Epilepsy, with its dramatic and obvious symptoms but complex array of different neurological causes, has been known of and written about for millennia, but little understood through the vast majority of that time. As a result, a number of myths have grown up around it. Narratives of epilepsy and individuals suffering from seizures have been tied to associations with violence since classical times. This is apparent in the etymology of the condition's name. The word 'epilepsy' has the same root as the classical Greek verb epilambanein, which means 'to attack' or 'to seize' (hence, 'seizure'). In the classical tradition, an epileptic seizure was, therefore, perceived as 'an attack,' potentially as the body being violently taken over from an external divine or demonic force.  (The classical myth of Hercules murdering his wife and children while consumed by a fit of manic rage has often been interpreted as a depiction of epilepsy in this sense with epilepsy also going by the name 'the Herculean Disease'). 
While in some respects the narrative of epilepsy in association with demonic possession still remains surprisingly present in our society,  post-Enlightenment studies of people afflicted by epilepsy attempted to move away from a spiritual explanation of seizures and towards one embedded in science and natural causes. This tended to be more as a result of how supernatural explanations 'seemed to be irrational and to postulate the impossible,' rather than any empirical evidence of how to understand or treat the condition.  Patients suffering from severe epilepsy were confined to asylums with people suffering from a wide variety of mental health conditions and their condition was studied in a rather haphazard fashion. In the early nineteenth century, patients at the asylum at Salpetriere in France were subject every spring and autumn to trials testing 'bloodletting, cathartics, baths, cauterization, and all kinds of antispasmodic and even secret medicaments,' while in Britain as late as 1861 one physician 'impressed by the older enthusiastic reports, recommended a new trial of mistletoe.' 
The National Hospital for the Paralysed and Epileptic (1860) was Britain's first special institution for patients with epilepsy. (Epilepsy sufferers were not segregated from other 'lunatics' for their benefit, though, but rather because the condition was still thought to be contagious and even seeing a seizure in another was thought to have the chance to pass it on) 
Dickens and degeneration
The difficulty of finding ways to classify and categorise epilepsy within the medical wisdom of the day led to a difficulty in finding appropriate language and terminology with which to define it. As Jeanette Stirling writes:
'Tensions between the project to modernise epilepsy as a neurological entity and frustrations with the intractability of the disorder to medical definition and control manifest in the language of Gowers and other physicians of the age. […] Given the crisis of language haunting late nineteenth-century neurologists, it is not surprising that they sometimes looked outwards for representational inspiration. And in Britain, where better to look than the literature of the day?' 
Thus, fictional depictions of epilepsy and the views of the medical establishment on the condition continued mutually informing the language with which each framed the moment of a seizure and the character of 'the epileptic.'
Stirling points to Dickens as the most obvious purveyor of literature as social and cultural criticism in the early Victorian period, a literary style that encompassed popular depictions of medical conditions.  J.E. Cosnett has suggested that Dickens' 'observation on the nature of epilepsy and its provocation and consequences are remarkable,' referring to 'realistically described seizures' depicted in the characters of Guster in Bleak House and Bradley Headstone in Our Mutual Friend.  Dickens' most notable depiction of epilepsy, however, occurs in the character of Monks from Oliver Twist. Monks is first introduced to the reader coming across Oliver by accident, bumping into him in an inn yard. The reader's instant impression of the character is one of violence and aggression. 'He advanced towards Oliver, as if with the intention of aiming a blow at him, but fell violently on the ground: writing and foaming, in a fit.'  The violence of his writhing seizure here is inextricably linked to his violent and aggressive character.
Monks, it later transpires, is the criminal alias used by Edward Leeford, Oliver's half-brother, who schemes to disinherit Oliver through involving him in criminal activity. In his narrative of the then-popular medical and psychological model of the criminal underclass, it is the epileptic Monks, even alongside the likes of Fagin and Sykes, that comes across the most irredeemably degenerate. As Stirling writes:
'There can be no doubt that Dickens shrewdly captures what was to become a resurgent preoccupation with hereditary taint in his exploration of the biological links between Oliver and Monks. He also perpetuates an image of the morally lax, violent epileptic that keeps returning to the centre of scientifically inclined discourse.' 
