I believe no mental patient should have family members make decisions
for them, as this can make the patient even more irritable. Ask the
patient what they want to achieve. Just like when someone is dying you
wouldn't disrespect their wishes.
Pekka Louhiala argues that "there is no alternative medicine" because
"it escapes a meaningful definition, and 'alternative medicine' cannot
be clearly differentiated from conventional medicine" [1]. I do not
consider that his arguments are valid.
Louhiala does not mention the proposed definitions for "alternative
medicine". For example, Eisenberg defined alternative medical therapies
as "interventions neither taught...
Pekka Louhiala argues that "there is no alternative medicine" because
"it escapes a meaningful definition, and 'alternative medicine' cannot
be clearly differentiated from conventional medicine" [1]. I do not
consider that his arguments are valid.
Louhiala does not mention the proposed definitions for "alternative
medicine". For example, Eisenberg defined alternative medical therapies
as "interventions neither taught widely in medical schools nor
generally available in US hospitals" [2]. Cochrane collaboration
defined: "Complementary and alternative medicine (CAM) is a broad
domain of healing resources that encompasses all health systems,
modalities, and practices and their accompanying theories and beliefs,
other than those intrinsic to the politically dominant health system of
a particular society or culture in a given historical period. CAM
includes all such practices and ideas self-defined by their users as
preventing or treating illness or promoting health and well-being.
Boundaries within CAM and between the CAM domain and that of the
dominant system are not always sharp or fixed" [3]. I do not consider
that these definitions are exhaustive, but they capture what I think is
the most essential.
These definitions consider that the relevant factor for setting up
the boundary around alternative medicine is by the lack of social
acceptance within mainstream medicine. Thus, alternative medicine
consists of interventions that are outside of the "conventional" or
"medical school" medicine. The definitions above do not consider
whether a treatment is effective or not. Effectiveness is located on a
different dimension and it is not part of a relevant definition for
alternative medicine.
Louhiala formulated numerous arguments that do not teach us anything
about the usefulness of the concept of "alternative medicine". Although
I agree that in many cases "modern medicine is much more varied in its
approaches than the propagandists for alternative medicine usually
imply", this statement does not imply any conclusions about the concept
of "alternative medicine".
I do not agree with Louhiala's statement that "alternative medicine
means that the other option is rejected". For example, many of my own
patients describe that they also use some forms of alternative
therapies, but they do not reject me therefore. Nevertheless, whatever
our opinion on this issue
is, that has no importance to the question whether "alternative
medicine"
is a useful concept.
I disagree also with the statement that "if a genuine alternative
medicine did exist, it should produce results that are similar to those
of ordinary medicine". There is much treatment variation
within mainstream medicine, and thus there is no uniform "treatment
result" to which the results of alternative therapists
might be compared unambiguously. Furthermore, when we accept the rather
large treatment variation within mainstream medicine, why should we not
accept variation between mainstream medicine and alternative medicine.
In any case, this issue does not seem relevant to the question whether
the concept of "alternative medicine" is useful.
I agree with the statement that "alternative medicine cannot be clearly
differentiated from conventional medicine". There are numerous cases
where the border between neighboring concepts is fuzzy. Internal
medicine cannot be clearly differentiated from general practice
medicine (e.g. both treat hypertension). Children cannot be clearly
differentiated from adults (e.g. teenagers are biologically adults but
psychologically children). However, the lack of a clear differentiation
does not imply that "internal medicine" or "child" are useless concepts.
Louhiala states that "bundling all the so called alternative therapies
under one heading is misleading. It is hard to see common features
between, say, healing using prayer and healing using megadoses of
vitamins." If alternative medicine is defined by the lack of social
acceptance as described above, that provides an unambiguous
justification to put prayer and megavitamins under the same heading.
Furthermore, there is great variation in the approaches within the
mainstream medicine from surgery to pharmacology to psychiatry. If
Louhiala's argument is valid, we should not bundle such different
methods under the one heading of "medical school medicine".
Louhiala states that "alternative medicine" is a buzzword, which may be
true in certain contexts. However, in mainstream medicine, there are
numerous buzzwords. Laser surgery, computed tomography, broad-spectrum
antibiotics, and many others are in certain contexts used to "impress
laymen", but that has nothing to do whether those methods are useful,
or whether those terms are linguistically sound.
