Dekkers W, van Domburg P
Department of Ethics, Philosophy and History of Medicine, Catholic University Nijmegen, The Netherlands.
Med Health Care Philos. 2000;3(1):29-38. doi: 10.1023/a:1009921329444.
Periodic attacks of uncertain origin, where the clinical presentation resembles epilepsy but there is no evidence of a somatic disease, are called Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEAD may be called a 'non-disease', i.e. a disorder on the fringes of established disease patterns, because it lacks a rational pathophysiological explanation. The first aim of this article is to criticize the idea, common in medical science, that diseases are real entities which exist separately from the patient, waiting to be discovered by the doctor. We argue that doctor and patient construct a disease, and that the construction of the disease PEAD includes many normative evaluations. The second aim is to provide insight into the suffering of patients with PEAD. We focus on three aspects of the patient, identity, autonomy and responsibility. We present some characteristic descriptions of (pseudo-)epileptic attacks by Fjodor Dostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosing PEAD reduces a meaningful life event into an insignificant, though intriguing, medical phenomenon, and that the patient will not benefit from being diagnosed as having PEAD.
发作原因不明，临床表现类似癫痫但无躯体疾病证据的周期性发作，被称为假性癫痫或假性癫痫发作障碍（PEAD）。PEAD可能被称作一种“非疾病”，即处于既定疾病模式边缘的一种病症，因为它缺乏合理的病理生理学解释。本文的首要目的是批判医学中常见的一种观点，即疾病是独立于患者之外真实存在的实体，等待医生去发现。我们认为医生和患者共同构建了一种疾病，而疾病PEAD的构建包含了许多规范性评估。第二个目的是深入了解PEAD患者的痛苦。我们关注患者的三个方面，身份认同、自主性和责任感。我们呈现了费奥多尔·陀思妥耶夫斯基、居斯塔夫·福楼拜和托马斯·曼对（假性）癫痫发作的一些典型描述。我们认为诊断为PEAD会将一个有意义的生活事件简化为一个微不足道但引人入胜的医学现象，而且患者不会从被诊断为患有PEAD中受益。
