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

在人类存在的整个过程中，癫痫发作总是发生的；已知的第一个记录癫痫的医学文献可以追溯到巴比伦人(大约。公元前1050年)。目前，癫痫被理解为一种神经疾病，导致大脑异常放电，导致发作性感觉障碍、意识丧失和抽搐。然而，随着时间的推移，人们以不同的方式对癫痫及其原因进行了概念化和理解。在人类历史的很大一部分时间里，癫痫被理解为超自然的术语，是神的惩罚或恶魔附身的结果。对癫痫生物学认识的增长无疑导致了对患者更好的诊断技术和治疗。然而，尽管人们对癫痫发作的原因有了越来越多的科学认识，但由于人们对这种疾病的看法，癫痫患者仍然遭受着耻辱和社会障碍。作为一种损害，癫痫已经从神圣的迷信中解放出来，走向科学启蒙；然而，癫痫患者在就业、教育、休闲和交通方面的障碍反映了耻辱和不平等的持续存在。这项拟议的研究将这些持续存在的障碍和不平等置于癫痫发作特征问题化的漫长历史中，虽然癫痫发作的特征有所改善，但今天仍在医学领域继续存在，尽管方式不同。癫痫的流行和漫长的历史意味着，已经有过几次这种疾病的病史，描述了它从一种神圣现象的理解到一种基于科学的诊断的发展。这些著作都是描述性的，并没有试图从社会学的角度探讨为什么以及如何随着时间的推移而改变对癫痫的理解。这本家谱将有别于这些作品，作为一种社会学分析，使用福柯学派的理论和方法论来追溯癫痫作为一种损害类别的历史创造和维持，以及它对我们现在的残疾社会和残疾经历的贡献。这项研究的灵感来自于坎贝尔(2013)在《阅读困难症：雷丁政府》一书中的研究。这项工作使用了福柯的权力和知识理论和谱系学的方法，将阅读障碍的发展历史定位为一个诊断范畴，以回应文盲的问题化和病理性。这种问题化是经济、政治和社会力量的结果，因为识字受到了更大的社会重视。这项工作的不足之一是，很难看出所有损伤类别都是如此，特别是那些具有已证实的生物学基础的损伤类别。这一拟议的癫痫诊断类别谱系将加强Campbell(2013)的论点，并通过批判性地检查一种通常被认为完全客观且以前没有受到质疑的慢性健康状况，并考虑可能塑造其作为诊断类别的发展的社会、政治和经济力量，来检验他工作的稳健性。这并不是为了争论癫痫的生物学基础，也不是为了开发有效的治疗方法。然而，癫痫等慢性健康状况通常被认为是基于生物差异和客观科学事实的不言而喻的诊断，因此不属于社会建设或道德价值观的领域。这项工作将批判性地涉及这一主张，并从社会学角度考虑导致癫痫作为特定诊断类别发展的主观和社会构成因素，以及这对癫痫经验的影响。这项研究将使用福柯谱系学的方法，批判性地检查癫痫发作随时间以不同方式变得有问题和病理性的方式，以创建癫痫的诊断类别。

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.