Forms and Rhythms of the Paroxysmal Imagination

by

Richard A. Hughes
M.B. Rich Professor of Religion

Lycoming College
700 College Place
Williamsport, PA     17701-5192
hughes@lycoming.edu

Forms and Rhythms of the Paroxysmal Imagination
	In the spring semester 1997 a 27 year old while female nursing major was a student in my Death and Dying course.  After my lecture on the metaphors of “attack sickness,” she informed me that she had suffered epilepsy and migraines since age 18.  I asked her how she became epileptic.  She explained that her father, an abusive narcoleptic, held a loaded shotgun in front of her face one day, and while shaking in a fit of rage, threatened repeatedly to kill her.  She said to me, with tears in her eyes:  “I believed him, and I seized and convulsed.”  Thereafter, she would suffer periodic grand mal seizures.
	She also reported that she knew when the seizures were coming, and every time she would have the same dream before the onset of the attack.  I asked her to write out her dream for me, and she complied with my request.  I quote her dream as follows:
It’s always been the same, at least since I can remember having seizures.  I’m in some kind of a boiler room where there are lots of big pieces of equipment and passageways.  There are areas of the walkway that blow steam across my face when I try to walk through.  I always feel as though someone is after me, and I am usually running.  I bump into the same spot on the boiler that sticks out.  The lever on the boiler that I hit says “DANGER HIGH VOLTAGE.”  As I jump back to avoid getting burned, I bump into the person (man) who is chasing me.  This man tries to grab me, but I get away.  As I continue to run, he is yelling after me to wait, that he just wants to help me, but I run on.  Then I see this woman (Grandmother figure—although I do not know her) and she tells me to follow her.  As I do, she turns around a bend out of sight and I follow.  Just as I turn the corner, the man who was chasing me grabs me by the arm and puts me into some sort of a head lock position.  As I struggle to get away, I kick and scream.  He tries to quiet me by shutting my mouth, and I severely bite my tongue.  As I squirm around wrestling with him, I catch a glimpse of him … it’s my father.  Then I awake.
	I invited her to come to my office to discuss the dream.  She agreed; and when she entered, she saw a copy of Vincent van Gogh’s painting “The Starry Night” hanging on the wall, and with a startle she exclaimed spontaneously:  “Oh!  I like it !”  I asked her if she knew that van Gogh had been diagnosed an epileptic.1  Still visibly shaking, she stammered:  “I guess so; but I don’t know.”
	In our discussion I suggested that her dream functioned as a prodromata and mirrored  three dynamics of the seizure.  1. The images of the boiler, high voltage lever, and hot steam, or fire and water, expressed pent-up emotion in the primictal phase.  2.  Biting the tongue was the seizure itself, or the ictal stage, serving as a defense against the assault by her father.  3.  Running away would be the fear of the approaching threat of death.  She assented to these suggestions and began her own study of the introspective aspects of epilepsy.
	After our discussion, I continued to be intrigued by the student’s shock of recognition in van Gogh’s painting.  What elements of the painting triggered her startle and stammering reactions?  Van Gogh’s painting has been described by a psychiatrist as an epileptic twilight state, in which the artist portrayed his own inner universe as one of “overpowering storms.”2  Did my student see in the painting elements of her own twilight states?  Was she reacting to the wave-like forces and swirling circles of energy in van Gogh’s stormy sky?  Were the wave and vortex the key imaginal forms?
	With these questions I began an extended search of personal statements by epileptics, in order to discover possible patterns of the seizure-induced imagination.  In this paper I set forth the findings of my search, and I attempt to generalize on the common imaginal forms and rhythms.  Epileptic seizures are understood herein as paroxysmal disturbances of the normal rhythms in the brain, originating in the “mesial temporal limbic” structures and including independent psychological states.3  The latter may involve intermittent twilight states, dysphorias, and affects, each of which can yield introspective forms and rhythms of the imagination.
