Fyodor Mikhailovich Dostoyevsky and his epilepsy
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.161979
Source of Support: None, Conflict of Interest: None
Fyodor Dostoevsky is one of the greatest novelists of all time.  Very few writers have explored human psychology the way he did in his works, particularly in the books "Crime and Punishment, The Idiot, and The Brothers Karamazov." Many critics have described him as the father of psychological novels, and some consider him as the leading writer in existentialist literature. The characters in his novels are most often portrayed as wretched, lewd and psychologically wrecked, living in impoverished conditions and indulging in crimes, and all sorts of nefarious activities. These features reflected a slice of the social, political, and economic milieu of Russia of those times. The dark and lurid side of human existence and epilepsy were the recurrent themes in his writings.
He was born in Moscow in 1821, was arrested in 1849 for his involvement in the Petrashevsky Circle, a secret society of liberal utopians and narrowly escaped execution. On his release, he worked as a journalist but developed an abiding addiction toward gambling, lost his fortune and had to beg for money. The contents of his works were mostly based on his personal experiences like the rape of a 9-year-old girl by a drunkard, an incident that found expression in his novel, "The Brothers Karamazov." In the later part of his life, he was elected to the Honorary Committee of the Association Litterateur and Artists International, whose members included litterateurs such as Victor Hugo, Ivan Turgenev, Alfred Tennyson, Henry Longfellow, Ralph Waldo Emerson, and Leo Tolstoy. He cast a spell upon future writers such as Anton Chekov, Ernest Hemingway, Friedrich Nietzsche, Franz Kafka, and Jean-Paul-Sartre; and, among the modern writers, Gabriel García Mαrquez and Hermann Hesse were deeply influenced by him. Knut Hamsun, the Norwegian Nobel Laureate, wrote that, "no one has analyzed the complicated human structure as Dostoyevsky. His psychologic sense is overwhelming and visionary." In his terminal days, he suffered from emphysema of the lungs which bled repeatedly, and he breathed his last in 1881.
Dostoyevsky's epilepsy was unusual in the sense that he used to experience an ecstatic aura prior to a seizure and, therefore, it has appropriately been termed, "Ecstatic Epilepsy."  He suffered from attacks of seizures and the first episode might have occurred on hearing the news of his father's alleged murder by his serfs in 1839. Sigmund Freud, the incomparable psychoanalyst from Vienna, was among the first scientists to study Dostoevsky's illness and in an essay entitled, "Dostoevsky and Parricide," published in 1928 he mentioned that there was some intimate connection between his epilepsy and his father's death.  He wrote,
"Dostoevsky called himself an epileptic…It is highly probable that this so-called epilepsy was only a symptom of his neurosis and must accordingly be classified as hystero-epilepsy - (a term, coined by his mentor, Jean Martin Charcot of Salpêtrière, Paris) that is, as severe hysteria. The most probable assumption is that the attacks went back far into his childhood, that their place was taken to begin with by milder symptoms and that they did not assume an epileptic form until after the shattering experience of his 18 th year, the murder of his father. It would be very much to the point if it could be established that they ceased completely during his exile in Siberia…" 
There are various accounts of the relation Dostoevsky had with his father and Freud asserted that the writer hated his father and wished him dead, and that Dostoyevsky's epileptic fits were the physical manifestation of the guilt he felt when his father died. Thus, according to Freud, Dostoyevsky's epilepsy was psychological in origin. However, more recent scholars such as Joseph Frank, Geir Kjetsaa, and Jacques Catteau openly declared that Freud's theory had no rational foundation, and they declared it as "purely fictitious.0" ,, Carr, Dostoyevsky's biographer, in fact, refuted Freud's contention that his epilepsy started following his father's death. He wrote that Dostoyevsky's seizures did not start before his imprisonment in 1849 and were not diagnosed before his first marriage in 1857. 
