police react aggressively.

    Like

    Comment by Christopher Range — August 20, 2017 @ 11:27 PM

  4. Hi Phylis! I remember during a study when they took me off of my meds. I ended up punching a nurse during a complex partial seizure without my knowledge while they were putting me in restraints. The nurse understood and said it happens all the time. Good thing I’m a weakling, but the stereotype persists. Friends have been arrested. I’ve been called a drunk during a seizure because I stumble (because of a physical disability) and sometimes swear during a CP. When will it end?

    Like

    Comment by Mary Ellen Gambon — August 21, 2017 @ 8:13 AM

    • I think public service people need hands-on education, along with ER personnel, nurses, even doctors. There is no excuse for ignorance or physical abuse.

      Like

      Comment by Phylis Feiner Johnson — August 21, 2017 @ 8:40 AM

      • Thanks. Even in physical therapy, I told the staff about my epilepsy. So when I commented that I didn’t like it that my PT was treating (or not treating, more accurately) me and 2 other patients at the same time, she asked if I was seeing a therapist (in front of everyone!) and if I was upset because of my disability. I was upset because I felt she wasn’t doing her job. I went back after the appointment (when I cooled down) and mentioned to the receptionist that bringing up a person’s disability in front of others like that was not cool. When will people be trained, and when will the health care industry truly get it?

        Like

        Comment by Mary Ellen Gambon — August 21, 2017 @ 10:14 AM

      • I’m so sorry to hear that. My Physical Therapist were wonderful. Considerate of all my needs and dangers.

        Of all people, you would think a PT would be empathic!

        Like

        Comment by Phylis Feiner Johnson — August 21, 2017 @ 10:52 AM

  5. I’d love to read the article, but where is it?

    Like

    Comment by Phylis Feiner Johnson — August 21, 2017 @ 8:37 AM

  6. I used to have gran mal seizures that changed to status epilepticus. I ended up being out in the er but not before an injury to neck causing 3 discs to be replaced. I needed physical therapy, but when I went to do all he did was put me on a stationary bike and I dislike them they just make me feel dizzy. He would disappear and help others. So now after a few years and more of the same seizures my internist has a different therapist who will help me.

    Like

    Comment by Deb — August 21, 2017 @ 11:22 AM

  7. I suppose I’m that exception that proves the rule, I’ve lived with a wrong diagnosis of uncontrolled epilepsy during which I could act unconsciously, frightened and attack people, but recently I’ve learnt that I’ve got complex PTSD due to ongoing civil conflict, dissociation, PNES or NEAD in UK, and epilepsy. I drift into a hazy world I don’t understand, get frightened by these strange white blobs that are really people and attack or run, so far I haven’t caused damage but it’s frightening being out of control. I can even go on blacked out in a usual way, working etc after seizures but those are the PNES

    Like

    Comment by Gail — August 22, 2017 @ 5:34 AM

    • Being in a world you can’t control must be terribly frightening. And, as you say, there is nothing you can do except to hang on.

      Hats off to you for working through it all. Others wouldn’t be as brave.

      Like

      Comment by Phylis Feiner Johnson — August 22, 2017 @ 8:11 AM

  8. My question is are we talking about violence during a seizure attack, or during periods of non seizure activities? During seizure attacks, we the ones seizing do not have control. Although during non seizing periods, we are in just as much control as the next person.

    I’m the same cheerful self i was before i had epilepsy as well as now when i do have it. I started to have epilepsy around age 36, thanks to an ever growing brain tumor.

    I think all the violence comes from people trying to help the person seizing and getting hit by a flailing hand, like one of the other commenters said she did to a nurse. When i’m having a big seizure, i cannot control my arms flailing movements. And to this day i know people that still believe they should help hold a person still/down during a seizure. I go ya, if you want to get hit by a flailing arm or two, try it. 🙂 Once Epilepsy hits me, my control over the electrical over activity in my mind starts to decrease dramatically, and that control gets totally knocked out if i go into a grand mal seizures.

    Zolt

    Like

    Comment by Zolt — August 22, 2017 @ 8:59 PM

    • Yes, it is during epileptic activity, most often during the postictal stage, which as you know, can be quite violent.

      Like

      Comment by Phylis Feiner Johnson — August 22, 2017 @ 10:03 PM

  9. Required school courses need to include a semester pertaining to Epilepsy. Being able to recognize a person undergoing a seizure is a lot more important than how to throw a baseball,

    People are often blamed for saying something prejudice about someone with different colored skin, etc. What is the difference between something like that and one who is epileptic? People need to take the ‘epilepsy course’ and know what to do should someone have a seizure- and people stay calm. Discrimination was always a problem for me, just as for many others.

    Like

    Comment by Karen — August 24, 2017 @ 6:14 PM

    • Interesting you should say this. Because a person on Facebook just posted about a book called “Epilepsy at School” for primary age kids. I thought it was brilliant!

      It’s called “Taking Seizures to School” and it’s a story that “dispels the myths and fears surrounding epilepsy in a positive, upbeat and entertaining style while explaining seizures in an understandable fashion.”

      Now, if only that was required reading!

      Like

      Comment by Phylis Feiner Johnson — August 24, 2017 @ 7:15 PM


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    About the author

    Phylis Feiner Johnson

    Phylis Feiner Johnson

    I've been a professional copywriter for over 35 years. I also had epilepsy for decades. My mission is advocacy; to increase education, awareness and funding for epilepsy research. Together, we can make a huge difference. If not changing the world, at least helping each other, with wisdom, compassion and sharing.

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