Introspective Statements by Epileptics
	An anonymous German author recalled in 1825 his fantasies, during a seizure.  He had visited his brother-in-law and was walking across a field, “when suddenly something like a constantly moving sun appeared before my eyes.”4  Unaware of what was happening to him, he continued on his way until Suddenly, an area about four or five feet square became light around me; it seemed that people, whom I nevertheless could not see, were approaching me.  Now I saw a figure like myself emerge on my right from the darkness, pass in front of me, and reenter the darkness on my left. He became afraid and went home to bed, but as he lay down and turned on his right side
Unknown men appeared before my eyes, and they, too, disappeared into the darkness on my left.  As I gazed after them, I had a feeling they were my enemies, who had first lain in wait in the darkness and then put a chain around my breast and heart.  It seemed to me that they wanted to tear me to pieces with the chain, and I defended myself with all the strength of my body, clenching my teeth and clasping my hands together.5
	After recovering, he learned that he had suffered an epileptic attack, accompanied by grinding his teeth, foaming at the mouth, and uttering a cry.  The fantasies came out of the primictal phase, and the clenching of the teeth would be the seizure itself.
	In the nineteenth century Johann Purkinje founded the German school of physiological psychology, and he was epileptic.  Paul Vogel has collected Purkinje’s introspective statements on the internal imaginal forms of the epileptic attack.  One of the statements described a primictal vertigo dream
Where we believe ourselves to be rotating in passive movement and in a whirlpool of dreadful feelings.  I suffered eclampsia as a child, from 7-10 years, and clearly remember having a dream symbol.  It came to me as an immense, swirling sea of fire, in which I would be turning ever more quickly, and struggle with all my powers, until I lost consciousness.  To bystanders these movements appeared externally to be clonic convulsions, even though they would only be a movement of a vertigo dream.6
	Purkinje conceived of a continuum, including both epilepsy and eclampsia, and he suggested that vertigo or dizziness was the essential element of both.  Inwardly, the dizziness appeared as a distortion of spatial perception but outwardly as a violent, involuntary convulsion.  He believed that the inner and outer aspects comprised a dialectical relationship.
	At mid twentieth century Peggy Williams was a British writer and epileptic, who wrote an autobiography under the pen name of Margiad Evans, revealing several imaginal forms:
They were fire—all fire.  And people running, all on fire with fire behind them.  I can remember what they looked like.  They were nuns.  I shall never forget them. They were dying.  I have never seen any nuns on fire, dying….
	I saw my great-aunt step out of a train and she was all on fire too.7 	In August 1949, as an adult, she had a series of absences, each one characterized by momentary pressure and a splitting of consciousness without pain.  During one absence, she walked across the room, momentarily lost consciousness; and after this moment, a split-off part followed her.  These were indications that her self-consciousness could be lost at any time and that she would submit to powerful forces rushing against her will.(93)  These experiences would also bring out a deep concern with death.
	Her first major attack came at age 42 on May 11, 1950, followed by a second one in October of that year; and then one every three weeks occurred until October 31, 1951.  With the frequency of seizures, known as the interictal stage, she felt a deep dread of an impending fit, and her senses became extremely acute.  In the primictal phase she would link her dread with the image of an ocean wave:
How very often, standing on the shore, have I seen that high line of water coming in, and wondered what tidal bird, what face, what being, tossed beyond it, moving always, and always hidden?  This is the mystery of the stormy sea, and the mystery of consciousness….(76)
	She admits that the onset of a fit resembles the approach of an enemy.  Her body trembles, as an emotional force enters, possessing and shaking her.  Her body is “blown away” like a curtain in the wind, before she falls into total darkness, which is a death-like state with a deep sense of peace.  Every seizure, except two, happened in a door way and featured a two-way splitting, a calling out one way and a falling another way.  In each instance a nameless power “visited” her before and after the seizure.
	Evans explains that in the primictal phase she experiences an acceleration of thought, packed with urgent imagery, but that postictally  she feels disconnected and deprived of a sense of self.  The empirical world has dissolved, but some awareness remains as a memory.  Self-consciousness endures, and she is able to recall each fit with an image.
	In the postictal phase she feels as though she has committed a crime, specifically, a murder:
There is, however, a strong morbid or puritanical tendency in me; this would tell me that I had committed some wrong, some mistake, in my past life, for which I had to pay compensation.  It might be an ethical sin, or a spiritual one, or an artistic one.  My belief fastened finally on the last.(86)
	She poses the question:  “Is epilepsy a religious or a moral disease?  Is it possible that it is my fault?”(97)  Eventually, she arrives at the conviction that the causes of her illness are her fault, even though she had committed no major sin.  She concludes that evil doing occurs in a cumulative manner, which does not go away with remorse or repentance.  Guilt is inherent in her being, as a “ray of darkness,” which is the title of her autobiography.
