Hector Berlioz and his Vesuvius: an analysis of historical evidence from an epileptological perspective.

ARTICLE IN PRESS

Hector Berlioz and his vesuvius: an analysis of historical evidence from an epileptological perspective Dirk-Matthias Altenm€uller1 Epilepsy Center, Department of Neurosurgery, University Hospital Freiburg, Freiburg im Breisgau, Germany 1 Corresponding author: Tel.:+49-761-27050950; Fax:+49-761-27050080, e-mail address: [email protected]

Abstract The epileptologically informed in-depth analysis of auto- and heteroanamnestic historical sources supports the hypothesis that Hector Berlioz (1803–1869) might have suffered from a photosensitive idiopathic generalized epilepsy syndrome with absences, absence status, myoclonic seizures, and bilateral tonic–clonic seizures. The study outlines the possible influence of the composer’s probable epilepsy on his literary and musical oeuvre, including the Symphonie fantastique en cinq parties.

Keywords Hector Berlioz, epilepsy, absence, absence status, myoclonic seizure, bilateral tonic–clonic seizure, photosensitivity, generalized, Symphonie fantastique

1 BIOGRAPHICAL BACKGROUND Hector Berlioz was one of the most colorful French artistic personalities of the nineteenth century. Born in 1803 in La C^ ote-Saint-Andre near Grenoble as the first son of a physician, he moved to Paris at the age of 17. After some years, he ultimately abandoned his medical studies in order to pursue a career as a composer. In 1830, he completed the composition of his most famous work, the Symphonie fantastique. Other important examples of his generally unconventional and innovative musical oeuvre (often misunderstood by his contemporaries) include the symphonies Harold en Italie (1834) and Rom eo et Juliette (1839) as well as the Grande Messe des morts (1837) and the operas Benvenuto Cellini (1838) and Les Troyens (1856–1858). He also Progress in Brain Research, ISSN 0079-6123, http://dx.doi.org/10.1016/bs.pbr.2014.11.007 © 2015 Elsevier B.V. All rights reserved.

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ARTICLE IN PRESS 168

Hector Berlioz and epilepsy

gained a reputation as a conductor and for his contributions to modern instrumentation and orchestration. What is less known is that Berlioz was also a prolific music critic and remarkably witty writer. He died in 1869 in Paris, at the age of 65. Brilliant accounts of his eventful life were penned by Berlioz himself in his M emoires (Berlioz, 2000) and by his many biographers (e.g., Cairns, 1999a,b).

2 A MYSTERY After winning the coveted Prix de Rome for his composition in July 1830, Berlioz presented to the French Minister of the Interior a medical certificate stating that he was suffering from “nervous affections,” a condition that worsened during the summer and under the influence of the sun. On account of this morbid disposition, it would be dangerous for him to complete the period of study at the Acad emie de France a Rome in the Villa Medici in Rome required in connection with the prize (Berlioz, 1972a, p. 377): Paris, le 8 Septembre 1830. Je soussign e, docteur en m edicine de la Facult e de Paris, d eclare avoir donn e, depuis cinq ans, des soins a M. Hector Berlioz pour des affections nerveuses, accompagn ees de sympt^ omes de congestion c er ebrale. J’ai observ e que cet etat maladif augmentait surtout pendant l’ et e, et sous l’influence plus imm ediate de l’action du soleil. En cons equence, je pense qu’il serait dangereux pour M. Berlioz d’habiter un climat chaud, tel que celui de Rome ou` il serait expos e a des causes capables de renouveler et d’augmenter l’intensit e de ses dispositions maladives. 1 Jules Guerin

(Paris, 8 September 1830. I, the undersigned, doctor of medicine at the Faculty of Paris, declare that I have, for five years, treated M. Hector Berlioz for nervous affections, accompanied by symptoms of cerebral congestion. I have observed that this unhealthy state worsened particularly during the summer and under the more immediate influence of the sun’s action. Consequently, I think that it would be dangerous for M. Berlioz to reside in a hot climate, such as that of Rome, where he would be exposed to causes capable of renewing and increasing the intensity of his morbid dispositions. Jules Gu erin) 1

Medical certificate dated September 8, 1830, enclosed with letter no. 187 to the Minister of the Interior from October 28, 1830.

ARTICLE IN PRESS 2 A mystery

The certificate also indicates that the 26-year-old Berlioz had already been receiving medical treatment for at least 5 years at this point. However, it is conspicuous that a clear medical diagnosis is not named or was possibly even left out on purpose.2 Only a few weeks before arriving in Rome in the spring of 1831, Berlioz himself wrote in a letter to Ferdinand Hiller of a “mystery of a terrible suffering” that would perhaps still affect him for a long time to come and about which he could not speak openly (Berlioz, 1972a, letter no. 207 from January 31, 1831, pp. 409–410): [. . .] je dois vous faire un myst ere d’un chagrin affreux que j’ eprouverai peut-^ etre longtemps encore3; il tient a des circonstances de ma vie qui sont compl etement ignor ees de tout le monde (C. . . except e); j’ai au moins la consolation de le lui e d’^ etre myst erieux avec avoir appris sans que. . . (assez).4 Quoique je sois forc vous sur ce point, [. . .] ([. . .] I must conceal from you a mystery of a terrible suffering that I will perhaps still experience for a long time to come; it is tied up with circumstances of my life that are entirely unknown by everyone (with the exception of C. . .); I at least have the consolation of having let her know of it without. . . (enough). Although I would be forced to be mysterious with you on this point, [. . .])

Berlioz was evidently afraid of being stigmatized by the diagnosis, which he thus attempted to conceal from others or even to deny whenever possible. Even to his close friend Humbert Ferrand in 1833, he brushed aside rumors apparently circulating at the time to the effect that he was suffering from epilepsy, ostensibly a ridiculous slander aimed at sabotaging his marriage to the Irish actress Harriet, alias Henriette Smithson (Berlioz, 1975, letter no. 351 from October 11, 1833, p. 121): Je suis mari e! enfin! [. . .] Henriette m’a expliqu e, depuis, les mille et une calomnies ridicules qu’on avait employ ees pour la d etourner de moi et qui avaient caus e 2

It is significant to remark, however, that the contemporary medical literature explicitly classified insolation (“l’insolation”) as one of the provocative factors for epilepsies and therapies recommended avoiding it. Other terms used at the time within the context of epilepsies include “congestion c er ebrale” and “disposition” (see Esquirol, 1838). 3 Indication of a chronic disease. 4 This passage also seems to be a mystery for Berlioz’ biographers, who in the context of this letter speculate on details concerning his relationship with his fiancee Camille Moke or even admit: “This allusion remains obscure” (Berlioz, 1972a, p. 407). One plausible interpretation could be that Berlioz had revealed his illness to Camille Moke by this time; see also the announcement 8 days beforehand: [. . .] il y a encore un sacrifice, le plus grand de tous, qu’elle ne connaıˆt pas, et que je lui ferai. ([. . .] there is still a sacrifice, the biggest one of all, of which she does not yet know, and which I will make for her.) (Berlioz, 1972a, letter no. 206 to Ferdinand Hiller from January 23, 1831, p. 407). However, it is also conceivable that Camille Moke had already heard of episodes with a fall before this point or had even witnessed them herself: Hier soir, je me suis evanoui devant elle, [. . .] (Yesterday evening, I fainted in front of her, [. . .]) (Berlioz, 1972a, letter no. 165 to E´douard Rocher from June 5, 1830, p. 333); see also below.

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ses fr equentes ind ecisions. Une, entre autres, lui avait fait concevoir d’horribles craintes: on lui avait assur e que j’avais des attaques d’ epilepsie. Puis on lui a ecrit de Londres que j’ etais fou, que tout Paris le savait, qu’elle etait perdue si elle m’ epousait, etc. [. . .] (Figure 1) (I am married! finally! [. . .] Henriette has explained to me, since then, the thousand and one ridiculous slanders that people have employed to lead her away from me and that have been the cause of her frequent indecisiveness. One of them made her imagine horrible fears: someone assured her that I had epileptic attacks. Then someone wrote her from London that I was mad, that all of Paris knew it, that she would be lost if she married me, etc. [. . .])

In his known extensive correspondence and in his autobiographical M emoires (Berlioz, 2000), first published as a book in 1865, this is also the only occasion

FIGURE 1 Autograph of the first page of Berlioz’ letter to his friend Humbert Ferrand from October 11, 1833, in which the term “epilepsie” appears openly. Bibliotheque nationale de France, departement Musique, NLA-275 (32), with permission.

ARTICLE IN PRESS 3 Le mal inexprimable: the ineffable malady

on which Berlioz used the term “ epilepsie” openly. Incidentally, it is worthy of note that he does not in any way explicitly contradict, let alone present arguments to refute, the diagnosis of epilepsy in this context.5 The following sections attempt to present evidence for the hypothesis that Berlioz did indeed suffer from a particular type of epilepsy. The struggle with the disease seems to have occupied him throughout his entire lifetime.

3 LE MAL INEXPRIMABLE: THE INEFFABLE MALADY As a rule, one cannot tell epilepsy patients have the disease merely by looking at them, except when they are having a seizure. At any rate, it is not possible to make a diagnosis on the basis of the Berlioz portrait painted by E´mile Signol during the composer’s stay in Rome in 1832 (Figure 2), despite its suggestion of a dreamy, absent look.