While Louhiala criticizes the vague definition of "alternative
medicine",
he does not consider the definition options for "homeopathy". When I
was young, I studied biochemistry and got a PhD
degree. At that stage of my life, I defined homeopathy as "diluting a
substance to such an extent that there are no molecules left in a
spoonful". Thereafter I studied medicine.
When I started to work as a GP, I realized that there is a
fundamentally
different second definition for homeopathy: "a person goes to a
homeopath and stays there for some time and then leaves". If we ask
whether homeopathy is beneficial for a patient, we should first define
what we mean by "homeopathy", but this was not done by
Louhiala.
In catholic countries, sometimes people go to see a priest for a
confession. I believe that the confession often decreases the anxiety
of a person, and in that respect it leads to positive health
effects. This health benefit has nothing to do whether we think that
there is evidence for God. Similarly, homeopathy as an encounter can be
beneficial for a patient because visiting a homeopath is much more than
biochemistry.
While working as a GP, I have realized that a large
part of the positive health effects that I am generating on my patients
are caused by listening and speaking. Why should we assume that a
priest or a homeopath is incompetent at such an activity? I have seen
many physicians who are rather poor in their communication with
patients. Compared with them, an average priest or homeopath probably
generates greater improvements in health if the major problems of the
patient are
anxiety and depression.
On average, alternative therapists may have better bedside manners than
physicians [4]. Time spent with each patient by an alternative medicine
practitioner
usually exceeds that spent by the average physician. Alternative
medicine practitioners provide patients with understanding, meaning,
and self-care methods for managing their conditions. These elements
are often lost in the subspecialization, technology and economics of
mainstream medicine.
Furthermore, even though it is paradoxical, in some cases homeopathy is
better pharmacology than some popular treatment options of physicians.
If a patient has a viral respiratory infection and a homeopath treats
the patient with a highly diluted solution, the product will not cause
harm. If the same patient goes to a physician and gets antibiotics, the
benefit is non-existent there too, but the harm is not [5,6]. In such a
case, it is the homeopath who follows more closely the guidance "first,
do no harm."
I have a long lasting interest in the concept of alternative medicine.
My personal interest largely arose from my long term research on
vitamin C and the common cold, mainly by carrying out systematic
reviews from various points of view. In the latest version of our
Cochrane review, we pooled the results of 29 placebo-controlled
comparisons measuring the effect of regular >0.2 g/day of vitamin C
[7]. We found that vitamin C shortened colds in adults by 8% (P=0.0002)
and in children by 13% (P=0.0003). In 5 trials with participants under
heavy acute physical stress (3 of them with marathon runners), vitamin
C reduced
the incidence of colds by 52% (95% CI: 36% to 65%; P=0.0000006), but we
found strong evidence with a narrow confidence interval that vitamin
C does not prevent colds in the general population.
Given that there is such a strong evidence, mostly from trials
published already in the 1970s, that vitamin C differs from the
placebo, why does
vitamin C fall under the heading "alternative medicine"? Textbooks on
medicine, infectious diseases, and nutrition have claimed over decades
that vitamin C is useless for the common cold [8-10], and systematic
bias against vitamins in general has been documented in the major
textbooks of
medicine [11,12]. In a Dutch survey, 47% of GPs considered that
homeopathy is efficacious in the treatment of the common cold, whereas
only 20% of the respondents considered that vitamin C was [13]. In a US
survey, 21% pediatricians considered that homeopathy may be effective,
and 21% considered that high-dose antioxidant vitamins may be so (e.g.
vitamin C for the common cold) [14]. Thus, vitamin C is comparable with
homeopathy, and in some cases the credibility of vitamin C is even
lower.
While I was wondering the puzzling discrepancy between the positive
findings in the placebo-controlled trials on vitamin C and
the classification of vitamin C under the heading alternative medicine,
I
started to think that the most relevant way of defining "alternative
medicine" is by the lack of social acceptance. This notion was
formulated to
explicit definitions by other authors [2,3].
Evidence-based medicine emerged because several physicians realized
that many treatments taught at the medical school were useless and
started to speak about it loud. Thus, when a treatment falls into
the
category of "medical school medicine", that will not prove that the
treatment is effective. My own observations on vitamin C showed that if
a treatment falls into the category of "alternative medicine", that
will
not prove that the treatment is ineffective. Thus, social acceptability
and effectiveness are located on different dimensions, and it is the
former that is relevant if we search for a reasonable definition for
alternative medicine. I consider that in his paper Louhiala ignores the
main characteristic that defines alternative medicine [2,3].
