I am a British neurologist who has practiced in London for over 45 years and specialising in epilepsy (at the ‘National Hospital, Queen Square’, originally called at the National Hospital for the Paralysed and Epileptic). I have carried out clinical research and written conventional medical screed on the topic, and am considered by some to be an international expert on epilepsy. Over the years I have consulted with tens of thousands of patients with epilepsy and have tried to deliver a good and compassionate care, and hope that I sometimes succeeded. In recent years my interest has also grown in the history of epilepsy – and in this regard I cut my teeth by writing books and papers on various aspects of epilepsy-history related aspects. In the last two years I turned to what has proved to be the most difficult task –a book about the nature of epilepsy itself.
Aiming to explore its subject at a number of different levels, the book is at its simplest a narrative and chronological history of epilepsy covering what were, in my opinion at least, the signal events in the evolution of epilepsy knowledge in the long twentieth century (1860-2020). Although often medical and scientific in nature, I have placed the events within the context of the societal and politico-economic trends of the time. In parallel I have also tried to explore what it is like to have epilepsy, and here relied not only on personal testimony in letters and biography, but also depictions in film, fiction and literature. The societal and personal aspects widen the scope of the book considerably, but in doing so provide a framework for understanding why epilepsy has taken its particular direction of travel.
This then is more than a medical history and the result a pot pourri. To give this coherence, in the first section of the book I have focused on the concept of epilepsy – its ‘idea’ – which has changed radically over time, and in final section I have attempted to summarise what has endured over the passage of time and what has not, by comparing epilepsy in 1860 and in 2020. Much of the medical practice inflicted on patients was, over the intervening years, ill-conceived or frankly harmful. Many theories were erroneous and indeed sometimes bizarre and outlandish but were widely accepted in their times only later to be rejected and forgotten. Epilepsy is littered with such detritus. The book documents these and tries to provide some explanation (often societal not scientific). The same fate might no doubt apply to some of our cherished practices of today, and in the last section I have also tried to identify where I think epilepsy may be currently on the wrong path.
It is a book intended for four audiences. First, the doctor (and other professionals) interested in epilepsy. Second, the lay public interested in the social and medical aspects of illness, third the professional medical historian whose topic I have trespassed upon, and finally the sufferer from epilepsy in an effort to explain its triumphs and disappointments. A guiding principle has been the thought, so eloquently put Oswei Temkin that epilepsy is ‘the paradigm of the suffering of both body and soul in disease’. As such epilepsy is more than just a medical phenomenon, but one at the heart of the human condition. It is this that provided the impetus for the writing.