FIGURE 2 Portrait of Hector Berlioz (1803–1869) by E´mile Signol, 1832. Academie de France a Rome, Villa Medici, Rome. 5

Berlioz had already spoken repeatedly of his illness in letters to his friend Humbert Ferrand but had requested that he keep the matter secret. See Berlioz (1972a), letter no. 94 to Humbert Ferrand from June 28, 1828, p. 201: [. . .] la crise est pass ee; je ne veux pas vous en expliquer la cause par ecrit, une lettre peut s’ egarer. Je vous recommande instamment de ne pas dire un mot de mon etat a qui que ce soit; [. . .] ([. . .] the crisis (or: seizure) is over; I do not want to explain the cause to you in writing, a letter can go wide of the mark. I recommend insistently that you refrain from saying a word to anyone concerning my state; [. . .]).

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Electroencephalography, a technique that delivers indisputable proof of epileptic activity and thus a clear diagnosis of epilepsy, was not developed until about 60 years after the death of Berlioz. It goes without saying that we do not possess any video recordings of his potential epileptic episodes and it is no longer possible to observe a seizure at first hand posthumously. In the case of Berlioz, we are thus forced to rely chiefly on a careful epileptological analysis of the available anamnestic evidence on the path to a possible diagnosis. The first crucial task will be to document the semiology of the presumed seizures in as much detail as possible. This will involve analyzing how the course of the seizures is perceived and described by the patient himself on the one hand and how it is witnessed by outside observers on the other. Other key epileptological parameters include the person’s age at the first manifestation of the disease and at the first instance of the individual seizure types as well as the frequency of the seizures. It will also be important to verify whether the seizures occur at certain times of day or whether they are provoked by specific factors. In addition, other criteria that might provide insights into the likely underlying epilepsy syndrome include the particular course of the disease, the presence or absence of other conditions such as a physical developmental disorder or cognitive impairments, and any signs of a potential genetic or nongenetic (e.g., traumatic) etiology. As already mentioned above, social stigmatization is also quite often associated with epilepsy.

3.1 OF LAUREL FORESTS AND VOLCANOES We will thus begin with the autoanamnesis, sharpening our understanding of Berlioz’ personal report of his medical history.6 Besides the M emoires, which were for the most part already edited in 1848, the main source we will consider is Volumes I and II of the Correspondance g en erale, which contain his letters from the critical period between 1819 and 1842 (particularly the third and fourth decades of his life). A letter Berlioz wrote to his mother from Rome in the spring of 1832 (Berlioz, 1972a, letter no. 266 from March 20, 1832, p. 542), for example, raises the following questions for the epileptologist: Is the “forced absence” ([. . .] absence forc ee [. . .]) he claims here to be currently making him ill really only a reference to his obligatory absence from Paris as a condition of accepting the Prix de Rome, or is it in fact an allusion to the medical term coined in 1824 by Louis-Florentin Calmeil to refer to a “minor” epileptic seizure characterized by a brief loss of consciousness (Calmeil, 1824)? What are we to make of Berlioz’ remark in the postscript of the same letter to the effect that he will need to wait until another day to write his sister Nanci, as he is 6

In view of the great amount of textual sources, it will be necessary to make a selection.


currently “in too bad a mood” and feels a “nasty fit” taking hold of him ([. . .] mais je suis trop mal dispos e, je sens un mauvais acc es me prendre [. . .])? On the other hand, it is certainly not legitimate to interpret a confession made to his niece decades later (Berlioz, 2001, letter no. 3165 to Josephine Suat from September 28, 1866, p. 463) that a two-night-long train journey caused him “grand mal” ([. . .] Je ne te dissimulerai pas que ces deux nuits pass ees en chemin de fer m’ont fait grand mal [. . .]) as evidence of a bilateral tonic–clonic (grand mal) seizure provoked by sleep deprivation. (The phrase applies a very common French expression and simply means that he suffered a lot of discomfort and pain.) However, why does Berlioz emphasize explicitly in his M emoires (Berlioz, 2000, chapter XXXVIII, p. 206) that during his excursions in Italy at a Benedictine monastery in Subiaco he was shown medicinal plants said to work miracles against convulsions and that the monks did a considerable business selling them (Ces fleurs ont la propri et e miraculeuse de gu erir des convulsions, et les moines en font un d ebit consid erable)? Surely it is no accident that the surviving historical textual records contain a conspicuous accumulation of characteristic French terms: Particularly worthy of mention are, besides the already mentioned “acc es” (fit) and “absence,” the nouns “spleen,” “crise,” “passion,” “exaltation,” “isolement,” “id ee,” and “tremblement” and the adverb “convulsivement.” Whereas in the nineteenth century “spleen” was an occasionally overused, rather vague “fashionable term” referring to various affections, today, “crise” is still a common specific term in French medicine referring to an epileptic seizure. Beyond the matter of terminology, it is of fundamental importance to read between the lines if one wishes to come closer to grasping the possibility of epilepsy in Berlioz. This is due not least to the following hypothetical circumstances: – Berlioz understandably had no interest in making his illness public, as this would have subjected him to incalculable social stigmatization, thus endangering his career as a musician—he had no desire to speak openly about it, nor would such openness have been accepted by the society he lived in. As a consequence, we cannot expect to find any direct confessions of his having been diagnosed with epilepsy in the documents that have come down to us. Rather, he probably would have preferred using nonstigmatizing and socially accepted terms like “spleen” or “passion” to refer to his disease in public. – A clear-cut diagnosis of epilepsy was in many cases not yet possible in the nineteenth century. In particular, the attribution of nonconvulsive seizure types to epilepsy was not obvious in every patient at the time. It might thus be assumed that Berlioz himself was long unaware of the epileptic cause of his symptoms, which,

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however, he observed very sharply and described in sophisticated terms—while also exploring aspects of them through the medium of art. – Like many epilepsy patients, Berlioz presumably did not register parts of his seizures directly due to the impaired consciousness they caused and was thus himself dependent on the accounts of others in his attempt to define that which was so elusive. Keeping these restrictions in mind, we can now turn to a text that is of central importance with regard to its possible epileptological aspects, namely chapter XL7 of the M emoires, which is embedded in the account of Berlioz’ stay in Rome, when he was 28 years of age, and bears the heading Vari et es de spleen. L’isolement. (Varieties of spleen. The isolation.). The following is an abbreviated version in which terms and sequences with potential special epileptological significance are highlighted (Berlioz, 2000, pp. 222–225): Ce fut vers ce temps de ma vie acad emique que je ressentis8de nouveau les atteintes d’une cruelle maladie (morale, nerveuse, imaginaire9, tout ce qu’on e un premier voudra), que j’appellerai le mal de l’isolement10. J’en avais eprouv acc es a l’^ age de seize ans, et voici dans quelles circonstances. Par une belle ote-Saint-Andr e, j’ etais assis dans une prairie, a l’ombre matin ee de mai, a La C^ d’un groupe de grands ch^ enes, lisant un roman de Montjoy, [. . .] Tout entier a ma epandant par lecture, j’en fus distrait cependant par des chants doux et tristes, s’ la plaine a intervalles r eguliers. La procession des Rogations passait dans le voisinage, et j’entendais la voix des paysans qui psalmodiaient les Litanies des saints. Cet usage de parcourir, au printemps, les coteaux et les plaines, pour appeler sur les fruits de la terre la b en ediction du ciel, a quelque chose de po etique et ege [. . .] reprit sa de touchant qui m’ emeut d’une mani ere indicible11. Le cort marche lente en continuant sa m elancolique psalmodie.12La voix affaiblie de notre vieux cur e se distinguait seule parfois, avec des fragments de phrases: ............. [. . .] Et la foule pieuse s’ eloignait, s’ eloignait toujours. ............. (Decrescendo) Sancte Barnaba Ora pro nobis! (Perdendo) 7

First published on June 30, 1844, in the magazine L’Artiste. The word “ressentir” might refer to recidivating symptoms. 9 From an epileptological perspective, the word “imaginaire” might reflect the subjective amnesia for a part of the seizures. 10 “le mal de l’isolement” is highlighted in the original. 11 From an epileptological perspective, the word “indicible” probably reflects the difficulty finding words to describe what is experienced during the epileptic seizure. 12 This scene finds a musical counterpart in the Pilgrims’ march in Harold en Italie (see below). 8


