ArticlePDF Available

Abstract

Literary accounts of epilepsy deserve our attention because they form part of the cultural history of the disease and reflect responses to it by society. Epilepsy has been reviewed, mainly in the British literature, from Shakespeare to contemporary fiction, and reveals a wide range of images from the objective to the bizarre, based on observation, empathy, or manifold prejudices about the disorder. Epilepsy has been used in the plot of detective stories and as a challenge to movie actors. Some authors are factual and are well-informed, whereas others emphasize a fascination with ancient beliefs relating seizures to prophecy and divinity. In contemporary literature physicians are often represented as only marginally involved, distant, and helpless. Epilepsy is rarely viewed as a treatable disorder.
Epilepsia,
36(
Su
ppl
.
I):
S
124
17,
1995
Raven Press, Ltd., New
York
0
International League Against Epilepsy
Epilepsy in Literature*
Peter
Wolf
Epilepsie-Zentrum Bethel, Klinik Mara
I,
Bielefeld, Germany
Summary:
Literary accounts of epilepsy deserve our at-
tention because they form part of the cultural history of
the disease and reflect responses
to
it by society. Epi-
lepsy has been reviewed, mainly in the British literature,
from Shakespeare to contemporary fiction, and reveals a
wide range of images from the objective
to
the bizarre,
based on observation, empathy, or manifold prejudices
about the disorder. Epilepsy has been used in the plot
of
detective stories and as a challenge
to
movie actors.
Some authors are factual and are well-informed, whereas
others emphasize
a
fascination with ancient beliefs relat-
ing seizures to prophecy and divinity. In contemporary
literature physicians are often represented as only mar-
ginally involved, distant, and helpless. Epilepsy is rarely
viewed as
a
treatable disorder.
Key
Words:
Epilepsy-
Literature-Medieval literature-Modern literature-
Medicine in literature-Knowledge, attitudes, practice.
Epilepsy is one of the few diseases known since
the dawn of history, and its reflections in the arts
are as much a part of its cultural history as
is
med-
ical tradition. It has frequently been a subject of or
motive for literary fiction. This article is restricted,
with few exceptions, to authors who are British,
mainly Londoners.
Literary accounts form part of the manifold re-
sponses of society to the disease
(1)
and are an im-
portant aspect of its reality. They consider epilepsy
from a variety of viewpoints and raise many ques-
tions, the discussion of which has hardly begun.
OLDER
LITERATURE
When Kent, in
King Lear,
scolds Oswald, in
what could be called
a
catalogue of abuse in Eliza-
bethan English, one phrase is
“a
plague on your
epileptic visage”. This tells us something about the
image of epilepsy in that period which we do not
learn from medical texts.
And why “epileptic visage?” Does it refer to the
marks that repeated cuts and falls may leave on a
patient’s face? We may suspect
so
because some
200
years later, Dickens
(1837-1838)
referred to the
same feature in Oliver Twist’s wicked half-brother
Monks, whose epilepsy makes him easily recogniz-
able by his scarred face
(2).
“His lips are often dis-
coloured and disfigured with the marks of teeth, for
he has desparate [sic] fits.”
. .
.“You,
. . .
in whom
all evil passions, vice, and profligacy festered, till
they found
a
vent in
a
hideous disease which has
made your face an index even
to
your mind.” Ep-
ilepsy is seen as
a
punishment for Monks’ vices and
he dies of it. This was consistent with
a
traditional
religious view of disease at that time, but not spe-
cific for epilepsy. Dickens, however, the avid ob-
server of all aspects of life and mankind, especially
the somber ones, including disease, knew more
about epilepsy. He let the seizures be provoked by
startle and by emotions. Monks is first shown to the
reader in a sudden encounter with Oliver whom he
believed dead and out of the way. In an outburst of
anger, “[He] advanced towards Oliver,
as
if with
the intention of aiming
a
blow at him, but fell vio-
lently on the ground, writhing and foaming in
a
fit.”
Another fit is precipitated by
a
thunderclap. Monks
is described
as
a
ruthless half-criminal, governed by
hatred and base inclinations. The prejudice that re-
lates epilepsy to criminality, which we still must
fight today, seems to have existed already in Dick-
ens’ time.
Another stereotype, the relation of epilepsy to
feeblemindedness, is found in Thackeray’s
Vanity
Fair
(1847-1848),
in
which an old gentleman is de-
man.” His seizures also can be precipitated by
emotional stimuli. His daughter is
a
religious fanat-
Address correspondence and reprint requests to Dr.
P.
Wolf at
Epilepsie-Zentrum Bethel, Klinik Mara
1,
Maraweg
21,
33617,
Bielefeld, Germany.
*Dedicated
to
Professor Dieter Janz for his 75th birthday.
scribed
as
‘‘an epileptic and simple-minded noble-
s12
EPILEPSY
IN
LITERATURE
S13
icist who, by her awful pronouncements of future
punishment frightens the timid old gentleman, “and
the physicians declared his fits always occurred af-
ter one of her Ladyship’s sermons.”
In
Thackeray’s satire, however, there is also an-
other old gentleman whose life has only one more
purpose: to die
so
he may be inherited. Of him,
Thackeray wrote: “as soon as poor dear Lord
Castletoddy dies, who is quite epileptic
.
. .
,
which is of interest although or because it does not
make sense. Thackeray wrote
Vanity Fair
in
monthly installments, and the quotation is from
a
chapter that contains several errors
(3),
which are
probably due to the resultant time pressure. He ei-
ther became confused about the two old gentlemen
or
about “epileptic” and “apoplectic.”
I
am inclined
to believe the latter, because then the line would make
sense. The blunder may
also
tell us that the concepts
of epilepsy and apoplexy in the mid-nineteenth cen-
tury mind were perhaps not yet clearly distinct.
Still another ambiguity, between epilepsy and
catalepsy, is apparent
in
two works of that period
(4):
Alfred Tennyson’s “The Princess”
(1847-51)
and George Eliot’s
Silas Marner
(1861).“The Prin-
cess. A Medley” describes
a
prince’s courtship of
the princess
of
the neighboring kingdom.
As
chil-
dren, they had been engaged but she has now
founded an all-women society in which men are not
allowed to enter. The long poem is partly satirical
and partly allegorical and deals with the theme of
finding one’s own identity as man
or
woman.