	She continues to reflect on her illness philosophically.  Her seizures induce a total unconsciousness and terror; but, ironically, the death-state of the ictal stage takes away her fear of death.  She interprets the ictal-death phase as a longing for relief from anxiety and exhaustion.  She alternates between joy and dread, as she passes through cycles of expansion and contraction.  This cycle reveals a mystical harmony and oneness of all things, specifically, the awareness that the universe consists of supportive relationships in which nothing is lost.
	Because of the terror of the unconscious, one is always grounded in darkness as a general source of being.  She explains that
The epileptic is bound to be reminded that his roots are in darkness far more often and more acutely than the ordinary person.  Also he is compelled, like the life of nature, to return and dwell in the root….
	The epileptic seems to be in a constant communion, dumb so far as memory is concerned, with a general and dark source of being.(131)
 	 In summary, we may analyze the introspective reports in terms of the following common themes:  (1) alternating cycles of light and darkness, expansion and contraction; (2) intrusion of an enemy or threat of death;(3) swirling whirlpools of fire; (4) ocean waves; and (5) a split-off afterimage of memory.
Literary Reflections by Epileptics
	As a second source of information, I select two nineteenth century literary epileptics, who portrayed paroxysmal images in their respective productions.  The first is Lord Byron, who suffered life-long convulsions and then grand mal seizures at the end of his life.8  In his play about the biblical character Cain (Act 2, Scene 1) he describes great twilight visions:
	‘tis a fearful light!
	No sun, no moon, no lights innumerable---
	The very blue of the empurpled night
	Fades to a dreary twilight; yet I see
	Huge dusky masses, but unlike the worlds
	We were approaching, which begirt with light
	Seemed full of life ev’n when their atmosphere
	Of light gave way and showed then taking shapes
	Unequal, of deep valleys and vast mountains,
		And some emitting sparks and some displaying
		Enormous liquid plains and some begirt
		With luminous belts and floating moons, which took
		Like them the features of fair earth.  Instead, 
		All here seems dark and dreadful.9
	Fyodor Dostoevsky suffered epilepsy and articulated some distinctly paroxysmal images in his writings.  One form is the “Dostoevsky aura,” which has been confirmed by his biographer Joseph Frank to be an authentic representation of his own epileptic experience.10  Dostoevsky’s epileptic character  Prince Myshkin in The Idiot explains:
When suddenly in the midst of sadness, spiritual darkness and oppression, there seemed at moments a flash of light in the brain, and with extraordinary impetus all his vital forces suddenly began working at their highest tension.  The sense of life, the consciousness of self, were multiplied ten times at those moments which passed like a flash of lightning.  His mind and his heart were flooded with extraordinary light; all his uneasiness, all his doubts, all his anxieties were relieved at once; they were all merged in a lofty calm, full of serene, harmonious joy and hope.11
	Autobiographically, the epileptic aura correlates with Dostoevsky’s mock execution on December 22, 1849, when condemned to death by a firing squad, he felt that in a few minutes he would enter another world.12  Through Prince Myshkin in The Idiot Dostoevsky explains that he was drawn to a radiant light: It seemed to him that those rays were his new nature and that in three minutes he would somehow melt into them….  The uncertainty and feeling of aversion for that new thing which would be and was just coming was awful.(57) With the reprieve by the Tsar Dostoevsky gained an “eternity of life,” as he called it, and thereafter he was willing to surrender his entire life in order to experience the ecstasy of that moment, as explained in his short story “White Nights”:  “Why is it, that long, sleepless nights pass, as though they were an infinitesimal fraction of time, in unending joy and happiness.”13
	These portrayals of the “Dostoevsky aura” represent the novelist’s concept of vortex time.14  As one approaches death, whether by execution or epilepsy, all of one’s internal forces swirl together, accelerating time and consciousness, until reaching a crescendo of unlimited ecstasy and radiant and radiant light.  In the epileptic seizure the aura is followed by a volcanic eruption of darkness, crashing consciousness into a death state, as if by an ominous storm.  Dostoevsky’s classic portrayal of epilepsy in The Idiot combines acceleration and crescendo, on the one hand, with storms of death or crises, on the other.15  Even William Lennox, who  discouraged psychological aspects of epilepsy, used paroxysmal metaphors to explain seizures.  He described the aura as a flash of lightning before the storm and the prodromata as the sultry stillness and distant heat lightning of a summer night.16
