The sacred disease
Finding the middle ground between myth and medicalisation
In late July this year, on a Ryanair flight back from the Greek island of Kos, I had an experience that changed the course of my life forever. Mildly hungover and in a generally gruff mode of being, I transferred from Kos to London Stansted, and then onto an internal flight from London to Cornwall. The take-off, with its predictable yet somewhat comforting safety demonstration, went smoothly, and I slowly drifted asleep.
In a sea of clouds, I awoke around twenty minutes later in a state of distress. With a pulsating headache, sweat pouring down my temples, and a pressing urge to go to the toilet to throw up, it wasn’t hard to tell that something was amiss. Before I could ask the couple next to me to vacate their seats so that I might make a desperate bid for the modest Ryanair loos, I saw a bright light appear before me. With my last thought, I wondered why I could see so many white lights with the window shut…
‘Hello? Can you hear me? Do you know where you are?’ These were some of the few words that I remember as I awoke in complete bewilderment. ‘It’s okay. You’ve just had a seizure. Do you know where you are?’ Fumbling for words, I responded in the positive to the concerned-looking air hostess. With the eyes of all those around me boring into my soul, I tried to gather myself and ascertain exactly what had just happened.
‘We’re going to have to make an emergency landing in Bristol, we don’t think Royal Cornwall Hospital has the necessary equipment to treat you.’ Even in my fugue state, I took offence at this—we’re not that backwards in Cornwall, surely; it isn’t just leeches and trepanning down there. So that was what happened next: the pilot announced over the tannoy that the plane would be making an emergency landing in Bristol, much to the audible chagrin of those around me (so much for good old-fashioned English reserve). Upon landing I was whisked away in an ambulance, the plane took off again down to Cornwall, and I was admitted to Bristol Royal Infirmary for a series of tests, where I was eventually told I was at risk of developing epilepsy (the general rule of thumb for diagnosing epilepsy is two seizures, many people only ever have one in their entire lives).
It wasn’t until two months ago in Rome that I was told by the neurologist that I did in fact have epilepsy, and would have to go for a further series of exams. In my fragile state, I had failed to tell the doctors in Bristol that I had already had a seizure last Christmas, only for this one I was conscious (it was, I came to find out, a ‘simple partial seizure’, as opposed to the ‘tonic-clonic’ or ‘grand mal’ seizure I had on the aeroplane—all rather funny names).
This diagnosis came as a profound shock to me. ‘What does it mean to be epileptic?’ ‘Am I now classed as disabled? But I don’t look disabled!’ These questions came back to me repeatedly as I tried to reconcile my new circumstances. There were immediate changes to be made, too: an inveterate lush, I now had to face the sobering reality that I would have to give up drinking for the foreseeable future; after a month’s worth of frolicking in the warmths of the Aegean, I discovered that swimming was out of the question as well; the names of grim-sounding, latinate medicaments like lamotrigine and sodium valproate whirled around in my head like the fever dreams of a Pfizer representative.
If this is what it means to be an epileptic, what was to be done? Where did I go from here?
Naturally, it was at this point that the history of epilepsy began to pique my interest. I remembered from my undergraduate degree in Classics that the Greek physician Hippocrates was the first person in recorded history to give a medical analysis of epilepsy in his treatise The Sacred Disease. I had also learnt from my university days, between numerous pints of subsidised lager and hastily cobbled-together essays on Ovid, that Hippocrates was from the island of Kos,1 so perhaps, in a magical-thinking sort of way, the whole experience was rather apposite.
This treatise, The Sacred Disease, is hailed as a triumph of rational inquiry in the history of medicine, mainly for its assertion that the aetiology of epilepsy is in the natural make-up of man’s biology rather than being divine in origin. Hippocrates writes,
I am about to discuss the disease called ‘sacred.’ It is not, in my opinion, any more divine or more sacred than other diseases, but has a natural cause, and its supposed divine origin is due to men’s inexperience, and to their wonder at its peculiar character. [...] But if it is to be considered divine just because it is wonderful, there will be not one sacred disease but many, for I will show that other diseases are no less wonderful and portentous, and yet nobody considers them sacred.2
Hippocrates saw his mission as one against superstition, hoping to dispel the myths surrounding the ‘god-sent’ disease in favour of a more practical, ‘clinical’ approach. He argues that, in reality, the ascribing of epilepsy as a ‘divine’ or ‘sacred’ disease was merely a way for quack doctors, in their ignorance of the inner mechanisms of nature, to explain a rather dramatic, and somewhat extraordinary phenomenon. After rattling off a list of ‘purification and incantation’ rituals they offer, alongside their esoteric, borderline absurd treatments (such as not wearing black or lying down on goat-skin),3 Hippocrates pillories these doctors, arguing that they are impious in attributing such attacks to the gods and in blaming the gods for that which is human (or ‘biological’ in more modern parlance). The disease is not sacred, but rather a workaround for bogus medical magicians to sell their wares. He continues,
But perhaps what they profess is not true, the fact being that men, in need of a livelihood, contrive and devise many fictions of all sorts, about this disease among other things, putting the blame, for each form of the affection, upon a particular god.4
Hippocrates is, of course, right in his condemnation of these practices. He was also correct in identifying that epilepsy is often hereditary, although this observation relies on the equally ludicrous humoral theory,5 which enjoyed a privileged position in the thinking of the medical establishment for more than two thousand years following the Greek physician’s death. Hippocrates further claims that the disease only attacks the ‘phlegmatic’, and is a product of an excessive buildup of phlegm on the brain, which in turn causes a seizure.6 As ridiculous as this claim might sound to us in the present, the exact cause of epilepsy remains unclear to this day, so in some respects, Hippocrates’ guess is as good as any.