Sancta Magdalena Ora pro Sancta Maria, Ora . . . . . . . . Sancta . . . . . . . . . . . . . . . . nobis. ............. Silence. . . [. . .] . . . coups sourds de mon cur. . . evidemment la vie etait hors de moi, loin, tr es loin. . . A` l’horizon les glaciers des Alpes, frapp es par le soleil levant, r efl echissaient d’immenses faisceaux de lumi ere. . . [. . .] . . . des passions ardentes e . . . quelque insondable bonheur. . . secret. . . [. . .] . . . mais je ne suis qu’un corps clou a terre! ces personnages sont imaginaires ou n’existent plus. . . [. . .] . . . Et l’acc es se d eclara dans toute sa force, et je souffris affreusement, et je me couchai a terre, g emissant, etendant mes bras douloureux, arrachant convulsivement des poign ees d’herbe et d’innocentes p^ aquerettes qui ouvraient en vain leurs grands yeux etonn es13, luttant contre l’absence14, contre l’horrible isolement. Et pourtant, qu’ etait-ce qu’un pareil acc es compar e aux tortures que j’ai eprouv ees depuis lors, et dont l’intensit e augmente chaque jour?. . . Je ne sais comment donner une id ee de ce mal inexprimable. [. . .] [. . .] il en est a peu pr es ainsi quand cette id ee15d’isolement et ce sentiment de l’absence viennent me saisir. Le vide se fait autour de ma poitrine palpitante, et il semble alors que mon cur, sous l’aspiration d’une force irr esistible, s’ evapore et tend a se dissoudre par expansion.16Puis, la peau de tout mon corps devient douloureuse et bruˆlante; je rougis de la t^ ete aux pieds. Je suis tent e de crier, d’appeler a mon aide mes amis, les indiff erentes m^ emes, pour me consoler, pour me garder, me d efendre, m’emp^ echer d’^ etre d etruit, pour retenir ma vie qui s’en va aux quatre points cardinaux. [. . .] Il y a d’ailleurs deux esp eces de spleen; l’un17est ironique, railleur, emport e, vi18 olent, haineux; l’autre , taciturne et sombre, ne demande que l’inaction, le 13 Berlioz probably attributes the singular look and the peculiar position of the eyes during epileptic seizures (possibly having been told of them by outside observers) to the daisies—with literary intent. 14 “l’absence” is highlighted in the original. As with “l’isolement,” it is most likely a term for a loss of consciousness. 15 A possible connection between this “id ee d’isolement” and the “id ee fixe” of the Symphonie fantastique will be suggested later on. 16 This description refers to a physics experiment conducted by Joseph Louis Gay-Lussac involving a vacuum. Berlioz had used this experiment previously as an illustration. The analogy to the events during a seizure (see below) is striking (increasing vacuum/absence status; boiling and evaporation of water/unstoppable transition to myoclonic and bilateral tonic–clonic seizure; remaining ice/postictal state). 17 Epileptological classification: bilateral tonic–clonic seizure or myoclonic seizure. 18 Epileptological classification: absence or absence status.

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silence, la solitude et le sommeil. A` l’^ etre qui en est poss ed e tout devient indiff erent;19 la ruine d’un monde saurait a peine l’ emouvoir.20[. . .] En proie a ce genre de spleen, je dormais un jour dans le bois de lauriers de l’Acad emie, roul e dans un tas de feuilles mortes, comme un h erisson, [. . .] (It was at roughly this time of my academic life that I again felt the pangs of a cruel disease (moral, nervous, imaginary, whatever you like), which I will call the malady of the isolation. I had my first bout of it at the age of sixteen, and this is how it ote-Saint-Andre, I was sitting in a came about. One beautiful May morning, in C^ meadow under the shade of some large oaks, reading a novel by Montjoy, [. . .] Although I was totally absorbed in my book, I was nevertheless distracted by a soft and sad singing that drifted over the plain at regular intervals. The Rogation processions were passing through nearby, and I heard the voices of the peasants chanting the Litany of the Saints. This custom of wandering through the hills and the plains at springtime to beseech heaven to bless the fruits of the earth has something poetical and touching about it that moved me in an inexpressible way. The peasants [. . .] continued steadily on their way, singing their melancholic psalmody. I could occasionally make out our old priest’s feeble voice, with fragments of the phrases: ............. [. . .] And the pious flock drifted farther and farther away. ............. (Decrescendo) Sancte Barnaba Ora pro nobis! (Perdendo) Sancta Magdalena Ora pro Sancta Maria, Ora . . . . . . . . Sancta . . . . . . . . . . . . . . . . nobis. ............. Silence. . . [. . .] . . . the dull beating of my heart. . . life was evidently outside of me, far, far away. . . On the horizon the glaciers of the Alps, struck by the rising sun, reflected immense beams of light. . . [. . .] . . . burning passions. . . what an unfathomable delight. . . secret. . . [. . .] . . . but I am only a body pinned down to the earth! those beings are either imaginary or exist no longer. . . [. . .] . . . 19 20

Probable paraphrase of the alteration of consciousness associated with a seizure. Probable description of the unresponsiveness to external stimuli caused by seizures.


And the fit broke out in full force; and I suffered terribly, and I lay down on the ground, moaning, extending my aching arms, convulsively tearing up fistfuls of grass and innocent daisies that opened in vain their great astonished eyes, struggling against the absence, against the horrible isolation. And yet, what is this fit compared to the tortures I have endured since, and which increase in intensity day by day?. . . I do not know how to convey an idea of this ineffable malady. [. . .] [. . .] it is much like this when this idea of isolation and this feeling of the absence seize me. The vacuum takes its place around my throbbing breast, and it feels as if my heart, under the aspiration of an irresistible power, were evaporating and tending toward dissolution by expanding. Then the skin of my entire body begins to ache and burn; I turn red from my head to my feet; I feel a need to cry out, to call my friends or even the indifferent people to help me, to console me, to take care of me, to defend me, to prevent me from being destroyed, to restrain my life, which is leaving in the four cardinal directions. [. . .] There are, by the way, two kinds of spleen; one is ironical, mocking, irascible, violent, and malicious; the other, taciturn and somber, requires but inaction, silence, solitude, and sleep. He who is possessed by it becomes utterly indifferent to everything; the ruin of a world would scarcely be able to move him. [. . .] Having fallen prey to this kind of spleen, I was sleeping one day in the laurel forest at the Academy, rolled up in a pile of dead leaves, like a hedgehog, [. . .])

From an epileptological perspective, it is possible to draw the following tentative conclusions from this autoanamnestic account of the composer’s illness (condensed in literary form, yet authentic in its multiple attempts to describe his symptoms by means of reformulations): After experiencing what could have been his first convulsive seizure at the age of 16, Berlioz evidently suffered repeated (and increasingly frequent) relapses during his time in Rome. The quite detailed description of the semiology of these events allows a distinction between two characteristic types of epileptic seizure: – Classical absences with arrest and brief lapses of consciousness, which are conveyed in the text by the repeated use of three or more periods (i.e., . . .). Of critical importance for this interpretation is that absences can also appear in the form of an absence status accompanied by a sustained (lasting up to several hours or even days) alteration of consciousness or cognitive impairment (fluctuating in intensity, yet sometimes only subtle), partly also by a gradually increasing state of detachment from one’s surroundings.21 – Bilateral tonic–clonic seizures with an initial cry, a loss of consciousness, a sudden fall to the floor, unnaturally wide-open eyes, tonic extension of the arms, “convulsions” in the sense of bilateral cloni, stertorous breathing, and other vegetative accompanying reactions as well as postictal sleep and muscle aches. 21

It seems plausible that this is why Berlioz uses the analogy with the pilgrimage.

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FIGURE 3 Light reflections in the laurel forest at the Academie de France a Rome (Villa Medici, Rome), where according to his accounts (Memoires, chapter XL) Berlioz probably experienced an epileptic seizure triggered by photic stimulation.

The absences or the absence status could occasionally develop into bilateral tonic– clonic seizures. There are indications that the seizures tended to happen at a certain time of day, with manifestations in the early morning hours on awakening. Furthermore, Berlioz clearly points to specific provocative factors: The seizures seem to have been characteristically favored by certain light stimuli (see Figure 3), and we can thus assume a photosensitivity. Special cognitive processes such as reading or the perception of particular musical patterns (here, the monotonous chants of pilgrims)22 might also have contributed to the manifestation of seizures. Remarkably, the passages referring to possible epilepsy in the M emoires correspond in large part to the details Berlioz revealed to his father, a physician23, in a 22 See also the following self-observation in the M emoires (Berlioz, 2000, chapter XL, p. 224): Les adagio de quelques-unes des sonates de Beethoven, et l’Iphigenie en Tauride de Gluck, au contraire, appartiennent enti erement au spleen et le provoquent; [. . .]. (The adagios of several of Beethoven’s sonatas, and Iphig enie en Tauride of Gluck, on the contrary, belong entirely to the spleen and provoke it; [. . .]). Regarding Berlioz’ reaction to the music of Richard Wagner, see Berger and Altenm€ uller (2003). 23 It is possible that Berlioz, increasingly unsettled by his symptoms, also hoped that his father would provide him with medical assistance. In the end, it remains unclear to what extent his father contributed to the diagnosis of his disease or whether he was even aware at all of his putative diagnosis with epilepsy.


highly personal letter in 1830 (Berlioz, 1972a, letter no. 155 from February 19, 1830, pp. 310–311): [. . .] Je voudrais trouver aussi un sp ecifique pour calmer l’ardeur fi evreuse qui me torture si souvent; je ne le trouverai jamais, cela tient a mon organisation. En outre, l’habitude que j’ai prise de m’observer continuellement fait qu’aucune sensation ne m’ echappe et la r eflexion la rend double, je me vois dans un miroir. J’ eprouve souvent des impressions extraordinaires dont rien ne peut donner une id ee,24vraisemblablement l’exaltation nerveuse en est la cause, cela tient de l’ivresse de l’opium. Mais ce qui me surprend c’est que je me rappelle fort bien emoire me avoir eprouv e exactement la m^ eme chose d es l’^ age de 12 ans, ma m retrace ces journ ees chagrines que je passais dans une emotion continuelle sans sujet et sans objet;25 je me vois d’ici, les dimanches surtout, dans le temps que vous me faisiez expliquer l’Eneide de Virgile, assistant aux v^ epres; l’influence e de celle de certaines paroles comme l’In exitu de ce chant calme et monotone, aid Israe¨l, qui me racontait le pass e, etait telle que je me trouvais alors saisi d’une affliction presque d esesp erante, mon imagination m’environnait de tous mes h eros troyens et latins, ce malheureux Turnus surtout me brisait le cur; le bon roi Latinus, cette Lavinie si r esign ee, et puis toutes ces armes brillantes ere, que je voyais r efl echissant le soleil d’Italie a travers des nuages de poussi otres, tout cela confondu et m^ el e avec les id ees bibces murs si eloign ees des n^ liques, les souvenirs d’E´gypte, de Moı¨se, me mettait dans un etat de souffrance ind efinissable, j’aurais voulu pouvoir pleurer cent fois davantage. Eh bien, ce monde fantastique s’est conserv e en moi et s’est accru de toutes les id ees nouvelles26que j’ai connues en avançant dans la vie; c’est devenu une v eritable maladie. Il m’arrive quelquefois de ne pouvoir qu’ a peine supporter cette douleur morale ou physique (car je ne sais faire la distinction), surtout dans les beaux jours d’ et e, me trouvant dans un lieu espac e comme le jardin des Tuileries, seul; oh, alors, M. Azaı¨s a raison, je croirais volontiers qu’il y a en moi une force d’expansion qui agit violemment, je vois tout cet horizon, ce soleil, et je souffre tant, tant, que si je ne me contenais, je pousserais des cris, je me roulerais par terre.27[. . .]

