Epilepsy in the Asylum

Glenside Hospital Museum


When I was a nursing assistant working on an elderly male psychiatric ward in the early 1980s I witnessed patients having grand mal epileptic fits about once a week. At first I found it quite frightening, but later I became quite blasé about it, although I did wonder why they were so common.

Epilepsy only began to be successfully treated in the late nineteenth century and early treatments such as bromine were very sedating. It was only with the advent of phenytoin in the twentieth century that successful non-sedating treatments became available.

R. A. Gross ‘A brief history of epilepsy and its therapy in the Western Hemisphere’, Epilepsy Research, 12(2) (1992): 65–74.

Of those conditions which are now seen as non-psychiatric, epilepsy was the most common at Bristol Lunatic Asylum. The Medical Superintendent Dr Benham asserted in 1890 that there were 120 patients with epilepsy; this was about one fifth of the patient population (Early, Pauper Palace). However, just 11 patients from 1861 to 1900 had epilepsy as the primary diagnosis. In total, 562 patients were noted as having epilepsy but their primary diagnosis was most commonly given as dementia. Yet, many of their symptoms, including memory loss, aggression and confusion, seem to have been a result of their epilepsy.

Andres Kanner,‘Psychiatric issues in epilepsy: The complex relation of mood, anxiety disorders and epilepsy’,Epilepsy and Behaviour, 15 (2009): 83–87.

Epilepsy was their main problem and is evidenced by the fact that they were housed in their own wards (male and female), presumably so they could be better observed.The table below is taken from the 1881 Superintendent’s Report and is rather shocking, showing that fits were very frequent.

 

Male Female
No. of epileptics Day Night Total No. of epileptics Day Night Total
January 24 162 200 362 24 256 440 696
February 25 210 149 359 24 216 415 631
March 26 202 234 436 25 218 491 709
April 29 210 219 429 27 257 479 736
May 24 215 207 422 24 283 396 679
June 23 210 231 441 26 240 459 699
July 26 182 195 377 26 294 568 862
August 27 216 220 436 25 198 390 588
September 27 192 182 374 23 177 329 506
October 27 223 193 416 22 182 221 403
November 25 219 181 400 22 233 290 523
December 28 226 185 411 24 227 340 567
Total 2467 2396 4863 2781 4818 7599

No. of fits during the year 1881

 

In 1881, there were 7599 fits from an average of 48 patients. Thus a patient with epilepsy could expect to average about three fits a week. This must have had a devastating effect on the sufferer and would have been difficult for the largely untrained attendants. On each epilepsy ward (one male, one female) there were about 79 fits each week.

The majority (65%) of patients diagnosed with epilepsy from 1861 to 1900 were to die in the asylum. Some 22% recovered, though the recovery would not have been from their epilepsy, rather from a concomitant psychiatric illness.

Epilepsy had for many centuries been associated with mental disorder. In the Middle Ages it was thought to be contagious, hence the need for them to be incarcerated. This very negative view of epilepsy led to much discrimination and Connecticut actually passed laws against epileptics in 1895 which restricted their freedom of movement.  

Shawn Masa and Orrin Devinsky, ‘Epilepsy and Behaviour: A Brief History’, Epilepsy and Behaviour, 1 (2000): 37.

The convulsions and postictal behaviour which could include violence, confusion and loss of memory were thought to be proof of the link between them. Later research does show a correlation between mood disorders and epilepsy and this is bidirectional; that is, those with mood disorders are more likely to suffer from epilepsy and also those with epilepsy are more likely to develop mood disorders.

Andres Kanner, ‘Psychiatric issues in epilepsy: The complex relation of mood, anxiety disorders and epilepsy’,Epilepsy and Behaviour, 15 (2009): 83.

Nowadays epilepsy is not seen as a psychiatric condition and a person with epilepsy is unlikely to be treated by a mental health unit. In the nineteenth century it was different as the Lifton family were to discover. Read all about them in next week’s blog.

Author: Paul Tobia

Feature image: Patient walking in the grounds of Bristol Lunatic Asylum, Denis Reed (RA, RWA)

Read Paul’s previous 5 blogs under ABOUT US: GHM Articles