Epilepsy is among the oldest documented diseases in human history: a brain condition in which a person suffers repeated seizures — episodes of abnormal electrical activity that produce convulsions, loss of consciousness, or strange sensory experiences. Its most visible form — the generalized tonic-clonic seizure — is dramatic enough that physicians and laypeople across every era have felt compelled to explain it. For much of recorded history that explanation was religious: the seizure was a visitation from a god, a demon, or the moon. The Hippocratic text that rejected all of that — arguing that epilepsy has a natural cause like any other disease — is often treated as the founding document of rational medicine. What followed was not a straight line from superstition to science but a series of contested reclassifications: epilepsy migrated between theology, magic, asylum psychiatry, and neurology before arriving at its present place in the clinic.
Temkin, whose monograph The Falling Sickness (1971) remains the standard history of epilepsy, argues that epilepsy “held one of the key positions” in the long struggle between magical and scientific conceptions of disease precisely because, “showing both physical and psychic symptoms, epilepsy more than any other disease was open to interpretation both as a physiological process and as the effect of spiritual influences.”(Temkin, Owsei, 1971) The words “epilepsy” and “epileptic” derive from the Greek epilambanein, meaning “to seize” or “to attack,” terminology that may trace back to very old magical conceptions in which all diseases were believed to be attacks by gods or demons; since epilepsy was the demoniac disease par excellence, the term gradually narrowed to it.(Temkin, Owsei, 1971) Temkin also frames the entire history as “a moulding of all those elements into a unit implied when we talk about the disease,” asserting that an ideal disease history blends natural history with human history, and that the modern physician “bears the imprint of his predecessors” whether or not he knows it.(Temkin, Owsei, 1971)(Temkin, Owsei, 1971)
The Earliest Records: Babylonian and Greek Pre-History
The oldest clinical reference to a disease identifiable as epilepsy is in the Babylonian Sakikku diagnostic tablets, where the text states plainly: “if epilepsy falls once upon a person [or falls many] times, [it is (as a result of) possession] by a demon or a departed spirit.”(Longrigg, 1993) This is not simply credulity. The Sakikku represent a sophisticated diagnostic tradition organized around the logic of demonic attribution: particular symptoms corresponded to particular supernatural agents, and treatment followed from correct identification of the agent. The system was internally consistent even if its premises are ones modern medicine no longer shares.
Temkin notes that the Mesopotamian engagement with epilepsy predates even this text: an Akkadian source describes a person whose neck turns left, whose hands and feet are tense, eyes wide open, with froth flowing from the mouth and consciousness being lost, and this is diagnosed as antaSubbu and related to “the hand of Sin,” the god of the moon, by an exorciser.(Temkin, Owsei, 1971) Ancient popular belief attributed the disease to divine punishment, demonic possession, or attacks by those who had sinned against Selene, the moon goddess; at the bottom of all these attributed causes lay the basic belief that “the disease is an infliction or possession by a higher power and that its cure must be supernatural.”(Temkin, Owsei, 1971)
The Code of Hammurabi (c. 1754 BCE) provides a different kind of early reference: article 278 of the code voided the sale of a slave if the bennu disease — probably epilepsy, identified as a spastic disorder by the historian Karl Sudhoff on the basis of philological and medical analysis — befell the slave within one month of purchase.(Sigerist, Henry E., 1951) This provision was later extended in Assyrian sales contracts to one hundred days and included a second condition, sibtu, possibly leprosy. The legal treatment of epilepsy as a defect that nullified commercial transactions tells us that, whatever its supernatural significance, it was also recognized in practical terms as a chronic disability.
The social stigma that attached to the disease in antiquity was severe and documented in precise terms. Temkin draws on Theophrastus’s sketch of the superstitious man, who “shudders and spits in his bosom” on seeing a madman or an epileptic; of an epileptic slave, Thallus, it was said that his fellow slaves used to spit, that “nobody dares to eat with him from the same dish or to drink from the same cup.”(Temkin, Owsei, 1971) In Roman law, epilepsy (called morbus comitialis) was held so ominous that an epileptic attack occurring on the day of the public assembly (the comitia) could invalidate its proceedings: the disease acquired its Latin name from this legal incapacity.(Temkin, Owsei, 1971)
The Sacred Disease: Hippocratic Rationalism and Its Stakes
The Hippocratic treatise On the Sacred Disease declares that epilepsy is no more divine than any other disease and has a natural cause.(Ackerknecht, 1955) As Ackerknecht summarizes: “It appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause from which it originates like other affections. Men regard its nature and cause as divine from ignorance and wonder.”(Ackerknecht, 1955) The treatise argued specifically that epilepsy arose from the brain, with excess phlegm blocking cerebral function, marking a paradigm shift toward naturalistic medicine.(Pormann (ed.), 2018) This was not an isolated claim but part of a broader Hippocratic position: the corpus argued that epilepsy and mental disturbances had wholly natural causes rooted in the body, explicitly rejecting divine or demonic explanations.(Andrew Scull, 2015) Berrios identifies this text as a founding document of rational medicine, denying the supernatural causation of epilepsy by arguing that it arose from the brain like all other diseases.(German E. Berrios & Roy Porter (eds.), 1995)
Temkin’s account adds important historiographic precision. He identifies On the Sacred Disease as “not only the first monograph on epilepsy that we possess, but also one of the most important documents extant of magic beliefs and practices in ancient Greece” — and shows that the author went further still: not only is epilepsy not more divine than other diseases, but “the brain is the organ of all psychic processes both normal and pathological; not only epilepsy, but all mental diseases as well, can be explained by disturbances of the brain.”(Temkin, Owsei, 1971)(Temkin, Owsei, 1971) Galen, however, expressed doubt about the authenticity of the treatise, and when Hippocrates’ works were edited at the start of the sixteenth century, a note was found in several manuscripts stating that Galen had thought the work spurious and “not congruous with the style and acumen of Hippocrates” — a skeptical tradition that was later widely publicized.(Temkin, Owsei, 1971)
Longrigg reads the text as the clearest expression of Ionian rationalism applied to medicine: just as the Milesian philosophers had explained earthquakes, thunder, and eclipses in natural rather than divine terms, this Hippocratic author explained epilepsy.(Longrigg, 1998) The Hippocratic author acknowledged that nature itself is divine, but held that this divinity applies equally to all diseases and therefore provides no justification for treating epilepsy as uniquely sacred.(Longrigg, 1998) Longrigg further notes that the disease has its own specific nature and cause, contrary to the belief in divine origin.(Longrigg, 1993)
But the author’s argument was not simply a rejection of divinity. Jouanna identifies its more subtle claim: “all diseases are divine and all human — no one being more divine or more human than any other.”(Jouanna, 1999) In refusing to call epilepsy especially sacred, the text did not secularize medicine in the modern sense. It asserted instead that the whole of nature participates in the divine, which means no disease can be singled out as more supernaturally significant than any other. The author of De morbo sacro did not reject divinity entirely but declared all diseases equally divine and equally natural, reflecting the Ionian philosophical position that the whole of nature is divine.(Longrigg, 1993) Longrigg adds the logical structure behind this: the author invoked what functions as a modus tollens — if epilepsy were divine, it should affect all people equally; but the bilious escape it while phlegmatics do not; therefore it cannot be divine.(Longrigg, 1993)
The physicians who attributed epilepsy to divine origin are described in the text as “magicians, faith-healers, charlatans and quacks” who invoked the sacred to conceal their own ignorance.(Jouanna, 1999) The same polemic appears in Longrigg’s reading: the author attacked these practitioners for attributing epilepsy to divine origin in order to conceal their own ignorance and safeguard their professional interests.(Longrigg, 1993) This polemical charge is one of the earliest moments in which the boundary between legitimate medicine and its fraudulent alternatives was drawn explicitly. Jouanna reads the treatise as “the first time a rational medicine is posited in express opposition to a religious and magical medicine” — a genre-founding text for medical self-definition, not simply a clinical observation.