24

This formulation reflects probably again the difficulty expressing what one experiences during an epileptic seizure. 25 Epileptological classification: absence status. 26 Probable reference to further seizure types in the course of the illness. 27 Epileptological classification: bilateral tonic–clonic seizure (with initial cry). The words Berlioz used to describe a later episode in Florence are similar: C’est l a que j’ai lu pour la premi ere fois Le Roi Lear et que j’ai pouss e des cris d’admiration devant cette uvre de g enie; j’ai cru de crever [sic] d’enthouerit e), mais je me roulais convulsivement pour satisfaire mes siasme, je me roulais (dans l’herbe a la v transports. (It was there that I first read King Lear and that I let out cries of admiration for this work of genius; I thought I would burst from enthusiasm, I rolled around (in the grass, in truth), but I rolled around convulsively to satisfy my outburst of feeling.) (Berlioz, 1972a, letter no. 223 to Gounet, Girard, Hiller, Desmarest, Richard, and Sichel from May 6, 1831, p. 442).

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Mais en voil a assez, ma lettre viendra peut-^ etre dans un moment inopportun, ainsi, silence. [. . .] ([. . .] I also wish to find a specific remedy to calm the feverish ardor that tortures me so often; I will never find it; that is due to my organization. Besides, the habit I have picked up of continually observing myself ensures that no sensation escapes me, and the reflection makes it double; I see myself in a mirror. I often experience extraordinary impressions, of which nothing can convey an idea; in all likelihood, my nervous exaltation is the cause of it; there is something of the intoxication of opium about it. But what surprises me is that I remember very well having experienced exactly the same thing since the age of 12; my memory recalls to me those morose days I passed in a continuous emotion without subject and without object; I see myself from here, particularly on Sundays, at the time at which you explained to me Virgil’s Aeneid, while attending vespers; the influence of that calm and monotonous singing, aided by that of certain lyrics, like the In exitu Israel, which narrated the past to me, was such that I then found myself seized by an almost desperate affliction; my imagination surrounded me with all of my Trojan and Latin heroes; that wretched Turnus in particular broke my heart; the good king Latinus, the resigned Lavinie, and then all of those shiny weapons I saw reflecting the sun of Italy across the clouds of dust, those customs so far removed from our own, all of this mixed up and blended with biblical ideas, the memories of Egypt, of Moses, put me in an indefinable state of suffering; I would have wanted to be able to cry a hundred times more. Well, this fantastic world is conserved in me and is augmented by all of the new ideas that I have become familiar with as I progress through life; it has become a veritable disease. Now and then it happens to me that I cannot but scarcely bear this moral or physical pain (for I know not how to distinguish between them), especially in the beautiful days of summer, finding me in a distant place like the Tuileries Garden, alone; oh, so, M. Azaı¨s is right. I gladly believed that there is inside of me a force of expansion that acts violently, I see that entire horizon, that sun, and my suffering is such, such, that if I did not control myself, I would cry out, I would roll around on the ground. [. . .] But this is enough; my letter will perhaps come at an inopportune moment; and so, silence. [. . .])

Here as well, we find the distinction between probable absences and bilateral tonic– clonic seizures in the subsequent course of the illness. Berlioz describes the absences or absence status—expressed here as “continuous emotion without subject and without object”—more precisely as having first manifested when he was 12 years old. He also again makes explicit reference to light stimuli and monotonous singing as typical provocative factors. In addition, he mentions the evening (during vespers) as a further characteristic time of day at which the seizures occur. He also speaks of the increase in emotional strain that accompanies a high frequency of paroxysmal episodes, implying that his illness might be assessed as affecting him in daily life. Moreover, Berlioz himself names a “predisposition” concerning his nervous system as the probable etiology, although he does not find it easy to define how his disease differs


from a mental disorder.28 He also remarks correctly on the limited options for pharmacotherapy in the nineteenth century. Berlioz and his doctors possibly mistook a further seizure type that occurred with full consciousness as nonepileptic in nature. However, in the overall context of his illness the peculiar “trembling” and “muscle twitching” that Berlioz mentioned repeatedly in his correspondence and in the M emoires can easily be interpreted as probable myoclonic epileptic seizures. It is only possible to provide a small selection of textual documents here (Berlioz, 1972a, letter no. 79 to Nanci Berlioz from January 10, 1828 (recte: 1829), p. 168; letter no. 94 to Humbert Ferrand from June 28, 1828, p. 201; letter no. 219 to his family from April 21, 1831, p. 432): [. . .] Derni erement apr es le concert [. . .], a peine fus-je dans la cour du Conservatoire, tremblant de la t^ ete aux pieds, il etait quatre heures; [. . .] ([. . .] Recently after the concert [. . .], scarcely had I made it to the courtyard of the Conservatory, trembling from my head to my toes, it was four o’clock; [. . .]) [. . .] . . . Tous mes muscles tremblent comme ceux d’un mourant!. . . O mon ami, envoyez-moi un ouvrage; [. . .] {Dimanche matin, 29.6.1828} [. . .] la crise est pass ee; [. . .] ([. . .] . . . All of my muscles are trembling like those of a dying man!. . . Oh my friend, send me a work; [. . .] {Sunday morning, June 29, 1828} [. . .] the crisis (or: seizure) has passed, [. . .]) [. . .] apr es ma lettre d’hier, mon tremblement convulsif me reprit plus fort que jamais; c’ etait la derni ere lutte entre la vie et la mort, entre le pardon et la vengeance; [. . .] Pourtant c’est affreux; il me semble que les os de mon cr^ ane etaient d esarticul es et tremblaient comme tout le reste. [. . .] ([. . .] after my letter from yesterday, I had a stronger bout of convulsive trembling than ever before; it was the last struggle between life and death, between forgiveness and retribution; [. . .] Still, it is dreadful; it seems to me as if the bones of my skull were disjointed and trembled like all the rest. [. . .])

These seizures appear to have occurred predominantly in the morning or in the evening—in the leisure time after his concert activity—and by all means involved considerable limitations in daily life. For example, he had to put off writing a letter (see above) or occasionally experienced difficulties walking and clothing himself due to the sudden onset of what might be identified as myoclonic jerks (Berlioz, 1972a, letter no. 128 to Humbert Ferrand from June 15, 1829, p. 260): 28

This corresponds to the assessment in chapter XL of the M emoires (Berlioz, 2000, pp. 222–225), in which he speaks of a “nervous illness” (maladie nerveuse)—or perhaps still a “moral illness” (maladie morale)—and the “incalculable superabundance of sensibility with which I am endowed” (l’incalculable surabondance de sensibilit e dont on est pourvu).

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[. . .] La semaine derni ere, j’ai et e pris d’un affaissement nerveux tel, que je ne pouvais presque plus marcher ni m’habiller le matin; on m’a conseill e des bains qui n’ont rien fait, je suis rest e tranquille, et la jeunesse a repris le dessus. [. . .] ([. . .] Last week I was taken by such a nervous collapse that I could hardly walk anymore or clothe myself in the morning; I was counseled to go to the baths, which did not have any effect; I remained calm, and my youthfulness prevailed over it. [. . .])

He also seems to have experienced accidents due to myoclonic seizures while conducting (Berlioz, 1972a, letter no. 77 to Humbert Ferrand from November 29, 1827, p. 160):29 [. . .] Je conduisais l’orchestre; mais, quand j’ai vu ce tableau du Jugement dernier, [. . .] j’ai et e saisi d’un tremblement convulsif que j’ai eu la force de maıˆtriser jusqu’ a la fin du morceau, mais qui m’a contraint de m’asseoir et de laisser reposer mon orchestre pendant quelques minutes; je ne pouvais plus me tenir debout, echapp^ at des mains. [. . .] et je craignais que le b^ aton ne m’ ([. . .] I was conducting the orchestra; but when I saw this tableau of the Last Judgment, [. . .] I was seized by a convulsive trembling which I had the strength to get under control by the end of the piece, but which compelled me to sit down and to have my orchestra rest for several minutes; I could not hold myself upright, and I was afraid the baton would not break loose from my hands. [. . .])

