CHAPTER

Epilepsy in Dostoevsky
14 Ivan Iniesta1,2
The Walton Centre NHS Foundation Trust & Liverpool University, Lower Lane,
Fazakerley, Liverpool, UK
1
Corresponding author: Tel.: þ64-63569169; Fax: þ64-63508391,
e-mail address: iniesta.ivan@gmail.com

Abstract
Fyodor M. Dostoevsky (Moscow, 1821–Saint Petersburg, 1881) suffered epilepsy throughout
his whole literary career. The aim here is to understand his condition in light of his novels,
correspondence, and his contemporaries’ accounts as well as through the eyes of later gener-
ations of neurologists. From Murin (The landlady, 1847) to Smerdyakov (The brothers
Karamazov, 1880), Dostoevsky portrayed up to six characters with epilepsy in his literature.
The first symptoms of the disease presented in early adulthood, but he was only diagnosed with
epilepsy a decade later. In 1863 he went abroad seeking expert advice from the famous neu-
rologists Romberg and Trousseau. Dostoevsky made an intelligent use of epilepsy in his lit-
erature (of his experiential auras or dreamy states particularly) and through it found a way to
freedom from perpetual military servitude. His case offers an insight into the natural history of
epilepsy (a cryptogenic localization related one of either fronto-medial or temporal lobe origin
using contemporary medical terms), thus inspiring later generations of writers and neurolo-
gists. Furthermore, it illustrates the good use of an ordinary neurological disorder by an
extraordinary writer who transformed adversity into opportunity.

Keywords
Dostoevsky, epilepsy, Dostoevsky syndrome, Dostoevsky’s epilepsy, history of neurology,
literature, medical humanities, on the good use of disease

2
Present address: Neurology Department, Palmerston North Hospital, MidCentral Health. 50 Ruahine
St., Palmerston North 4442, New Zealand.

Progress in Brain Research, Volume 205, ISSN 0079-6123, http://dx.doi.org/10.1016/B978-0-444-63273-9.00014-9

© 2013 Elsevier B.V. All rights reserved.
277
278 CHAPTER 14 Dostoevsky’s Epilepsy

1 INTRODUCTION
In a letter to his colleague and literary rival, Ivan Turgueniev, dated June 17, 1863, the
Russian novelist, Fyodor Dostoevsky (Fig. 1), revealed his intentions of going abroad
in pursuit of medical advice from eminent neurologists: “I am very ill with epilepsy,
which is getting worse and worse and driving me to despair. If only you knew how
dejected I feel after my fits, sometimes for whole weeks on end! Actually, I am going
to Berlin and to Paris– but for the shortest possible time – for no other reason than to
consult specialists on epilepsy (Trosseau in Paris, Ramberg in Berlin). There are just
no specialists in Russia, and I receive such a variety of contradictory advice from the
local doctors that I have lost all faith in them” (Frank and Goldstein, 1987).
It remains uncertain whether the consultations actually took place, but
Dostoevsky had previously sought help from doctors within Russia, including one
mentioned in a letter written from Siberia to his older brother, Mikhail, on March
9, 1857: “On the way back (we came through Barnaul), I quite unexpectedly had
an epileptic fit that scared my wife to death and filled me with sadness and depres-
sion. The doctor (a learned and competent one) told me that, notwithstanding what
other doctors had previously told me, I had real epilepsy and that I could expect to
suffocate during one of the fits as a result of throat spasm. . .. In general, he advised
me to beware of the new moon” (Frank and Goldstein, 1987).

FIGURE 1
Fyodor M. Dostoevsky (1821–1881) in a portrait painted by Vasili G. Perov (1833–1882) in 1872.
Tretyakov Gallery. Moscow.
 2 The Epilepsy of Dostoevsky: Clinical History 279

Interestingly, Moritz Heinrich Romberg (not “Ramberg,” as misspelled in the 1863

letter) also appears to have believed in the link between the neurological condition and
the moon. In the mid-1850s, Romberg noted that: “The planetary influence of the
moon (especially of the new and full moon) upon the course of epilepsy, was known
to the ancients, and although here and there doubts have been raised against this view,
the accurate observations of others have established its correctness” (Romberg, 1853).