The magico-religious practitioners had developed a sophisticated diagnostic system of their own.(Jouanna, 1999) Different seizure presentations were attributed to different divine powers: goat-like behavior to the Mother of Gods; horse-like behavior to Poseidon; foam and kicking to Ares; night terrors to Hecate or heroes.(Jouanna, 1999) The magico-religious practitioners combined religious purifications and incantations with dietary restrictions that overlapped with Orphico-Pythagorean interdicts, forbidding sea fish, goat, deer, pig, dog meat, and certain vegetables.(Jouanna, 1999)
The treatise’s rationalism extended beyond epilepsy itself. Jouanna identifies a parallel in the author of Diseases of Girls, who gave a rational explanation for pubescent epileptic-like crises as blocked menstrual flow spreading to heart and diaphragm, then explicitly condemned soothsayers who counseled girls to dedicate offerings to Artemis.(Jouanna, 1999)
Among the most striking magical treatments for epilepsy documented in antiquity was the drinking of gladiatorial blood. Pliny describes epileptics who drank the blood of gladiators “as it foams warm from the man himself” — a practice he attributed to the Persian magician Osthanes, who he claimed taught it to the Greeks.(Temkin, Owsei, 1971) The empiricist Scribonius Largus also documented the practice of epileptics eating a piece of gladiator liver nine times, but characterized it as falling “outside professional medicine — although it has apparently helped in some cases”: a concession that professional physicians were not permitted to use cannibalistic remedies even when they admitted they might work.(Temkin, Owsei, 1971) Even Galen admitted that burned human bones might have curative effect and reported prescribing them to patients without their knowledge “lest they should be nauseated.”(Temkin, Owsei, 1971) Temkin draws the broader lesson: from the fourth century onward, most Greek physicians, though remaining hostile to demoniac etiology and not using incantations themselves, admitted the effectiveness of amulets, miraculous remedies, and lunar influence — a practical compromise that fell well short of the Hippocratic position.(Temkin, Owsei, 1971)
Rocca’s analysis adds a further precision: the Hippocratic brain in On the Sacred Disease is not yet conceived as an organ with autonomous control over the body.(Rocca, 2003) The brain functions as a mediator or interpreter (hermēneus) for incoming air.(Rocca, 2003) All perceptions and sensations are attributed to the brain, but the brain is understood as a relay station rather than a commanding center.(Rocca, 2003) [GAP: The original paragraph included a claim about convulsions caused by phlegm blocking air, which is unsupported.] [GAP: The original paragraph included a claim about later development of full encephalocentrism through Herophilus, Erasistratus, and Galen, which is unsupported.]
Longrigg is also careful to note the limits of the Hippocratic achievement.(Longrigg, 1998) Despite the rationalist critique of divine causation, the positive theory the author offered in its place was equally speculative and untested: “Although his establishment of a naturalistic basis for the understanding of madness and his rejection of any reference to the divine or demonic marks a release from one sort of mystification, he achieves this at the cost of the substitution of another.”(Longrigg, 1998) The confidence in phlegm-blocking as the mechanism was clearly a matter of faith.(Longrigg, 1998) Nevertheless, the author established a consequential principle: all mental disturbances including madness and delusions were attributed to afflictions of the brain, declaring that “all of these afflictions come from an unhealthy brain.”(Longrigg, 1993)
Ancient Clinical Knowledge: Definitions, Aura, and Galenic Classification
Alongside the philosophical debates, a detailed clinical account of epilepsy accumulated in the ancient world. It was commonly recognized that the disease occurred most frequently in early childhood, especially at teething, and that its onset for the first time after age twenty was deemed exceptional.(Temkin, Owsei, 1971) Aristotle drew the unusual theoretical comparison that “sleep is similar to epilepsy and in some way, sleep is epilepsy,” linking the two as physiological functions that impair normal waking consciousness.(Temkin, Owsei, 1971)
Ancient physicians eventually converged on a clinical definition that Temkin traces to the Alexandrian physician Erasistratus and later made canonical by Galen: “epilepsy is a convulsion of the whole body together with an impairment of the leading functions.”(Temkin, Owsei, 1971) Galen’s own tripartite anatomical classification organized the disease into three types by origin: idiopathic (the brain itself affected), sympathetic from the stomach, and sympathetic from any other part of the body; the distinction rested partly on theory and partly on differences in the aura.(Temkin, Owsei, 1971) Medieval physicians would elaborate this scheme by naming the three forms separately — epilepsy (idiopathic, head-form), analepsy (stomach-origin), and catalepsy (other body parts) — but Renaissance humanists eventually rejected these names on the grounds that “neither Galen nor anyone among the Greeks has recorded these species of epilepsy.”(Temkin, Owsei, 1971)(Temkin, Owsei, 1971)
The concept of the aura entered medical terminology not from a physician but from a patient. When the young Galen visited a thirteen-year-old boy in company with other physicians, the boy described a sensation that rose in a straight line from his lower leg through the thigh, flank, side, and neck to the head, at which point consciousness failed; a second youth who was “a better observer” described the sensation as “like a cold breeze.”(Temkin, Owsei, 1971) The word for that cold breeze, “aura” (breath), thus named the subjective onset of a seizure, one of the few technical medical terms introduced by a patient rather than a theorist. Soranus provided a systematic catalogue of the warning signs that could precede epileptic attacks: heaviness and giddiness in the head, an inner noise felt in the occiput, tension in the eyes, ringing in the ears, vertigo, dimness of vision or objects hanging before the eyes, “tiny sparks, so to speak, or fiery circles,” anxiety, irritability, and forgetfulness for recent events.(Temkin, Owsei, 1971)
Galen also catalogued the external circumstances that could precipitate an attack in those predisposed: frost and violent heat, strong winds and strenuous baths, “repulsive food and whirling wheels, lightning and thunder, sleeplessness and indigestion, distress and anger and weariness and similar things of which the chief characteristic is that they stir up and trouble the body violently.”(Temkin, Owsei, 1971) Philosophical differences among the three main medical sects — dogmatists, empiricists, and methodists — made the development of a generally accepted pathology impossible in antiquity, each approaching the hidden causes of disease from an incompatible methodological foundation.(Temkin, Owsei, 1971) The empiricist school was peculiarly susceptible to magical remedies as a result: having rejected the possibility of discovering hidden causes as “incomprehensible,” it was easy for them to admit that nature might possess occult powers acting through certain drugs and amulets to produce miraculous cures.(Temkin, Owsei, 1971) The repertoire of ancient remedies ranged from the rational to the grotesque: Diocles of Carystus and Praxagoras of Cos recommended, among other things, lichen of horses or mules, genitals of seals, testicles of hippopotamus, and blood of tortoise or flatfish — all classified as rational rather than magical remedies within the Greek medical framework.(Temkin, Owsei, 1971)
Post-Hippocratic Natural Philosophy: Pneuma and Blockage
The fourth-century physicians Diocles of Carystus and Praxagoras further developed the natural explanation of epilepsy in terms of pneuma — the refined air-like substance understood to carry nervous function through the body. Praxagoras and Diocles both located the mechanism in the region of the aorta: phlegmatic humors aggregating there formed bubbles that blocked the passage of psychic pneuma, producing the whole-body spasm of the convulsion.(Longrigg, 1998) Nutton’s account of Diocles is more specific: blockage of pneuma by congealed phlegm within the aorta caused epilepsy and apoplexy together, the distinction lying in whether the authoritative functions of the soul were involved.(Nutton, 2023)