As
a
metaphor of the prince’s indecision and ambiva-
lence, he suffers from “weird seizures,” during
which he loses the ability to distinguish the sub-
stance from the shadow, dream from reality. The
seizures eventually remit when the prince and prin-
cess find each other and themselves in mature love.
The description of the seizures is highly suggestive
of an epileptic aura with an experience of derealiza-
tion, although the diagnosis given is catalepsy. Bar-
bara Herb Wright
(5)
has clarified that Tennyson
probably used his own father’s seizures as a model.
These were obviously complex partial seizures
(CPS), but the diagnosis given to the family was
catalepsy, perhaps with a purpose of extenuation.
Tennyson had in his possession Quincy’s medical
dictionary of
1802,
in which the definition of cata-
lepsy overlapped to some extent with complex par-
tial seizures:
9,
The patients are said to be
for
some minutes, some-
times (though rarely) for some hours, deprived of
their senses, and
all
power
of
voluntary motion.
. . .
When they recover from the paroxysm, they remem-
ber nothing
of
what passed
during
the time of it, but
are like persons awakened out of a sleep.
This is too different from the prince’s seizures to
possibly have been used by Tennyson. It would
seem, however, that Quincy’s
or
a similar definition
and description were closely followed by George
Eliot when she described the trances of Silas
Marner to whom she gave a diagnosis of catalepsy.
During the trances, Marner falls into
a
motionless
state that lasts
for
a
few minutes to more than one
hour, and for which he has no recollection, even of
their occurrence. Such states today would not be
diagnosed as catalepsy but as twilight states, raising
a suspicion of nonconvulsive status epilepticus. In
Silas Marner,
they are highly important for the nar-
rative.
In
his religious community, Marner had been
highly respected for his exemplary life, and his
trances had been considered
a
sign of divine distinc-
tion. Then, however, an enemy suggests that they
are of satanic origin, and a theft is blamed on him
during one of the twilight states. He is expelled
from his community and lives a solitary life as
a
weaver in
a
far village where he
is
considered an
outsider because of his seclusion and his seizures.
He slowly collects
a
treasure of gold sovereigns
which becomes his onlyjoy in life. When one day
these are stolen, the compassion of his neighbors
makes him again part of
a
community. During an-
other trance,
a
small orphan girl with golden hair
crawls into his cottage, which restores his golden
treasure in a much better form. Eliot said that in this
novel she had tried to write a legendary tale in
a
realistic way. Marner’s twilight states, apart from
making certain events possible, explain his help-
lessness and passivity, which are important for the
legendary atmosphere and would otherwise seem
unnatural (6).
Wilkie Collins, who was
a
friend of Charles Dick-
ens, was mostly concerned in his novel
Poor Miss
Finch
(1872)
with new discoveries about the expe-
riential space of blind people and its transformation
after successful ophthalmic surgery. The beautiful
and capricious blind Lucilla returns the love of
Os-
car, whose vicious twin brother Nugent tries to win
Lucilla for himself. Nugent’s hopes are based on
the moment when Lucilla’s sight will be restored by
an operation, because she has
a
prejudice against
dark colors, and the twins are indistinguishable but
for their complexion. The bad brother Nugent has
a
fair skin, whereas Oscar, the good brother, has a
dark skin as a result of treatment with silver nitrate
for epilepsy. His epilepsy is traumatic and caused
by
a
brain concussion after
a
robbery which has its
own place in the plot of Collins’ novel. There is
a
clear, detached, almost clinical description of a con-
vulsive seizure with
a
right versive onset and the
reactions of an onlooker (the narrator) and
a
physi-
S14
P.
WOLF
cian. The diagnosis
is
calmly given, and etiology
and therapy are part of the case history in this re-
alistic novel.
A
frightful contortion fastened itself on Oscar’s face.
His eyes turned up hideously. From his head
to
foot
his whole body was wrenched round, as if giant
hands had twisted it, towards the right. Before
I
could speak, he was in convulsions on the
floor
at his
doctor’s feet.
“Good God, what is this!”
I
cried out.
The doctor loosened his cravat, and moved away the
furniture that was near him. That done, he waited-
looking at the writhing figure
on
the
floor.
“Can you do nothing more?”
I
asked.
He shook his head gravely. “Nothing more.”
“What is it?”-“An epileptic fit.”
Silver nitrate was a common treatment for epi-
lepsy
in
the mid-nineteenth century. It was mostly
useless, and “argyrism was a common result of this
type of treatment. Todd complained of the fact that
so
many patients showed in the discoloration of
their faces the indelible marks of the ineffective
treatment they had undergone”
(7).
Collins
,
how-
ever, wished better for Oscar and let him be cured
by this therapy.
Eliot and Collins shared that sense of profes-
sional quality characteristic of the great English re-
alist authors of the
last
century who felt that they
owed their readers a well-constructed plot with no
hanging loose ends, and factual precision, including
in regard to medical or legal questions. One of the
consequences is that their epileptic characters are
depicted according to the best available medical in-
formation, and they are described with sympathy
and dignity.
THE DETECTIVE STORY
Some of Collins’ works are early examples of the
detective story, a genre which derives partly from
the romantic-fantastic and partly from the realist
novel. One of its masters, Agatha Christie followed
in
the tradition of the great realists when, in
The
ABC
Murders
(1936), she described
a
highly intelli-
gent criminal who with an almost perfect plan
makes all clues in a series of murders
to
incriminate
a veteran who suffers from traumatic epilepsy and
cannot account for what he may have done in
a
seizure which makes him
a
good suspect in some
people’s eyes. Christie’s Hercule Poirot, however,
with his clear reasoning, discovers the improbabil-
ities
in
the story and rescues the poor man who is
quite unable to defend himself.
To
hang a murder on
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. Another cel-
ebrated writer, the Californian Raymond Chandler
in
The Big Sleep
(1939) fell for the temptation and
created Carmen, a lovely halfwit with an uncon-
vincing, unprofessional seizure description who in a
twilight state kills her sister’s husband after having
unsuccessfully tried to seduce him. Although Chan-
dler tells his readers that epilepsy is a treatable dis-
ease-which is something-his treatment of the
condition
is
in
a
problematic way influenced by
pre-
conceived ideas rather than facts. The comparison
between Chandler and Christie clearly does credit
to Christie’s better insight.
