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.

 Études cliniques sur l'hystéro-épilepsie ou grande hystérieCredit: Wellcome Library, London. WellcomeÉtudes cliniques sur l'hystéro-épilepsie ou grande hystérie. Epilepsy.1881 Études cliniques sur l'hystéro-épilepsie ou grande hystérie /Paul Marie Louis Pierre RicherPublished: 1881Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0
Études cliniques sur l’hystéro-épilepsie ou grande hystérieCredit: Wellcome Library, London. WellcomeÉtudes cliniques sur l’hystéro-épilepsie ou grande hystérie. Epilepsy.1881 Études cliniques sur l’hystéro-épilepsie ou grande hystérie /Paul Marie Louis Pierre RicherPublished: 1881Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0

Demons and Possession

Prior to the development of neurology in the mid nineteenth century, the history of epilepsy was closely tied to cultural beliefs and folk medicine.  Some historians think that from the Greeks to the modern day, epilepsy was the perfect example of science triumphing over medicine. Greek doctors such as Hippocrates, and Roman doctors such as Galen knew that the cause of epilepsy lay in the brain. A collection of medical writings in 400BC ‘on the Sacred Disease’ argued that epilepsy was not a divine disease, to be attributed to the Gods, but was caused by a disturbance in the brain. Ancient Greeks believed that the body was made up of four humours: black bile, yellow bile, phlegm and blood. The imbalance of any of these was believed to cause disease, and idea which remained central to medical thought until well into the eighteenth century. The theory of four humours was in part the basis of the popular practice of bloodletting as a treatment for fevers In the case of epilepsy, convulsions were meant to be caused by too much phlegm in the brain which rushed into the body and produced the symptoms of an attack.  Hippocrates recommended the purging of phlegm, taking a hot bath and anointing the head with oils and salt.

However, popular beliefs about epilepsy at the time led it to be called the ‘sacred disease’, because it was believed that the condition was sent by a deity, or that a demon had entered the body of the sufferer.   Therefore, in addition to the balancing of the humours, many ‘cures’ were based on the supernatural beliefs.  The Romans believed that epilepsy was the result of vengeance from Mene, the goddess of the moon. There was also the strong association with epilepsy and the moon, and of seizures playing a part in omens in dreams. The avoidance of goats was recommended, because of the animals’ connection with the moon goddess and to Hekate.  Gladiator blood was used until the fifth century to strengthen and cure those who experienced seizures, partly due to the belief that it had magical properties.It was common practice up to the Roman times to spit on people experiencing a fit, in order to ward off contagion.

Christian writers and theologians in the late medieval period wrote frequently about sufferers’ unclean spirits and the activity of the devil causing seizures within the body. This led to the attempts to cure epilepsy through the medium of prayer and attempted exorcism of evil spirits. People relied heavily on help from saints and relics to ward off epilepsy, and to enact a cure. In part, this explains why there has always been a prevailing fear of people with epilepsy. In the nineteenth century, this was translated into the language of medical modernity. While neurology was being developed, elsewhere epileptics were being re-case in the language of lepers–not for fear of contagion through disease, but added into the dialogue of ‘deterioration’ of the urban population and the avocation of separate communities.

It’s important here to recognise that the development of medical knowledge does not necessarily mean that folk beliefs are eradicated. In fact, scientific studies still examine the link between seizures and the state of the moon, and although nobody is going around spitting on people having seizures (hopefully!) there remains a constant perception of epilepsy as the ‘epileptic cry’, foaming at the mouth and convulsions associated with a tonic clonic seizure. Its history, as its experience, is so much more than that.

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