	The crashing shock of darkness correlates with the “mystical depression” in Dostoevsky’s personal life.  This term came out of his postictal state, as he explained in a letter to Anna Snitkin on December 29, 1866:  “I often feel very depressed.  It is a sort of abstract depression, as if I had committed a crime against someone.”17  He felt intense guilt for having committed a murder in a distant time and place.  During the 1870s, his postictal depression intensified so much that he called it a “mystical terror.”18
	Closely related to the “mystical depression” was Dostoevsky’s theme of aimless, delusional wandering, known as poriomania.  He recalled in a letter of February 11/23, 1870, while traveling in Germany, the aftermath of an attack:
Coming to, for a rather long time I was not in my complete senses, and I recall that I walked all over the hotel and spoke with those whom I met about my attack, among others the hotel manager.  I didn’t go to bed but went again to the station.  In general the attack was severe, both mystical depression and nervous laughter.19
In The Idiot poriomania appears with alienation, absent-mindedness, irritability, and angry outbursts.  These correlate with Myshkin’s high spirituality and ethical integrity.  He is charitable and conscientious.  He has “double thoughts,” which include a fascination with death and murder trials along with moments of intense joy.  These polar opposites characterize the interictal stage of epilepsy.
	Dostoevsky also wrote about fire in light of the fact that large fires would evoke great fear in his family.20  In The Possessed he explains:
A real fire is quite a different matter.  There’s horror in it, combined with a feeling of being personally endangered, however slightly, and that is again combined with the exhilarating effect a fire at night causes in the spectator … a certain mental excitement ….21
Red on black backgrounds are the dominant patterns in this novel, as illustrated by fires in the night and lanterns in the darkness.22  Similarly, in The Brothers Karamazov Smerdyakov suffers a violent epileptic attack, leaving him unconscious for two days.  Upon awakening at night, he murdered his father with a paper weight.  After the third blow against the head, Smerdyakov said:  “I knew I’d broken his skull.  He suddenly rolled on his back, face upwards, covered with blood.”23  Patterns of fire and blood illustrate the fact that epileptics tend to choose red as their preferred color, and they view black as nothingness and death amid struggle.24
	In summary, the foregoing statements reveal additional forms of the paroxysmal imagination:  (1) twilight states; (2) patterns of height and depth, light and darkness; (3) poriomania; and (4) a preference for red.
Metaphors of an Epileptic Relative
	After the second quarter of the twentieth century, the medical management of epilepsy came increasingly under the control of neurology.  Consequently, quantitative neurological descriptions of brain activities tended to displace personal introspective accounts in psychiatry.  Neurology began in London on January 10, 1894, when J. Hughlings Jackson attended the autopsy of one of his deceased patients, known in the history of medicine as “Dr. Z.”  The patient had been an unmarried physician, who died by an overdose of chloral hydrate at age 42.
	Jackson claimed to have found the cause of the patient’s seizures in a lesion, located in the left temporal lobe of the brain and linked to the smacking movements of the lips, tongue, and cheek.25  His description of the neurological processes was purely objective, physiological, and mechanistic, totally excluding any references to the patient’s biography and relationships.  Nevertheless, Jackson took over notions of “dreamy states” or “intellectual aura” and déjà vu or “recollection” from the patient’s own writings about his illness.  The “dreamy states,” along with the dread, came before the attacks; and the “recollection” was a reminiscence of events occurring ages ago, which had been forgotten but seemed familiar.26
	Many years after the autopsy, two British scholars revealed the identity of “Dr. Z.” to be that of Arthur Myers, a member of a distinguished British family, consisting largely of clergymen, scholars, businessmen, and members of Parliament.27  Arthur Myers’ father was a priest in the Church of England, and he had two brothers.  One brother, Frederic W.H. Myers was a classics scholar, trained at Cambridge University, and he made pioneering contributions to the psychology of death and the theory of the unconscious.28  His principle concept was that of the subliminal self, for which the epileptic seizure was the medical paradigm.