FICTION AND OBSERVATION
From the same time period, there is a reappear-
ance of epilepsy as caricature. Among the bizarre
characters who give Mervyn Peake’s
Titus Groane
(1946)
its specific flavor are the silly old twin aunts
who in their youth had convulsions, after which one
side of their bodies was “starved,” though they
never can agree on which one.
Even in novels that do not belong to the realm of
the fantastic, however, the example of the great re-
alists’ was not always followed. Compare the sei-
zure description in
Poor Miss Finch
with the fol-
lowing:
Their attention was caught by the sound as of
a
horse
galloping. They looked up
a
side-street in the direc-
tion of the sound and found it to come from
a
man
lying
on
his back outside
a
pub. His legs were kicking
out and his heels clop-clopped on the pavement.
A
few people had gathered in the roadway and
a
young
policeman circled round the man as if he were
a
tiger.
“Is
he drunk?” Matthew said.
Ronald went over to the young policeman. “Turn his
head to one side,” he said,
“or
he might damage his
tongue.
“Are you a doctor?” said the policeman.
“No,
but
I
understand fits. The man’s
an
epileptic.”
Ronald took his own wedge
of
cork from his pocket
and handed it to the policeman.” Stick this between
his teeth. Then kneel
on
his knees and try and get his
boots off.”
“There’s an ambulance coming,” said the police-
man.
“He could bite his tongue in the meantime,” Ronald
said. “There could be
a
lot
of
damage. I’d shove in
the wedge if
1
were you.”
The policeman knelt and grasped the man’s head. He
tried to thrust the wedge into the frothing mouth, but
the man’s convulsions kept throwing the policeman
off.
The policeman looked up at Ronald. “Would you
mind trying to get his boots off, then, Sir?”
“I
doubt if
I
can do it,” Ronald said. He was greatly
agitated, for if there was one thing he did not like to
Epilepsiu,
Vol.
36,
Suppl.
I,
1995
EPILEPSY
IN
LITERATURE
S1.5
see it was another epileptic. The thought of touching
the man horrified him. “Matthew!” he called out.
“Come and lend
a
hand.”
Matthew approached and,
as
Ronald instructed,
threw himself upon the man’s jerking knees. The
po-
liceman jammed the wedge between the teeth. Ron-
ald felt for the shoes as one thrusting his hand into
flames. He shut his eyes, and felt for the laces, loos-
ened them, threw the shoes aside
so
violently that
one of them nearly hit an onlooker, and sprang back
from the kicking figure.
The man was still jerking when the ambulance ar-
rived, and he was lifted up by two men in hospital
uniform and taken away.
Whereas Collins in
Poor iMiss Finch
was sympa-
thetic but unemotional, brief, and close to the facts
in his description, even instructive about how to
deal correctly with
a
convulsive seizure, the above
example is highly emotional, exaggerated, and of-
fers wrong advice. It is from Muriel Spark’s
The
Bachelors
(1960), and a novel with
a
leading char-
acter who
has
epilepsy and is experiencing a grow-
ing
isolation brought on by a slow change of attitude
toward him by his friends and acquaintances and by
the restrictions which the possibility of having
a
seizure at any moment imposes on his daily life. It
is
written with much insight and empathy, and
seems to be drawn from life. It was a great surprise
for me to learn from the author that she never knew
a person with epilepsy. Her starting point was
a
seizure which she had happened to observe in the
street and which her memory had increased in
drama. Spark’s objective was highly humane: to
imagine the life conditions of
a
person whom she
had perceived in a convulsion, and in this she was
highly successful.
In two other novels, the epilepsy motive is based
on personal experience, and in both instances these
experiences are much more intimate than those of
Spark. Penelope Farmer is the wife of a prominent
British epileptologist and shared his involvement in
a field project on epilepsy epidemiology and care in
Ecuador. Her novel
Snakes and Ladders
(1993) is
based on this experience and is fascinating reading
for epileptologists with
a
literary taste because they
will
be able to follow the author’s unfolding of fact
from fiction.
The other novel is
Owls
Do
Cry
(1959) by Janet
Frame,
a
New Zealander who qualifies for inclusion
in this article because she has been
a
patient at the
Maudsley and talks very favorably of the experi-
ence in the last part of her autobiography,
The En-
voy from Mirror City
(1984). Although not an auto-
biographical work,
Owls
Do
Cry
is built on many
motives from her childhood, and the epileptic boy
in it, Toby, is depicted after her own brother whose
epilepsy, and its consequences for the family life,
are reported in her autobiography. In neither book
does she give
a
description of the seizures, but it is
of great interest that they are at once perceived by
the family as an incurable disease, which does not
keep the father from suspecting
a
lack of good will
in the boy nor the whole family from
a
constant
search for all kinds of magic cures. The time is the
mid-l920s, and bromide is the only drug given. The
mother gets rid of the medicine in the sink, but the
boy later learns to take it, and obtains his driver’s
license. In the novel, the experience of the aura is
described in
a
poetic, metaphoric way (8).
When he was sick his hand shook as if it felt cold and
then
a
dark cloak would be thrown over his head by
Jesus or God, and he would struggle inside the cloak,
pushing
at
the velvet folds, waving his arms and legs
in the air till the sun took pity, descending in
a
daz-
zling crane of light to haul, but, alas, preserve, where
in all the sky, Toby wondered, this cloak of stifling
recurring dream.
Another work concerning
a
person who is at least
believed to have suffered from epilepsy is Julian
Barnes’
Flaubert’s Parrot
(1984). Barnes’ book
could be called an alternative project to
a
biogra-
phy, and is highly enjoyable reading. Although it
does not question Flaubert’s epilepsy diagnosis
(which someone should do because it seems to be
dubious), Barnes must have the credit of not having
introduced prejudices about epilepsy in his treat-
ment of the subject.
Not everyone can receive credit for a fair presen-
tation of epilepsy, and some recent best-selling
writers cannot.
PREJUDICES
AND
DRAMA
Rosamund Pilcher presents Danus, the amiable
and eligible young man in
The
Shell
Seekers
(1987)
in
a
mysterious seclusiveness that seems out of
character and turns out to be due to his fear of
having epilepsy. Relief comes when the suspicion
turns out to have been wrong. The plot is unfortu-
nate because for the hero’s trouble to seem great,
the possible diagnosis must appear
as
the worst of
disasters, and all the prejudices about epilepsy are
manifest. Danus copes well enough with not being
allowed to have alcohol or to drive
a
car, but in-
stead of finishing his law studies,
a
gardener’s
helper is the only job open for him; the possibility of
marriage is out
of
the question
as a
matter
of
course.