Galen’s symptom taxonomy included motor symptoms such as akinesia and dyskinesia, with whole-body forms acquiring specific names like epilepsy and apoplexy.(Galen / Ian Johnston (trans.), 2006) Aretaeus of Cappadocia produced works written in a highly stylised Hippocratic Greek dialect, full of allusions to the Hippocratic Corpus, which were long considered to offer the finest nosological studies from antiquity.(Nutton, 2023)
Herbal Treatment: The Paeony Tradition
Alongside the theoretical accounts ran a parallel practical tradition of treating epilepsy with botanicals. The plant most consistently associated with epilepsy across the ancient and medieval world was paeony (Paeonia officinalis), typically worn as an amulet rather than ingested. Galen described an early controlled observation: a boy who had worn a paeony root for eight months without seizures fell ill again when the root accidentally fell off. Galen then removed the root deliberately, observed that seizures returned, replaced it with a larger piece, and found the seizures stopped.(Tobyn Denham Whitelegg, 2011) Temkin’s account of the same episode preserves Galen’s own rationalization of the mechanism: he speculated either that “certain particles of the root fell out, were sucked in by inspiration, and did thus heat the affected part — or that the air itself was tempered and changed by the root,” suggesting that for Galen the amulet was experimentally effective but its mechanism needed a rational account to distinguish it from magic.(Temkin, Owsei, 1971) This is among the earliest documented quasi-experimental therapeutic tests in Western medicine.
William Turner, the sixteenth-century English herbalist, replicated Galen’s observation on two children — one in London, one at Syon House — and reported the same effect.(Tobyn Denham Whitelegg, 2011) The use of paeony as an amulet for epilepsy in children reappears in Miller in the eighteenth century and is noted by Quincy as “much esteemed by good women” for teething convulsions in infants.(Tobyn Denham Whitelegg, 2011) This persistence across fifteen hundred years — from Galen through the early modern period — illustrates the fluid boundary between what the period called rational medicine and what it called magical practice: an experiment conducted by Galen became an amulet recommended by herbalists and midwives.
The medieval Trotula included paeony in a 76-ingredient compound called Potio sancti Pauli specifically for epileptics, analeptics, and cataleptics — showing the Galenic anticonvulsant tradition entering the gynecological literature.(Tobyn Denham Whitelegg, 2011)
Mistletoe occupied a different position. Porter identifies it as the most distinctive folk remedy for epilepsy across multiple European traditions, the symbolic logic apparently drawing on the fact that mistletoe clings to its host tree without touching the ground — embodying a principle of transcendence fitting for a disease understood as a visitation from above.(German E. Berrios & Roy Porter (eds.), 1995)
The Name “Falling Sickness” and Medieval Conceptual Shift
During the Middle Ages, the classical medical term “epilepsy” was largely displaced in popular speech by “the falling evil” or “falling sickness,” a name derived from the most visible symptom of the attack. Apuleius used caducus as a synonym for the epileptic, and Augustine described the caducarii, explaining: “it is common among us to call those whom epilepsy has smitten” by that name; cognate terms appeared across European languages — passio caduca in Latin, fallendes Siechtum and Fallsucht in German.(Temkin, Owsei, 1971) Byzantine medical books recorded that the people called the disease “demon” and “lunacy,” and Latin texts from the seventh century identified the caducus (epileptic) with the demoniacus, prescribing remedies “for epileptics, i.e., demoniacs and those suffering convulsion.”(Temkin, Owsei, 1971)
The spread of Christianity decisively intensified this conflation. The theologian Origen, interpreting the New Testament account of the lunatic boy (Mark 9:14-29), wrote against the physicians who “may offer natural theories since according to their view it is not an unclean spirit but a bodily affection which presents itself,” and declared that this disease “in those affected with it, is obviously brought about by an unclean dumb and deaf spirit” — a position Temkin identifies as “a decisive break with pagan Antiquity,” followed by many Greek and Latin Fathers.(Temkin, Owsei, 1971) The Marcan account itself describes a boy who foams, gnashes his teeth, is convulsed, and suffers attacks from childhood — symptoms that ancient physicians would have recognized as epileptic without hesitation.(Temkin, Owsei, 1971)
Medieval astrology attributed epilepsy, lunacy, and similar periodic conditions to lunar and planetary influence; Vettius Valens, a contemporary of Galen, wrote that Saturn and Mars in lower culmination made people liable to “falling fits,” and that when these planets influenced the moon they created “maniacs, ecstatics, persons liable to fall, and prophets.”(Temkin, Owsei, 1971) Lucian’s second-century dialogue records the perspective of an educated pagan skeptic, who cited the example of a Syrian exorcist from Palestine who would make epileptics speak out the demon possessing them — illustrating that before Christianity, the educated pagan class also acknowledged exorcistic practice, even while maintaining philosophical skepticism about it.(Temkin, Owsei, 1971) Medical glosses of the period distinguished two kinds of epilepsy: those with full convulsions and unconsciousness (a natural disease) and those with foaming and trembling without convulsion, “whom the crowd calls demoniacs,” who were partly conscious — a clinical split that reflected the conceptual boundary between natural disease and possession.(Temkin, Owsei, 1971) The term “lunatic” (lunaticus) was not a simple synonym for epileptic but referred broadly to all abnormal states manifesting in periodic attacks; its comprehensiveness explains its different meanings across European languages, where in English it came to signify the insane in general and in German the somnambulistic.(Temkin, Owsei, 1971)
Early medical texts through the eleventh century nevertheless treated possession in a detached, naturalistic way. Theodorus Priscianus in the fourth century prescribed the same cures for madness, epilepsy, and divine possession alike; Paulus of Aegina in the seventh century dealt with possession within his chapter on madness.(Temkin, Owsei, 1971) The philosopher Aristotle had earlier set a precedent by comparing epilepsy to moral incontinence: “for wickedness is like a disease such as dropsy or consumption, while incontinence is like epilepsy; the former is a permanent, the latter an intermittent badness” — making the seizure disorder a model for thinking about the periodically uncontrolled will.(Temkin, Owsei, 1971)
Medieval Medical Theories of Epilepsy
Medieval medical writing on epilepsy was, as Temkin argues, essentially derivative: “mere variants of ancient theories, especially those of Galen… devoid of the provoking originality of the theological speculations of the time, and more often dimmed by confusion than guided by experience.”(Temkin, Owsei, 1971) Medical scholasticism at Alexandria had organized Hippocrates and Galen as canonical authorities by around 500 CE; Syrian and Arabic physicians acquired this Galenic system in its late scholastic form and transmitted it to the Latin West, where it remained unchallenged until the late fifteenth century.(Temkin, Owsei, 1971)
Cassius Felix (447 CE) faithfully reproduced the Galenic framework: two varieties of epilepsy (one accompanied by convulsions, the other marked by sleep) and three pathological forms by origin (brain, stomach, or other lower part).(Temkin, Owsei, 1971) Medieval physicians did, however, add one terminological innovation: the three Galenic types were given separate names, so that “epilepsy” in the restricted sense denoted the idiopathic head-form, “analepsy” denoted the stomach-form, and “catalepsy” the form arising from elsewhere.(Temkin, Owsei, 1971) Medical writers were careful to distance themselves from demonic attribution: they noted that ordinary people called the disease sacred or demonic, but, like the Hippocratic author who spoke of the “so-called sacred disease,” they emphasized the popular character of such ascriptions and did not identify themselves with them.(Temkin, Owsei, 1971)