In particular, Dickens makes a point of contrasting the two brothers' physiognomies as a way of indicating the differences inherent in their nature. While Mr Brownlow, a symbol of civilised society, recognises Oliver's worth through seeing signs of innocence on his face even while he is on trial, he describes Monks as someone 'in whom all evil passions, vice, and profligacy, festered, till they found a vent in a hideous disease which had made your face an index even to your mind,'  suggesting that the damage done to Monks' face – his lips discoloured and disfigured from being bitten during seizures – reflects the darkness of his soul.
Monks in an illustration by Sol Eytinge Jr. for Chapter 38 of Oliver Twist.
'The Epileptic Character'
The character of Monks popularised, and perhaps even influenced, the growing link between epilepsy and theories of degeneration in the nineteenth century. The pseudoscience of phrenology and related ideas around physiognomy were clearly influential on the descriptions of Monks' epileptic facial features and these combined with a growing discussion of evolution and the descent of man in the aftermath of the 1859 publication of Darwin's On the Origin of Species to create a growing notion of crime as the product of a degenerate class afflicted by hereditary neurological or psychological disorders. Psychiatrist Bénédict Morel's 1860 book on degeneration in mental disorders became a standard text and linked inherited epilepsy with increasing criminal behaviour.  Morel would be influential in coming to define what became known as 'the epileptic character,' defined by irritability, anger and aggression even when seizures were not occurring.  Such concepts were taken up and developed by Cesare Lombroso, often perceived as the father of criminology, who based his views on the idea that criminal activity was a product of degeneration, that the criminal personality was atavist and bestial, and that this manifested itself via epilepsy. 'We must not forget that the basis of criminal tendencies is always of an epileptic nature,' Lombroso wrote in 1899's Crime, its Causes and Remedies.  Lombroso was a highly influential and popular thinker and his notions of the atavist, bestial, and epileptic criminal were taken up in the fictions of the day, most obviously in Emile Zola's La Bête Humaine. Lombroso himself is said to have praised Zola for his depiction of 'a criminal epileptoid vertigo' in Jacques Lantier's violent rage, loss of awareness of his surroundings and confused later awakening. 
The idea, popularised in studies like Morel's and Lombroso's and fictions like Zola's, of a 'masked epilepsy' in which somebody could commit a murder under the influence of an epileptic seizure and later awaken and be unaware of their earlier acts became increasingly influential as a defence in criminal trials in the late nineteenth century. In one trial in 1884 of a man who had suffered from seizures since childhood and was now charged with murdering his sister with a razor, the defence lawyer stated that 'epilepsy sometimes produced a generally deteriorating condition of the brain. After a fit of epilepsy patients were very commonly unconscious and did acts of which they had no knowledge.'  In another, in 1899, the psychiatrist Henry Maudsley (a strong advocate of the degeneracy and atavism school of criminology) was called as a witness and suggested that 'Masked epilepsy might appear suddenly and go away suddenly. He did not see the least trace of epilepsy, but he could not say that the prisoner had not an epileptic fit on that day. In a fit of mania the prisoner might have committed the act and forgotten all about it.' 