Joan Aiken
is
worse. Why she, in
The Weeping
Ash
(1980) has the brother of one of her two con-
trasting heroines have epilepsy has remained
a
mys-
tery to me. It contributes neither to the plot nor the
Epilepsia,
Vol.
36,
Suppl.
1,
1995
S16
P.
WOLF
character, but there is no plot to speak of anyway,
and the characters are one-dimensional. The silly
young man is supposed to be a poet, walks with his
head in the clouds, sleeps with his sister by mistake,
and dies by mistake. Aiken believes that personality
traits such as daydreaming, moodiness, or swings
between high activity and apathy are typical enough
to suffice for a diagnosis of “the falling sickness,”
and even indicate a disposition to epilepsy before
the manifestation of the first seizure.
A few other popular novels have epilepsy
themes. One,
Green City in the Sun
(1988)
by Bar-
bara Wood, is a voluminous novel which tells the
story of Kenya from the perspective of a fictitious
British planter’s family. A son develops epileptic
seizures at age
7.
The father considers this as an
indication of insanity and brings his son to “every
specialist in London” who, however, seem to know
no better than to treat him with bromides. Before
ever becoming an important character in the book,
the boy is killed in a race riot in Nairobi. Apart from
characterizing the boy as weak and sickly, the epi-
lepsy serves no specific function in the book apart
from creating one very dramatic scene in which he
has his first seizure in the presence of his deeply
shocked parents.
Green City in the Sun
is written in
a sequence of relatively short chapters, all of equal
length, and all comprising scenes that can be well
visualized. It was probably written with a prospect
of its use in a television series, and the seizure may
have been added to create a dramatic scene.
A seizure as a challenge to the actors in a soap
opera may be an unusual motive for epilepsy in
fic-
tion, but one additional work presumably has such
intentions:
The Rich are Different
(1977)
by Susan
Howatch. In this English-American novel, there is
hereditary epilepsy in the family of one of the lead-
ing characters, the American magnate Paul van
Zale. He had himself seizures as a child, but suc-
cessfully fought the disease with rigorous exercise
and sports. Once in a while, he takes
a
few capsules
of
phenobarbital. His seizures return when his wife
confronts him after discovering his infidelity. Be-
sides making him impotent, the seizures represent a
great danger to his position in the world of big busi-
ness because it will be used against him by his en-
emies should it become known to them. Epilepsy
here is viewed predominantly as a social stigma,
medical care is practically nonexistent, and the sei-
zures are considered dependent on emotions and
stress.
Whereas the psychogenesis of seizures, already
referred to by Dickens and Thackeray, is still under
scientific debate, it is a central feature of epilepsy
for Wood, Howatch, Aiken, and many other au-
thors of fiction. This apparently reflects a popular
and widespread assumption.
PROPHECY AND DIVINITY
The last works to be mentioned lead back to an
ancient layer in the perception of epilepsy which
relates it to prophecy and divinity and which was
briefly touched on in the discussion of
Silas
Marner.
In Salman Rushdie’s
Midnight’s Children
(1981),
a dubious figure on a roof in Delhi prophesizes the
main character’s future in an ecstasy in which he
speaks in sybillinic verses, which later all come
true. The trance ends with his collapsing in
a
con-
vulsive seizure. An important character in Rush-
die’s
The Satanic Verses
(1988)
is the false prophet
Ayesha who leads a whole village on a mad pilgrim-
age that ends with all of them walking into the Red
Sea and drowning. Ayesha has “the falling sick-
ness” and is “possessed by the demon of epi-
lepsy.” She is called a demon herself, but also a
seer and prophetess.
Many great historical figures have been sus-
pected of having had epilepsy, often on very dubi-
ous
grounds, and Rushdie’s narrative relates to
such speculations concerning the prophet Moham-
med. These were also shared by Dostoyevsky, who
compared his own ecstatic aura with
a
mystic ex-
perience of Mohammed. For Dostoyevsky, this was
an experience of highest importance and deep reli-
gious significance
(Sll).
He wrote
The Idiot
with
the intention of creating an all-good, Jesus-like fig-
ure which then became the epileptic Prince Mysh-
kin, whose seizures resemble Dostoyevsky’s own.
The central character in
La Storia
(1974)
by Elsa
Morante, an important Italian novelist, is a small
boy with epilepsy who has many of the legendary
traits of the divine child
(12,13).
Another such child
is born in
The Children of Men
(1992)
by
P.
D.
James. Her story takes place in England in the year
2021, 25
years after all mankind has lost its fertility.
The novel describes a society and its autocratic
government, which try to cope with the threat of
slowly dying out. A group of dissidents use the
early Christian symbol of the fish, and one of them,
a young woman with a congenitally deformed hand,
surprisingly becomes pregnant. From eugenic con-
siderations, neither she nor the child’s father,
a
priest who had epilepsy as a young man, had been
tested like everyone else for reoccurrence of fertil-
ity. Now, the crippled woman and her future pos-
sibly epileptic child bear the hopes of mankind and
are spared, whereas all the other dissidents are
Epilepsia,
Vol.
36,
Suppl.
I,
1995
EPILEPSY
IN
LITERATURE
S17
killed. The ruler, another Herod, attempts to cap-
ture the newborn boy, who first sees the light of day
in a woodshed. Dr. Faron, a former government
councillor who kills the tyrant in
a
final showdown
is the Joseph figure who completes the Christmas
setting.
PHYSICIANS AND EPILEPSY IN FICTION
It is interesting that contemporary authors return
to such ancient, mythological conjectures about ep-
ilepsy at a time of great advances in its care and
cure. Do such conjectures provide a necessary
counterweight to the medical progress in epileptol-
ogy which people find too abstract to be grasped
and felt? This would be a radical change as com-
pared with Collins, who acquainted his readers with
new medical results and could count on their being
interested. His book also is the last in the series
presented here which depicts a physician as both
amiable and competent; doctors in many current
books appear distant and often helpless when con-
fronted with epilepsy. They explain very little, if
anything at all, and write a prescription which the
patient does not follow as a matter of course.
Is
this
perhaps the patients’ aspect of “noncompliance”?