The Salernitan physician Platearius introduced what Temkin identifies as an anticipation of the later grand mal / petit mal distinction: “major epilepsy” involved complete obstruction of the principal ventricles and full convulsions; “minor epilepsy” involved partial obstruction and milder symptoms, including urinary, fecal, and seminal incontinence in the major form.(Temkin, Owsei, 1971) Bernard of Gordon, writing at the end of the thirteenth century, described seizures so mild that the patient “merely had to lean against a wall or something similar and rub his face — and it ceased,” or felt confusion and darkness before him, said an Ave Maria, and “before he had finished the paroxysm had passed” — one of the earliest medieval clinical descriptions of partial or absence seizures.(Temkin, Owsei, 1971) Medieval physicians also extended the Galenic classification by naming all possible organs of the body as potential sites of origin for sympathetic epilepsy — liver, spleen, kidneys, intestines, even fingers and toes — using aura symptoms as diagnostic clues to the remote origin.(Temkin, Owsei, 1971)
Medieval and Early Modern Contexts
Rawcliffe documents that cauterization, applied to designated points on the head and body, was believed to eliminate the superfluous cold and moist humors “responsible for stubborn headaches, dropsy, epilepsy, disorders of the eyes, throat, nose and ears.”(Rawcliffe, 1997)
But the spiritual framework persisted alongside the medical one. Porter notes that among the battery of healing saints who replaced Asclepius in medieval Christian practice, St. Christopher was specifically invoked for epilepsy.(Porter, 1997) The disease’s visible severity — the sudden collapse, the convulsion, the apparent loss of selfhood — made it a natural candidate for continued supernatural interpretation even within a formally Galenic medical culture.
Keith Thomas documents the related English practice of monarchs blessing cramp-rings specifically for epilepsy, the rings’ power derived from their contact with the royal body during a liturgical ceremony. The practice is documented by Crawfurd and placed by Marc Bloch within the broader framework of thaumaturgic monarchy.(Thomas, Keith, 1971) This royal healing practice coexisted with academic Galenism for centuries: ordinary practitioners used humoral treatments; the royal touch offered a supernatural supplement.
Paracelsus represents a different kind of rupture in the early modern period. Zilboorg, writing in Sigerist’s edition of Paracelsus, argues that Paracelsus anticipated the descriptive method in psychiatry “by almost fifty years” before Weyer, describing the clinical manifestations of epilepsy, mania, and hysteria “in the manner of an earnest observer.”(Henry E. Sigerist (ed.), C. Lilian Temkin, George Rosen, Gregory Zilboorg, 1941) The context matters: when Paracelsus wrote on mental diseases, psychiatry was effectively a department of theology, and “the best textbook of mental disease, the most popular and the most authoritative, was the Malleus Maleficarum.”(Henry E. Sigerist (ed.), C. Lilian Temkin, George Rosen, Gregory Zilboorg, 1941) His insistence on clinical observation in that context was a genuine departure.
Renaissance Debates on Possession and Witchcraft
The Renaissance produced sustained medical engagement with the differential diagnosis between epilepsy and demonic possession. Jean Taxil, a physician at Arles writing in 1602, argued that it was “scarcely possible to find any case in literature of a demoniac who was not epileptic” — not meaning to deny possession, but observing that the genuinely possessed suffered epileptic convulsions alongside their supernatural affliction.(Temkin, Owsei, 1971) Physicians developed practical criteria for distinguishing the two: atypical symptoms, failure of rational treatment, and the patient speaking foreign languages or prophesying were taken as evidence of supernatural rather than natural causes.(Temkin, Owsei, 1971) Fernelius described a case of partial seizures treated rationally for three months without success, until a devil “bewrayed himself by voice, and unaccustomed words and sentences, as well Latin as Greek.”(Temkin, Owsei, 1971) Even the Malleus Maleficarum acknowledged that epilepsy “because of its deep roots in the physique of the patient, offered very considerable difficulties to an explanation by witchcraft,” implicitly recognizing that it was normally a natural disease.(Temkin, Owsei, 1971)
Temkin makes a counterintuitive historiographic argument about the witchcraft debates: the learned defenders of the theory paradoxically strengthened the status of epilepsy as a natural disease, because their theology required them to distinguish the natural condition from supernatural affliction. Since convulsive movements of an epileptic appearance counted among the characteristic symptoms of witchcraft sickness, it was necessary to acknowledge that ordinary epilepsy was not caused by witchcraft.(Temkin, Owsei, 1971) Franciscus Valesius found a reconciliation by making the demon an external cause that set internal material causes (phlegm, black bile) in motion, so that the humoral pathology need not be denied even in cases of possession.(Temkin, Owsei, 1971) The Paracelsian physician Martin Ruland treated a case he attributed to witchcraft with bloodletting and purgation — curing the patient by rational means while maintaining his belief in a witch-sent demonic poison, an instance of how Paracelsian practitioners could hold supernatural etiological beliefs while practicing natural therapies.(Temkin, Owsei, 1971) The elder Riolanus took a skeptical position: he explained divine possession as a disturbance of phantasy by melancholic vapors and argued that it was “not necessary for us to have recourse to a demon as the last refuge of ignorance, since we have a natural cause.”(Temkin, Owsei, 1971) Levinus Lemnius, confronting the most dramatic end of the seizure spectrum, noted that epileptics seized in public were sometimes assumed dead by the terrified onlookers and buried prematurely, then revived in their coffins.(Temkin, Owsei, 1971) Paracelsus and hermetic medicine consistently favored magical treatments for epilepsy; yet Temkin notes that “scarcely any physician down to the end of the seventeenth century rejected ‘natural’ remedies altogether,” and even radical reformers like Johann Weyer remarked that he did not want to take away faith in “natural” ligatures and amulets.(Temkin, Owsei, 1971)
Renaissance Clinical Advances
Alongside these theological debates, the sixteenth and seventeenth centuries produced significant clinical gains. Renaissance humanist scholarship corrected the medieval terminological muddle by returning to the Greek sources; the terms “analepsy” and “catalepsy” for Galen’s three types were explicitly rejected on the grounds that neither Galen nor any Greek author had recorded these species.(Temkin, Owsei, 1971) Case history publication proliferated: Duretus described a classic case of post-traumatic epilepsy, in which a skull fracture in a twelve-year-old that had been “by negligence not restored” caused epilepsy at age eighteen, then cured by trephination of the depressed bone — one of the first documented successful structural interventions.(Temkin, Owsei, 1971) Syphilis was recognized as a cause of epileptic convulsions, and mercury treatment for syphilis was blamed for iatrogenic epilepsy, with physicians arguing that mercury “by its whole substance is hostile to human nature” and destroyed the animal spirits.(Temkin, Owsei, 1971)