Others have written that the illness might have had started earlier when he was 9 years of age or when he was forced to undergo an utterly humiliating public parade after his release from Siberia following his arrest for involvement in anti-establishment political activities. He has given an account of his attacks in his personal diary and in letters to his friends, while others are available as second-hand descriptions from his wife, his friends, and physicians. The nature of the characters in his novels adds further to the repertoire. He kept records of his 102 epileptic seizures during his last two decades, which mainly occurred at night and were tonic or generalized tonic-clonic in nature. Seizures in the daytime were often preceded by an ecstatic aura, consisting of pleasant odors, lights or other sensations, which have led neurologists to assume that he had temporal lobe epilepsy or what went by the name of complex partial seizures in the recent nomenclature, with secondary grand-mal epilepsy. This aura was similar to the one described by John Hughlings-Jackson, the father of British neurology, who called it the dreamy state, and the postmortem examination revealed mesial temporal sclerosis in the vast majority of cases. Jackson said that the aura was accompanied by increased sensitivity to the sense of smell and taste and a heightened intellectual state. This so-called "intellectual aura" is a prominent symptom of temporal lobe epilepsy. ,, However, a neurologist of the stature of Gastaut in his long career and specializing in epilepsy reported that pleasant auras were an extreme rarity and he went to the extent of saying that Dostoevsky was engaged in "unconscious mythologizing" that is, he was deceiving himself.  The experience of Hughes was no different and Voskuil from Netherland maintained the same view. , However, in an article, in more recent times, entitled "Neural Substrates of Religious Experience," Saver and Rabin emphasized that temporolimbic epilepsy may lead to a pleasurable experience and others as well have mentioned pleasurable auras as having sexual connotations. ,
A few other issues lead us strongly to believe that Dostoyevsky was a victim of temporal lobe epilepsy. First, he wrote in his diary, "I was for a long time unable to speak" and again, "When writing, I still made mistakes with my words." Some historians suggest that these are accounts of impaired speech following a seizure, a form of postictal dysphasia, which had its origin in the medial region of the left temporal lobe, since increased activity in this area is likely to involve the Broca's area.  In addition, in a letter to the contemporary novelist, Ivan Turgenev in 1863, he wrote, "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 (Trousseau in Paris, Romberg 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."  Furthermore, some reports suggest that his father had frequent seizures, and there were psychiatric ailments in some other members of his family. His 3-year-old son died of epilepsy in 1880, and this autosomal dominant nature of their illness attests the possibility of temporal lobe epilepsy. ,
Nikolay Strakhov, a philosopher and literary critic, and a friend of Dostoyevsky relates Dostoevsky's description of the aura:
'…Often told me that before the onset of an attack there were minutes in which he was in rapture.' "For several moments," he said, "I would experience such joy as would be inconceivable in ordinary life" - such joy that no one else could have any notion of. I would feel complete harmony in myself and in the whole world and this feeling was so strong and sweet that for few seconds of such bliss I would give ten or more years of my life, even my whole life perhaps." 
However, in 1865, Dostoyevsky once wrote to his brother Mikhail, that he was afflicted with all varieties of epilepsy and consequently, it has all along been difficult to categorize precisely his illness. In at least four of his novels namely, "The Possessed, The Brothers Karamazov, The Insulted and the Injured, and The Idiot," Dostoevsky portrayed characters who suffered from epilepsy, Prince Myshkin in "The Idiot" being the most conspicuous case in point.  Some authors believe that while portraying these characters, Dostoevsky had two ideas in his mind namely, affirming that people suffering from epilepsy were no demons, and expounding that they often had greater cognitive, philosophical, moral, and religious accomplishments than others.  In 'Crime and Punishment,' he wrote piquantly, "...There is, of course, no reason why a healthy man is mainly a being of this earth, and therefore for completeness and order he must live only this earthly life. However, as soon as he falls ill, as soon as the normal healthy state of the organism is disturbed, the possibility of another world begins to appear, and as the illness increases, so do the contacts with the other world." 
Nikolay Strakhov, witnessed one of the attacks in 1863 and wrote,
"…Walked into the room while I sat on the table. He was saying something lofty and joyous; when I encouraged his idea with some comment or other, he turned to me with an exalted look, showing that his emotion was at its height. He stopped for a moment, as if seeking words for his thought, and had already opened his mouth. I gazed at him with fixed attention, sensing that he was about to say something unusual, I would hear a revelation of some kind. Suddenly, there came from his open mouth a weird, long-drawn-out and senseless sound, and he fell unconscious on the floor. This time the fit was not a strong one. The effect of his convulsion was that his whole body stretched out, and he foamed at the mouth. In half an hour, he regained consciousness, and I walked home with him." 
Anna Grigorievna, Dostoyevsky's second wife, described an episode in the following way:
"…Was talking with my sister and was very excited; suddenly he became pale, lurched on the divan and began to lean over to my side. I looked with much astonishment at the change in his face; suddenly came a fearful cry, a cry that had nothing human about it - almost a howl and my husband continued to lean over more and more." 
Various neurologists over the ages have tried to understand the nature of Dostoevsky's epilepsy and Théophile Alajouanine from Salpêtrière, Paris and a true descendant in the tradition of Jean Martin Charcot believed that Dostoyevsky suffered from partial and secondary generalized seizure, whereas Henri Gastaut felt that it was idiopathic in nature, though at a later date he thought that Dostoyevsky had a lesion in the temporal lobe. ,,, Gastaut wrote, "Dostoevsky may have presented with both a temporal lesion of very limited magnitude and thus devoid of mental or somatic expression in the interictal periods and a constitutional predisposition to epilepsy of sufficient magnitude to render epileptogenic this otherwise silent temporal lesion and to induce an almost immediately secondary generalization to each seizure." 