I
am afraid that this image of contemporary phy-
sicians dealing with epilepsy may not be altogether
false and may indicate where patients needs are not
sufficiently met today. To educate doctors and en-
able them to provide competent and comprehensive
care, the ultimate goal of the Institute, whose
launch is commemorated in this supplement, is the
best remedy for such defects.
REFERENCES
1.
Ozer IJ. Images
of
epilepsy in literature.
Epilepsia
1991;32:
2. Cosnett JE. Charles Dickens and epilepsy.
Epilepsia
1994;
3. Stewart JIM. Introduction and notes. In: William
Makepeace Thackeray,
Vanity Fair,
London: Penguin
Books,
1968, 7-23 a. 799414.
798-809.
35~903-5.
4. Wolf P. Epilepsie und Katalepsie in der angelsachsischen
Literatur zwischen Romantik und Realismus.
Epilepsie-
Bliitter
1994;7(suppl 2): 11-14.
5.
Wright BH. Tennyson, the weird seizures in The Princess,
and epilepsy.
Lit
Med
1987;6:61-76.
6. Holloway J. Introduction. In:
George
Eliot,
Silas
Marner.
London: Dent (Everyman’s Library) 1962:V-IX.
7. Temkin
0.
The falling sickness,
2nd ed. Baltimore: Johns
Hopkins University Press, 1971.
8. Wolf
P.
Epilepsie als Metapher in der zeitgenossischen Lit-
eratur.
Epilepsie-Bliitter
1994;7(suppl 2):31-5.
9. Vogel P. Von der Selbstwahrnehmung der Epilepsie. Der
Fall Dostojewskij.
Nervenarzt
1961 ;32:438-41.
10.
Janz D. Anmerkungen zu Epilepsiegestalten bei Dostojews-
kij.
Epilepsie-Bliitter
1994;7(suppl 2): 15-7.
11.
Kierulf H. Dostojevskij og epilepsien.
Tidsskriftfor Den nor-
ske laegeforening.
1972;92: 1303-7.
12. Schmidt L. Epilepsie als literarisches Motiv-Elsa Morantes
Roman “La Storia.”
Epilepsie-Bliitter
1990;3:7-12.
13. v. Engelhardt D. Epilepsie in Elsa Morantes “La Storia.”
Epilepsie-Bliitter
1994;7(suppl 2):36-9.
BIBLIOGRAPHY
Aiken
J.
The Weeping Ash.
New York: Doubleday, 1980.
Barnes
J.
Flaubert’s Parrot.
London: Picador, 1985.
Chandler R.
The Big Sleep.
New York: Vintage Books, 1976.
Christie A.
The
ABC
Murders.
London: Collins, 1936.
Collins W.
Poor Miss Finch.
Sutton, Stroud: Pocket Classics,
Dickens C.
Oliver Twist.
Ware: Wordsworth Classics, 1992.
Dostoyevsky FM.
The Idiot.
[numerous editions].
Eliot
G.
Silas Marner.
London: Dent, (Everyman’s Library),
Farmer P.
Snakes and Ladders.
London: Abacus, 1994.
Frame
J.
Owls Do
Cry.
London: Women’s Press, 1985.
Frame J.
The Envoy from Mirror City.
London: Flamingo, 1993.
Howatch
S.
The Rich are Different.
London: Penguin, 1989.
James PD.
The Children ofMen.
London: Penguin, 1994.
Morante E.
La Storia.
Torino: Romanzo, Einaudi, 1974.
Peake M.
Titus Groane.
London: Mandarin, 1989.
Pilcher R.
The
Shell
Seekers.
Coronet Ed. London: Hodder
&
Rushdie
S.
Midnight’s Children.
London: Picador, 1982.
Rushdie
S.
The Satanic Verses.
London: Viking Penguin, 1988.
Shakespeare W.
King Lear.
[numerous editions].
Spark M.
The Bachelors.
London: Penguin, 1963.
Tennyson A. The Princess. A Medly. In: Tennyson A.
Poems
and Plays.
Oxford, New York: Oxford University Press,
1965.
1994.
1962.
Stoughton, 1989.
Thackeray WM.
Vanity Fair.
London: Penguin Classics, 1968.
Wood B.
Green City in the Sun.
London: Macmillan, 1988.
Epilepsia,
Vol.
36,
Suppl.
1,
1995
... Shakespeare benyttet seg av epilepsibegrepet i adjektivform i en replikk fra King Lear (1605) der Kent overhøvler Oswald: «A plague on your epileptic visage.» «Det epileptiske ansiktet» i denne sammenhengen representerer et forslått ansikt som følge av multiple anfall uten evne til å kunne ta seg for (5). ...
Article
Full-text available
In the spring of 2013, the Swedish journalist Maciej Zaremba wrote a series of articles criticizing the impact of NPM (New Public Management) on Swedish health care. The present study examines the views of experienced Swedish physicians (general practitioners and internal medicine speclialists) on the problems focused in Mr Zaremba's article series. The respondents (51 general practitioners and 61 internal medicine specialists) mention advantages as well as disadvantages with NPM in Swedish health care. The majority agrees that with NPM, physicians loose influence over health care governance to other professional groups. The majority disagree with the charge made by Mr Zaremba that NPM has had the effect of manipulating Swedish physicians away from the standards of good medical care.
Article
Full-text available
Jane Austen normally avoids discussing appearance throughout her works. Persuasion constitutes the exception to the rule, as the story focuses on the premature aging experienced by her protagonist, Anne Elliot, seemingly due to disappointed love. Much has been written about Anne’s “loss of bloom,” but never from the perspective of psychoneuroimmunology, the field that researches the interrelation between psychological processes and the nervous and immune systems. In this paper, we adopt a perspective of psychoneuroimmunology to argue that Austen established a connection between psychological distress, specifically lovesickness, and the development of early senescence signs, and vice versa, since the recovery of love is associated with happiness and physical glow. From a gender perspective, we discuss how Austen brightly reflected these interrelationships through the story of Anne, when the latest psychoneuroimmunological research has actually shown that women age earlier than men as a consequence of psychological turmoil.