It is not uncommon for myoclonic seizures to lead to sudden falls. Against this backdrop, an episode Berlioz refers to several times (Berlioz, 1975, letter no. 449 to an unknown recipient from November 22 or December 13, 1835, p. 259; Berlioz, 1971, pp. 343–344), in which he lost his footing and plunged into the Tiber ([. . .] le pied me manqua [. . .] or [. . .] la terre manqua sous mes pieds, et je tombai dans le fleuve [. . .]), appears in a new light: with epileptological knowledge in mind, one might speculate that the abrupt fall could have been brought about by a seizure (and then embellished in his writings). Indeed, Berlioz’ condition seems to have again worsened during his stay in Italy in 1831 and 1832.30 In a letter to Thomas Gounet (Berlioz, 1972a, letter no. 248 from November 28, 1831, p. 499), for instance, the composer writes that his unfortunate illness is progressing daily in Rome ([. . .] ma malheureuse maladie fait tous les jours a Rome de nouveaux progr es, je n’y connais d’autre rem ede, quand les acc es sont trop forts, que la fuite. [. . .]). Similarly, in chapter XL of the M emoires, which deals with his time in Rome, he remarks that “the tortures [. . .] increase in intensity day by day” (see above) and that he—translated into epileptological terms—“perceives little absences again and again” (M^ eme a l’ etat calme, je sens toujours un peu d’isolement 29

See also the episode that took place while he was conducting The blessing of the swords from Giacomo Meyerbeer’s opera Les Huguenots, described in Berlioz, 2000, chapter LIII, pp. 425–426. 30 As far as can be inferred from the correspondence, the seizures had already been worsening since 1827 (the year in which Harriet Smithson entered Berlioz’ life).


les dimanches d’ et e, [. . .] parce qu’on est absent. [. . .]) (Berlioz, 2000, chapter XL, p. 224). It is significant to point out, however, that his symptoms were not continually present but appeared in paroxysmal bursts. Berlioz himself repeatedly uses the image of a volcano to characterize the sudden and violent eruptions of his probable epilepsy with myoclonic and bilateral tonic–clonic seizures. After returning from Rome in June 1832, for example, he writes in a letter to Albert Du Boys (Berlioz, 1975, letter no. 278 from June 21, 1832, pp. 14–15) that he had gained weight because his Vesuvius had been outwardly calm since its last explosion ([. . .] Mais je vous pr eviens que je suis fort engraiss e; il n’y a pour me maigrir que l’agitation des passions violentes, et depuis sa derni ere explosion mon V esuve est tranquille a l’ext erieur. Nous causerons, nous causerons. [. . .]). A previously little known autobiographical sketch (Berlioz, 1832) that Berlioz penned in 1832 as the basis for an article in the Revue de Paris reveals a lot about how he dealt with the course of his illness, which in his role as an active member of society he was evidently not always able to conceal from the public eye. Essentially, here again we encounter the same epilepsy motifs now familiar to the reader. The composer describes openly (and possibly also with a specific intent) how he was often seen abruptly breaking off a cheerful conversation (Souvent [. . .] on le voyait tout a coup s’interrompre au milieu d’une conversation joyeuse, [. . .])—a typical symptom of classical absences. The autobiography also contains a rather frank account of a bilateral tonic–clonic seizure ([. . .] un tremblement convulsif faisait fr emir tout son corps [. . .]; [. . .] a convulsive trembling made his entire body shake [. . .]), albeit embellished with tears ([. . .] un d eluge de larmes terminait cet effrayant paroxysme; [. . .] a torrent of tears ended this terrifying paroxysm). Finally, one episode related in the sketch involving an odd bout of involuntary laughter ([. . .] de temps en temps [. . .] un affreux eclat de rire semblable a ce rire involontaire qui r esulte de la contraction spasmodique des muscles dans le chatouillement; from time to time [. . .] a horrid bout of laughter similar to that involuntary laughter that occurs as a result of the spasmodic contraction of the muscles when one is tickled) that makes him into the subject of ridicule (sujet de raillerie) while attending a theatrical performance can be interpreted as a possible instance of a myoclonic seizure (with involvement of the muscles of the diaphragm or the larynx). Thus, Berlioz might have no longer even tried to conceal or dispute the spectrum of his probably epileptic symptoms (which were likely to have been in any case evident in public and a topic of general conversation by this point). However, the autobiographical sketch provides a typical example of how Berlioz embeds these symptoms, as bizarre as they must have at times seemed, and the resulting episodes in his social environment within a certain context with the (probably for the most part conscious) intention of suggesting other explanations for them than a socially stigmatizing disease like epilepsy—as he does here in particular by evoking his intense romantic love affair

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with an Irish actress ([. . .] elle a caus e de maux31a cette a^me de feu, [. . .]; she has caused the maladies of that blazing soul, [. . .]), a circumstance that was more compatible with the life of an artist in the nineteenth century, or even by stylizing his life story into a novel ([. . .] toutes ces circonstances produites par le hasard, donne a notre biographie l’air d’un roman. [. . .]; [. . .] all of these circumstances, brought about by chance, give our biography the atmosphere of a novel; [. . .]32).

3.2 OF WILD BOARS AND POLAR BEARS But how did friends and other contemporaries actually experience Berlioz? What heteroanamnestic records do we have that document the possible presence of epilepsy? That it was not only claimed that Berlioz had the devil in his body (see Berlioz, 1972a, letter no. 189 to Humbert Ferrand from November 19, 1830, p. 383), but that he was evidently also linked specifically with epilepsy during his lifetime, may be seen in a not exactly favorable review of his music by Henri Blaze in the Revue des deux Mondes from the year 1838 (Blaze, 1838, p. 114): [. . .] les foudroyans effets d’ emotion religieuse et d’ epouvante que ces grands maıˆtres n’ont pas trouv es dans leur sentiment m elodieux, puisque la multitude qui les ecoute ne tombe pas la face contre terre en des convulsions d’ epileptique, M. Berlioz les cherchera dans les abıˆmes de son orchestre, [. . .] ([. . .] the crushing effects of religious emotion and terror that these grand masters did not find in their melodious sensibility, because the multitude that listens to them does not fall to the ground on their faces in epileptic convulsions, are what M. Berlioz will look for in the abysses of his orchestra, [. . .])

In a probable allusion to the composer’s bilateral tonic–clonic seizures, the critic asserts further that music should touch the audience “without convulsion” and without “dangerous paroxysm.” The pain that emerges from art, he reasons, has no wrinkles on its face, no foam on the mouth ( ecume sur la bouche), and no disheveled hairs on its head (Blaze, 1838, p. 106). It is perhaps possible to interpret a remark by the pianist Camille Moke (documented by Berlioz in his correspondence) as having been made after the latter had suffered an epileptic seizure with a backward fall in her presence, or at least as evidence that she was aware that her then fiance experienced such seizures (Berlioz, 1972a, letter no. 182 to Humbert Ferrand from October 1830, p. 368):33 31

The word “maux” is ambiguous in that the term “mal” was also used in medicine to refer to an epileptic (grand mal or petit mal) seizure. 32 For those close to him, what follows is likely an allusion to his underlying epilepsy: Elle est vraie cependant; ceux qui connaissent Berlioz ne le savent que trop. (Yet it is true; those who know Berlioz know it all too well.) 33 See also footnote 4.


Eh bien, vous ne vous e^tes pas trouv e mal? Tu n’es pas tomb e a la renverse? (So, you did not pass out? You didn’t fall backward?)

More significant, however, are the personal observations left to us by the dramatist and friend of the composer Ernest Legouve in his autobiography, first published in 1886 (Legouve, 1886, p. 327 and 296): [. . .] Tout etait original dans Berlioz. Un m elange extraordinaire d’enthousiasme et de sarcasme! Un esprit toujours impr evu! Une conversation qui vous tenait toujours en eveil par son in egalit e m^ eme! Parfois de longs silences, avec de sombres regards pench es en bas, et qui semblaient plonger au fond de je ne sais quels abıˆmes. Puis des r eveils soudains, eblouissants!34Un jaillissement de mots spirituels, comiques, touchants! Des eclats de rire hom eriques! Des joies d’enfant! [. . .] ([. . .] Everything about Berlioz was original. An extraordinary mixture of enthusiasm and sarcasm! An always unexpected spirit! A conversation that always kept you wide awake due to its very irregularity! Sometimes long silences, with somber looks downward, and that seemed to plunge down to the bottom of I don’t know what abysses. Then sudden, dazzling awakenings! A burst of spiritual, comical, touching words! Homeric peals of laughter! Childish pleasures! [. . .]) [. . .] cet e^tre qui vivait a la merci de ses nerfs, qui etait l’esclave de toutes ses impressions, qui passait subitement d’un sentiment a un autre, qui p^ alissait, tressaillait, pleurait malgr e lui, et ne pouvait pas plus commander a ses paroles qu’aux muscles de sa face35[. . .] ([. . .] this being who lived at the mercy of his nerves, who was the slave of all of his impressions, who would pass all of a sudden from one feeling to another, turn pale, quiver, cry in spite of himself, and lose all command over his words and the muscles of his face [. . .])

These are almost textbook accounts of classical absences with frequent brief (and sometimes prolonged) periods of “blanking out” in the form of a sudden interruption of ongoing activities (like a conversation), an oddly blank stare, a pallor, and then an abrupt termination, as well as of myoclonic seizures with involuntary twitching and a lack of control over one’s (facial) muscles. In addition, Ernest Legouve’s account of an incident that transpired during an evening opera performance in 1832 lends itself to interpretation as a poetically embellished description of a bilateral tonic–clonic seizure in which the subject lets out an initial cry and then causes an uproar (Legouve, 1886, p. 290): [. . .] Tout a coup [. . .] un de mes voisins36se l eve, se penche vers l’orchestre et en eral, je me retourne et s’ ecrie d’une voix tonnante: [. . .]. Au milieu du tumulte g 34

Epileptological classification: absences or absence status. Epileptological classification: myoclonic seizures. 36 Namely, Berlioz 35

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je vois a mes c^ ot es un jeune homme tout tremblant de col ere, les mains crisp ees, etait a la fois comique les yeux etincelants, et une coiffure, une coiffure!. . . [. . .] C’ et diabolique! [. . .] ([. . .] Suddenly [. . .] one of my neighbors stands up, leans toward the orchestra and cries out in a thundering voice: [. . .]. In the middle of the general tumult, I turn around and I see at my side a young man shaking all over with anger, his hands clenched, his eyes sparkling, and such hair, such hair!. . . [. . .] It was at once comical and diabolical! [. . .])