2 THE EPILEPSY OF DOSTOEVSKY: CLINICAL HISTORY

Fyodor Mikhailovitch Dostoevsky was born at the Moscow Hospital of the Poor on
October 30, 1821, the second son of an army surgeon. Contrary to what Dostoevsky
reiterated throughout his life, most likely in order to support a report from another army
surgeon (Dr. Ermakov), through which he was able to escape perennial army servitude,
his epilepsy had not started in Siberia in the 1850s but most probably in the late 1830s to
early 1840s—or perhaps slightly earlier in a milder form—as several firsthand accounts
from his contemporaries suggest (Iniesta, 2004, 2006). The first convincing account of a
witnessed epileptic attack dates back to October of 1844, aged 22, as his fellow student
and roommate at the Military Academy of Engineers Grigorovitch recalls: “He had fits
of illness several times, when we were out walking. Once, when we were walking along
Troitsky Street, we met a funeral procession. Dostoevsky quickly turned aside; he
wanted to return home, but, as soon as he walked several steps, he had a strong attack
of the illness. It was so strong that I had to ask passers-by to take him to the nearest drug-
store, and we could hardly revive him. Usually, after such fits, he experienced a depres-
sion which lasted for two or three days” (Sekirin, 1997).
By the time Dostoevsky first portrayed epilepsy in his literature, he had already
become acquainted with a physician with whom he was to enjoy a lifelong friendship.
Stefan Ianovsky was indeed the first doctor as well as one of the earliest witnesses of
his fits, as the following firsthand account referring to an 1847 episode suggests: “As
soon as I approached the Hay Market Square, I saw Fyodor Mikhailovich. He was
bareheaded, his coat was unbuttoned, and his tie was loosened. Some officer in a mil-
itary uniform was supporting him by the elbow” (Sekirin, 1997).
Dostoevsky apparently only became convinced about the diagnosis of epilepsy
during the decade of forced exile in Siberia (1849–1859) to which he had been con-
demned for joining a group of dissidents to the Tzar in the late 1840s, as he explains
in the 1857 letter to his brother (Frank and Goldstein, 1987) (Figure 2).
As far as his family history is concerned, Dostoevsky’s 3-year-old son (Alexey, or
Alyosha in the diminutive form), died as a result of a prolonged epileptic attack in 1878
(Frank, 2002). Dostoevsky’s beloved older brother Mikhail had died from either a liver
or gallbladder disease in the mid 1860s, while his phthisic first wife had also passed
away a few months before his brother. Unlike his first wife his second wife, the ste-
nographer Anna Grigorievna, who he employed in 1866 in order to finish in time The
Gambler and married in 1867, was not scared of epilepsy. On the contrary, she
was perfectly aware, supportive, and caring beyond professional advice, as her own
account of her husband’s illness suggests: “The greatest interval between the fits of
his illness was four months; sometimes they happened every week. There were terrible
cases such us when he had two fits during the week, and sometimes had two seizures,
280 CHAPTER 14 Dostoevsky’s Epilepsy

FIGURE 2
Letter of Dostoevsky to his brother Mikhail from the Fortress of Peter and Paul. Saint
Petersburg, 1849.

one following another with an interval of several hours. He uttered a terrible, inhuman
cry, a noise a normal person cannot make. Very often I ran from my room to his room
and held him standing in the middle of his room with his face contorted by convulsions,
his body shaking all over. I embraced him from the back, and then we went down on
the floor together. Usually the catastrophe happened at night. . . Therefore, he used to
sleep on a wide and low sofa, in case he regained his consciousness. (. . .) You know,
one could not cure this illness. All I could do was to loosen the upper button of his shirt
and take his head into my hands” (Sekirin, 1997).
His last and probably most accomplished novel The brothers Karamazov was remark-
ably only written a year before his death, which was not caused by epilepsy but by a severe
hemopthysis from a pulmonary ailment (possibly tuberculosis) for which he received
treatment in several European spas, as reflected in his Writer’s Diary throughout his last
decade (Dostoevsky, 1994) and in his correspondence (Frank and Goldstein, 1987).

3 DOSTOEVSKY’S DOCTORS: MEDICAL HISTORY AND

NEUROLOGY IN THE NINETEENTH CENTURY
In 1863, the Russian neurophysiologist Ivan Sechenov (1829–1905), who like
Dostoevsky had been a student at the Military Academy of Engineers of Saint
 3 Dostoevsky’s Doctors: Medical History 281

FIGURE 3
Handwriting with self-portrait of Dostoevsky for his novel The devils, 1872.

Petersburg a few years earlier, published his important Reflexes of the Brain on
returning to Russia. It was a period where the essential knowledge about the epilep-
sies was flourishing thanks to the ongoing works of neurologists across England,
Germany, and France. John Hughlings Jackson had been appointed in 1862 as
Assistant Physician to the National Hospital for Epilepsy and Paralysis at Queen
Square, London: the first institution dedicated to Neurological Disorders, founded
in 1860 with James Ramskill and Charles Edouard Brown–Sèquard as Physician
in chief. In 1862—the year Dostoevsky went abroad for the first time, visiting
282 CHAPTER 14 Dostoevsky’s Epilepsy

