Beyond Epilepsy

Hysteria and epilepsy had been linked long before Jean Paul Charcot attributed seizures to a physical disturbance within the brain. Seizures, according to Charcot, were the manifestation of true hysteria. Charcot had the advantage of his position at the Salpêtrière, a general asylum with a large number of chronic epileptic patients, largely poor and female. The reorganisation of the Salpêtrière led to a ward dedicated to epilepsy, which was then divided into those who were ‘sane’ and those who were ‘insane’. Charcot’s hysterical patients were therefore mixed with long-stay epileptic patients without any formal differential diagnosis being given. It was further believed to be the case that hysterical patients mimicked the convulsive seizures of epileptic patients as part of the ‘crisis’ in le grand hysterie, and that such attacks rendered both epileptic and hysteria patients in the same category.

Charcot therefore identified a hybrid form of epilepsy and hysteria which was said to mimic the progression of the newly named ‘grand mal’ seizure but was caused by hysteria.  After 1878, his studies of epilepsy moved into theatrical séances, in which female patients were hypnotised to laugh, cry and to fall into convulsions. Although identified by the Romans, the trance-like state produced by temporal lobe epilepsy was forgotten until the 1950s. However, Mesmer and his followers were operating on epileptic patients were able to produce seizures through light, sound and touch as triggers.  One of Charcot’s colleagues at the Salpêtrière, Paul Richer, discussed a close link between hypnotic states and epilepsy in 1885, namely in hystero-epilepsy, arguing that this included hallucinations, automatism and état somnambulique, or sleepwalking.

Ian Hacking, in discussing the cultural figure of ‘the fugue’ in French psychiatry further adhered to some knowledge of the link between automatic action and epilepsy, arguing that French neurologists had identified a latent form of epilepsy in men found wandering for days with little memory of their actions.  This semi-permanent state of hypnosis fell firmly into late nineteenth century French ideas of trance-like states, and the link with epilepsy is identified not by convulsive seizures, but in temporary lapses in consciousness.