‘A botanist, a forester, an artist, and a  carpenter will not see the same tree’.

Martti Siirala

Doctors who have trained in the last decade should have had first hand experience of taking a psychiatric history. It is useful because in any situation of medical complexity it is advisable to move from the medical tradition of focusing on the history of the present disorder to the psychiatric tradition of coming to know the predicament of the family through a systematic exploration of it.1 This perspective of epilepsy comes from working with children at various special centres for epilepsy, in tertiary consultation about learning and behavioural problems, and looking at child and adult candidates for operations for epilepsy. It depends on an acquaintance with the biography of the child.

The comforting popular nostrum is that most people with epilepsy have no behavioural problems and respond well to treatment.2Such people would, presumably, attend hospital rarely and hardly affect my experience. An alternative view (‘reframing’ is the psychiatric term) is that no less than one in five people with epilepsy have persistent difficulties that create therapeutic challenges: a fairly large number. This is certainly a better view for childhood onset epilepsy, where the more usual story is that, behaviourally, things were not too good before treatment began and have been worse since.3 It is more consistent with epidemiological studies,4 which find that up to 75% of children with epilepsy will have behavioural problems, depending on whether there is a structural disorder above the brain stem.

The behavioural aspects of …