London and Paris during the summer—Jean Martin Charcot had just joined the Parisian
Salpêtrière Hospital where he was to become the first Professor in Neurology. Bromides
were introduced by Wilks and Locock as the first effective pharmacological treatment
used for the prevention of epileptic seizures from the late 1850s and were widely avail-
able by the early 1860s (Hutchinson and Jackson, 1861). It was in this scientific and
historical context when Dostoevsky wrote the letter to his colleague and ideological
rival Ivan Turgueniev dated June 17, 1863 expressing his intention of going abroad
in search of medical advice from two of the most famous neurologists of his time
who were known and referred to by Dostoevsky as specialists in epilepsy: Romberg
in Berlin and Trosseau in Paris (Catteau, 1998; Frank and Goldstein, 1987). Regardless
of whether the above intended consultations actually took place, Dostoevsky—who in
1863 and from 1867 to 1871 also traveled and lived in France, Italy, Germany, and
above all in Switzerland—in fact became acquainted with several doctors throughout
his life, including the aforementioned friend doctor Ianovsky from whom he borrowed
medical textbooks, with the doctor he had referred to before as a “learned and competent
one” on his way back from Barnaul (Frank and Goldstein, 1987), with Dr. Troitski dur-
ing his penal servitude (1849–1854), with Dr. Ermakov in the seventh Battalion while
serving in the army in Siberia (1855–1859) as well as with Dr. Blagonravov later on in
life, from whom he sought specific advice for his medically informed fictional descrip-
tions of The brothers Karamazov (Frank, 2002).
Doctors in his novels refer to the importance of taking “the powders,” in reference
to the only effective treatment at the time (bromides), which had only just become
available—coinciding with Dostoevsky’s diagnosis of epilepsy—although it is far
from certain that he himself was compliant with any medication or indeed confident
in their curative properties (not least considering the significant, perhaps intolerable,
side effects they would have caused); a skepticism which was shared by some of the
most recognized physicians at the time. Indeed, his relationship with medicine and with
doctors was always far from smooth and often contradictory, as the opening paragraph
of his autobiographical 1865 Notes from Underground suggest: “I am a sick man. . .I am
a wicked man. An unattractive man. I think my liver hurts. However, I don’t know a fig
about my sickness, and am not sure what it is that hurts me. I am not being treated and
never have been, though I respect medicine and doctors. What’s more, I am also super-
stitious in the extreme; well, at least enough to respect medicine” (Dostoevsky, 1993).

4 EPILEPSY IN THE LITERATURE OF DOSTOEVSKY

4.1 The landlady, 1847
Dostoevsky’s first depiction of the condition in The landlady (1847) is striking:
Murin, an old landlord, suffers an attack in which his body is racked by convulsions,
his face distorted with agony and foam is visible on his twisted lips. Here, an epileptic
seizure constitutes a precedent as instrumental to the plot as the one involving the
protagonist of his later and more famous novel Idiot. In this earlier novella, the
writer’s unfortunate familiarity with the epileptic condition was nevertheless
 4 Epilepsy in the Literature of Dostoevsky 283

evident, as the following lines suggest: “A shot rang out, followed by a wild, almost
inhuman shriek, and when the smoke had cleared a strange spectacle met Ordynov’s
eyes. Trembling all over, he bent down over the old man. Murin lay on the floor; he
was being racked by convulsions, his face was distorted with agony, and foam was
visible on his twisted lips. Ordynov realized that the unhappy man was suffering an
acute fit of epilepsy” (Dostoevsky, 1988).

4.2 The humiliated and injured, 1861

Establishing a parallel between reality and fiction enables us to look at the disease
from an objective as well as from a subjective perspective. The following account of
his friend AG Shile refers to an incident contemporary to the novel where epilepsy
appears for the second time in his oeuvre, on returning from his forced exile to
Siberia: “I came to his apartment on the Ekaterinsky Channel. He was deeply in
meditation about something. His face was pale; he looked at my face and did not
recognize me. He had some strange expression in his eyes. . . In less than ten minutes,
Fyodor Mikhailovich had an epileptic fit. His face was completely changed by a
painful grimace, (. . .) A foam appeared from his mouth, and he made such a snore
that I felt terrified. I could not leave him; I was afraid that something worse could
happen. I asked for the landlady” (Sekirin, 1997).
An account from reality that can be compared with a passage extracted from The
insulted and injured, where the mistreated orphan Nellie is portrayed in similar cir-
cumstances, albeit in the aftermath or post-ictal phase of a seizure as opposed to
the preceding stages: “It was three o´clock in the morning. I had hardly knocked at
the door of my room when I heard a moan, (. . .) There was a candle alight. I glanced
into Nellie´s face and was dismayed; it was completely transformed; her eyes were
burning as though in fever, and had a wild look as though she did not recognize
me. (. . .) She nestled up to me tremulously as though she were afraid of something,
(. . .) her words were strange and incoherent; I could understand nothing. (. . .) At last
something like a thought was apparent in her face. After a violent epileptic fit she was
usually for some time unable to collect her thoughts or to articulate distinctly”
(Dostoevsky, 2003a).
Further evidence of Dostoevsky’s familiarity and use of medical knowledge is
shown in this novel, where he most likely is referring to the said first efficacious
treatment for epilepsy, introduced in Europe only 4 years earlier: “Follow my advice,
lead a quiet life, and take the powders regularly. (. . ..) For the time the only remedy is
to take the powders and she must take the powders. I will go and try once more to
impress on her the duty to obey medical instructions, and . . . that is, speaking gen-
erally. . . take the powders” (Dostoevsky, 2003a).
But in a letter to his brother Mikhail, written only 3 years later, he contradicts The
insulted and injured doctor’s opinion: “Announce that I have been sick. I saw the
announcement of the publication of the March issue of Notes of the Fatherland in
the papers. That announcement by itself is as bad as a dose of medicine” (Frank
and Goldstein, 1987).
284 CHAPTER 14 Dostoevsky’s Epilepsy