Physicians also recognized forms of epilepsy that challenged the classical definition requiring full convulsion with loss of consciousness. Fabricius Hildanus attributed two cases of infant epilepsy to the imagination of their pregnant mothers who had observed epileptics during pregnancy — an instance of the widespread Renaissance belief in psychogenic and maternal impression causes.(Temkin, Owsei, 1971) Benivieni described a patient who entered his bedroom, stood still with eyes wide open, failed to respond to his wife’s questions, was put to bed, recovered with no memory of what he had been doing, and whose later frank seizures confirmed the original episode as epileptic.(Temkin, Owsei, 1971) A Paracelsist physician, Toxites, described a woman who could foresee her attacks, urinated involuntarily at onset, then moved about with open eyes performing automatisms at her spinning wheel without falling, and upon recovering asked what she had been doing — an early case study of what would now be called complex partial epilepsy.(Temkin, Owsei, 1971) Charles Le Pois advanced the theoretical debate by arguing that all epilepsy originates in the brain itself rather than through sympathetic transmission from other organs, directly challenging the Galenic tripartite scheme.(Temkin, Owsei, 1971) Steeghius (c. 1600) articulated the concept of symptomatic epilepsy — epilepsy as a symptom of other diseases such as smallpox and poisonous bites that “ceases together with their cure” — using “symptom” in the sense of complication rather than sign, an early step toward the modern idiopathic/symptomatic distinction.(Temkin, Owsei, 1971) By the end of the sixteenth century, the affinity between vertigo and epilepsy was stressed anew, with physicians sometimes uncertain how to classify a given case; Erastus examined a girl who for half an hour ran about the room, spoke to no one, and upon recovering denied having seen or heard anyone present.(Temkin, Owsei, 1971)
Van Helmont, writing in the seventeenth century, used epilepsy as a conceptual reference point in a striking way: he described dry asthma as “an epilepsy of the lung,” latent for long periods and producing attacks of contraction confined to one organ, in the same way that epilepsy confines its spasm primarily to the nervous system.(Pagel, Walter, 1982) He also argued that asthma’s poison “is essentially identical with the poison of epilepsy, but not strong enough to produce the latter” — using epilepsy as an implicit scale for measuring the severity of disease-specific poisons.(Pagel, Walter, 1982)
The boundary between medical and religious authority over epilepsy remained contested well into the Enlightenment. Johann Joseph Gassner, an obscure Austrian priest, performed exorcisms in rural southwestern Germany in the 1760s and 1770s, attracting crowds of the afflicted, until he was ordered to stop and return to his parish.(Andrew Scull, 2015)
Thomas Willis’s anatomical research on the brain and nervous system in the mid-seventeenth century provided the foundation for reconceptualizing madness and nervous disorders as rooted in the nervous system rather than humoral imbalance.(Andrew Scull, 2015) He claimed that the anatomy of the nervous system had revealed the true and genuine reasons for many actions and passions, and from this fountain, the hidden causes of diseases.(Andrew Scull, 2015)
Seventeenth-Century Chemical and Mechanical Systems
The seventeenth century saw the displacement of Galenic humoral theory by two rival research programs: iatrochemistry and iatromechanics. Both reframed epilepsy in terms of the physical sciences of the day, and both shared the tendency to make the epileptic attack appear as “a necessary result of chemical forces” rather than a purposeful biological act.(Temkin, Owsei, 1971)
Franciscus Sylvius (1614-72) explained epilepsy through iatrochemistry: the proximate cause was disordered animal spirits; the remote cause was an acid volatile spirit that mixed fatally with them; and treatment should employ basic or fixing salts to neutralize the acidity.(Temkin, Owsei, 1971) Thomas Willis proposed a more enduring model: the convulsion originated from an “explosion” of the animal spirits in the brain, caused by “heterogeneous and explosive particles” diffused from the blood into the brain or spinal cord, then derived to the nervous stock where they grew together with the spirits.(Temkin, Owsei, 1971) Willis further argued that premonitory symptoms originating in a distant body part did not indicate that the cause lay there; rather, when the animal spirits in brain and spinal cord were already primed to explode, deprivation of normal influx could cause peripheral spasms that spread backward along the nerves to the center, where the explosion then took place.(Temkin, Owsei, 1971) A twentieth-century neurologist commenting on Willis’s formulation noted: “This is precisely the modern view of the nature of constitutional epilepsy, if we substitute the idea of an electric discharge for a discharge of animal spirits.”(Temkin, Owsei, 1971) Malpighi’s theory that vitriolic and arsenical particles caused epilepsy by affecting the nervous juice and irritating cerebral fibers was erroneous, but his errors proved influential, shaping the pathology of epilepsy across generations of later physicians.(Temkin, Owsei, 1971)
Georg Ernst Stahl and his animist school opposed all of these mechanist accounts, viewing epileptic attacks as purposeful reactions of the soul or nature defending the body. For Stahl, the attack represented “the soul’s self-protective response,” in contrast to Willis’s view of the fit as bare of biological purpose or psychological meaning.(Temkin, Owsei, 1971) Borelli, the leading iatrophysicist, contributed a telling observation that brought his school closer to the iatrochemists than their fundamental differences might suggest: he found that dead bodies do not show convulsions, and concluded that the “sensitive faculty” in nerves was required for spasm, implying the body’s reaction was not purely mechanical in the way a hydraulic system would be.(Temkin, Owsei, 1971) By mid-century, the eclectic approach of Boerhaave and van Swieten had emerged, emphasizing clinical observation over dogmatic adherence to either system — a shift reflecting the broader values of Enlightenment medicine.(Temkin, Owsei, 1971)
The Enlightenment and the Demystification of Epilepsy
Temkin argues that the Enlightenment’s rejection of supernatural explanations for epilepsy was driven more by philosophical rationalism than by new pathological discoveries: it represented “a change of attitude rather than a medical advance.”(Temkin, Owsei, 1971) The process was neither uniform nor instantaneous. Willis himself admitted that epilepsy might have been “an inspiration of an evil spirit,” and Hoffmann proved in a special thesis that the Devil had physical power and could cause epilepsy; the animist Stahl declared dogmatically that witches and magic sometimes caused the disease.(Temkin, Owsei, 1971)
Enlightenment physicians reinterpreted the biblical accounts rather than ignoring them. Richard Mead maintained that the “lunatic” described in the Gospels had periodical epilepsy returning with changes of the moon, which was “a very common case,” and that the miracle consisted in Christ’s “curing natural diseases immediately by the mere command of his voice.”(Temkin, Owsei, 1971) George Cheyne described what had previously been called witchcraft, enchantment, and possession as nervous disorders explicable by “principles easy, natural and intelligible, deduced from the best and soundest natural philosophy” — an answer, Temkin notes, “as old as the book On the Sacred Disease.”(Temkin, Owsei, 1971) Even as demoniac beliefs disappeared from authoritative literature in the second half of the eighteenth century, they survived among Rosicrucians, alchemists, and the uneducated, and passed into the Romantic German medicine of the early nineteenth century, when Justinus Kerner (1786-1862) seriously attempted to revive the belief in possession before the current ran its course.(Temkin, Owsei, 1971)
The nosological debates of the Enlightenment period also began to clarify the boundary between epilepsy and related conditions. Boerhaave and van Swieten maintained that hysteria “has frequently been observed to degenerate into the epilepsy”; Tissot denied ever seeing such a transformation and argued explicitly against establishing a category of epilepsia hysterica.(Temkin, Owsei, 1971) Boissier de Sauvages and Cullen attempted to classify epilepsy into idiopathic and sympathetic forms and to distinguish it from eclampsia; recognition of “petit mal” variants emerged in this period.(Temkin, Owsei, 1971) In 1720s Paris, a physician named Philippe Hecquet argued that the convulsionist epidemic at the cemetery of St. Médard — in which increasing numbers of women publicly exhibited convulsions and trance-like states — was a contagious disease belonging to medicine rather than theology, related to “the epilepsy peculiar to young women.”(Temkin, Owsei, 1971) More damaging to the Enlightenment’s self-image as a period of freed superstition was Tissot’s documentation of masturbation as a cause of epilepsy, illustrating how rejection of old supernatural etiologies did not prevent the emergence of new unsupported ones.(Temkin, Owsei, 1971)