Maudsley had previously declared in 1873 that the 'epileptic neurosis' was characterised by a 'singularly vivid imagination, which is apt sometimes to occupy itself with painful or repulsive subjects. Probably the invention of the modern sensation novel, with its murders, bigamies, and other crimes, was an achievement of the epileptic imagination.'  Perhaps, however, it might be more accurate to take the opposite view: that the modern conception of epilepsy was probably itself an invention best suited to the imagination of the murder-filled sensation novel. (The most enduring sensationalised fictional criminal of the era, Jack the Ripper – the imagined scapegoat conjured up by journalists and fiction writers to pin the very real Whitechapel Murders on – was, for example, repeatedly associated with epilepsy with little real world justification ). As Peter Wolf wrote on the Agatha Christie mystery The ABC Murders, in which the murderer frames a man who suffers from epileptic seizures, 'To hang a person with epilepsy who has lapses of consciousness during which he or she may be suspected to act in an irresponsible way is a temptation not only to a scoundrel in a detective story but also to writers of mysteries.'  Christie received a British Victorian education, as did the major American crime writer of the twentieth century Raymond Chandler whose most influential work The Big Sleep also hinges on a murderer with epilepsy.  Perhaps for both writers the epileptic murderer narrative of their youth was simply too good a story structure to resist, even as twentieth century neuroscience moved beyond notions of degeneracy and masked epilepsy.
Unfortunately, the power of fiction is such that the image of the epileptic murderer remains embedded in the cultural consciousness long after it has ceased to be relevant in contemporary neurology and criminology.  As Irma Jacqueline Ozer writes of Othello's status as required reading for many school children, 'the image of the raging, jealous murderer with epilepsy has taken root – at least subliminally – in the public psyche.'  Studies continue to indicate that associations with epilepsy drawn from its depiction in fiction hold sway over a surprisingly significant amount of the public. One transnational study across Britain and the Netherlands found 15% of people still believed in 'the epileptic personality,'  another in 2007 found that 'about a quarter of those studied considered violence and epilepsy to be associated' (a percentage that had not changed since a similar study in 1981),  while a 2013 study referred to the ongoing stigma faced by over 40% of respondents as 'more akin to 1913 than 2013.'  Until cultural depictions of epilepsy progress beyond the convenient Victorian fiction of the bestial, murderous epileptic, these ingrained attitudes are unlikely to change.
Jack Gann is a PhD student at Leeds Trinity University. His research looks at representations of the Victorian street scene in the contemporary heritage industry. He was diagnosed with epilepsy during the first year of his PhD research.
For reliable, accurate, and up to date information about epilepsy and its effects, visit Epilepsy Action.
Header Image: Jean Duplessi-Bertaux, 'A group of people standing around a man having an epileptic fit', Wellcome Library, London. Wellcome Images.
John William Simpson, 'The National Hospital for the Paralysed and Epileptic, Queen Square' (1884), Wellcome Library, London. Wellcome Images.
Sol Eyntige Jr, 'Monks' (1867), Eighth illustration, The Adventures of Oliver Twist (Scanned image and text by Philip V. Allingham)
 Oswei Temkin, The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology (Baltimore: Johns Hopkins University Press, 1945, 1971), p. 21
 Temkin 1971, p. 20
 See the depictions of seizure-like incidents in possession-based horror films such as The Exorcist or The Exorcism of Emily Rose, almost certainly responsible for the findings in a 2013 study that reported 20% of young people with epilepsy had been accused of being possessed and 18% asked if they could talk to spirits – Young Epilepsy, Children with epilepsy face stigma and discrimination as they would have a century ago – according to new survey 2013 - http://www.youngepilepsy.org.uk/news-and-events/media-centre/media-releases/children-with-epilepsy-face-stigma-and-discrimination.html