	The subliminal self is an extended continuum of awareness, dwelling beneath a permeable threshold of consciousness; and the threshold functions as a filter of empirical stimuli.  Myers portrays the subliminal self metaphorically as a vast ocean; and the ego, at the supraliminal level, is like an island, which is vulnerable to unexpected eruptions from the unconscious sea.  When the threshold is bombarded with eruptions, it declines, as consciousness fades away and yields to a dream-like twilight state.  Myers acknowledges that dreams are occurring all the time; and, unchecked by consciousness, they are like postictal epileptic states in the midbrain.29
	When discussing the workings of the subliminal self, Myers draws upon several paroxysmal-epileptoid metaphors.  For example, unconscious communications are compared to “an uprush of the hidden fire.”(Vol. 1, 101)  Motor and sensory representations of the internal auditions express states, through which “reverberating tremors rise and fall” and “flood the flats of common consciousness as with the earthquake—wave of an unfathomed sea.”(Vol.1, 102)  All inner visions are pictorial metaphors, as exemplified by the “scarlet fire of the epileptic.”(228)  In volume two Myers goes on to describe messages from the unconscious “as profound ocean-currents bear to waves and winds on the surface of the sea.”(Vol. 2, 119)  We live in darkness, but se see the distant glow through the light of the sea by the ray of the moon.(277)
	In the second volume Myers conceptualizes activities of thought in relation to death.  When one dies by natural causes, one feels an acceleration of thought, beginning about one week before death and coming to a peak at the moment of death.  At death a real, nonmaterial afterimage splits off from the body and then levels off slowly and gradually in a long, slow trajectory for about one year, until fading away completely.  This movement of rapid acceleration, followed by a long descending trajectory manifests a wave-like pattern, which Myers compares to a supernova in physics.
	In cases of traumatic death, as with accidents, suicide, or homicide, a current of energy radiates outwardly from the death site in wave-like circles and is also followed by a long, slow descending trajectory for about one year.  Myers points out that the wave-like radiant energy of thought carries on the memories of the deceased and takes shape as his or her afterimage.(Vol. 2, 56)
	Myers’ conception of the afterimage is the same as the split-off parts experienced by the epileptic writer Margiad Evans, as discussed above.  She suffered seizures as death states, while her consciousness split-off into afterimages, packed with imaginal figures and memory.  By means of the afterimage she was able  to infer an unconscious continuity of awareness, through a dark ground of being, despite the absence of consciousness in the attack itself.  Altogether, she realized that the acceleration of thought, death state, and afterimage comprised a wave-like patterns, through which she imagined the world as a vast cosmic sea.
The Paroxysmal Pattern in Psychiatry
	In medicine the term paroxysmal designates a sudden intensification of energy up to a climax, followed by a period of rest.  Fever and tachycardia are examples of some paroxysmal conditions.  The concept has been developed, mainly by German-speaking psychiatrists, as a biological startle pattern that triggers surprise or shock against threats of danger.  Among humans defenses take shape as affects or emotional energies; and epilepsy is a paroxysmal condition that expresses paroxysmal affects.30
	The Hungarian-Swiss psychiatrist Leopold Szondi conceptualized the paroxysmal pattern as an affective drive-like defense mechanism.31   With temporal lobe epilepsy, in particular, the paroxysmal pattern consists of (1) a tendency to accumulate gross affects, such as anger or rage, against a real or imaginary enemy; (2) discharge of these affects through a seizure; and (3) a movement toward restitution through feelings of anxiety, remorse, or dread of punishment.  These paroxysmal phases also generate corresponding ego-states, often independently of attacks, in the forms of (1) poriomania; (2) alienation; (3) catastrophic premonitions; and (4) ego-loss in a twilight state.  In his writings about religious experience Szondi found preferences for fire and water, height and depth, and vortex and wave metaphors.32
	The paroxysmal pattern should be differentiated from the sexual drive.  This distinction was established by Henri Gastaut, who discovered that most temporal lobe epileptics lack sexual activity, interest, or arousal as the rule.33  This distinction wwas subsequently confirmed by observations of neural surgeries.34  For example, unilateral temporal lobectomy led to a decline of epileptoid impulsive-irritable behavior and a normalization of sexuality.  Since fire plays a leading role in epileptic imagery, it has been presented misleadingly in psychoanalysis as a sexual rather than a paroxysmal factor.35
Conclusion
	In conclusion, I attempt to interpret the imaginal forms of epilepsy in terms of the paroxysmal pattern.  Both personal and literary statements reflect a broad field of darkness, as a general and groundless depth of being.  Out of the darkness an enemy appears, threatening to assault, dismember, or kill  the self and releasing an intense fear or dread in the epileptic.  The approach of the enemy brings a threat of death, which triggers an acceleration of consciousness independently of bodily tremors.  As the acceleration intensifies up to a climactic peak, the variable threshold of consciousness lowers, causing the subject-object empirical world to fade away and be replaced by an unconscious awareness and memory.  The seizure manifests the crescendo of the acceleration, and it is expressed unconsciously with images of teeth grinding, biting the tongue, or violent storms.   At the climax consciousness crashes into darkness, and in some cases guilt for a crime or the Dostoevsky “mystical depression” may appear.