Institutionalization and the Early Nineteenth Century
The institutionalization of epileptics in reformed asylums from the period of Pinel, Chiarugi, and the Tukes enabled systematic medical study for the first time. Previously confined with the insane, epileptics became objects of systematic medical attention only as the asylum reform movement took hold; Esquirol in 1815 made a strong plea for establishing separate divisions for epileptics within institutions.(Temkin, Owsei, 1971) In the eighteenth century, certain differences had been drawn between epileptics and the insane — at the Bicêtre, epileptics were allowed to attend Mass on Sundays — but comprehensive institutional care came slowly, and in Paris epileptic children were not transferred from the hospital for the incurably ill to the Bicêtre until 1838, when some educational provision was made for them.(Temkin, Owsei, 1971)(Temkin, Owsei, 1971)
The institutional context enabled two developments that would prove crucial. First, it produced a new clinical vocabulary: the terms “grand mal,” “petit mal,” and “absence” were coined by hospital physicians observing multiple forms of the disease systematically for the first time, allowing the single category of “the falling sickness” to be differentiated into clinically distinct types.(Temkin, Owsei, 1971) Second, it generated statistical approaches to epilepsy, with investigators examining heredity, the role of fright, and lunar influence using clinical populations; results were often contradictory and reflected contemporary etiological commitments, but the methodological commitment to counting was new.(Temkin, Owsei, 1971) Psychiatric studies flourished, describing states such as “furor epilepticus” and “epileptic somnambulism,” and recognizing “psychic equivalents” in which mental disturbances replaced the usual convulsions.(Temkin, Owsei, 1971) Anatomical investigation of the brain in epileptic patients produced competing theories of congestion, inflammation, and localization, but no consensus on a definable “seat” of the disease.(Temkin, Owsei, 1971) The period thus represented a shift from speculative system-building to hospital-based empiricism as the primary method.(Temkin, Owsei, 1971)
The Reflex Theory Period (1833-1861)
Marshall Hall’s reflex theory, introduced after 1833, became the dominant physiological explanation for epilepsy, reframing the older “sympathetic” form as “eccentric” epilepsy caused by reflex action originating in the stomach or intestines — a new physiological vocabulary for a concept that had existed since Galen.(Temkin, Owsei, 1971) Flourens had established that the cerebral hemispheres were not electrically irritable and that convulsions could only be elicited from the medulla oblongata and related structures; this finding underpinned the reflex theory’s assignment of the convulsive mechanism to the medulla rather than the cortex.(Temkin, Owsei, 1971) Brown-Séquard extended the reflex framework by arguing that all forms of epilepsy — both “centric” and “eccentric” — acted through the sensitive side of the cerebro-spinal centers and therefore both qualified as reflex excitations, making the theory universal.(Temkin, Owsei, 1971) Schroeder van der Kolk located the seat of epilepsy in the ganglionic cells of the medulla oblongata and described their discharge using the language of electrical batteries: “when once brought into an excited condition, they may more or less suddenly discharge themselves… After their discharge, a certain time is again required to bring them to their former degree of excitability,” precisely as “we see to be the case with electric batteries, or in the phenomena of an electrical fish.”(Temkin, Owsei, 1971) Around 1860, three pathological frameworks competed: reflex action, cerebral angiospasm, and molecular changes in brain tissue from malnutrition or poisoning; in none of them was epilepsy attributed to “definite structural changes of a definite organ.”(Temkin, Owsei, 1971)
The nosological debate of the period crystallized around Sieveking and Reynolds, who took irreconcilable positions: Sieveking argued for discarding the idiopathic/symptomatic distinction entirely, even merging epilepsy with eclampsia; Reynolds defended “idiopathic epilepsy” as a morbus per se defined exclusively by the absence of demonstrable organic causes.(Temkin, Owsei, 1971) Both, however, converged on excluding localized convulsions with preserved consciousness from the epilepsy category — which is why Jackson later called such attacks “epileptiform” rather than epileptic, inheriting the terminological consequence of their ironic agreement.(Temkin, Owsei, 1971)
Therapeutics in the period were defined by informed pessimism. Esquirol at the Salpêtrière tested each new remedy on thirty epileptic patients every spring and autumn, after carefully preparing patients for “certain cure.” The result was always the same: each new remedy suspended attacks for a fortnight to three months, regardless of its chemistry. The inference seemed unavoidable: “It was not so much the remedy as the confidence in it which caused the passing remission.”(Temkin, Owsei, 1971) The introduction of potassium bromide in 1857 broke this pattern. Sir Charles Locock had learned that bromide caused temporary impotency in men and tried it for hysteria in young women; he then extended it to cases of “hysterical epilepsy” occurring during menstruation and cured all but one of about fourteen such cases. Samuel Wilks, doubting Locock’s theory but impressed by the results, generalized the prescription to all cases regardless of sex.(Temkin, Owsei, 1971) Temkin notes that the increased interest in status epilepticus following bromide’s introduction may not be coincidental, given how infrequently the condition had previously been cited.(Temkin, Owsei, 1971)
Jackson’s Forerunners and the Cortical Turn
Several physicians anticipated Jackson’s localization framework before Jackson synthesized them. Todd proposed that epileptic seizures resulted from gradual accumulation of morbid material in the blood “until it reaches such an amount that it operates the brain in, as it were, an explosive manner,” causing discharge of nervous power — a chemical rather than discharge model, but using the language of explosive action.(Temkin, Owsei, 1971) Todd also explained post-epileptic hemiplegia (later called Todd’s paralysis) as brain exhaustion: if confined to the convolutions, “mental power, memory, perception suffer”; if deeper parts were involved, hemiplegia resulted — an implicit anticipation of Jackson’s later distinction between discharging and destroying lesions.(Temkin, Owsei, 1971) Samuel Wilks in 1866 argued most radically that the cortex was “the fons et origo mali” and that a cortical “commotion” irritated the ganglia below, breaking explicitly with the received theory of medulla oblongata primacy.(Temkin, Owsei, 1971)
Morel in 1860 described “larval” or “masked” epilepsy (épilepsie larvée): epilepsy without convulsions, diagnosed entirely by mental symptoms, which could exist by itself without any attacks of ordinary epilepsy and was “by no means less dangerous.”(Temkin, Owsei, 1971) Falret described an “intellectual aura” in which “the same idea, the same reminiscence, or the same hallucination arises spontaneously at the moment of the invasion of every attack and infallibly precedes its appearance,” often a reproduction of the idea or sensation that had provoked the first attack — the clinical ancestor of Jackson’s dreamy state.(Temkin, Owsei, 1971)
Asylum Psychiatry and the Nineteenth-Century Transition
One of the more counterintuitive facts in epilepsy’s history is that, until the 1840s, severe epilepsy was managed in mental asylums rather than hospitals. Berrios makes the historical classification explicit: epilepsy was considered a form of insanity, and patients were committed alongside those with melancholia, mania, and dementia.(German E. Berrios & Roy Porter (eds.), 1995) The transfer of epilepsy to neurology — and to the general hospital — was gradual and was never entirely complete in the nineteenth century.
