My patients have taught me a great deal about how people who are disadvantaged live in our society. Many of my patients are indigent and have problems obtaining sufficient food and adequate housing; troubles with drugs, crime, and familial discord can affect their attitudes toward seizures. Contrary to what their doctors may think, seizures may not be the most important threat in their lives and taking seizure medications properly and establishing good daily habits may therefore not rank high on their list of priorities.

The physician who recognizes this fact will avoid the frustration of trying to help patients who do not seem to want to help themselves. This point becomes even more important when patients appear to engage in self-destructive behavior. The “shoot-yourself-in-the-foot” phenomenon is apparent in some patients whose lives have been troubled and they do not feel comfortable when medical treatment is successful and, therefore, they seek out further trouble. One of my patients, Jose was forever noncompliant because he felt it was not macho to take medicine. After a decade I finally convinced him to change that attitude and became compliant. Then he developed a new problem-the uncomfortable feeling of success. His successful treatment gave way to renewed noncompliance, not because of macho feelings, but seemingly to seek out more trouble.

All of us become used to our living conditions, even if they represent the ultimate in chaos and difficulty. Accommodating to these conditions psychologically leads to patients to become noncompliant and unable to handle any kind of success. This phenomenon can be a real challenge for the epileptologist.

Indeed, these unfortunate attitudes can be understood in terms of the most inclusive rule of human behavior: people treat the outside world the same way they think the outside world has treated them. Furthermore, people may also treat themselves the way they think the outside world has treated them. Thus, trouble from the outside world brings on self-destructive behavior, often exacerbated by the patient’s negative actions towards others.

The role of the epileptologist is to break this negative cycle. Then when patients experience a few triumphs (it is hoped) in the treatment of their seizures and acquire insight into their self-destructive behavior, they will seek further success.

The Brainstorms Healer: Epilepsy In Our Experience edited by Steven C. Schachter, M.D. and A. James Rowan, M.D., Raven Press, 1998, Lippincott Williams & Wilkins