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Many scientific authors – among them famous names such as Henri Gastaut or Sigmund Freud – dealt with the question from what kind of epilepsy Fyodor Mikhailovitch Dostoevsky (1821–1881) might had suffered. Because of the tight interplay between Dostoevsky's literary work and his own disease we throw light on the author's epilepsy against the background of his epileptic fictional characters. Moreover, we attempt to classify Dostoevsky's epilepsy on the basis of his bibliography, language, and literary work.
Fyodor Mikhailovich Dostoevsky (1821–1881) is one of the greatest writers of Russian literature in the 19th century (Fig. 1). His psychological penetration into the human soul and his dealing with moral and philosophical questions had a profound influence on the literature of the 20th century. Dostoevsky's literary work has strong autobiographical elements. He therefore presented interacting characters with contrasting views about freedom of choice, religion, socialism, atheism, good and evil. Some of his characters suffered – like the author himself – from epilepsy. However, despite the fact that famous people suffered from epilepsy (only to name Alexander the Great, the Roman emperor Cesar, Gustave Flaubert, or Lord Byron), and that important past and contemporary authors such as William Shakespeare, Charles Dickens, or Edgar Allen Poe described epileptic seizures in their works, this common and inconsistent neurological disorder kept a shadowy existence and a mystery for non-affected people. Accordingly, Maxim Gorky described Dostoevsky retrospectively as “our evil genius” (1913),
According to the spirit of this time, Dostoevsky's epileptic characters were interpreted in a psychiatric–psychological manner. Thus, Muratov said: “I dare say that the correct comprehension of the Dostoevsky's types is only possible by psychiatric evaluation”.
The first scientific interpretation of Dostoevsky's literary work, however, was made by Tchich who wrote: “It is difficult to understand how Dostoevsky could collect such extensive experiences in psychopathology; it is even more difficult to answer the question if Dostoevsky was aware of his profound knowledge about the systematology of the sick soul. Of course, he could use the experiences with his own illness for the analysis of abnormal conditions of the human soul. We know from him that he suffered from hallucinations already in early childhood. And it is common knowledge that he suffers from epilepsy”.
Because of this interplay between Dostoevsky's literary work and his own disease, we throw light on the author's epilepsy against the background of his epileptic fictional characters. Moreover, we attempt to classify Dostoevsky's epilepsy on the basis of his bibliography, language, and literary work.
Dostoevsky's family had old-Lithuanian aristocratic origins. The name was derived from the Russian word dostoijny, which means dignified, deserved. Fyodor Mikhailovich Dostoevsky was born on October 30th, 1821 (old Julian calendar; on November 11th, 1821 according to the Gregorian calculation) in Moscow, as the second son of Mikhail Andreevich Dostoevsky, a doctor at the hospital for the poor. Maria Fyodorovna Nechayeva, his mother, was descended from a conservative Moscow merchant family. Dostoevsky was educated at home and at a private school. The family lived in a very small apartment, which his father also used as a doctor's practice. The patriarchal and avaricious character of his father was seminal for the personal and the artistic development of Fyodor. In 1833, the family moved to Tula where the father bought a manor. Shortly after the death of his mother in 1837, Fyodor was sent to St. Petersburg where he entered the Army Engineering College. In 1839, Dostoevsky's more and more tyrannical father died, probably of apoplexy, but there were strong rumours that he was murdered by his own serfs in a quarrel. Against the background of this legend, Sigmund Freud later interpreted the patricide in the novel “The brothers Karamazov” as derivated from Fyodor's hate against his father.
Dostoevsky graduated as a military engineer and started to work at the ministry of war. With the help of a small income from the estate and because of his being bored by this work, he resigned in 1844 his commission to devote himself to writing. His first novel “Poor Folk” (1846) gained a great success with the critics. It was followed by “The Double” (1846) and other small novels which were considered a failure. Therefore, and due to an addiction to gambling, Dostoevsky was constantly pushed for money.
In 1847, Dostoevsky participated in a revolutionary group around Petrashevsky. He was arrested and sentenced to death in 1849, during a reading of a radical letter. On December 22nd, 1849 he experienced mock execution while he was expecting death during some minutes quite seriously. However, the sentence was commuted to Katorga, a penal camp in Siberia. Dostoevsky spent four years in hard labour and wearing fetters. During that time, Dostoevsky's health dramatically deteriorated and he suffered from his first generalized epileptic attacks. On his release in 1854 he was assigned as a common soldier in Semipalatinsk. His military career allowed him to marry Maria Dmitrevna Isaeva, a 29-year-old widow and mother of a son. In 1859, he was dismissed because of his bad health. The troop doctor wrote: “1850, he had his first epileptic attack with crying, amnesia, cloniform movements, foam around his mouth, and dyspnoea with weak and rapid pulsation of the heart. This first attack lasted for 15 min. The attack was followed by common exhaustion and reachievment of consciousness. 1853, he had another attack, and meanwhile, the attacks return at every end of the month”.