Moreover, in a 1839 letter to Franz Liszt, the writer Marie d’Agoult related an episode in which it was impossible for the literary critic Charles-Augustin SainteBeuve to engage Berlioz in a conversation—all one could get out of him were grunts resembling those of a wild boar (Ollivier, 1933, p. 289): L’autre soir il s’ etait mis en t^ ete de faire causer Berlioz: chose difficile! chose impossible! Un grognement de sanglier est tout ce qu’on obtient de lui. (The other night he got it into his head to get Berlioz to have a chat: a difficult task! an impossible task! A wild boar’s grunt is all one got out of him.)

It is possible that this inadequate responsiveness while being addressed, evidently extending over a prolonged period of time, is an example of an absence status associated with vocalizations induced by laryngeal myoclonia. Finally, there are indications that the topic of epilepsy was also taken up in contemporary Berlioz caricatures. In 1847, for example, the magazine Charivari (Anonymous, 1847) depicted Berlioz bound to his bed with peculiar oscillatory head movements (mouvement d’oscillation que d ecrit la tête) that occurred particularly in the summer (Figure 4), a phenomenon that most likely corresponds to myoclonic seizures.37 The caption also describes an attempt to administer a therapy involving ice on him,38 which might be understood as a reflection of the fact that there was no effective drug therapy for epilepsy available at the time.39,40 Jean-Pierre Dantan41, to give another example, made a bust in 1833 that must be understood as a caricature (Figure 5). On its base, the name Berlioz appears as a pictograph: following the “BER” at the bottom left-hand corner is a bed (“lit” in 37

See the description already quoted above from Berlioz (1972a), letter no. 219 to his family from April 21, 1831, p. 432. 38 An application of cold substances to the face or head is also documented in the contemporary medical literature as a common method for treating epilepsy (Herpin, 1867, p. 182). 39 The first effective antiepileptic agent, potassium bromide, was not introduced until 1857. 40 Regarding the influence of the illness on his musical work also hinted at here (D ej a on sentait l’ours blanc dans ses symphonies; One already felt the polar bear in his symphonies), see below. 41 Significantly, the brother of the sculptor Dantan the Elder, who according to the M emoires (chapter XL) personally helped Berlioz back to his feet when he was found sleeping in a grove of laurels after a probable seizure (Berlioz, 2000, p. 225).

ARTICLE IN PRESS

FIGURE 4 Caricature of Hector Berlioz drawn by an unknown artist. Anonymous, 1847; Bibliotheque nationale de France, with permission.

FIGURE 5 Ber-Lit-Haut. Bust made by Jean-Pierre Dantan (1800–1869): Caricature de Louis-Hector Berlioz, 1833, Musee Carnavalet, Paris. Carnavalet/Roger-Viollet. All rights reserved. Parisienne de Photographie, with permission. # Eric Emo/Musee



French), which is placed high (“haut” in French).42 In the knowledge that epilepsy was also termed “haut mal,” this might be interpreted as an allusion to the sculptor’s personal observation that Berlioz was sometimes found in bed (or lying on the ground) due to his epilepsy, although this remains speculative.

4 THE DIAGNOSIS By nature, a retrospective diagnosis of a famous person, born more than 200 years ago and living in a medical and cultural context different from ours, harbors inherent problems and pitfalls (see Karenberg, 2014). All diagnostic clues from various historical sources are based on indirect hints or variably filtered information, and there is no modern diagnostic technology available to definitively verify the resulting hypothetical diagnosis. In addition, the “decoding” of historical evidence may be substantially influenced by subjective viewpoints and personal experience. In the case of Berlioz, it is also important to consider that our modern conceptual understanding of epilepsies was not yet developed during his lifetime. In particular, a clear differentiation between (nonconvulsive) epileptic seizures and nonepileptic psychogenic (in contemporary terms: “hysterical”) attacks in some patients was not obvious for nineteenth-century physicians (see Faber, 1997). Moreover, the French terms “convulsif ”/“convulsivement” and “ epileptique” occasionally were used rather loosely at that time. Therefore, the historical application of the terms “epilepsy” and “epileptic” in conjunction with Berlioz, on its own, should not be interpreted as proof that the composer definitively suffered from epilepsy as defined today. On the other hand, a detailed clinical anamnesis continues to be the essential diagnostic tool in epileptology. In individuals with a classical manifestation and course of epilepsy, accurately ascertained anamnestic data may yield a high degree of diagnostic reliability and allow a fairly clear distinction from potential differential diagnoses even retrospectively and without additional technical equipment. In the case of Berlioz, the refined self-observation with respect to his symptoms and the circumstances of their occurrence may perhaps be ascribed to skills he acquired during his own medical studies. Some of the presumptive disease-related, sociocultural, artistic, or even strategic aspects which might have contributed to the peculiarities of Berlioz’ own report on his illness have already been addressed above. With these critical methodological remarks in mind, the following tentative diagnostic hypothesis might be put forward: The auto- and heteroanamnestic records analyzed above provide clear evidence that Berlioz suffered from a chronic illness that presented him with considerable difficulties and challenges in daily life, the more so as he was unable to conceal the symptoms and their occasionally bizarre effects from his contemporaries.

42

The “z” at the end of the name Berlioz was probably not pronounced by many contemporaries.

ARTICLE IN PRESS 4 The diagnosis

In light of this first ever in-depth analysis of the historical sources from an epileptological perspective, and applying medical knowledge not yet fully available during Berlioz’ lifetime, however, his disease is no longer so “mysterious.” Rather, the ample congruent evidence leaves little doubt that the paroxysmal episodes described in such astoundingly nuanced language both by Berlioz himself and by outside observers might specifically have been recurrent spontaneous epileptic seizures and that he thus, by definition, could have been suffering from epilepsy. The quality of the descriptions even allows a reliable distinction between different types of seizure with regard to their semiology. The identifiable types include classical absences and absence status, myoclonic seizures, and bilateral tonic– clonic seizures. Significantly, however, the documents do not reveal any characteristic indications of (additional) epileptic auras43; in view of his excellent faculty of self-perception, it is thus improbable that Berlioz ever experienced auras of any kind.44 He suffered initial manifestations of his seizures in adolescence at the ages of 12 (absences and absence status) and 16 (bilateral tonic–clonic seizures) years. At least the “minor” (nonconvulsive) seizures were quite frequent. All seizure types showed a circadian predilection with predominant occurrence in the morning (on awakening) and in the evening (after work). Apparently, the presumed epilepsy was also characterized by photosensitivity. In addition to sunlight, however, Berlioz also named several other potential seizureprecipitating factors, including changes in the rhythm of his life (most likely with an altered sleep–wake cycle)45 as well as specific complex mental demands (e.g., reading or the perception of certain music), typical of a reflex epilepsy.46 It was obviously a lifelong illness, even though it perhaps appeared in a weaker form in later years, whether spontaneously or because Berlioz learned to avoid situations in which he knew he would be particularly prone to seizures. There are no clear indications that any other member of his family suffered from epilepsy. The extensive contemporary sources do not provide any signs of additional physical impairments, cognitive deficits, or a possible nongenetic cause of the disease.47 To conclude, in view of the typical constellation of clinical symptoms and additional anamnestic details, the findings of this epileptological analysis allow us not

43

Auras would point to a focal epilepsy in the differential diagnosis. He fell back on his own subjective experience, however, for his account of the presumed absence status, the myoclonic seizures, and the postictal state following a bilateral tonic–clonic seizure. 45 Compare [. . .] je sens que le spleen va me reprendre plus fort qu’auparavant. Il faut je crois que je dorme beaucoup. ([. . .] I sense that I will have a stronger bout of spleen than previously. I think I need to get a lot of sleep.) (Berlioz, 1972a, letter no. 141 to his father from November 3, 1829, p. 282). 46 This is perhaps a reason why Berlioz himself was occasionally unable to distinguish between an organic illness and a mental illness. 47 These factors would rather point to a focal epilepsy in the differential diagnosis. 44

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FIGURE 6 Electroencephalogram showing typical generalized polyspike–wave complexes in a patient with idiopathic generalized (genetic) epilepsy.

