From Demons to Diagnosis? A genealogy of the diagnostic category of epilepsy.

Context Seizures have always occurred throughout human existence; the first known medical text documenting epilepsy goes as far back as the Babylonians (circa. 1050BC). In the present, epilepsy is understood as a neurological disorder which causes abnormal electrical discharges in the brain, leading to episodic sensory disturbance, loss of consciousness and convulsions. However, seizures and their causes have been conceptualised and understood in different ways over time. For a substantial part of human history epilepsy was understood in supernatural terms, a result of divine punishment or demonic possession. The growth of the biological understandings of epilepsy have undoubtedly led to better diagnostic technologies and treatment for patients. However, despite growing scientific understanding of the cause of seizures, people with epilepsy still experience stigma and societal barriers because of perceptions of the condition. Epilepsy as an impairment has been liberated from divine superstition and has moved towards scientific enlightenment; however, the disabling barriers to employment, education, leisure and transport for people with epilepsy reflect the continuation of stigma and inequality. This proposed research situates these ongoing disabling barriers and inequalities within a long history of the problematisation of the characteristics of seizures, which, although improved, continues today within medicine, albeit in different ways. The prevalence and long history of epilepsy has meant that there have been several medical histories of the disease, describing its development from an understanding as a divine phenomenon to a scientifically based diagnosis. These works have been descriptive and have not attempted to sociologically engage with why and how understandings of epilepsy have changed over time. This genealogy will distinguish itself from these works as a sociological analysis using Foucauldian theory and methodology to trace the historical creation and maintenance of epilepsy as an impairment category and its contribution to our present disabling society and disabled experience. This research is inspired by and will build upon the research of Campbell (2013) in Dyslexia: The Government of Reading. This work used Foucauldian theory of power and knowledge and the method of genealogy to historically situate the development of dyslexia as a diagnostic category in response to the problematisation and pathologisation of illiteracy. This problematisation was the result of economic, political and social forces, as greater societal importance was placed on literacy. One of the shortfalls of this work is that it is difficult to see how the same could be true of all impairment categories, particularly those which have a proven biological basis. This proposed genealogy of the diagnostic category of epilepsy will enhance Campbell's (2013) argument and test the robustness of his work by critically examining a chronic health condition usually considered wholly objective and previously unquestioned and consider the social, political and economic forces that may have shaped its development as a diagnostic category. This is not to dispute the biological basis of epilepsy, or the development of effective treatment. However, chronic health conditions like epilepsy are often considered self-evident diagnoses based upon biological difference and objective scientific facts, and are therefore outside the realms of social construction or moral values. This work will critically engage with this claim and consider sociologically the subjective and socially constructed elements that have led to the development of epilepsy as a specific diagnostic category and the effect this has had on the experience of epilepsy. This research will use the method of Foucauldian genealogy to critically examine the ways that seizures have become problematised and pathologized over time in varying ways to create the diagnostic category of epilepsy.