At the end of his paper, Louhiala comments that "demand that
alternative medicine be taught in medical schools and/or financed
through public funding has no foundation whatsoever". I disagree also
with this opinion.
Louhiala does not define what he means by teaching. It is possible 1)
to teach the practical methods; how to carry out alternative therapies
at one's own office or 2) to teach about the most usual types of
alternative therapies in a descriptive way, so that a medical student
better understands our surrounding society.
If we follow the definitions described at the beginning of this
comment, it is logically impossible to teach medical students how to
start using alternative therapies, because including a therapy in the
medical school curriculum removes the status "not taught at medical
schools". The therapy that was "alternative" is not so any more.
On the
other hand, I cannot see any basis to oppose the second kind of
teaching. The purpose of education should be to increase understanding
why patients use alternative medical treatments, learning how to ask
about and discuss alternative treatments in a nonjudgmental manner,
learning which therapies can be harmful, and
understanding the basic tenets of the most common alternative healing
systems [15-17].
Furthermore, Louhiala's final comment is illogical. Given that he
states that "there is no alternative medicine", how could "alternative
medicine" be used as a criterion for not financing some activity - if
there is
no alternative medicine.
The purpose of my commentary is not to increase the social
acceptability of alternative medicine. I point out that the lack of
social
acceptability seems to be a reasonable basis for defining
alternative medicine [2,3], but this was not considered by Louhiala
[1]. I do not
hope that the use of homeopathy increases, instead I hope much the
contrary. Nevertheless, the question about homeopathy is more complex
than whether it is absurd from the biochemical point of view.
A Google search with the term "alternative medicine" finds over 10
million
web pages and one survey reported that 40% of Americans had used
alternative treatments over the preceding year [2]. I think that it is
much more fruitful to contemplate on the nature of alternative medicine
[3,4,15-22], instead of trying to argue that such a field does not
exist
[1].
I would like to commend the authors for implementing an interesting
and pertinent educational programme on spirituality. As a primary care
doctor seeing patients in the Middle East, I am aware of the wide range of
complaints Muslim patients will attribute to spirit or 'jinn' possession,
ranging from infertility, to headaches, to depression and so on.
Our approach in dealing with such health beliefs in Muslim pati...
I would like to commend the authors for implementing an interesting
and pertinent educational programme on spirituality. As a primary care
doctor seeing patients in the Middle East, I am aware of the wide range of
complaints Muslim patients will attribute to spirit or 'jinn' possession,
ranging from infertility, to headaches, to depression and so on.
Our approach in dealing with such health beliefs in Muslim patients
must take into account that such beliefs are a core part of Islamic
teachings. Dismissing such concepts as superstition leads to discordance
between the doctor and patient. I am sure this is the type of theme you
cover in your course.
However a further question that wasn't explicitly addressed, is how
far do we go in challenging or sanctioning traditional spiritual
treatments that patients may wish to use? If a patient for example wants
to have the Quran read to him (a common traditional treatment for jinn
possession), is it the physician's job to discourage him from this? Can we
allow him to use such spiritual treatments alongside the medication we
prescribe?
If the answer is yes, on the basis that listening to the Quran will
not have any adverse effects on the patient, what about other treatments?
Cupping (blood letting) is another popular alternative therapy that has
been specifically recommended in Islamic texts. Where do we draw the line?
I would welcome feedback from the authors on this topic, as I feel
this is an important discussion that will have bearing on the practice of
many physicians across the world.
Caruncho and Fernandez interpreted Chopin's hallucinations as
temporal lobe epilepsy.(1) Recently, Karhausen examined the 140 causes of
death of Mozart that have been proposed in the medical literature.(2)
These studies on both composers nicely illustrate how a mechanistic view
of death and disease still dominates modern medicine.
Identifying the cause of death can be difficult. Many physicians will
share the e...
Caruncho and Fernandez interpreted Chopin's hallucinations as
temporal lobe epilepsy.(1) Recently, Karhausen examined the 140 causes of
death of Mozart that have been proposed in the medical literature.(2)
These studies on both composers nicely illustrate how a mechanistic view
of death and disease still dominates modern medicine.
Identifying the cause of death can be difficult. Many physicians will
share the experience that one is sometimes uncertain about the cause of
death. In these instances, cardiac arrest is often written on the death
certificate, which almost seems true by definition; the heart stopped
beating. Intuitively, physicians realise that the mechanistic view of a
single cause and a single effect is not always appropriate. Death
certificates and national statistics however demand the identification of
a single cause of death.