only to reasonably diagnose Berlioz with probable epilepsy but also to classify his disease as likely belonging to the idiopathic generalized (genetic) epilepsies. An additional electroencephalographic proof of pathognomonic generalized epileptiform potentials in the form of 3/s spike–wave complexes and polyspikes (Figure 6) seems unnecessary for this assessment. Nevertheless, such EEG recordings (not available during Berlioz’ lifetime) would have been the only method to confirm definitively the retrospective diagnosis of epilepsy, which is merely based on indirect historical evidence and therefore to some extent speculative. However, with regard to potential differential diagnoses, there are no convincing alternative medical conditions that might plausibly explain the particular combination of symptoms and associated distinctive features elaborated above. For example, a personality disorder on its own might account for some of the odd behavioral patterns (including occasional impairment of impulse control and emotional instability) described by Berlioz’ biographers, but it does not sufficiently explain the apparent paroxysmal character of his disease. On the other hand, such particular personality traits are well known in patients with idiopathic generalized (genetic) epilepsy (see Janz and Christian, 1957; Janz and Durner, 1997). In view of the now unraveled historical sources available to us and with our modern epileptological knowledge, it also seems rather improbable that Berlioz had a pure dissociative disorder with nonepileptic psychogenic seizures (as suggested by Hughes, 2005). Among other things, such a disorder does not typically present with a triad of distinct seizure types whose semiologies mimic those of epileptic

ARTICLE IN PRESS 5 Encore: la symphonie fantastico-epileptique

absences, myoclonic seizures, and bilateral tonic–clonic seizures. In addition, seizure provocation by light stimuli is not characteristic of psychogenic seizures. Altogether, in consideration of the described characteristic types of seizures, there are reasons to suspect that Berlioz suffered from a specific epilepsy syndrome that fulfills all of the criteria of juvenile myoclonic epilepsy ( Janz and Christian, 1957; Janz and Durner, 1997), a well-defined subtype of idiopathic generalized (genetic) epilepsy. Juvenile myoclonic epilepsy, also known as Janz syndrome, is one of the more common epilepsy syndromes, accounting for 5–10% of all epilepsy cases and with a prevalence of 1:1000–1:2000 (at the age of 20 years). Its diagnosis is commonly made solely on the basis of a thorough patient history. The basic features of this syndrome were first described in 1867, shortly before the death of Berlioz, in the posthumous publication Des acc es incomplets d’ epilepsie of the neurologist Theodore Herpin (Herpin, 1867).

5 ENCORE: LA SYMPHONIE FANTASTICO-E´PILEPTIQUE It is only possible to address the obvious question of whether Berlioz’ presumed epilepsy also left traces in his works in cursory form here. Definitely, there are clear references to epilepsy in his literary creations. Besides the passages quoted above from his autobiographic M emoires, it is certainly no coincidence that there are also frequent epilepsy motifs48 in his novellas, published between 1834 and 1848 (Berlioz, 1995). They include allusions to absences, absence status, myoclonic seizures, and bilateral tonic–clonic seizures as well as a emoires, he also actually used the term “ epilepsie” tongue bite49. Unlike in the M here.50 Against this backdrop, it is plausible to assume that Berlioz’ continuing struggle with epilepsy also influenced his musical oeuvre thematically and—not least in view of the particular compositional techniques he made use of—possibly even had a profound impact on his compositional style in general.51 For instance, in a letter to Ferdinand Hiller in January 1832 (Berlioz, 1972a, letter no. 256 from January 1, 1832, p. 516), Berlioz himself remarks that he composed a ame est triste jusque’ a la Psalmodie52pour ceux qui ont beaucoup souffert et dont l’^ mort (Psalmody for those who have suffered much and whose soul is sad up until 48

Occasionally, they are strikingly similar, even down to the wording, to those in the M emoires. See Le Suicide par enthousiasme: [. . .] l’ ecume sanglant qui s’ echappait de ses l evres [. . .] ([. . .] the bloody foam that drooled from his lips [. . .]) (Berlioz, 1995, p. 16). 50 See Un b en eficiaire et Rubini a Calais (Berlioz, 1995, p. 31) and Histoire du harpiste ambulant (Berlioz, 1995, p. 120). 51 The role of a possible seizure provocation by specific musical stimuli in terms of a musicogenic epilepsy would also still need to be clarified in this connection. 52 Presumably an early version of the M editation religieuse (Tristia, Opus 18, no. 1). 49

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death) on a day in Rome on which he had been afflicted with the “spleen” (translated into epileptological terms: under the influence of an absence status). The second movement of his symphony Harold en Italie (Opus 16)53, composed in 1834, bears the heading Marche des p elerins (Pilgrims’ march) and clearly calls to mind the scene from chapter XL of the M emoires with the procession of peasants singing psalmodies, analyzed in detail with regard to its epileptological content above. From an epileptological perspective, it might thus be seen as an attempt by Berlioz to express in music the subjective experience of absences or an absence status he found so difficult to capture in words (see Berger, 2010). Last but not least, however, it is conspicuous how many connections there are between Berlioz’ probable epilepsy and his Symphonie fantastique en cinq parties (Opus 14), which was composed and first performed in 1830. The second part of the title, E´pisode de la vie d’un artiste (Episode from the life of an artist), already alludes to the fact that the work contains autobiographical elements. Berlioz himself had a program distributed to the audience (revised several times over the years) in which he emphasized that the work tells the romantically tinged love story of a young musician (identifiable as the composer’s unrequited love of the actress Harriet Smithson) and that an “id ee fixe” serves as a musical leitmotif, which reflects the image of the beloved as it appears to the lover’s mind in various situations. Besides the fact that the notes on the third movement (Sc ene aux champs) in the program54 Berlioz wrote personally are strongly reminiscent in both content and style of the description of probable absence seizures in chapter XL of the M emoires, also treated in Harold en Italie, the various versions of the program also contain several of the terms the composer used—as illustrated above—in attempting to grasp his own illness (e.g., “maladie morale,” “acc es,” “sans sujet,” “isolement,” “ eloign e,” “silence,” “opium,” “sommeil,” and “volcanique”). In this context, it does not seem absurd to reason that the “monde fantastique” (“fantastic world”) with which Berlioz summarized his presumed subjective experiences with epileptic seizures in the letter to his father quoted above (Berlioz, 1972a, letter no. 155 from February 19, 1830, p. 310), which was penned at the beginning of the composition process in early 1830, might have provided the name for the entire symphony. If we take this thought one step further, then the term “id ee” used immediately afterward in the same letter (see quotation above) might stand for “seizure” or “subjective correlate of a seizure.”

53

The work relates, autobiographically as it were, scenic memories of Berlioz’ time in Italy; see Berlioz, 2000, chapter XLV, p. 265 (I imagined writing a series of scenes for the orchestra, in which the viola would find itself mixed up, like a more or less active person who always preserves his own individuality; I wanted to make the alto, placing it in the middle of my poetic memories of my wanderings in the Abruzzi, into a sort of melancholic dreamer in the manner of Byron’s Childe Harold. Hence the title of the symphony: Harold in Italy.). 54 Version 1830 (Berlioz, 1830; cf. Berlioz, 1972a, letter no. 158 to Humbert Ferrand from April 16, 1830, pp. 318–320), version 1845 (Berlioz, 1972b, p. 3), and version 1855 (Berlioz, 1972b, p. 170).

ARTICLE IN PRESS 5 Encore: la symphonie fantastico-epileptique

Consistent with this assumption, Berlioz also combined the “id ee fixe” directly with a description of probable absence status and myoclonic seizures (with typical exacerbation in the morning) in a letter to Stephen de la Madelaine, also written in early 1830 (Berlioz, 1972a, letter no. 153 from February 1830, p. 307): [. . .] Je comptais aller vous voir aujourd’hui, mais l’ etat horrible d’exaltation que e ce je supporte avec tant de peine depuis quelques jours, ayant encore augment matin, je ne suis plus capable d’un entretien parl e un peu raisonnable. Une id ee fixe me tue, tous mes muscles tremblent comme ceux d’un mourant. [. . .] Mais ne faut-il pas que la lave d eborde. Vous savez bien certainement ce que je veux dire. [. . .] ([. . .] I had the intention of going to see you today, but the horrible state of exaltation I have endured with so much pain for several days having again become aggravated this morning, I am no longer capable of carrying on a reasonable conversation. An idee fixe is killing me, all of my muscles are trembling like those of a dying man. [. . .] But the lava must not overflow. I’m certain you know what I mean. [. . .])

Incidentally, the explanation concerning the Symphonie fantastique Berlioz provides in his M emoires (Berlioz, 2000, chapter XLV, S. 265) to the effect that the “id ee fixe” again and again intrudes episodically into various scenes, diverting one’s attention away from them ([. . .] le th eme de la Symphonie fantastique, “l’id ee fixe”, s’interpose obstin ement comme une id ee passionn ee episodique au milieu des sc enes qui lui sont etrang eres et leur fait diversion, [. . .]) corresponds to the everyday life experience of epilepsy patients, whose ongoing activities are interrupted repeatedly by seizures with impairment of consciousness (e.g., absences).55 From an epileptological perspective, it is also noteworthy that Berlioz made a significant change to the program in the 1855 version (Berlioz, 1972b, p. 170): The original jeune musicien, affect e de cette maladie morale qu’un ecrivain c el ebre appelle le vague des passions (young musician, affected by that moral malady that a celebrated writer calls the vagueness of passions) from the earlier versions (Berlioz, 1830; Berlioz, 1972b, p. 3) is now a jeune musicien d’une sensibilit e maladive (young musician with a pathological susceptibility).56 Remarkably, this introduction is now followed by the addition [. . .] ses sensations, ses sentiments, ses souvenirs se traduisent dans son cerveau malade en pens ees et en images musicales ([. . .] his This also correlates with remarks like [. . .] Malgr e tous mes efforts, la vie m’ echappe, je n’en retiens que des lambeaux. Avec mon a^ge, avec mon organisation, n’avoir que des sensations d echirantes; [. . .] ([. . .] Despite all of my efforts, life escapes me; I don’t retain anything but fragments. At my age, with my organization, to have but disrupting sensations; [. . .]) (Berlioz, 1972a, letter no. 94 to Humbert Ferrand from June 28, 1828, p. 201) and Berlioz’ calculated use of three periods (. . .) in accounts of his seizures, probably to express in language—in analogy to the “id ee fixe”—the seizure-associated lapses of consciousness. 56 Berlioz also used the expression “sensibilit e maladive” in a letter to his sister Nanci (Berlioz, 1972a, letter no. 79 to Nanci Berlioz from January 10, 1828, (recte: 1829), p. 171). 55