	Two imaginal forms spin off from the acceleration process, and they flow into unconscious awareness, whether through a dream, fantasy, or artistic creation.  The two are a swirling sea of fire and stormy ocean waves.  These images contain two basic paroxysmal forms, namely, the vortex and the wave.  The vortex mirrors the intensification of affect, and the wave reflects the acceleration of thought as well as the afterimage, which separates from consciousness with the epileptic attack, suffered as a death event.  Consequently, wave-like patterns of storms may be prominent in twilight states, as illustrated by van Gogh’s painting “The Starry Night.”  I infer that these twilight flow patterns in the painting attracted my student in a shock of recognition.
	The frequent choice of red by epileptics, as in Frederic Myers’ phrase “the scarlet fire of the epileptic,” expresses a paroxysmal need to maximize affective excitability.  Turning toward blue indicates a need to inhibit the excitement; and the mixing of blue and yellow shows a depressive mood.36  “The Starry Night” features stormy waves of blue and yellow, which would imply a depressive mood of the epileptic twilight state.  Frequently, Dostoevsky portrays red on a black background, as with fires in the night or lanterns in the darkness.  The presence of black reflects a loss of consciousness caused by the seizure.  Both red and black have been found in images of the epileptic twilight state.37
	The decisive condition of the paroxysmal imagination is the acceleration of thought, and this arises naturally as a defense against morbid or mortal danger.38  When the acceleration becomes luminous, the radiance projects an expanded sense of self.  This occurs in the “Dostoevsky aura” and its literary equivalents, particularly in the imaginal forms of height, open-ended space, eternal light, and timeless moment.  In contrast, the death state of the seizure contracts the self like a supernova, crashing consciousness into a boundless depth of darkness, nothingness, and the unconscious.  These recurrent cycles of light and darkness, height and depth, vortex and wave generate unconscious forms and rhythms to compensate the paroxysmal dysrhythmias of the epileptic attack.
Notes
1.	Henri Gastaut, “La Maladie de Vincent Van Gogh,” Annales Medico-Psychologiques 114 (Février, 1956):  196-238; and William Meissner, “The Artist in the Hospital,” Bulletin of the Menninger Clinic 58 (Summer, 1994):  283-306.
2.	Dietrich Blumer, “L’épilepsie de Vincent van Gogh,” http://www.motiv-analysis.se/szondi/lepileps.htm (20 December 1999).
3.	Dietrich Blumer, “Dysphoric Disorders and Paroxysmal Affects,” Harvard Review of Psychiatry 8 (May/June, 2000):  8; and William Lennox, Epilepsy and Related Disorders, Vol. 1 (Boston:  Little, Brown, 1960), 38.
4.	Owsei Temkin and C. Lillian Temkin, trans., “Subjective Experiences in Temporal Lobe Epilepsy,” Bulletin of the History of Medicine 42 (1968):  566-567.
5.	Ibid., 567.
6.	Paul Vogel, “Joh. Purkinjes Auffasung der Epilepsie,” Nervenarzt 8 (1935):  229.
7.	Margiad Evans, A Ray of Darkness (New York:  Roy Publishers, 1953), 49.  Hereafter page numbers are cited parenthetically in the text.
8.	William Lennox, Epilepsy and Related Disorders, Vol. 2 (Boston:  Little, Brown, 1960), 705.
9.	Truman Steffan, ed. Lord Byron’s Cain (Austin:  University of Texas Press, 1968), 200-201.  Byron’s choice of Cain reflects the fact, probably unintentionally, that in the history of Christian thought Cain has been considered an epileptic, particularly by the Fathers of the Eastern Church.  See my book Cain’s Lament (New York:  Peter Lang, 2001), 182-193.