In a seminal paper, Rothman has argued that death and disease seldom
have single causes.(3) His model of causation identifies multiple
components. Sufficient causes are subdivided into component causes. This
model illuminates important principles as multi-causality, the dependence
on the strength of component causes and interaction between component
causes. In his view the death from a fall is caused by the combination of
e.g. visual problems, a loose rug, osteoporosis and sarcopenia. This has
important consequences, since it is therefore recognised that intervention
with any of these component causes is important to prevent the formation
of a sufficient cause for the fall.
In the next century, people will live longer lives without
disabilities.(4) The challenge in the future will be to manage elderly
patients with multiple chronic diseases. A mechanistic view of single
causes of death and disease is not appropriate for our growing population
of elderly patients. A more widespread appreciation of the multi-causal
nature of death and disease could be an important step to successful
ageing in the next century.
1. Caruncho MV, Fernandez FB. The hallucinations of Frederic Chopin.
Med Humanities 2011 doi:10.1136/jmh.2010.005405
2. Karhausen LR, Mozart's 140 causes of death and 27 mental
disorders. BMJ 2010; 341:c6789. doi:10.1136/bmj.c6789
3. Rothman KJ, Greenland S, Stat, C. Causation and causal inference
in epidemiology. Am J Public Health 2005; 95:s144-s150.
doi:10.2105/AJPH.2004.059204
4. Perenboom RJ, Van Herten LM, Boshuizen HC, Van Den Bos GA. Trends
in disability-free life expectancy. Disabil Rehabil. 2004 Apr 8;26(7):377-
86.
One of the best episodes (and probably most shocking to thousands of
people of all ages)of a medical programmes in UK dealt exactly with the
need to reassure people about the huge variation in genitalia. Shocking
because genitalia are so taboo that a penis still cannot usually even be
shown on TV. The programme continues to run a web site so that people can
see different genitalia for themselves and also to share experi...
One of the best episodes (and probably most shocking to thousands of
people of all ages)of a medical programmes in UK dealt exactly with the
need to reassure people about the huge variation in genitalia. Shocking
because genitalia are so taboo that a penis still cannot usually even be
shown on TV. The programme continues to run a web site so that people can
see different genitalia for themselves and also to share experiences and
worries . It simply does not work for healthworkers to assume it is
reassuring to somebody being examined that they 'have seen hundreds of
them, it means nothing...' when there is such a strong taboo about
exposing private parts of the body. This programme gave people of all
ages the chance to look at real human beings who were at ease with their
different bodies including their genitalia. It is to be expected that
reactions would be different and they did range from shock, disgust,
curiosity, embarrassment to positive acceptance and healthy interest
instead of secretive voyeurism or anxiety. It was also the case though
that even after seeing how much variation is normal, many youngsters, boys
and girls,preferred a cosmetically enhanced version of the stereotypical
most ideal bodyshape to variations on that,including a majority preference
for certain size and shape genitalia. Some would still choose surgery to
conform. Hopefully when the issue is so complex, as many healthworkers as
others will access the programme and web site as well as using what are
often rather dehumanising descriptions or photographs of parts of bodies.
The doctors who ran the programme are to be congratulated for breaking the
taboo which causes so much distress.
We thank van Bodegom and Engelaer for their interesting letter. They
pose a fundamental philosophic and practical issue in modern medicine:
causation. Nevertheless, we did not intend to elaborate a causal network
of the diseases of Chopin. Our aim was to find an explanation to a few
biographical accounts of the composer and make a retrospective clinical
diagnosis. Our diagnostic guess is a syndromic one as we can't provi...
We thank van Bodegom and Engelaer for their interesting letter. They
pose a fundamental philosophic and practical issue in modern medicine:
causation. Nevertheless, we did not intend to elaborate a causal network
of the diseases of Chopin. Our aim was to find an explanation to a few
biographical accounts of the composer and make a retrospective clinical
diagnosis. Our diagnostic guess is a syndromic one as we can't provide any
causal diagnosis.
We do believe that Chopin suffered from temporal lobe epilepsy, but we do
not know of any clue to conclude if his epilepsy was primary or secondary.
We do not know if he could have had febrile convulsions during his infancy
or childhood, or an arteriovenous malformation, or mesial temporal lobe
sclerosis, or any other cause of secondary epilepsy, and we will never
know. Notwithstanding, we know of some possible seizure triggers, such as
fever, late nights, playing difficult music, and so on.