4.3 Idiot, 1868

In 1868, as Hughlings Jackson was delivering his Goulstonian Lecture On certain
points in the study and classification of diseases of the nervous system, Dostoevsky
was publishing Idiot: a remarkable novel depicting an epileptic character and indeed
the epileptic process with unprecedented detail.
Nowhere else does Dostoevsky or any other writer depict epilepsy with such
accuracy as in the following paragraph extracted from his remarkable Idiot: “Then
suddenly something seemed torn asunder before him: his soul was suffused with in-
tense inner light. The moment lasted perhaps half a second; yet, nonetheless, he
clearly and consciously remembered the beginning, the very first sound of his terrible
scream, which broke of itself from his breast and which he could not have checked by
any effort. Then his consciousness was instantly extinguished and complete darkness
followed. He was having an attack of epilepsy, of which he had been free for a very
long time now. It is well known that attacks of epilepsy, that is the seizure itself,
come on in an instant. In this instant, the face is suddenly horribly distorted, espe-
cially the gaze. Convulsions and spasms overwhelm the whole body and all the fea-
tures of the face. A terrible, inconceivable scream that is unlike anything else breaks
forth from the breast, in that scream everything human seems suddenly to vanish and
it is impossible, or at the least very difficult, for the observer to conceive and admit
that it is the very same man screaming (. . .)From the convulsions, thrashings, and
shudders, the body of the sick man slipped down the steps, (. . .)The prince was car-
ried to his room; though he had come to, he did not fully regain consciousness for a
rather long time” (Dostoevsky, 2003b).

4.4 The devils, 1872

In a contemporary para-fictional novel of the Soviet physician–writer and neuroscien-
tist Leonid Tsypkin (1926–1982), Dostoevsky is portrayed having epileptic attacks
around the time when he was writing The devils. The attacks were triggered by emo-
tional stress and progressing from a dreamy and contradictory psychological state to
loss of consciousness and convulsions followed by confusion and disorientation, as
he was being helped by his wife: “But suddenly the floor began to shake beneath
him, and instead of her face, which he had expected to see, (. . .) he saw some kind
of strange, shifting, white blot, which began to expand rapidly, losing its whiteness
and filling firstly with blue light but then darkening almost to the point of blackness,
like the sky which he had observed that day, when he had been standing on the castle´s
edge – and yes, this really was a sky, nocturnal almost and filled with stars which for
some reason were enormous, like the sun, each(. . ..) and a strange unexpected smell
emanated from these lifeless stony wastelands – the smell of ozone usually experienced
after thunderstorm – (. . .) and he flew after the shield with such effortless ease that he
lost all sensation of his own body, merging with what had earlier been inaccessible
and had now become a part of his own flesh. He was half-sitting on the rug between
Anna Grigorievna´s bed and the wall, where she had dragged him, gasping under the
 4 Epilepsy in the Literature of Dostoevsky 285

weight of his body, and placed a pillow under his head – and his convulsions were al-
ready coming to an end, but there was foam on his lips, and so she wiped it away – and
slowly opening his eyes, he looked at her without recognition” (Tsypkin, 2005).
Initially projected as a novel with an epilepsy sufferer as the protagonist, like Idiot,
successive versions of The devils and a subsequent crime perpetrated on the student Iva-
nov at the hands of terrorists, diverted the novel leaving epilepsy to one of the secondary
characters, the suicidal Kirillov. Here, the novelist draws from his own experience to
explain how epilepsy can begin with subtle psychological symptoms and sensations that
could be the warning of forthcoming more overt attacks: “There are seconds; usually no
more than five or six at a time; when you suddenly feel the presence of eternal harmony;
completely attained (. . .) -Kirillov, does this occur often? -Once every three days, once a
week. -Do you have epilepsy? -No. -Well, you will. Watch out Kirillov, I´ve heard that´s
just the way epilepsy begins. An epileptic once described in detail his sensation before a
seizure just the way you did” (Dostoevsky, 1999).
Dostoevsky’s friend and fellow writer Strakhov, like the mathematician Sofia
Kovalévskaya, was the witness of Dostoevsky’s epileptic attacks and explained
how Dostoevsky told him about the aura of ecstasy that heralded a grand mal attack,
as well as the increasingly serious nature and frequency of the fits. In his memoirs
about Dostoevsky, Strakhov, his friend and poet, points to a remarkable parallelism
between Dostoevsky’s own reality and his fiction: “This fit of illness was not actually
very strong. He trembled, his whole body beat with the convulsions, and, in the cor-
ner of his mouth, there appeared flakes of foam. . ..Fyodor Mikhailovich told me
many times that before a fit of illness he reached an elevated state. . .. ‘For several
moments’ he said, ‘I feel a happiness, which is not possible in a usual state, and usual
people cannot understand it. I feel completely at harmony with myself, and with the
whole world, and this feeling is so strong, and so sweet’ ” (Sekirin, 1997).