During his Siberian years, Dostoevsky became a devout follower of the Russian Orthodox Church and a persuaded monarchist. In 1859, he returned to St. Petersburg. His subsequent three works (“The Insulted and Injured”, 1861; “The House of the Dead”, 1862; “Winter Notes on Summer Impressions”, 1863) reflected his Siberian experiences, religiousness, and criminological mastership. Dostoevsky earned some money as editor of the monthly newspaper “Vremya” (Time), in which two of his novels appeared.
The happiness, indeed, did not last for a long time. During repeated trips to many European cities in the years 1862–1865, Dostoevsky got to know the complacence and arrogance of the aristocratic European ‘Bourgeoisie’. These experiences supported his slavophilic attitude and resulted in some crucial essays. In the same time his life was influenced by his brother and the oppression of his journal “Vremya” by the Russian authorities. Furthermore, his wife suffered from tuberculosis, and an impassionate affair with a young woman called Apollinaria Suslova ended tragically due to his obsession with gambling. Beside of these blows he suffered from frequent epileptic seizures. At the bedside of his sick wife he wrote “Notes from Underground” (1864), a psychological study of an outsider. The book marked a pause in Dostoevsky artistic development. The work starts with a confession by the narrator: “I am a sick man … I am a wicked man …”
In 1864, Dostoevsky's wife died, and shortly after he left Petersburg again to meet his beloved Apollinaria. The reunion with Apollinaria became a great failure, because he continued gambling. Thus, he returned to St. Petersburg impecuniously and started to write his novel “Crime and Punishment” (1866), which was followed by the novel “The Gambler” (1866), an honest testimonial of Dostoevsky's own gambling which was written within a few weeks. On the 15th of February, 1867, Dostoevsky married Anna Grigoryevna Snitkina, his stenographer who seemed to have understood her husband's manias and rages. Ten days later, Dostoevsky had an epileptic attack which was described in Anna Grigoryevna's memories:“Fyodor Mikhailovich was extremely excited and telling something interesting to my sister. Suddenly he broke his speech off, stood up and began to lean over me. I looked astounding at his changing face. Suddenly, a terrible cry or even a howl was heard and Fyodor Mikhailovich began to bend forward. I took his shoulders and put him to the sofa. But it was terrible to see that the lifeless body of my husband was slipping down from the sofa and I had no force to hold him up. Taking back a chair with a burning lamp I gave him possibility to come down to the floor and came down myself. All the time of his convulsions I had kept his head on my knees … Fyodor Mikhailovich began to come to his senses but he didn’t understand where he is and even had lost the freedom of speech. He wanted to tell something but he mixed the words and it was impossible to understand him. Only half an hour later we managed to pick him up and put him upon the sofa. It was decided to allow him to calm himself before going home. But the seizure repeated in an hour and it was very strong. Fyodor Mikhailovich after regaining consciousness cried because of pain during more than two hours. It was something terrible”.
The young couple left Russia to avoid the creditors and spent some time in Germany, Italy, and Switzerland, mostly in poverty, while Dostoevsky lost his money again and again with his obsession of gambling. Meanwhile, his literary fame grew in Russia.
After their return to Russia, the couple purchased a house in a provincial town. From his second marriage, he had four children of whom one son suffered from epilepsy most likely due to encephalitis. At that time, Dostoevsky wrote two of his most popular novels, which consolidated his fame as one of Russia's greatest writers. Firstly, “The Idiot” (1868), a large novel depicting a Christ-like figure suffering from epilepsy, prince Myshkin.
Secondly “The Devils” (1872), an exploration of philosophical nihilism, became a great success and helped to surmount the former living in debts.
In the following years, Dostoevsky remained productive, although his health continued to deteriorate. On one side, he suffered from heavier and more frequent epileptic attacks, one the other side, he complained about a lung disease, which forced him to stay repeatedly in a Swiss sanatorium.
By the time of his great novel “The Karamazov Brothers” (1879–1880), Dostoevsky was recognized in Russia as one of its great writers. This final novel culminated his lifelong obsession with patricide. The assumed murder of his father had left deep marks on the author's psyche.
In the evening of January 28th, 1881 (Julian calendar), Dostoevsky died in St. Petersburg from his lung disorder – it is unclear whether it was an emphysema or tuberculosis. Three days later, Fyodor Mikhailovich Dostoevsky was buried in the Aleksandr Nevsky monastery.
Epileptic characters in Dostoevsky's novels
Epilepsy was an inventive source in Dostoevsky's creating. He described several figures suffering from epilepsy. The very detailed description of epilepsy in these figures may indicate that Dostoevsky was aware of this disorder apart from his own experiences.
