EPILEPSY AS A PSYCHO-SOCIAL DISEASE: “HOW DO YOU HELP TEENAGERS COPE?” “DOES COUNSELING ALWAYS WORK OUT THIS WELL?”
“Not for everyone, but it does for many. Sometimes you have to take different approaches. The clinic had one teenage boy whose seizures were under complete control for long periods of time, and then he would have another tonic-clonic seizure. He swore that he took his medicine, but at the time of each seizure the blood levels would be low. He was never interested in counseling. He thought he was too macho and that he could handle it. He was really a good kid, off at college, and he wanted to get his own car. In Maryland you now can drive when you have been seizure-free for three months. Finally, after he wrecked the family car in what was presumed to be a seizure, the doctor said to him, ‘Look, you are wasting my time and your parents’ money. I don’t care if you have seizures or if you never drive. I don’t want to see you again until you can look me in the eye and tell me that you have been taking the medicine regularly and not drinking. If you have a seizure under those circumstances and the blood level is good, then I’ll work hard with you to get the seizures under control. Then perhaps we’ll try another medication, but not until that time. What’s more, I’d suggest to your parents that they not let you drive until you’ve shown that you can take responsibility.’”The doctor told this to the boy and then told this to the parents in the boy’s presence. John has not had any seizures since. Sometimes tough love is necessary, and putting the responsibility in the patient’s court gives a person the control that is needed. It’s their epilepsy, not their parents, not the physician’s, not the counselor’s.”This concept of control can apply to other issues as well. We recently saw a teenage girl who had not had seizures for two years. We suggested that she begin to taper the medication now, in advance of starting to drive. She wanted to be off medication, but was afraid she would have another seizure and, worst of all, that she might have one at school. We talked about her fears, but we left the decision about stopping the medicine to her. Several months later she decided to try it, and has done well. These were things she wouldn’t discuss with the doctor, but would discuss with me. I seemed to her to be less threatening.”*226\208\8*