4.5 The brothers Karamazov, 1880

Regarded as one of the best novels of the nineteenth century, The brothers Karama-
zov is also a medico-legal treatise. Structured in four parts with an epilogue, The
brothers Karamazov tells the story of the murder of Fyodor Paulovich Karamazov
at the hands of his bastard son and servant, Smerdyakov. His hated stepbrother
Dymitri is instead found guilty, and Smerdyakov later commits suicide. But during
the trial a proud and remorseless Smerdyakov, who has epilepsy, confesses to his
other hated stepbrother, Ivan, how he made everyone, including three medical ex-
perts, believe that he was having a seizure in the night of the parricide, whereas
he was in fact pretending to be sick by “shamming a falling fit” (Dostoevsky,
2004). Ivan then falls ill and is examined by a doctor who establishes that he has
a brain disorder for which serious treatment is recommended, but the skeptical Ivan
declines. To justify the hallucinations (criticized by some readers) depicted by his
character on the novel, Dostoevsky sought the support of a doctor, Blagonravov,
who verified the accuracy of the mental illness of Ivan Karamazov for his
medically-informed fictional descriptions: “The doctor, having listened to him
286 CHAPTER 14 Dostoevsky’s Epilepsy

and examined him, concluded that he was indeed suffering from something like a
brain disorder (. . .) ‘In your condition hallucinations are quite possible, though they
should be verified. . . but generally it is necessary to begin serious treatment without a
moment´s delay, otherwise things will go badly’” (Dostoevsky, 2004). An account
which was indeed endorsed by doctor Blagonravov’s opinion, as the following letter
of appreciation by Dostoevsky suggests: “I thank you, especially as a doctor, for your
informing me of the accuracy of that person’s mental illness depicted by me. An ex-
pert’s opinion will support me, and you have to agree that under the given circum-
stances a person (Ivan Karamazov) could not have had any hallucination other than
that one” (Frank and Goldstein, 1987).
In The brothers Karamazov three assessments from doctors take place in order
to determine whether the suspect and step-son of father Karamazov, the epileptic
Smerdyakov, had genuine attacks of his epilepsy or whether he was pretending at
the time of the parricide, as it turned out (Frank and Goldstein, 1987). The protag-
onist of The brothers Karamazov is the third son of Fyodor Paulovich. A Christ-like
figure somewhat reminiscent of the most famous of Dostoevsky’s epileptic charac-
ters, Prince Myshkin of the Idiot, he bears the name of Dostoevsky’s beloved 3-year-
old son, who had passed away with status epilepticus in 1878. An epilepsy sufferer
for nearly four decades by the time he wrote The brothers Karamazov, Dostoevsky
knew much about his condition—not least from his own experience—and explicitly
portrayed characters with epilepsy in the four previous novels discussed, while
the influence of epilepsy is palpable throughout the rest of his works. In The brothers
Karamazov, Dostoevsky also refers to the scientific investigations of one of the
founders of experimental medicine, Claude Bernard, with regard to the mechanisms
of epilepsy (Dostoevsky, 2004). Despite the impairment caused by the epilepsy,
Dostoevsky produced accomplished works whose major preoccupations, all of
which occur in this novel, were the struggle for faith in God; the nature of love
and hate, salvation and suicide, and reality and fiction; and generational conflict
(Iniesta, 2009).

5 DOSTOEVSKY’S EPILEPSY IN THE MEDICAL LITERATURE

In the first retrospective study of Dostoevsky’s literary epilepsy, Stephenson and
Isotoff noticed the influence of Carus’ 1848 Psyche in the preparation of his char-
acters (Stephenson Smith and Isotoff, 1935). While subsequent studies have put most
emphasis in the literary aspects and the writer’s own interpretation of his epilepsy in
his novels (Catteau, 1989; Iniesta and Lopez Agreda, 2000; Iniesta, 2004; Siegel and
Dorn, 2001), quite often they have focused on attempting to diagnose with up-to-date
scientific knowledge the epilepsy of Dostoevsky retrospectively (Iniesta, 2007). In
doing so, they have revived a passionate dispute held between the great Austrian
writer Stefan Zweig and Sigmund Freud at the beginning of the twentieth century;
the former, admiring the way his Russian homonymous made an intelligent use of
epilepsy in favor of his art (Zweig, 2004); the latter, denying the existence of genuine
 5 Dostoevsky’s Epilepsy in the Medical Literature 287

epilepsy inspired by his revolutionary psychoanalytic theories through which he ar-