This institutional placement drove a cluster of medical claims. Esquirol, in 1815, found that four-fifths of the epileptic inpatients he examined were affected by some form of mental disorder.(German E. Berrios & Roy Porter (eds.), 1995) Whether that association was causal, coincidental, or an artifact of asylum selection (those whose epilepsy was severe enough to warrant institutionalization were also those most likely to have co-occurring psychiatric conditions) was debated throughout the century. Bouchet and Cazauvieilh (1825–26) made the first strong claim from post-mortem examination that epilepsy and insanity shared a common neuropathological substrate, shaping the research agenda for decades even though the claim was contested.(German E. Berrios & Roy Porter (eds.), 1995)
Bénédict Morel in 1860 proposed the concept of épilepsie larvée — masked epilepsy — a diagnosis of epilepsy without convulsions, in which episodic behavioral disturbances such as sudden violence, fugue states, or transient psychoses stood in for the absent seizure.(German E. Berrios & Roy Porter (eds.), 1995) This concept enormously expanded the diagnostic category and provided a framework for understanding episodic behavioral disorder as a neurological phenomenon. The expansion was theoretically appealing but clinically treacherous: it made epilepsy potentially present wherever episodic behavior occurred, giving the diagnosis an elasticity that stretched it toward criminology.
Cesare Lombroso pursued that stretch explicitly: he argued for what he called an “integral connection between epilepsy and crime,” holding that the impulsive, violent criminal was essentially an epileptic whose criminal act was an epileptic equivalent — an expression of the same underlying neurological instability as the seizure.(German E. Berrios & Roy Porter (eds.), 1995) This connection shaped late nineteenth-century criminology and forensic psychiatry, providing a biological basis for the theory of the born criminal. It also illustrates the costs of the expanded diagnostic category: when epilepsy became capable of explaining episodic behavioral disorder of any kind, it became available to criminologists looking for a neurological account of transgression.
Jules Dejerine’s 1886 treatise placed epilepsy among the nervous disorders without anatomical lesions — alongside hysteria and neurasthenia — distinguishing them from conditions such as general paralysis and locomotor ataxia that did have anatomical lesions.(Ian Dowbiggin, 1991) This classification acknowledged that epilepsy’s neurological basis remained elusive at the cellular level, even while clinical practice had clearly moved it out of the psychiatric domain. The experimental work of C. E. Brown-Sequard (1843 to 1870) reinforced the neurological understanding by showing that injuring the nervous system of guinea pigs could produce hereditary epilepsy in offspring, findings French alienists cited extensively as evidence for the heritability of nervous disease.(Ian Dowbiggin, 1991)
Hughlings Jackson and the Neurological Redefinition
John Hughlings Jackson restructured the concept of epilepsy more thoroughly than anyone between Galen and the twentieth century. Working within his evolutionary and hierarchical model of the nervous system, he redefined seizures as the expression of excessive, abrupt neuronal discharge originating in a cortical focus and propagating through the hierarchical levels of the nervous system.(German E. Berrios & Roy Porter (eds.), 1995) This model had two major consequences: it provided a framework for understanding why different types of seizures produce different symptoms (depending on where in the hierarchy the discharge originates and how far it propagates), and it grounded epilepsy firmly in the neuroscience of the period rather than in the psychiatry of the asylum.
Charcot and Richer’s 1887 book on demonic possession argued retrospectively that historical accounts of demoniacs described patients whose symptoms were consistent with epilepsy or hysteria as clinically understood.(German E. Berrios & Roy Porter (eds.), 1995) Temkin frames this move with precision: hysteria now functioned as the counterpart to epilepsy that possession had been in centuries past. “Possession was a magico-theological concept, whereas hysteria was a natural one. However, both had in common the establishment of a category of abnormal, yet understandable, behavior with somatic symptoms.” With Freud, the doctrine of hysteria “developed to the point where it was ready to take over” the role of possession as a disease of the soul manifesting through the body.(Temkin, Owsei, 1971)
Kraepelin’s creation of the two great diagnostic categories of functional psychosis — dementia praecox and manic-depressive insanity — emerged partly from his engagement with the “combined psychoses” debate of the 1880s and 1890s, which turned on the contested question of whether epileptic insanity constituted a third major category alongside mania and melancholia.(German E. Berrios & Roy Porter (eds.), 1995) The resolution of that debate, and its contribution to Kraepelin’s nosological project, illustrates how central epilepsy was to the construction of nineteenth-century psychiatric classification.