Voskuil suggested the possibility of complex partial seizure with secondary generalization,  whereas DeToledo felt that he was prone to feigning and, therefore, suffered from pseudoseizures.  This view is bolstered by the fact that Smerdyakov, the key character in his novel 'The Brothers Karamazov' suffered from true epileptic fits and was also given to shamming for secondary gain. When asked whether it was a true fit or not, Smerdyakov replied, "A sham one, naturally. I shammed it all. I went quietly down the steps to the very bottom and lay down, and as I lay down, I gave a scream and struggle, until they carried me out into the room..."  DeToledo writes that "Dostoyevsky was well aware of the advantages of the ability to stage sham seizures, and may have done so himself on some occasions, to avoid over-emotional situations with his spouses or encounters with those he owed money to."  Moreover again, in 'The Idiot,' Dostoevsky describes the aura of Prince Myshkin in the following way,
"…Remembered that during his epileptic fits or rather immediately preceding them, he had always experienced a moment or two when his whole heart and mind, and body seemed to wake up to vigor and light; when he became filled with joy and hope, and all his anxieties seemed to be swept away forever; these moments were but presentiments, as it were, of the one final second (it was never more than a second) in which the fit came upon him." 
In more recent times, Rosetti and Bogousslavsky wrote that Dostoevsky suffered from left mesial temporal sclerosis with complex partial and secondary generalized seizures, and the course was relatively benign.  Baumann et al., have written that Dostoevsky showed certain curious features in the style and language in his literary works.  They felt that it was
"Nervous, tense, and impulsive. His phrases are sometimes long and complicated, containing a fanciful conglomeration of colloquial words and expressions, official, journalistic and scientific terms, and slips of the tongue, foreign words, names and quotations... Dostoevsky's favorite word was "vdrug," meaning "suddenly." A lot of events in his novels begin suddenly, without preparations and explanations - like seizures... He wrote in a meticulous manner, using every empty space of a sheet. His style showed a tendency toward extensive, and in some cases, compulsive writing and the writings were often concerned with moral, ethical or religious issues. This may reflect a syndrome of interictal behavior changes that was described in temporal lobe epilepsy by Waxman and Geschwind... There is no doubt that Dostoevsky's writing witnesses a large awareness of and sometimes even obsession with religious, philosophical, and emotional questions as well as questions of guilt."
As a matter of fact, Dostoevsky was gripped by an intense feeling of guilt and felt that many of his vices and wrong-doings went unnoticed by the people around him. , Yarmolinsky, an authority on Dostoevsky described his personality as "super-sensitive, misanthropic, of unstable disposition, marked by hypochondria, a strong religiosity with God as his central obsession, and a tendency to take refuge from reality in a dream world"  and in another volume he further wrote about some unmistakable traits in his character namely, "marked irritability, fits of anger, a large capacity for hatred, all earmarks of an aggressive - destructive disposition." The latter characteristics are typical of some patients with temporal lobe epilepsy. ,, In later years, the frequency of his seizures abated but he seemed to hallucinate at times, particularly after emotionally exhausting situations and Landolt, the neurologist has raised the important question of "forced normalization" or increase in the manifestation of psychic symptoms with the diminution in the intensity or frequency of seizures. 
Some authors believe that Dostoevsky suffered from localization-related cryptogenic epilepsy and the first physician to note his seizure was Dr. Stefan Ianovsky with whom Dostoevsky built a life-long camaraderie. Ianovsky wrote, "As soon as I approached the Haymarket Square, I saw Fyodor Mikhailovich. He was bareheaded, his coat was unbuttoned, and his tie was loosened. Some officer in a military uniform was supporting him by the elbow." , Nikolay Strakhov witnessed one such attack and he wrote, "This fit of illness was not very strong. He trembled, his whole body beat with the convulsions, and in the corner of his mouth, there appeared flakes of foam…"  It is evident that with time Dostoevsky gained in knowledge about epilepsy and the subtleties of the condition were depicted in a more succinct and sensitive manner in his later novels. 
In the final analysis, what did Dostoevsky suffer from? The available body of literature has done little to investigate and settle the issue; on the contrary, it has rendered the matter nebulous and vexing. Opinions are too many, too diverse, and far too confusing. Yet, there can be little doubt that he suffered from some sort of epileptiform disorder. Freud's contention of "hystero-epilepsy" stands nullified in the light of later works, though DeToledo has categorically stated that Dostoevsky was well aware of the advantages of feigning seizures, and Smerdyakov, the chief character in 'The Brothers Karamazov' openly admitted that shamming was advantageous in certain situations. On the other hand, accounts of Nikolay Strakhov, his friend, Anna Grigorievna, his second wife, and other accounts almost compellingly suggest that he suffered from an organic seizure disorder. The important issue that Dostoevsky experienced "ecstatic aura" is debated by a number of researchers while some again attest the existence of this extremely rare variety of epileptic aura. What William Gordon Lennox, a world authority on epilepsy, said is especially noteworthy, "A given person may suffer from both of these disorders (hysteria and epilepsy), separately or perhaps as a hybrid phenomenon" and John M. Sutherland and Mervyn J. Eadie said, "Epilepsy and a hysterical reaction may co-exist as two separate etiologically unrelated entities in one individual."