rived to the conclusion that the writer suffered with “hysteroepilepsy” (Freud, 2001),
nowadays termed psychogenic non-epileptic attack disorder.
Dostoevsky’s epilepsy has ever since inspired generations of epileptologists and, as
rightly pointed out by Temkin, “The genesis and nature of Dostoievski’s own epilepsy
is still a matter for debate” (Temkin, 1971). Thus, in 1907, Segalov first reflected
on Dostoevsky’s epilepsy from a medical perspective (Segalov, 1907). Freud’s
subsequent bet against epilepsy in Dostoevsky is also a reflection of his contemporaries’
scientific view that an organic disease of the brain was highly unlikely to take place in
someone capable of such outstanding intellectual achievements, although he conceded
some degree of uncertainty, reckoning that a mind as bright as Helmhöltz’s had excep-
tionally been afflicted by epilepsy (Freud, 2001). The scientific influence of Freud’s
main hypothesis prevailed over the somewhat more romantic view of his fellow-
countryman Zweig, with later generations of psychoanalysts assuming Freud’s theory.
Consequently, in his encyclopedic biography of Dostoevsky, Joseph Frank makes the
following statement apropos of Freudian sequelae on the subject: “Lack of documentary
evidence is no obstacle to zealous Freudians. Dominique Arban, in a supposedly schol-
arly study of Dostoevsky’s pre-Siberian years, simply invents a primal scene out
of whole cloth to support the Freudian view. She depicts Dostoevsky at the age of seven,
awakened one night by his mother’s outcries, entering his parents’ bedchamber, and
being struck down by his first epileptic seizure at the sight of his father beating his
helpless and pleading mother. Not a shred of proof can be offered to support this
flight of the psychobiographical imagination” (Frank, 1990).
Supported by increasingly available material and equipped with relevant histor-
ical background in addition to scientific knowledge, neurologists have gathered
not just literary depictions of epileptic phenomena, as portrayed in several of the
fictional characters throughout Dostoevsky’s work, but they also included firsthand
accounts from his contemporaries and new biographical data and in vogue classifi-
cations of the epilepsies based on electroencephalographic in addition to clinical
semiology to offer plausible scientific contemporary views on the subject. Backed
by Voskuil’s article of 1983 (Voskuil, 1983), Gastaut clarified his first impressions
on Dostoevsky’s epilepsy, asserting that the writer had a very discreet temporal
lesion causing immediately secondarily generalized seizures (Gastaut, 1984), instead
of primary generalized epilepsy as he had proposed 6 years earlier (Gastaut, 1978).
Gastaut had anticipated his conclusions earlier “At a symposium organized by the
Institut Nacional d’Etudes Slaves de Paris to commemorate the one-hundredth
anniversary of the author’s birth” held in Sophia Antipolis (Southern France) in
1981 (Frank, 1990). It was in fact the one hundredth anniversary of the death of
Dostoevsky, as he passed away on January 28, 1881.
In 1963 Alajouanine had already proposed a diagnosis of temporal lobe epilepsy
in Dostoevsky (Alajouanine, 1963); a hypothesis that has been backed with some
twenty-first century assessments (Baumann et al., 2005). And indeed, based on the-
oretical superstructure free modern diagnostic criteria and taking into consideration
the biographical data inferred from literary depictions as well as other writings, his
notebook, correspondence and witnessed accounts from his contemporaries, it would
288 CHAPTER 14 Dostoevsky’s Epilepsy

seem difficult to go any further than to say that Dostoevsky’s disease falls into the
category of cryptogenic localization-related epilepsy of probable fronto-mesial
(Iniesta, 2004) or of temporal lobe origin (Iniesta, 2008).

