Dostoevsky'S The Idiot and Psychic Disorders in Epilepsy

DOSTOEVSKY'S THE IDIOT AND PSYCHIC DISORDERS INEPILEPSY TONY MIKSANEK* I have my own special view on reality in art; what the majority call almost fantastic and exceptional sometimes signifies for me the very essence of reality.—Fyodor Dostoevsky [1, p. 105] Art and science are not always the best of friends. The objectivity of the scientist is often rejected by the romantic writer. Similarly, the mysticism of the artist is in distinct contrast to the reductionism of many scientists. Despite this apparent dichotomy, there remains a unity of art and science. Utilizing different media, artist and scientist alike strive to identify and describe essential truths. A striking example of this unity of art and science involves the neurosurgeon, Wilder Penfield, and the author, Marcel Proust. Penfield's electrical stimulation of certain areas of the temporal lobe [2] resulted in the elicitation oflong-term memories in many ways paralleling Proust's detailed recollection of distant experiences and exploration ofa man's mind in his classic work, Remembrance of Things Past [3]. An equally striking parallel exists in the work of the Russian author, Fyodor Dostoevsky, and contemporary theories regarding psychic disorders in epilepsy. In his novel The Idiot [4] Dostoevsky constructs an elaborate tale centered on the life and experiences of an epileptic hero, Prince Myshkin. Dostoevsky presents a lucid and accurate description ofepileptic seizures and the effect of epilepsy on the life of an individual. Such sensitivity and insight into the nature of this illness are not surprising; Dostoevsky was himself epileptic [5]. In this novel written more than a century ago he describes an epileptic seizure: The epilepsy itself comes on instantaneously. At this moment the face is suddenly horribly distorted, especially the eyes. Convulsions and spasms seize the Essay received honorable mention in the first Dwight J. Ingle Memorial Writing Award for authors under 35.»Address: 7746 South McVicker, Burbank, Illinois 60459.© 1982 by The University of Chicago. All rights reserved 003 1-5982/82/2502-0272$0 1 .00 Perspectives m Biology andMedicine, 25, 2 ¦ Winter 1982 \ 231 whole body and the features of the face. A terrible, incredible scream, unlike anything imaginable, breaks forth; and with this cry all resemblance to a human being seems suddenly to disappear. ... It is actually as if someone else was screaming, inside the person. [4, p. 254] The prince was carried to his room; and though he regained consciousness, he did not come fully to his senses for some time. . . . About an hour later, the prince began to understand fairly well what was going on around him. [4, p. 255] More than 1 00 years later, Dostoevsky's account of an epileptic seizure remains impressively accurate as evidenced by comparison with a contemporary clinical description: The recurrent generalized seizure . . . begins with a sudden loss of consciousness , a cry, a fall to the ground, tonic then clonic movements of muscles of cranium and limbs, sometimes sphincteric incontinence, and other autonomic disorders. The motor activity soon terminates, leaving the patient in a state of coma, which lasts for many minutes or even as long as a half-hour. As the coma recedes, mental confusion, drowsiness, and headache become evident. [6] Dostoevsky was not, however, the first author to describe epilepsy. As early as 400 b.c., Hippocratic medical texts contained a treatise entitled On the Sacred Disease. In contrast to the title, this medical writing argued that epilepsy was not a sacred disease involving an act of possession by spirits [7, p. 13]; instead the text offered a scientific explanation about the etiology of the illness. Hippocrates attributed epilepsy to a softening of the brain secondary to flooding and disintegration of the cerebral tissue by phlegm [8]. At various other times in history, epilepsy was believed to be the result of supernatural forces, irritating or toxic substances , or the humors. As late as the seventeenth century, epilepsy was believed to be an infectious disease, which no doubt accounted for some of the social ostracism associated with the illness. In 1684 Thomas Willis departed from traditional medical thinking when he stated that all seizures must arise in the brain and attributed the epileptic muscle movements to chemical reactions in the central nervous...