We agree with van Bodegom and Engelaer that a single cause of disease is
not appropriate for explaining most of the human diseases. Chopin suffered
from other diseases that ultimately caused his death. Analising his health
status and the relationship among his sufferings is an interesting topic,
but it was not the aim of our article.
I read with interest Caruncho and Fernandez postulation of Chopin
possibly having temporal lobe epilepsy, and resultant complex
hallucinations.
I was struck by a few other explanations which could account for these
bizarre phenomena. He was in a state of poor health, and could have had a
few subacute confusional state in clear consciousness.
Secondly it is not uncommon for truly gifted people such as Chopin to have
synaes...
I read with interest Caruncho and Fernandez postulation of Chopin
possibly having temporal lobe epilepsy, and resultant complex
hallucinations.
I was struck by a few other explanations which could account for these
bizarre phenomena. He was in a state of poor health, and could have had a
few subacute confusional state in clear consciousness.
Secondly it is not uncommon for truly gifted people such as Chopin to have
synaesthesia, a a process in which one type of stimulus produces a
secondary, subjective sensation( for example when some color evokes a
specific smell)What could be in favour of this is considering that in some
of the accounts these events happened while he was playing music.
What isn't in doubt was that these "hallucinations" did not impede him
from being one of the greatest musicians of all time.
We thank Dr. Ntanda for his interesting remarks, but we disagree with
them. We think temporal lobe epilepsy is the most plausible diagnosis
because Chopin had paroxysmal crisis as he was disconnected from reality.
Sand and Mme Streicher narrated it quite precisely. To the best of our
knowledge he had neither alteration in his mental status, nor problems
in orientation, nor cognition deficit, thus a confusional state see...
We thank Dr. Ntanda for his interesting remarks, but we disagree with
them. We think temporal lobe epilepsy is the most plausible diagnosis
because Chopin had paroxysmal crisis as he was disconnected from reality.
Sand and Mme Streicher narrated it quite precisely. To the best of our
knowledge he had neither alteration in his mental status, nor problems
in orientation, nor cognition deficit, thus a confusional state seems not
a good option. On the other hand, synaesthesia is a quite simple process
in wich a sensory stimulus produces a normal sensation in the stimulated
sensory pathway and the stimulation of other sensory pathway. The
synaesthetic sensation appears automatically, like a reflex, and it is
always the same within each synaesthete. Chopin had complex visual
hallucinations, not the perception of colours when he was playing;
moreover, he had other symptoms consistent with epilepsy during the crisis
such as piloerection, fear, paleness, and sweating. A lot of gifted artits
were synesthetes: Rimbaud, Baudelaire, Scriabin. Rimsky-Korsakov,
Messiaen, Kandinsky, to quote a few.(1) (2) Chopin was not one of them. It
is true that synaesthesia could be secondary to temporal lobe epilepsy,
but we do not know of any account of Chopin complanining about it
throughout his whole life.
(1) Marti i Villalta JL. Musica y neurologia. Barcelona: Lunwerg.
2010.
(2) Mulvenna CM. Synaesthesia, the arts and creativity: a neurological
condition. In Bogousslavsky J, Hennerici MG (ed): Neurological disorders
in famous artists. Part 2. Basilea: Karger. 2007.
Ian C. M. Williams' article on the use of comics as a suitable medium
for medical narratives is a timely evaluation of the potential of the
comicbook form to address several medical issues. For a medium that is
roughly over a hundred years old (although some scholar might argue that
comics had their roots in the inception of printed cartoons, whereas
others trace back their origins as far as the Bayeux Tapestries or even...
Ian C. M. Williams' article on the use of comics as a suitable medium
for medical narratives is a timely evaluation of the potential of the
comicbook form to address several medical issues. For a medium that is
roughly over a hundred years old (although some scholar might argue that
comics had their roots in the inception of printed cartoons, whereas
others trace back their origins as far as the Bayeux Tapestries or even
prehistoric cave paintings), comics have surely evolved in content,
variety of subject matter and format. As noted, comic studies are
relatively new, but a number of books have been published, there are post-
graduation courses focusing in comics theory (as the one offered by Opet
in Curitiba, Brazil) or literary studies of comics (as the University of
Dundee's, Scotland, that began last year), theses, Manchester's University
International Comic Conference and even two peer-review periodicals;
Studies in Comics and The Journal of Graphic Novels and Comics.