Article
This paper represents a unique study carried out by a team of physicians having diverse medical experience (practitioners, residents, students), who relying on own viewpoints positions came to a common understanding and began to consider epilepsy not only as a severe, chronic, and widespread brain disease, but also as a part of human culture reflected in many literary works. Our study was aimed at searching and analyzing available sources that describe a course of epilepsy and its impact on life of famous people as well as its role in society. Literary images created in diverse centuries and eras by writers who personally suffered from epilepsy (F.M. Dostoevsky, Edgar Allan Poe, Wilkie Collins, and many others) turned out to be so colorful and convincing that they sometimes anticipated appearance of the first descriptions in professional medical literature, and even lay down in their basis.
Article
For a long time, people suffering from epilepsy have been feared, suspected, and misunderstood, socially stigmatized and viewed as outcasts. On the other hand, epilepsy was attributed to many remarkable personalities, among whom are Julius Caesar, Alexander the Great, Socrates, Aristotle, Joan of Arc, Leonardo da Vinci, Michelangelo, Ivan the Terrible, Newton, Peter the Great, Napoleon, Walter Scott, Paganini, Byron, Van Gogh, Dostoevsky, Leo Tolstoy, and many others. The article is aimed to confirm on historical facts or debunk the myths about the essence of epilepsy in some of these individuals.
Article
Full-text available
Novels represent a corpus of data that offers innovative opportunities for research and theory in health psychology. This article discusses how adding ‘health humanities’ to health psychology opens up a potentially rich domain for research and clinical application. The concept of ‘health humanities’ is discussed and put into a context of related fields. The concepts of ‘illness perceptions’ and ‘models of patient–health care provider interaction’ are used as illustrations. Applications are given, focusing on patients and their caregivers, health care providers and society at large (bibliotherapy and expressive writing). Suggestions for further development of the area are included.
Article
Internationally, publications have dealt repeatedly and elaborately with the depiction of epilepsy in television and feature films: 11 of 18 PubMed listed publications were reviews, in which more than 240 films were listed. German authors have also discussed the topic of epilepsy in television and feature films. An English film database could facilitate the discussion and the reception of films, especially concerning films that have not been produced in the film-dominating Anglo-American countries. Historical and obsolete notions about aspects of epileptology seem to persist in certain film genres (e. g. ictal aggression in horror films). Some films are discussed in detail to exemplify methodical problems that might arise during the analysis of the depiction of epilepsy in television and feature films.
Article
The history of epilepsy is not exclusively medical history but also cultural history with contributions from medical, juridical, religious and literary texts. Literary texts can be considered from many different points of view. This article sketches a brief history of epilepsy in the German language literature since the Age of Enlightenment. Writers have very diverse reasons for mentioning epilepsy but these are always in an artistic rather than a medical context. Unlike the literature from some neighboring countries, German nineteenth century realists showed little interest in epilepsy, whereas German literature stands out by a particular satirical tradition starting with Lichtenberg and Jean Paul, which does not exist in other countries. From Nazist Germany the fates of three Jewish writers (Georg Hermann, Joseph Roth and Ernst Weiss) are remembered, and epilepsy is a literary theme because of the threats by enforced sterilization and murder. In German as in most other contemporary literature there is a great deal of interest in epilepsy where metaphors of weakness are increasingly being replaced by attractive and independent characters. Authors who cannot draw on their own experience nowadays usually adequately research epilepsy but it still appears only rarely as a treatable condition. Drug treatment is mostly represented as a useless medical whim primarily resulting in side effects.
Article
The Institute of Epileptology of King's College, London has arisen from need and from opportunity. The need is due to the relative neglect nationally and internationally of the most common serious brain disorder with important physical, psychological, and social complications. The relative neglect is reflected in services, research, charitable donations, public profile, and stigma and in a serious lack of professional education. The opportunity arose because of the existence in several medical institutions at Denmark Hill, London, of a group of medical and related colleagues with a special interest covering almost every aspect of this multidisciplinary disorder who agreed to combine their expertise in this initiative. The idea was born and developed in 1991–1992 and was supported by all the parent institutions: The Maudsley and King's College Hospitals, St Piers Lingfield, The Institute of Psychiatry, King's College School of Medicine and Dentistry, and the School of Life, Basic Medical and Health Sciences, all under the umbrella of King's College, University of London. Further stimulus and help came from a group of dedicated supporters in private and public life. There are three strands to this initiative: (a) a charity, The Fund for Epilepsy; (b) the clinical Centre for Epilepsy, which was formally opened at the Maudsley Hospital in July 1994; and (c) the academic Institute of Epileptology for research and teaching, which was launched on November 15, 1994.
Article
Purpose: A total of 131 adults and children (mean age, 27 years; range, 3–59 years) with generalized tonic-clonic seizures (GTCS) of nonfocal origin resistant to other antiepileptic drugs (AEDs) were treated with open-label topiramate (TPM) after completing double-blind placebo-controlled trials. Results: The mean duration of open-label TPM treatment was 387 days (range, 14–909 days); the mean TPM dose was 7 mg/kg/day (range, 1–16 mg/kg/day). At the last study visit, the frequency of GTCS was reduced 50% from baseline in 63% of patients and by 75% in 44%. Among patients treated 6 months, 16% were GTCS free ges;6 months despite a pretreatment seizure frequency of one GTCS/week (median). Treatment with TPM was being continued in 82% of patients (n = 107) at the last visit. During treatment periods of up to 2·5 years, 11 (8%) patients discontinued TPM because of adverse events and seven (5%) because of inadequate seizure control. Conclusions: TPM therapy was well tolerated, and seizure control was maintained with long-term, open-label therapy in patients with GTCS, leading to prolonged seizure-free intervals in some patients with seizures previously resistant to AED therapy.
Article
Full-text available
Machado de Assis (1839-1908) is considered the most important Brazilian writer and a great universal literary figure. Little is know about his medical, personal and family history. He hid his "disease" as much as possible. Machado referred to "strange things" having happened to him in his childhood. He described seizures as "nervous phenomena", "absenses", "my illness". Laet observed a seizure and described it as: "... when Machado approached us and spoke to me in disconnected words. I looked at him in surprise and found his features altered. Knowing that from time to time he had nervous problems, ... and only permitted Machado take the Laranjeiras Street car, when I saw that he was completely well". A photographically documented seizure is shown. Alencar wrote, "The preoccupation with health was frequent: either he was having the consequences of a fit or was foreboding one". It is clear that Machado presented localized symptomatic epilepsy with complex partial seizures secondarily generalized of unknown etiology. The seizures which began in infancy or childhood had remission in adolescence and then recurred in his thirties and became more frequent in his later years. His depression got markedly worse with age. In our opinion, the greatest consequence of Machado's epilepsy, was his psychological suffering due to the prejudice of the times. Despite this Machado showed all his genius, which is still actual and universal.