In his novel “Khoziaika” (The Landlady, 1847), the first epileptic characters were described: the old man Murin and the eccentric artist Ordynov who both loved the same woman.
The epilepsy is a fundamental element in one of the culminations of the novel: when Murin tried to kill his rival Ordynov, he suffered an epileptic attack and missed his target. On the other hand, Ordynov experienced feelings of happiness and lucky recollections of his childhood during a febrile delirium. Unequal to his later literary works, Dostoevsky did not describe the attacks precisely but noted that, in the case of the old man, the attack was preceded by alcohol consumption – a personal experience of Dostoevsky himself.
The proud girl Nelly in the novel “Unizhennye i oskorblennye” (The Insulted and the Injured, 1861) was the third epileptic fictional character in Dostoevsky's work.
The girl's epilepsy began already in early childhood: “suddenly, she exclaimed. Her face convulsively shivered and she fell.” Also, the postictal time was described precisely: “She looked at me for a long time without any motion, but with high tension, just as she tried to understand something. But it was obvious that it was troublesome for her. Finally, something like a thought enlightened her face. After an attack, she usually could not think clearly and only mumbled inapprehensible words.”
The most famous epileptic fictional character in Dostoevsky's work probably is prince Lew Nikolaevich Myshkin from the novel “Idiot” (The Idiot, 1868).
Just as the author, prince Myshkin prefers the crowd to the aristocracy. His reputation as a “good man” who loves old Russian traditions and follows faithfully the Russian-orthodox church is like a mirror of Dostoevsky's own slavophilic attitude, as an antipole to the decadent noble Petersburg aristocracy who tried to imitate Western living style. Another important topic in this novel is forgiveness. Myshkin forgives even his worst enemies. He suffered from epileptic auras as well as from generalized epileptic attacks. When his rival Rogoshin wanted to kill him, he suffered from a generalized attack, fell down the stairs, and was, hereby, prevented from being killed.
In “Besy” (The Devils, 1872), Dostoevsky picked up a famous criminal story.
A nihilistic student kills a fellow student because of other opinions. Kirillov, an atheistic mystic, suffers from epilepsy with auras of happiness and is obsessed with the idea of self-destruction. He finally kills himself under dreadful circumstances.
In his last and perhaps greatest novel “Brat’ia Karamazovy” (The Brothers Karamasov, 1880), the epileptic was a key figure: Smerdyakov, a ‘bastard’, is known as a shy, silent and haughty misanthrope.
After long religious and moralistic reflecting, he decides that everything in the world is permitted. The consecutive murder of his tyrannical and wrongful father is a criminological masterpiece. As he suffers from epilepsy, he simulates a status epilepticus at the time of the murder and thus gets a perfect alibi. After the murder, however, his epilepsy worsens, and he suffers from dreadful hallucinations. Last not least the devil appears in his imaginations, whereupon he commits suicide.
Dostoevsky's language and writing style are mirroring his disease
Dostoevsky's illness has influenced some peculiarities of his writing, his language and style. His language is 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. But now and then we can see here very short, elliptic phrases. Dostoevsky's favorite word was “vdrug” (“suddenly”). A lot of events in Dostoevsky's novels begin suddenly, without preparations and explanation – like seizures. Dostoevsky also used frequent repetitions of the same word with different intonations. It made an impression of convulsions and shocked the literary critics. He wrote in a meticulous manner, using every empty space of a sheet (see Fig. 2). 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.
Dostoevsky as a writer was rather “strange” for the 19th century; his language had reputation of a “wrong”, “incorrect” speech. But it was a language of future, of the tragic 20th century with its world wars and revolutionary terrors. The “sick” language of Dostoevsky has become the mirror of the human nature and the structure of the universe.
Dostoevsky's epilepsy – a scientific approach
Although Dostoevsky did not write essential information on his own epilepsy, many scientific authors dealt with the question from what kind of epilepsy he might had suffered.
The few traditions of Dostoevsky himself, from friends, his second wife as well as the description of epilepsy patients in his novels (we assume that he had probably experienced some of the epileptic symptoms he attributed to his characters in the course of his own disease) should be considered when dealing with this question.
: once young Dostoevsky heard somebody sounding a warning cry “a wolf, a wolf”, although there was nobody having cried.
Following his first severe seizures in the age of 25 years, frequency and severity of the attacks worsened.
Type of seizures and epilepsy
Some famous authors assumed that he suffered from a “hystéroépilepsie” (today: non-epileptogenic psychogenic seizures). Two arguments have been brought forward to prove this theory: First, Dostoevsky's first seizure in 1846 occurred very soon after the death of his father, and secondly, his epilepsy was interpreted as a consequence of an oedipus complex towards his father.
