Overcoming the stigma of epilepsy.

A prime difficulty facing all people with epilepsy is dealing with the stigma which is associated with it in almost all societies. Stigma arises from the perception of difference from the norm, particularly powerful when that difference is not understood. This arises from the uniquely human need for predictability, resulting from the ability to think abstractly, and thus to surmise the future. A failure of expectation, or the uncertainty caused by an inability to predict, causes insecurity, or a "fear of the unknown", which we try to reduce by rejecting its perceived cause. Stigma can be attached to themselves or their epilepsy by the person with epilepsy, as well as by others about them. Such discomfort is accentuated by perceived inconsistency between the familiar and unfamiliar. Discrimination occurs as a result of stigma, causing people with epilepsy to be preoccupied with epilepsy and expending much psychological energy on disclosure anxiety, vigilance and a consequent uncertainty of identity. This can result in lower self-esteem, self-fulfilling prophecies, self-blame and self-rejection, and ultimately dehumanisation. The most effective means of overcoming stigma is by contact between people with epilepsy and those holding the stigma against them. Such contact must be on an equal status footing, repeated and consistent, require interdependence, be socially approved and enjoyable, contradict the stereotypes held, and be with individuals seen as representative of the out-group as a whole. Hence familiarity, rather than breeding contempt, produces the predictability and consequent comfort and acceptability of the normal. [ABSTRACT FROM AUTHOR]