6 THE SO-CALLED EPILEPSY OF DOSTOEVSKY (WITH

ECSTATIC AURAS) AND THE INTELLECTUAL AURA OR
DREAMY STATE
In the nineteenth century, Hughlings Jackson described “intellectual warnings of epilep-
tic fits” including “dreamy states” and “super-positive states” with “increased subjective
consciousness” and even “pleasurable sensations” in the context of “a particular variety
of epilepsy” originated in the right temporosphenoidal lobe (Jackson, 1888).
Nearly a century later, Cirignotta and colleagues named a rare seizure type after
the Russian novelist, when analyzing electro-clinically an aura of ecstasy in a patient
with right temporal lobe epilepsy (Cirignotta et al., 1980), a symptom that had been
depicted in detail by Dostoevsky in Idiot and in The devils.
With the current classification of epilepsies under continuous scrutiny, it is worth
rewinding to the time and scientific environment surrounding Dostoevsky when he
wrote his novels. By 1873, Hughlings Jackson had defined an epileptic fit and epi-
lepsy as we essentially understand them nowadays. Coined by Charcot, the term
Jacksonian epilepsy has been used to describe a characteristic type of epilepsy
included in our still in vogue classifications. And in 1878 Hughlings Jackson
co-founded with David Ferrier and others Brain: the first scientific journal in the
medical literature entirely devoted to Neurology (Iniesta, 2011).
It is precisely in the journal Brain where Hughlings Jackson went on to describe
those “intellectual warnings of epileptic fits,” including a connection with “a partic-
ular variety of epilepsy” originated in the temporal lobe (Jackson, 1888) and linked
by later generations of neurologists with temporal lobe epilepsy and indeed with the
epilepsy of Dostoevsky. Although dreamy states, intellectual auras or déjà vu
phenomena had indeed been identified as possible epileptic symptoms of probable
temporal lobe origin by contemporary neurologists of Dostoevsky, it was Bancaud
and colleagues in recent times who demonstrated this hypothesis (Bancaud et al.,
1994). Well recognized by Dostoevsky as a warning sign of an imminent major
fit and very much related with the above described ecstatic feeling, those déjà vu
phenomena are involuntary psychological experiences that may give one the impres-
sion of being seized by the muse (Slattery, 1999). His seminal idea—that a moment of
happiness is worth a lifetime—was probably inspired by his epileptic aura (Iniesta,
2004). In Apropos of the wet snow (1865), Dostoevsky had already described such
experiential phenomena including dreamy states and déjà vu feelings: “Yet it was
strange: everything that had happened to me that day seemed to me now, on awak-
ening, to have happened long, long ago, as if I had long, long ago outlived it all”
(Dostoevsky, 1993). And perhaps the ecstatic aura of Dostoevsky was a literary exa-
geration of the far more common déjà vu phenomena.
 7 The Syndrome of Dostoevsky?: Interictal Behavioral Changes 289

In describing those subtle symptoms called auras Dostoevsky not only provides
us with a detailed case history of the nineteenth century, but he also proves how lit-
erature has the potential to enrich or even inspire prospective scientific and literary
views (Iniesta, 2010). And indeed, apart from subsequent scientific approaches
studying his epilepsy retrospectively, contemporary writers such as the 2003 Nobel
Prize JM Coetzee provide a fictionalized biographical depiction of Dostoevsky’s
whereabouts abroad during the late 1860s, just like Tsypkin had done with Summer
in Baden—Baden, and invents the death and recreates the terrorist plot that prompted
Dostoevsky to write The devils as well as the aura experienced by the novelist just
before having a secondarily generalized tonic–clonic epileptic seizure: “He stands
before the Finn like an actor who has forgotten his lines. The silence lies like a weight
upon the room. A weight or a peace, he thinks: what peace there would be if every-
thing were to fall still, the birds of the air frozen in their flight, the great globe sus-
pended in its orbit! A fit is certainly on its way: there is nothing he can do to hold it
back. He savors the last of the stillness. What a pity the stillness cannot last forever!
From far away comes a scream that must be his own. There will be a gnashing of
teeth—the words flash before him; then there is an end” (Coetzee, 1994).
Such different approach and indeed contribution to medicine through medical
literature and fictional literature, between doctor and writer, this kind of symbiosis be-
tween medicine and literature has been admirably expressed by Temkin in these terms:
“What a contrast in perspective between Nietzsche´s epileptics of the idea and Jack-
son´s sufferers from discharging lesions and dreamy states! The contrast does not lie in
scientific explanations but in the evaluation of the disease, Zola, Nietzsche, and
Dostoievski, each in his own way dealt with epilepsy within the world of social inter-
course and human values, in contrast to Jackson, for whom this world was not much
more than an index of biological processes(. . .) If we do not look upon man at the end
of the nineteenth century as isolated in national and professional departments, Jackson,
Gowers, Samt, Falret, Lombroso, Dostoievski, Zola, Nietzsche, and others, all repre-
sent facets of the knowledge of and about epilepsy” (Temkin, 1971). And indeed, it
would be fair to consider using the eponym Dostoevsky, hence honoring the great
writer’s contributions to epilepsy, when referring to the focal epilepsies which are
characterized by experiential or psychological phenomena ranging from the common
déjà vu to the uncommon ecstasy and not confining it to the latter.

7 THE SYNDROME OF DOSTOEVSKY?: INTERICTAL

BEHAVIORAL CHANGES IN TEMPORAL LOBE EPILEPSY
From a different but complementary approach to Hughlings Jackson’s, Dostoevsky
influenced our knowledge about epilepsy, perhaps not as involuntarily as previously
thought (Gastaut, 1978). For, not only has his illness been retrospectively investi-
gated by all of the above cited twentieth and twenty-first century neurologists, but
since reading Dostoevsky, contemporary neurologists were to some degree prompted
to describe behavioral changes in the context of an epileptic syndrome. Thus, Waxman
and Geschwind for instance identified in patients with temporal lobe epilepsy a typical
290 CHAPTER 14 Dostoevsky’s Epilepsy

interictal personality consisting in circumstantiality, hyperreligiosity, hyposexuality,

and hypergraphia (Waxman and Geschwind, 1974, 1975), all of which were thought
to be present in or attributed to Dostoevsky. This syndrome of interictal behavioral
changes in temporal lobe epilepsy has been acknowledged by some and challenged
by other neurologists over the years. One of the criticisms for which the proposed
syndrome with its different variants—including the extended symptomatology
included in the Bear and Fedio inventory (Bear and Fedio, 1977)—remains to be
subject to debate, is the heterogeneous nature of epilepsy and indeed of temporal lobe
epilepsies and great variation among individuals. No less controversial would be to use
of the eponym of Dostoevsky in association with the syndrome (widely accepted
as Geschwind syndrome but occasionally referred to as Dostoevsky syndrome),
not least given the fact that he was a writer—hence the hypergraphia (Figure 3)—,
significant biographical evidence of an active sexual life as well as the existence of a
type of epilepsy with ecstatic aura already associated with the Russian novelist.