We are a long way away from the days of incantation rituals and phlegm-based diagnoses, and perhaps, in a way, we have strayed a little too far in the other direction. It goes without saying that medicine took the correct path in seeking the origin of diseases in the natural order of things, rather than being predicated on the divine. We could not expect nor want that in the modern day a GP would dismiss our coeliac disease as a product of ‘Demeter’s wrath’ or our cataracts as ‘the vengeance of Artemis’, punishing us for our hubris. With all this being said, in casting out the divine from our modern, rational approach to illness and health, we lose a vital (and vitalising) tool—not in curing disease or treating it, but rather in coping with the psychological and emotional impact that lifelong conditions present. It is very easy to dismiss the ancients as fools for believing that their sickness was brought on by some intangible, metaphysical force, but what the moderns (and in many ways Hippocrates himself) miss is that these explanations give meaning and structure to what otherwise seems like a cruel and unjust twist of fate, one for which the science of the time had no concrete answer.
In narrativising the incomprehensible, seemingly random affliction of an illness, the patient is allowed to piece together some semblance of meaning from their oftentimes shattered understanding of themselves and the world around them. There is a reason why, in our era of ever-increasing rates of ‘irreligion’ or ‘atheism’, people flock to horoscope apps like Co-Star to seek out their fate amongst the zodiac. People need meaning in their lives and, for better or for worse, in the words of Hippocrates, ‘contrive and devise many fictions of all sorts’. In the pursuit of a purely scientific approach to sickness and health, we have arrived at an impasse where, beyond rational explanations, we have no recourse or succour in our most profound moments of vulnerability.
These ‘fictions’ we create surrounding our sorry state of affairs are not new, and in times past may have helped give way to novel modes of viewing the world. Retrospective diagnoses of epilepsy include Socrates, Julius Caesar, St. Paul (whose Damascene conversion was very possibly triggered by a seizure), and even Joan of Arc.7 It is not much of a stretch to say that, in the absence of a serious, scientifically-backed diagnosis, these figures from history, who had such innovative and diverse visions of the world and their own lives, perhaps derived some of these perspectives from their rather unusual experiences with the ‘sacred disease’.
If I, a figure as unqualified as the quacks to whom Hippocrates was so inimical, were to give a modern (or rather, postmodern) narrativisation of epilepsy, I would suggest that what epilepsy represents, and how it so easily became associated with the ‘sacred’, is a moment of ekstasis—that is, quite literally, a moment of standing outside of oneself, time outside of time. The seizure is the raptus of St. Paul, ‘And I knew such a man, (whether in the body, or out of the body, I cannot tell: God knoweth;) How that he was caught up into paradise, and heard unspeakable words, which it is not lawful for a man to utter.’;8 it is the ecstasy of St. Teresa of Ávila (another potential epileptic)—the mystic, who all at once was ‘seized’ by the spirit, only to awaken, exhausted, having lived a moment outside of herself; epilepsy, the nexus of mysticism thrust into modernity, where it can only be received with pity, and treated with medicines.
Accepting that our lives, our diseases, and our vision of the world can be purely reduced to the natural order of things has helped us progress in ways that were unimaginable to Hippocrates and his disciples on that little island in the Aegean. Nevertheless, having accepted the advances of modern medicine, the need for narrativisation lingers, much like the life-long conditions themselves. And for want of a concrete cause as in the case of epilepsy, this narrativisation gives meaning and structure to the mystery.
Finlay Darlington-Bell
I would like to acknowledge that there is still debate in academia around the biography of Hippocrates and the authorship of The Sacred Disease, but for the sake of brevity and style I will avoid a lengthy discussion on the personage of the good doctor.
Hippocrates, Prognostic. Regimen in Acute Diseases. The Sacred Disease. The Art. Breaths. Law. Decorum. Physician (Ch. 1). Dentition., trans. by W. H. S. Jones (Cambridge, MA: Harvard University Press, 1923), pp. 139-141.
Ibid., p. 143.
Ibid., p. 147.
Ibid., p. 150.
Ibid., p. 159.
2 Corinthians 12:3-4 (KJV).