Sunday, November 26, 2017

Blog #88: Epilepsy in Life and in Literature: Dostoevsky

          Fyodor Dostoevsky (1821-1881) is among the world’s greatest authors. He is especially famous for Crime and Punishment, The Idiot, and The Brothers Karamazov. The central character in The Idiot, Prince Myshkin was beleaguered by epilepsy as was one of the Karamazov brothers, Smerdyakov. So, too, was their creator, author Fyodor Dostoevsky.
            Dr. Howard Markel recently reviewed Fyodor Dostoevsky’s life with epilepsy on the PBS NEWS HOUR. His review is available on-line. 1  Markel noted that Dostoevsky wrote he was grateful for his seizure disorder because of the “abnormal tension” the episodes created in his brain, which allowed him to experience “unbounded joy and rapture, ecstatic devotion and completest life.” At other times, the author regretted the disability because he thought it had wreaked havoc with his memory.
            Thoroughly familiar with epilepsy, Dostoevsky’s descriptions are spot on. For example, the fictional character Smerdyakov was said to, “…sometimes stop suddenly…and stand still for ten minutes, lost in thought. Studying his face one would have said that there was no thought in it…” (page 123). 2 A classical description that defines a complex partial seizure with post-ictal confusion. Some of his seizures are followed by headaches, which is a known post-ictal phenomenon.
            Smerdyakov makes prior plans to kill his father, the loathsome buffoon, Fyodor Karamazov, whose life is driven by narcissistic greed and lust. Smerdyakov will then blame the murder on one of his seizures. But, Smerdyakov tells a brother of a forthcoming seizure to the hour that will occur on a particular day. He is suspected of feigning some of his seizures, i.e., they are pseudoseizures. And, indeed, he later admits (page 570) to a brother that he did feign that seizure and that he consciously did murder Fyodor. 2
            Neurologists’ experiences lead us to believe that one-third of seizures in well-documented epilepsy patients whose seizures have been EEG-verified, are psychogenic or pseudoseizures, i.e., they are not true seizures. In these situations the patient is seemingly in the midst of a seizure but the EEG remains normal. Additionally, the patient can be susceptible to voice communications during the “seizure.” These pseudoseizures can have psychological causes beyond the patients’ conscious control; these are termed “conversion-type” seizures. I describe this phenomenon in greater detail in previous blogs at # 10, September 23, 2011: “Is It a True Epileptic Seizure or a Faked, Psychogenic Seizure with a Psychological Cause?” and Blog # 49 August 27, 2014: “Psychogenic ‘Fake’ Non-Epileptic Seizures.” 
            In The Idiot, Prince Myshkin described after-effects of his seizurea description of the classical post-ictal state (page 52): “…after a long series of fits. I always used to fall into a…torpid condition…and lost my memory almost entirely…I had no logical power of thought…I remember my melancholy was intolerable; I felt inclined to cry…” 3
             My blog followers who have epilepsy will be able to identify with these fictional characters’ epilepsy. I encourage you to explore Dostoevsky’s writings. Although he created these works over one and a half centuries ago, all of us can relate to his characters’ personalities and motivations. He describes us humans and our natures as we are.     

1. Dr. Howard Markel. “For Dostoevsky, epilepsy was a matter of both life and literature.” PBS News Hour. Health: Nov 10, 2017 3:05 PM EST.
2. The Brothers Karamazov by Fyodor Dostoyevsky. A Signet Classic published by the New American Library: 1957.
3. The Idiot by Fyodor Dostoyevsky. Everyman’s Library #682 published 1914.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. Presented as a medical mystery, it is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.