8 ON THE GOOD USE OF EPILEPSY: FINAL COMMENTS

Dostoevsky was repeatedly recommended by doctors not to write in order to prevent
epileptic attacks and he himself acknowledged several times in his correspondence,
that overconcentrating and lacking sleep had a detrimental effect on epilepsy. Thank-
fully, not only for his contemporary and future readers, but also for himself, he also
acknowledged the therapeutic properties that literature had in his mental health and
never took the advice (well aware as he was of the adverse effects the antiepileptic
drugs available at the time had) and continued writing until the end.
Dostoevsky made an intelligent use of disease and reacted to epilepsy by incor-
porating his own suffering into his art. Furthermore, he used it as a reasonable excuse
to postpone some of his later publications, including certain chapters of his periodical
Writer’s Diary (1873–1881), and he also found a way to freedom from the perpetual
military servitude for which he had been condemned in 1849 by the Tzar Nicholas I
(having previously undergone a mock execution) for the clandestine reunions he had
held within the so-called Petrachevski circle. Such practical use of the disease came
through a report from his Army physician (Dr. Ermakov) to whom he had asked to
raise the question to the new and not so tyrant Tzar Alexander II. The following letter
together with the support of his influential friend baron Wrangler were instrumental
in order to obtain the endorsement of the Royal Academy of Medicine of Moscow
and the subsequent approval by the new Tzar: “Dostoyevsky had his first serious sei-
zure of epilepsy in 1850. . . In 1853 he had another seizure, and now he has seizures
each month. His present state of health is very weak. . . For several years he suffered
from epilepsy, and now, as he is deteriorating from the disease, he cannot stay in the
service of Your Majesty any longer” (Sekirin, 1997).
An epilepsy sufferer for two thirds of his life and conscious of the heterogeneous
nature of the condition, Dostoevsky depicted epilepsy on characters of different age,
sex, and social background, with up to six characters portrayed with epilepsy in his
literature and has contributed more than any other literary author to raise awareness
 References 291

about epilepsy at a time when the essential knowledge about the condition as we
largely understand it nowadays was being unraveled. For, not only did he make sig-
nificant use throughout his 40 years of artistic creation often under extreme circum-
stances, but he also used his epilepsy in an encouraging and not so degrading way by
making a Don Quixote or Christ-like figure of one of his masterpieces as well as
the novel where the whole epileptic process is best depicted—Prince Myshkin in
Idiot—suffer from it, or write extensively about epilepsy thus creating strong char-
acters that represent diverse aspects of the epileptic experience, whatever
their position, whatever their intelligence, vices or virtues. In this novel, the Prince
asks: “What of it, if it is disease? (. . .) What does it matter that this intensity is
abnormal, if the result, if the minute of sensation, remembered and analyzed after-
ward in a healthy state, turns out to be the acme of harmony and beauty, and gives a
heretofore unheard – of an undivined feeling of completeness, of proportion, of rec-
onciliation, and of ecstatic worshipful fusion with the highest synthesis of life”
(Dostoevsky, 2003b).
Because of the use of his dreamy states, intellectual, experiential or indeed
ecstatic aura, most notably in Idiot and in The devils, his epilepsy has sometimes been
misinterpreted almost as a positive aspect of his life. Much to the contrary, the nov-
elist had a far from idealized view of epilepsy in reality, which he always considered
a burden causing significant disruption, memory problems, and certainly nothing
pleasurable in his day-to-day life, as he confessed to Dr. Ianovsky late on in his
life as well as to his acquaintance Yurev: “The thing is that, for twenty-five years
now, I have been suffering from epilepsy, which I contracted in Siberia. This illness
has gradually deprived me of the ability to remember faces and events, to such an
extent that I have (literally) even forgotten all the themes and details of my novels
and, since some of them have never been reprinted since they were first published, I
actually have no idea of what they are about. And so please do not be angry with
me for having forgotten the time and circumstances of our acquaintance and of
our subsequent meetings” (Frank and Goldstein, 1987).
Finally, Dostoevsky’s case illustrates the good use of a common neurological dis-
order by a remarkable writer who transformed suffering into art and adversity into
opportunity.

Acknowledgment
I am indebted as always to Luis Montiel for his mentorship in Literature and Medicine.

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