Article
Raphael's last painting reveals, in the upper half of the picture, Christ's transfiguration on Mount Tabor and, in the lower half, the young boy's epileptic seizure at the foot of the mountain in the presence of the other disciples. Raphael depicts both events, which are told in succession in the Gospels, as if they took place at the same time. By synchronizing both scenes Raphael demonstrated a significant correspondence between Christ and the epileptic boy, which reveals the epileptic seizure as a symbolic representation of a transcendent event. This metaphysical aspect of epilepsy depicted by Raphael can also be found in the corresponding biblical passages. In the Gospels, the metamorphosis caused by the epileptic seizure is used as a simile for Christ's transfiguration through suffering, death, and resurrection. RESUMEN En la mitad superior del último cuadro de Rafael aparece la transfiguraciǒn de Cristo en el Monte Tabor y en la porciǒn inferior del mismo cuadro y en la presencia de otros discípulos, se observa la presencia de un muchacho en pleno ataque epiléptico al pie de la montaña. Rafael pinta ambos acontecimientos, que en las Sagradas Escrituras son descritos sucesivamente, como si hubieran ocurrido al mismo tiempo. Al sincronizar ambas escenas Rafael desmostró la correspondencia significativa entre Cristo y el muchacho epiléptico lo cual revela la representación simbólica del ataque epiléptico de un acontecimiento trascendental. El aspecto metafísico de la epilepsía tal como lo pinta Rafael puede también encontrarse en los correspondientes pasajes bíblicos. En las Sagradas Escrituras la metamorfosis causada por el ataque epiléptico se usa como un símil de la transfiguración de Cristo a través del sufrimiento, muerte y resurrección. ZUSAMMENFASSUNG Das letzte Bild von Raphael zeigt in der oberen Hälfte die Verwandlung Christi auf dem Berg Tabor und in der unteren Hälfte die Vorstellung des epileptischen Knaben vor den am Fuß des Berges zurückgebliebenen Jüngern. Raphael stellt die beiden Geschichten, die in den Evangelien nacheinander erzählt werden, so dar, als ob sie sich gleichzeitig ereignen. Durch die Synchronisation beider Szenen wird eine bedeutsame Korrespondenz zwischen Christus und dem epileptischen Knaben sichtbar, die den epileptischen Anfall als eine symbolische Representation eines transzendenten Geschehens erkennen läßt. Dieser von Raphael dargestellte metaphysische Aspekt von Epilepsie läßt sich auch in den biblischen Texten belegen. In den Evangelien hat die im epileptischen Anfall vor sich gehende Metamorphose die Bedeutung eines Gleichnisses für die auf Leiden, Tod und Auferstehung hinweisende Transfiguration von Christus.
Article
A patient had seizures while playing chess or cards or when filling out complex forms, doing complex mathematical problems, and during certain parts of the neuropsychological testing. Seizures were myoclonic and accompanied and electroencephalographic dysrhythmia of the atypical spike and wave type. Evoked seizures were not related to visual, tactile, or auditory stimuli or clues. In chess, seizures occurred when he was on the defense and threatened. Simple decision making or physiologic stress did not evoke seizures nor did nonsequential decision making under verbal pressure. Evoking factors were complex decision making in a sequential fashion and with an element of stress or concern regarding the outcome of the decision making. Stimulus was usually nonverbal. Three major factors--decision complexity, sequential factor, and related stress or concern--may have some reciprocal relationships.
Article
Literature primarily reflects and affirms existing attitudes and conceptions regarding the epilepsy population. In the fiction of many nations for many centuries, individuals with epilepsy have emerged as evil or saintly, as geniuses, or as objects of pity whose lives were not worth living. The character who had epilepsy was outside the realm of personal identification, too far beneath or too far above us. Nevertheless, there were exceptions. Literature, as well as film and television, especially in the last 2 decades, has shown both readers and audiences that there are human beings who have epilepsy (rather than who are epileptics). These human beings are simply part of the continuum of what we know as normal: no more and no less than merely human. Key Words: Epilepsy‐Modern literature, RÉSUMÉ La littérature reflète et confirme les attitudes et conceptions prévalentes concernant les épileptiques. Les oeuvres de fiction de nombreux pays, à travers de nombreux siècles, ont mis en scène des individus épileptiques caractérisés comme des méchants ou comme des saints, comme des génies ou comme des objets de pitié dont les vies ne valaient pas la peine d'être vécues. Le personnage épileptique se situait en dehors due domaine de l'identification personnelle, trop loin en‐dessous ou trop loin au‐dessus du commun des mortels. Cependant, il y a eu des exceptions. La littérature comme le film et la télévision, en particulier pendant les deux derniéres décennies, a montré au lecteur et au spectateur qu'il y a des êtres humains qui ont une épilepsie (plutot que des êtres humains qui sont épileptiques). Ces êtres font partie du continuum des individus normaux: ils ne sont ni plus ni moins que simplement humains. RESUMEN Fundamentalmente la literatura refleja y afirma la existencia de actitudes y conceptos en relatión con la población que padece epilepsyía. En las leyendas de muchas naciones y a lo largo de muchos siglos, los individuos con epilepsyía han sido considerados como malignos o santos, como genios o como merecedores de compasión cuyas vidas no eran dignas de ser vividas. La persona que padecía epilepsyía no se la identificaba como persona por ser demasiado inferior o demasiado superior al resto. Sin embargo existieron excepciones. La literatura, así como las películas y la televiseón, especialmente en las dos últimas décadas, han mostrado a los espectadores o a los lectores que existen seres humanos que TIENEN EPILEPSIA (más que SON EPI‐LEPTICOS). Estos seres humanos son, simplemente, parte de lo que se considera como normal: ni mas ni menos que simplemente humanos. ZUSAMMENFASSUNG Die Literatur reflektiert oder bestätigt vorhandene Einstellun‐gen gegenüber Anfallskranken. In Jahrhunderte überdauernden Vorstellungen zahlreicher Nationen waren Menschen mit einer Epilepsie böse oder heilig, Genies oder Opfer von Mitleid, deren Leben nicht als lebenswert betrachtet wurde. Der Charakter des‐jenigen mit Epilepsie lag außerhalb des Bereichs der persönlichen Identifizierung: entweder weit unter oder weit über uns. Trotzdem gab es Ausnahmen. In der Literatur aber auch in Film und Fernsehen, besonders in den vergangenen zwei Jahr‐zehnten, wurde sowohl dem Leser als auch dem Zuschauer gezeigt, daß es sich um menschliche Wesen handelt mit einer Epilepsie (und nicht, daß sie Epileptiker sind). Diese Menschen gehören dem Kontinuum an, welches wir Normalität nennen und sie sind nicht mehr oder weniger menschlich.