10.	Joseph Frank, Dostoevsky, The Years of Ordeal (Princeton:  Princeton University Press, 1983), 195.
11.	Fyodor Dostoevsky, The Idiot, trans. By C. Garnett (New York:  Bantam Books, 1868/1958), 218.
12.	Frank, Dostoevsky, The Years of Ordeal, 55-56. 
13.	David Magarshack, trans., The Best Short Stories of Dostoevsky (New York:  The Modern Library, 1955),
14.	Gary Morson, “Introductory Study,” In: Fyodor Dostoevsky, A Writer’s Diary, Vol. 1 (Evanston:  Northwestern University Press, 1993), 94-95.
15.	Jacques Catteau, Dostoevsky and the Process of Literary Creation, trans. by A. Littlewood (Cambridge:  Cambridge University Press, 1989), 339-341.
16.	Lennox, Epilepsy and Related Disorders, Vol. 1, 176.
17.	Joseph Frank and David Goldstein, eds., Selected Letters of Fyodor Dostoevsky, trans. by A. MacAndrew (New Brunswick:  Rutgers University Press, 1987), 237.
18.	James Rice, Dostoevsky and the Healing Art (Ann Arbor:  Ardis, 1985), 87.
19.	Cited in ibid., 294.
20.	Joseph Frank, Dostoevsky, The Stir of Liberation (Princeton:  Princeton University Press, 1986), 50.
21.	Fyodor Dostoevsky, The Possessed, trans. by A. MacAndrew (New York:  Penguin Books, 1872/1991), 533.
22.	Catteau, 128.
23.	Fyodor Dostoevsky, The Brothers Karamazov, trans. by C. Garnett ( New   American Library, 1880/1960), 570.
24.	Jaakko Borg, Farben, Affekte und Szondi-Triebe (Tampere:  Universitāt Tampere, 1988), 67, 143.
25.	J. Hughlings Jackson, Selected Writings, Vol. 1, ed. By J. Taylor (London:  Hodder and Stoughton, 1931), 461.
26.	Ibid., 459.
27.	David Taylor and Susan Marsh, “Hughling Jackson’s Dr. Z.”, Journal of Neurology, Neurosurgery, and Psychiatry 43 (1980):  760.
28.	Frederic W.H. Myers, Human Personality and its Survival of Bodily Death (New York:  Longsman, Green, 1903).
29.	Ibid., Vol. 1, Append. 224A, 60.  Hereafter page references and volumes are cited parenthetically in the text.
30.	Blumer, “Dysphoric Disorders and Paroxysmal Affects,” 15-16.
31.	Leopold Szondi, Triebpathologie (Bern:  Hans Huber, 1952), 105; and Schicksalsanalytische Therapie (Bern:  Hans Huber, 1963), 326.
32.	Leopold Szondi, Moses, Antwort auf Kain (Bern:  Hans Huber, 1973), 64; and Schicksalsanalyse, Vierten Auflage (Basel:  Schwabe, 1987), 274.
33.	Henri Gastaut et Henri Collomb, “Étude du Comportement sexuel chez les Epileptiques Psychomoteur,” Annales Medico-Psychologiques 122 (Dec., 1954):  664-665.
34.	Dietrich Blumer, “The Temporal Lobes and Paroxysmal Behavior Disorders,” Kriminalität, Erziehung und Ethik (Bern: Hans Huber, 1967), 276-283; and David Trieman, “Psychobiology of Ictal Aggression,” Neurobehavioral Problems in Epilepsy, ed. By D. Smith, et al. (New York:  Raven Press, 1991), 347.
35.	Gaston Bachelard, The Psychoanalysis of Fire, trans. by A. Ross (Boston:  Beacon Press, 1964), 24, 55.
36.	Borg, 114, 146.
37.	Dietrich Blumer, “The Psychiatric Dimension,” Psychiatric Aspects of Epilepsy, ed by. D. Blumer (Washington D.C.:  American Psychiatric Press, 1984), 31.
38.	Acceleration of thought occurs in the face of terminal illness and near-death experiences, as discussed in my book The Radiant Shock of Death (New York:  Peter Lang, 1995), 131-136, 229-230.