As a practicing neurologist and life-long comics reader I had the
opportunity to present last year at the 29th International Epilepsy
Congress a poster based on Joshua Hale Fialkov and Noel Tuazon's graphic
novel Tumor entitled TUMOR - A GRAPHIC NOVEL REPRESENTATION OF
GLIOBLASTOMA MULTIFORME AND MULTIPLE SEIZURES TYPES. This is the story of
a private detective who is diagnosed with GB, while solving his last case.
A variety of seizure types and other symptoms, such as confusional state
and space-time disorientation are presented in graphic form from the
standpoint of the main character/patient, providing a layman's
interpretation of seizure semiology.
Again, as mentioned in William's article, comics provide a rich
source of material for medical studies. Even the so-called mainstream
comics have featured characters with multiple medical conditions, such as
Barbara Gordon's spinal injury in The Killing Joke, which ultimately led
her to become the paraplegic heroine Oracle; David Lapham's Young Liars,
where the main female character suffers a bullet wound to the frontal lobe
and looses impulse control; or Sue Dibny's death in Identity Crisis as a
result of a brainstem stroke caused by the murderous Jean Loring's
stepping over her basilar artery in microscopic size.
Also, several characters are Medical Doctors, such as Marvel's Doctor
Strange, Gotham City's Dr. Leslie Thompson, the X-Men's Dr. Cecilia Reyes
or JSA's Dr. Mid-Nite. There will be more articles on the interaction
between comics and Medicine in the coming years for sure.
I believe no mental patient should have family members make decisions for them, as this can make the patient even more irritable. Ask the patient what they want to achieve. Just like when someone is dying you wouldn't disrespect their wishes.
Conflict of Interest:
None declared
Louhiala does not mention the proposed definitions for "alternative medicine". For example, Eisenberg defined alternative medical therapies as "interventions neither taught...
Dear Editor
This is an excellent article, which throws new insight ito the phenomenon of Anorexia Nervosa.
The author deserves my heartfelt thanks.
Regards.
I would like to commend the authors for implementing an interesting and pertinent educational programme on spirituality. As a primary care doctor seeing patients in the Middle East, I am aware of the wide range of complaints Muslim patients will attribute to spirit or 'jinn' possession, ranging from infertility, to headaches, to depression and so on.
Our approach in dealing with such health beliefs in Muslim pati...
Caruncho and Fernandez interpreted Chopin's hallucinations as temporal lobe epilepsy.(1) Recently, Karhausen examined the 140 causes of death of Mozart that have been proposed in the medical literature.(2) These studies on both composers nicely illustrate how a mechanistic view of death and disease still dominates modern medicine.
Identifying the cause of death can be difficult. Many physicians will share the e...
One of the best episodes (and probably most shocking to thousands of people of all ages)of a medical programmes in UK dealt exactly with the need to reassure people about the huge variation in genitalia. Shocking because genitalia are so taboo that a penis still cannot usually even be shown on TV. The programme continues to run a web site so that people can see different genitalia for themselves and also to share experi...
We thank van Bodegom and Engelaer for their interesting letter. They pose a fundamental philosophic and practical issue in modern medicine: causation. Nevertheless, we did not intend to elaborate a causal network of the diseases of Chopin. Our aim was to find an explanation to a few biographical accounts of the composer and make a retrospective clinical diagnosis. Our diagnostic guess is a syndromic one as we can't provi...
I read with interest Caruncho and Fernandez postulation of Chopin possibly having temporal lobe epilepsy, and resultant complex hallucinations. I was struck by a few other explanations which could account for these bizarre phenomena. He was in a state of poor health, and could have had a few subacute confusional state in clear consciousness. Secondly it is not uncommon for truly gifted people such as Chopin to have synaes...
We thank Dr. Ntanda for his interesting remarks, but we disagree with them. We think temporal lobe epilepsy is the most plausible diagnosis because Chopin had paroxysmal crisis as he was disconnected from reality. Sand and Mme Streicher narrated it quite precisely. To the best of our knowledge he had neither alteration in his mental status, nor problems in orientation, nor cognition deficit, thus a confusional state see...
Ian C. M. Williams' article on the use of comics as a suitable medium for medical narratives is a timely evaluation of the potential of the comicbook form to address several medical issues. For a medium that is roughly over a hundred years old (although some scholar might argue that comics had their roots in the inception of printed cartoons, whereas others trace back their origins as far as the Bayeux Tapestries or even...
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