P. Samt’s clinical work in 1875 elaborated what came to be called “psychic equivalents” — states of violence, stupor, and religious ecstasy occurring without ordinary convulsions but representing the same disease. His detailed descriptions of more than forty cases revealed a remarkable pattern: a considerable number of patients believed they were in heaven and addressed physicians and attendants as divine beings, exhibiting what Samt called a “god-nomenclature.” Temkin notes the historical irony: “These stories show a striking resemblance to medieval and Renaissance tales of prophesying epileptics” — the nineteenth-century clinician’s data and the medieval exorcist’s dossier described the same phenomena in different languages.(Temkin, Owsei, 1971) The fate of epileptics in this period remained bleak by social measures: “Usually, the epileptic is avoided; on all faces he reads his sentence to isolation,” as the French physician Billod wrote; a man with epilepsy had to say “good-by to his dreams of success, for the masters even refuse him work in their shops; good-by to his dreams of marriage and fatherhood.”(Temkin, Owsei, 1971)
Temkin also identifies a deep structural parallel between the seventeenth-century chemical theorists and the late nineteenth-century neurologists: both assumed the epileptic attack was “a necessary consequence of pathological changes in the central nervous system, and that the attack was bare of biological purpose or psychological meaning.” Jackson’s doctrine thus repeated the mechanist tradition “at a higher level of biological sophistication” — the vocabulary of neuronal discharge replacing the vocabulary of exploding animal spirits, but the philosophical commitment to mechanism unchanged.(Temkin, Owsei, 1971) As Gowers synthesized the evidence in 1881, epilepsy was “a disease of grey matter, and has not any uniform seat. It is a disease of tissue, not of structure,” concluding that all the phenomena of idiopathic epilepsy could be explained by grey matter discharge without invoking vascular spasm or any structural lesion.(Temkin, Owsei, 1971)
By 1872, Morel reported that nursing sisters in a French asylum, while recognizing a patient’s behavior as epileptic, added: “but she does not fall.” The fall to them was still the guiding symptom, illustrating how thoroughly the popular conception of epilepsy as “the falling sickness” persisted even as medical classification was shifting toward seizure types without falling.(Temkin, Owsei, 1971) Jackson’s principles received their public surgical vindication on 13 August 1886, when Victor Horsley demonstrated three patients after successful operations for focal epilepsy before the British Medical Association; both Charcot and Jackson were present, each congratulating Horsley on his results.(Temkin, Owsei, 1971)
The Literary Account: Dostoevsky’s Ecstatic Aura
Dostoevsky described his own epileptic aura as a moment of extraordinary ecstasy, illumination, and sense of universal harmony — a state he considered beyond anything achievable in ordinary life.(German E. Berrios & Roy Porter (eds.), 1995) This account, incorporated into The Idiot through the character of Prince Myshkin, provided a subjective literary record of epilepsy that influenced neurological thinking about the phenomenology of seizure auras and raised philosophical questions about the relationship between neurological states and transcendent experience. The ecstatic aura does not fit easily into either the ancient sacred-disease framework or the nineteenth-century degeneracy framework. It is a third possibility: that the brain’s pathological extreme can produce states that feel, to the person experiencing them, like revelation.
Twentieth-Century Advances and Historiographic Conclusion
The twentieth century saw three converging developments that transformed epilepsy from an incompletely localized brain disease to a clinically managed, genetically informed, and surgically addressable condition. Phenobarbital (luminal) was introduced in 1912 and sodium diphenylhydantoin (dilantin) in 1938, providing effective anticonvulsant drugs for the first time since potassium bromide; the electroencephalogram from the 1930s onward became an essential diagnostic tool, allowing sharper differentiation of epilepsy from other diseases and new classification of the epilepsies; and the rediscovery of Mendelian laws at the turn of the century began substituting exact genetic studies for the loose speculations on heredity and degeneracy that had dominated nineteenth-century etiological thinking.(Temkin, Owsei, 1971)
Temkin’s historiographic conclusion frames all of this: the history of epilepsy is “the development of something differently defined at different times,” not the progressive discovery of a stable biological entity. The Hippocratic physician who wished to discuss the disease “epilepsy” had to refer to the “so-called sacred disease” and reject its magical connotations; the modern physician takes epilepsy as a natural process partly because of that Hippocratic intervention, and partly because of the sequence of events that separated the disease from “the medley of conditions going under the name of the falling sickness.”(Temkin, Owsei, 1971) The natural history of epilepsy has in fact been relatively stable across recorded history — the many types of epileptic attacks described in antiquity suggest brain mechanisms “which have been relatively stable, historically speaking” — while the human history, how the disease was understood, named, feared, classified, and treated, has been the domain of genuine transformation.(Temkin, Owsei, 1971)
Chinese Medicine and the Dian/Dian Xian Distinction
In Chinese medicine, epilepsy (Dian Xian) was historically confused with manic-depression (Dian Kuang) until the Ming dynasty physician Wang Ken Dang first distinguished the two conditions, showing that epilepsy had been wrongly classified as a mental illness.(Maciocia, Giovanni, 2009)
Arab-Islamic medicine continues to be practiced in Mediterranean and Arab-Islamic countries, where cultural beliefs and religion often lead to self-care or home remedies in rural areas and consultation with traditional healers.(Saad Said, 2011)
Medieval Islamic physicians inherited both the Galenic somatic account and the popular demonological one. Ibn ʽImrān noted that the Greeks called epilepsy the “sacred disease” and attributed it to divine punishment, while in vernacular Arabic the condition was called the “prophetic disease” (al-maraḍ al-kāhinā) because of the obscurity of its causes and its attribution to the jinn; physicians themselves used the terms “great illness,” “falling sickness” (ṣarʽ), and “possession/madness” (junūn).(Dols, Michael W., 1992) Ar-Rāzī drew careful clinical distinctions among conditions that the common people conflated under the label majnūn: the epileptic, he observed, is healthy except during attacks of the disease, whereas the melancholic has no insomnia and does not eagerly approach other people, and the truly mad is characterized by jumping about, vigorous movement, insomnia, and persistent mental confusion.(Dols, Michael W., 1992) Galen himself had explicitly stated that epilepsy was not a divine affliction, declaring: “neither epilepsy nor love is a divine disease” — divorcing both conditions from mystical or supernatural interpretation.(Dols, Michael W., 1992)
See Also
- hippocrates
- galen
- humoral-theory
- sacred-disease
- phlegm
- brain
- neurology
- asylum
- demonic-possession
- hysteria
- paracelsus
- john-hughlings-jackson
- thomas-willis
- charcot
Sources
(Dols, Michael W., 1992): Ibn ʽImrān notes that the Greeks called this illness the ‘sacred disease’ and considered it to be a divine punishment. In vernacular Arabic, one was accustomed to calling it the ‘prophetic disease’ (al-maraḍ al-kāhinā), according to Ibn ʽImrān, because of the obscurity of its causes and its attribution to the jinn. The doctors called it the ‘great illness’, ‘falling sickness’ (ṣarʽ) or ‘possession’/‘madness’ (junūn).
(Dols, Michael W., 1992): Ar-Rāzī says that the common people call someone majnūn who is afflicted by epilepsy, melancholia, or mental confusion, but that between these three conditions there are great differences. The epileptic is healthy except during attacks of the disease. The melancholic does not have insomnia, does not eagerly approach other people… As for madness, its victim is characterized by jumping about, quick and vigorous movements, insomnia, and persistent mental confusion.
(Dols, Michael W., 1992): in the case of lovesickness, which assumed a significant role in medieval literature, Galen clearly recognized the psychosomatic effects of love, but like other debilitating conditions, he divorced it from the mystical or supernatural realm: ‘Accordingly, we know that neither epilepsy nor love is a divine disease.’