Also, Freud's interpretation might not be accurate for he focussed only on the odium against Dostoevsky's father, and he did not pay attention to the semiology of the seizures and the natural course of the disease.
Facing the assumption that Smerdyakov, the epileptic son of old Karamazov, both had epileptic and non-epileptic (pretended) seizures, DeToledo, finally, hypothesized that Dostoevsky himself was aware of the secondary gains deriving from simulating seizures and might have had “all kinds of seizures” (both epileptic and nonepileptic), as Dostoevsky stated earlier in his life.
He argued that the initially mostly generalized semiology of the seizures, the predominant nocturnal appearance during the first night half, the probable genetic disposition (epilepsy of the son), and the interictal lack of neuropsychological deficits, may indicate a primary generalized epilepsy. Furthermore, he referred to the fact that Dostoevsky only rarely experienced auras and doubted the existence of happiness as a form of aura (ecstatic aura) since he never saw a patient with such an aura.
New interpretation of Dostoevsky's epilepsy
In our opinion, however, there is evidence that Dostoevsky suffered from temporal lobe epilepsy. We even hypothesize that his seizures originated from the mesial temporal lobe. Thus, the semiology of Dostoevsky's seizures is basically compatible with epilepsy of mesial temporal origin. Strakhov, a close friend of Dostoevsky, described the seizures as follows: “Normally, the attacks occurred once a month, sometimes, however, he suffered also from two seizures a week – but this was not common … He reported a signalling emotion before every attack, but sometimes this impression was misleading. I had the opportunity to watch one seizure in the year 1865. Late in the evening, he came to see me, and very soon, we had an intensive discussion … I remember that Dostoevsky brimmed over with enthusiasm for the topic and started to wander in my room … He spoke about something noble and delightful. When I agreed, he turned his head to me, and I was aware of his glowing countenance, which was associated with the highest infuriation. He paused, just as if he were looking for words, and opened his mouth … Suddenly, a sustained, strange and senseless scream exhausted from his mouth, and he fell unconscious. The attack itself was not very strong. His body winded with convulsions, and foam was seen in the corners of his mouth … – Dostoevsky often told me that he fell into a sort of ecstasy before his seizures. ‘During few seconds’ he told me, ‘I am penetrated by an immense happiness, which cannot be experienced in normal circumstances’ …
The description by his friend does not allow classifying Dostoevsky's epilepsy but it gives some important evidence for a partial seizure with an initial aura (“signalling emotion before every attack”), followed by arrest reaction with vocalisation, and secondary generalization. In our opinion, it is not clear if the bilateral cloni were an initial symptom or a secondary generalization of a focal seizure. Also, the predominant nocturnal appearance is no proof for primary generalized epilepsy – contrariwise it can be a sign of frontal lobe epilepsy or nocturnal temporal lobe epilepsy.
With reference to Gastaut's opinion regarding the aura, we have a different view on the existence and interpretation of aura in Dostoevsky's case. First, Schutz et al. showed in a prospective study, that patients with complex focal epilepsy often forget the aura. In patients with bilateral EEG-changes, auras were remembered only in 73% of tested cases.
Accordingly, the rare report of auras by Dostoevsky does not allow the conclusion that he did not have any as Gastaut postulated. Secondly, psychic, visual, olfactoric or auditive hallucinations are typical for temporal lobe epilepsies. Furthermore, we believe in the presence of ecstatic auras, for we have seen a few in our clinic, and some cases have been reported.
The ‘epilepsy’ of Dostoevsky's son may not be taken into account as an existing familial primary generalized epilepsy. His son suffered from a status epilepticus that likely was the manifestation of encephalitis. Even if there were a genetic predisposition, it could still have been focal epilepsy such as autosomal-dominant frontal lobe epilepsy.
There is clear evidence of a (however, not accurately defined) temporal lobe epilepsy personality syndrome including a deepening of emotionality with a serious, highly ethical, and spiritual demeanour and an interictal dysphoric disorder.
Bear and Fedio described typical interictal findings in patients with temporal lobe epilepsy including hyperreligiosity, euphoria, depression, hypergraphy, hypo- or hypermoralism, interest in philosophical questions, altered sexual behaviour, paranoia, consciousness of guilt, and emotional alteration. 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 question of guilt. Myshkin from the novel “The Idiot” shared many character traits with his creator, such as russophilia, hyperreligiosity with profound believe in the Russian-orthodox church, melancholy, auras of happiness, generalized seizures. Furthermore, Dostoevsky wrote in large letters, and his style was sometimes compulsive and abrupt.
In conclusion, the exact classification of Dostoevsky's epilepsy remains elusive. We believe, however, that many signs indicate that this famous writer might have suffered from mesial temporal lobe epilepsy.