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Dostoyevski - Epilepsy in Dostoevsky-Iniesta 2013
Dostoyevski - Epilepsy in Dostoevsky-Iniesta 2013
Dostoyevski - Epilepsy in Dostoevsky-Iniesta 2013
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.
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
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).
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).
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).
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).
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).
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).
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.
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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