Article
Barbara Herb Wright is a Ph.D. candidate at the University of Colorado at Boulder and has served as an administrator for the Sandoz Pharmaceutical Company. Her dissertation is entitled The American Mining Frontier and the American Novel. I thank my husband, Roy R. Wright, M.D., for talking about epilepsy with me. I also thank both him and David Stumpf, M.D., for helping direct my research to the books and periodicals that provide the basis for this essay. 1. Edgar Finley Shannon, Jr., Tennyson and the Reviewers: A Study of His Literary Reputation and of the Influence of the Critics upon His Poetry, 1827-1851 (Cambridge: Harvard University Press, 1952), 131. 2. Quoted in Christopher Ricks, ed., The Poems of Tennyson, Longmans Annotated English Poets Series (London: Longmans, Green, 1969), 742. 3. Quoted in Ricks, 742. 4. Clyde de L. Ryals, "The 'Weird Seizures' in The Princess," Texas Studies in Language and Literature 4 (Summer 1962): 269. 5. Catherine Barnes Stevenson, "The Aesthetic Function of the 'Weird Seizures,'" Victorian Newsletter 45 (Spring 1974): 22-23. 6. Jerome Hamilton Buckley, Tennyson: The Growth of a Poet (Cambridge: Harvard University Press, 1960), 101. 7. James E. Sait, "Tennyson, Mesmerism, and the Prince's 'Weird Seizures,'" Yearbook of English Studies 4 (1974): 211. 8. Robert Bernard Martin, Tennyson: The Unquiet Heart (New York: Oxford University Press, 1980), 10. All quotations are from this edition and are cited parenthetically in the text as UH, followed by the page number. Copyright © 1980 by Robert Bernard Martin. Reprinted by permission of Oxford University Press, Inc. 9. Alfred Lord Tennyson, The Princess, 4th ed., in The Poems of Tennyson, ed. Christopher Ricks, Longmans Annotated English Poets Series (London: Longmans, Green, 1969), 741-844. All quotations are from this edition and are cited parenthetically in the text by part and line numbers. Copyright © 1969 by Longmans, Green and Co Ltd. Reprinted by permission of Longman Group UK, Limited. 10. Hallam Tennyson, Alfred Lord Tennyson: A Memoir by his Son, vol. 1 (New York: Macmillan, 1897), 320. 11. David D. Daly, "Ictal Clinical Manifestations of Complex Partial Seizures," in Complex Partial Seizures and Their Treatment, ed. J. Kiffin Penry and David D. Daly, Advances in Neurology, vol. 11 (New York: Raven Press, 1975), 57. All subsequent quotations are from this edition and are cited parenthetically in the text as "ICM," followed by the page number. 12. Selected Writings of John Hughlings Jackson, ed. James Taylor, vol. 1 (New York: Basic Books, 1958), 274, 297. All subsequent quotations are from this edition and are cited parenthetically in the text as SW, followed by the page number. 13. Owsei Temkin, The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology, 2d ed., rev. (Baltimore: Johns Hopkins University Press, 1971), 3, 7. 14. John Quincy, A New Medical Dictionary (London, 1802), quoted in Sait, 205. 15. Ibid. 16. J. Russell Reynolds, Epilepsy: Its Symptoms, Treatment, and Relation to Other Chronic Convulsive Diseases (London: John Churchill, 1861), 122. 17. J. Kiffin Penry, "Perspectives in Complex Partial Seizures," in Complex Partial Seizures and Their Treatment, ed. J. Kiffin Penry and David D. Daly, Advances in Neurology, vol. 11 (New York: Raven Press, 1975), 6. 18. Ibid., 6-7. 19. Robert Thomas, The Modern Practice of Physic: Exhibiting the Characters, Causes, Symptoms, Prognostic, Morbid Appearances, and Improved Method of Treating the Diseases of All Climates, 3d ed. (New York: Collins, 1815), 317. 20. W. R. Gowers, Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms & Treatment, American Academy of Neurology Reprint Series, vol. 1 (1885; reprint, New York: Dover Publications, 1964), 19. 21. Ryals, 275. 22. Stevenson, 23. 23. Anita B. Draper, "The Artistic Contribution of the 'Weird Seizures' to The Princess," Victorian Poetry 17 (Autumn 1979): 185. 24. Gowers, 19. 25. Quoted in Temkin, 32. 26. Temkin, 32. 27. Thomas, 319. 28. Temkin, 32. 29. The Letters of Alfred Lord Tennyson, vol. 1 (1821-1850), ed. Cecil Y. Lang and Edgar F. Shannon, Jr. (Cambridge: Belknap Press of Harvard University Press, 1981), 222-23. 30. Hallam Tennyson, 320. 31. William H. Theodore, Roger J. Porter, and J. Kiffin Penry, "Complex Partial...
Article
Literature can be viewed as a mirror that reflects society's attitude toward epilepsy. This article examines how epilepsy is portrayed in selected twentieth century literary works. Although these works were written by intellectuals, they still offer an image of epilepsy as a phenomenon characterized by supernatural features.
Article
The Norwegian author Tryggve Andersen (1867-1920) had epilepsy, but was not aware of the diagnosis until late in life. In one novel, Towards Night (Mot Kvaeld), published in 1900, he described in detail nocturnal attacks with formed visual hallucinations as the initial event, seeing always the same face. He was familiar with the works of Ernst Hoffmann and probably also with those of Fiodor Dostoyevsky, but deduction of the literary influence leaves a precise description corresponding to an epileptogenic focus in the right posterotemporal region. Knowledge of his work may elucidate the subjective experience of initial epileptic manifestations, uncontaminated by previous knowledge of what can be expected in epilepsy. The descriptions provided by Andersen's writings are compared with more formal contemporary definitions of seizure events.