Epilepsy as a Model for Psychopathology

Abstract

Although neurobiology plays an increasingly important role in psychiatry, we stand merely at the threshold of understanding at least part of the interface of behaviour and its neural substrates and largely ignore perhaps the most dramatic expression of that relationship. In the older textbooks, epilepsy, along with schizophrenia and affective illness, formed the triad of major psychiatric disorders referred to as “insanity.” Since the introduction of EEG, though, epilepsy has been a disturbance belonging to the domain of neurologists, while psychiatrists have concentrated more on understanding the cerebral substrate of the major psychoses. In the case of epilepsy, with its obvious physical aspects, those of a psychiatric nature have been largely overlooked. Many neurologists have made major contributions to knowledge of the behavioural aspects of epilepsy, but they have not focused on the psychiatric features of their patients’ conditions. On the other hand, for a long time, psychiatrists have favoured purely psychological theories and treatment approaches, while ignoring the brain and anything that could be labelled a “brain disease” (Blumer 1984). It is surprising that even modern, biologically oriented psychiatrists do not seem to consider epilepsy to be within their field of expertise and interest.