 Temkin 1971, p. 227
 Temkin 1971, pp. 291-292
 Temkin 1971, pp. 256-257
 Jeannette Stirling, Representing Epilepsy: Myth and Matter (Liverpool: Liverpool University Press, 2010), pp. 25-26
 'Inspiration was not a one-way process,' she adds, 'medical writers also looked to Dickens when naming symptoms,' citing the case of Pickwickian Syndrome – Stirling 2010, p. 26
 J. E. Cosnett, 'Charles Dickens and Epilepsy', Epilepsia July 1994, Volume 35 (4), pp. 903-905
 Charles Dickens, Oliver Twist edited by Kathleen Tillotson (Oxford: Oxford University Press, 1838, 2008), p. 260
 Stirling 2010, p. 29
 Dickens 2008, p. 400
 Simon G. Shorvon, 'Historical introduction: the causes of epilepsy in the pre-molecular era (1860-1960)', The Causes of Epilepsy: Common and Uncommon Causes in Adults and Children (Cambridge: Cambridge University Press, 2011), pp. 1-20
 Temkin 1971, pp. 317-318
 Cesare Lombroso, Crime: Its Causes and Remedies translated by Henry P. Horton (Boston: Little, Brown and Company, 1911), p. 324
 Temkin 1971, pp. 378-379
 'The Ancoats Murder: Sentence of Death', The Manchester Guardian 21 July 1884, p. 7
 'The Drury Lane Murder: Sentence of Death', The Manchester Guardian 10 March 1899, p. 8. See also 'The Old Trafford Murder: Sentence of Death', The Manchester Guardian 13 May 1881, p. 8; 'The Woolwich Murder', The Times 2 February 1885, p. 12; John W. Ogle, 'The Case of Mrs. Pearcey', The Times 22 December 1890, p. 7; 'North Wales Assizes: The Attempted Murder Near Wrexham', The Manchester Guardian 31 October 1893, p. 8; 'The Helmsley Murder: Verdict and Sentence', The Manchester Guardian July 24 1894, p. 6 for further examples of masked or hidden epilepsy as a defence in Victorian murder trials
 Quoted in Temkin 1971, p. 379
 See the memoirs of psychiatrist and police consultant L. Forbes Winslow who recalled 'I imagined that Jack the Ripper suffered from this malady, and that, during the seizure, he might perform the most extraordinary and most diabolical actions, and upon his return to consciousness would be in perfect ignorance of what had transpired when the attack was on him, and would conduct himself in an ordinary manner before people.' (L. Forbes Winslow, Recollections of Forty Years: Being an account at first hand of some famous criminal lunacy cases, English and American; together with facsimile letters, notes and other data concerning them (London: John Ousley Ltd., 1910), p. 258); the trial of Frederick Bailey Deeming, popularly believed at the time to be 'the Ripper', at which a witness observed 'If the man is an epileptic savage you cannot gauge his conduct by any particular circumstances. […] The fits from which he had suffered in prison showed that he was an epileptic subject.' ('The Trial of Deeming: Doctors and the Insanity Plea', The Manchester Guardian 29 April 1892, p. 8); and even the recent acclaimed graphic novel From Hell in which the Ripper character suffers from seizures during and after the murders (Alan Moore and Eddie Campbell, From Hell (London: Knockabout, 2000), ch. 14, pp. 1-25)
 Peter Wolf, 'Epilepsy in Literature', Epilepsia January 1995, Volume 36 (1), p. 14
 Raymond Chandler The Big Sleep (London: Penguin, 1939, 1970), pp. 210-211
 Studies in the late twentieth century showed 'Automatic action of any kind in association with a fit is rare (10% of cases), but acts of violence in this context are exceptionally so' and, amongst prisoners who also suffer from epilepsy, 'Very little direct relationship between the crimes committed and the men's epilepsy could be detected.' Meanwhile, a 2007 study 'stresses the rarity of a direct relationship between epilepsy and violent acts.' (Cited in John Gunn, Michael T. Kopelman, Veena Kumari, Pamela J. Taylor, Birgit Völlm, and Mairead Dolan, 'Disorders of brain structure and function and crime' in Forensic Psychiatry: Clinical, legal and ethical issues edited by John Gunn and Pamela J. Taylor (Boca Raton, FL: CRC Press, 2014), pp. 285-286)
 Irma Jacqueline Ozer, 'Images of Epilepsy in Literature', Epilepsia December 1991, Volume 32 (6), p. 799
 'The History and Stigma of Epilepsy', Epilepsia September 2003, Volume 44 (6), p. 13
 Gunn et al. 2013, p. 283
 Young Epilepsy 2013
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