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sensations, his feelings, his memories are translated in his diseased brain into musical thoughts and images). Thus, a conscious diagnostic shift from an ill-defined mental disorder to an organic brain disease has taken place. Moreover, as one may infer from the greater context, this is a rather concrete indication that the work perhaps actually does intend to represent in musical form perceptions and experiences ultimately made during epileptic seizures.57 Could it therefore be that in his composition E´pisode de la vie d’un artiste Berlioz—applying a strategy similar to that revealed above for his autobiographical sketch from 1832—portrayed his life as an individual suffering from epilepsy while at the same time ingeniously throwing the auditorium off the scent of this narrative with a fantastic love story that in addition enabled him to publicly justify in an apparently plausible way his use of the unconventional stylistic techniques58 necessary for conveying epileptic phenomena in music? Does the Symphonie fantastique en cinq parties in the end illustrate five different seizure types or seizure-related situations (possibly merging into one another in an extended episode) Berlioz himself had experienced and succeeded in differentiating?59 This hypothesis receives additional support from an article published by Berlioz in the journal Le R enovateur in November 1834 (Berlioz, 1834), in the run-up to a planned series of concert performances, in which he explicitly warns the public— with ironic undertones but also with a deeper meaning—of his own work, ambiguously and seemingly casually pointing out that his “concert illness”60 has once again taken hold of him. He characterizes his music as a web of extravagancies and absurdities unequaled even at the lunatic asylum Charenton61 outside of Paris. It is in all

57 A remark to Humbert Ferrand (Berlioz, 1972a, letter no. 152 from February 6, 1830, p. 306) can ultimately also be understood in this way, if one comprehends “passion” as referring not to the affliction of a lover but to that of one suffering from epilepsy: J’ etais sur le point de commencer ma grande symphonie (E´pisode de la vie d’un artiste), ou` le d eveloppement de mon infernale passion doit e^tre peint; [. . .] (I was at the point of beginning my great symphony (Episode from the life of an artist), which will portray the development of my infernal passion; [. . .]). 58 The possible epilepsy-specific compositional details will be worked out in further musicological analyses. 59 Such an interpretation would—bearing in mind formulations used in connection with accounts of probable seizures like [. . .] la vie m’ echappe [. . .] ([. . .] life escapes me [. . .]) (Berlioz, 1972a, letter no. 94 to Humbert Ferrand from June 28, 1828, p. 201) or [. . .] pour retenir ma vie qui s’en va aux quatre points cardinaux ([. . .] to restrain my life, which is leaving in the four cardinal directions) (Berlioz, 2000, chapter XL, p. 224)—also make it seem consistent that Berlioz attached great importance to ensuring that the Symphonie fantastique and the subsequently composed melologue Le retour a la vie (Opus 14b, later called L elio) formed an obligatory unity. 60 Possibly also interpretable as the (epileptic) illness reflected in his musical works and hence also in his concerts. 61 Most likely a deliberate allusion: this institution was particularly specialized in treating epilepsy patients at the time. From 1825 to 1830, it was run by the well-known psychiatrist Jean E´tienne Dominique Esquirol, who also wrote extensively on epilepsy in chapter 6 (1815) of his landmark treatise Des maladies mentales (Esquirol, 1838) and coined the terms “grand mal” and “petit mal”.

ARTICLE IN PRESS References

likelihood no accident that Berlioz lifts the veil on his Symphonie fantastique on this one occasion and refers to it openly as the Symphonie fantastico- epileptique: Voil a ma maladie de concerts qui me reprend. [. . .] je vous dirai tout net que ma musique est un tissu d’extravagances et d’absurdit es comme on n’en fait pas m^ eme a Charenton. [. . .] ma conscience m’oblige de dire a toutes les personnes [. . .] qui n’ont pas entendu [. . .] les farces de la symphonie fantastico- epileptique, de consulter les malheureux auditeurs de mon concert de l’ann ee derni ere, et je doute qu’apr es les renseignements qu’ils leur donneront, il puisse rester dans leur esprit l’ombre du doute sur l’atrocit e de ces symphonies. (There is my malady of concerts that takes hold of me once again. [. . .] I will tell you straight out that my music is a web of extravagancies and absurdities unequaled even at Charenton. [. . .] my conscience obliges me to tell all the people [. . .] who haven’t heard [. . .] the farces of the symphonie fantastico-epileptique, to consult the unfortunate auditors who attended my concert last year, and I doubt that, after hearing the information that they will give to them, there could remain in their minds the shadow of a doubt concerning the atrociousness of these symphonies.)

6 CONCLUSION The epileptologically informed in-depth analysis of auto- and heteroanamnestic historical sources supports the hypothesis that Hector Berlioz might have suffered from a photosensitive idiopathic generalized epilepsy syndrome with absences, absence status, myoclonic seizures, and bilateral tonic–clonic seizures. There is some evidence for a possible influence of the composer’s probable epilepsy on his literary and musical oeuvre, including the Symphonie fantastique en cinq parties.

ACKNOWLEDGMENT My sincere thanks go to Prof. Dr. Christian Berger, Director of the Institute of Musicology of the University of Freiburg, for the inspiring interdisciplinary discussions I have had with him and for his active musicological support.

REFERENCES Anonymous, 1847. Depart de Berlioz pour la Russie. Le Charivari, Paris, In: Jullien, A., 1888. Hector Berlioz: sa vie et ses uvres. Librairie de l’art, Paris, p. 200. Berger, C., 2010. Harold in Rom. Eine Analyse von Berlioz’ Marche des p elerins. Internationale Tagung der Gesellschaft f€ur Musikforschung, Roma. Berger, C., Altenm€uller, D.-M., 2003. War Hector Berlioz epilepsiekrank? Ein Zwischenbericht. In: D€ohring, S., Jacobshagen, A., Braam, G. (Eds.), Berlioz, Wagner und die Deutschen. Dohr, K€oln, pp. 53–58.

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Berlioz, H., 1830. Programme autographe de la Symphonie Fantastique. Bibliotheque nationale de France, departement Musique, LA-BERLIOZ HECTOR PAPIERS-37. Berlioz, H., 1832. Biographie autographe. Bibliotheque nationale de France, departement Musique, LA-BERLIOZ HECTOR PAPIERS-38 (P.-R. Serna, Ed.). 2005. http://www. hberlioz.com/Works/autobiographie.htm. Berlioz, H., 1834. Avis aux lecteurs assez desuvres pour lire mes feuilletons. Le Renovateur, 2–3 novembre, Paris. In: Berlioz, H., 1996, La critique musicale, vol. 1 (H.R. Cohen, Y. Gerard, Eds.). Buchet/Chastel, Paris, pp. 438–440. ` travers chants (L. Guichard, Ed.). Gr€ Berlioz, H., 1971. A und, Paris. Berlioz, H., 1972a. Correspondance generale I: 1803–May 1832 [nos. 1–273] (P. Citron, Ed.). Flammarion, Paris. Berlioz, H., 1972b. Symphonie fantastique (N. Temperley Ed.; New Berlioz Edition 16). Ba¨renreiter, Kassel. Berlioz, H., 1975. Correspondance generale II: June 1832–September 1842 [nos. 274–775] (F. Robert, Ed.). Flammarion, Paris. Berlioz, H., 1995. Le suicide par enthousiasme et autres nouvelles (A. Galliari, Ed.). L’Arche, Paris. Berlioz, H., 2000. Memoires (P. Citron, Ed.). Editions Flammarion, Paris. Berlioz, H., 2001. Correspondance generale VII: 1864–1869 [nos. 2817–3380] (H.J. Macdonald, Ed.). Flammarion, Paris. Blaze, H., 1838. De l’Ećole fantastique et de M. Berlioz. Revue des Deux Mondes XVI, 97–121. Cairns, D., 1999a. Berlioz. Vol. 1: The Making of an Artist 1803–1832. Allen Lane the Penguin Press, London. Cairns, D., 1999b. Berlioz. Vol. 2: Servitude and Greatness 1832–1869. Allen Lane the Penguin Press, London. Calmeil, L.-F., 1824. De l’epilepsie, etudiee sous le rapport de son siege et de son influence sur la production de l’alienation mentale. These, Imprimerie Didot le Jeune, Paris. Esquirol, E´., 1838. Des maladies mentales considerees sous les rapports medical, hygienique et medico-legal, vol. 1. Bailliere, Paris. Faber, D.P., 1997. Jean-Martin Charcot and the epilepsy/hysteria relationship. J. Hist. Neurosci. 6 (3), 275–290. Herpin, Th., 1867. Des acces incomplets d’epilepsie. Bailliere, Paris. Hughes, J.R., 2005. Did all those famous people really have epilepsy? Epilepsy Behav. 6, 115–139. Janz, D., Christian, W., 1957. Impulsiv-Petit mal. Dtsch. Z. Nervenheilkd. (J. Neurol.) 176, 346–386, translated into English by Genton, P., 1994. Impulsive petit mal. In: Malafosse, A., Genton, P., Hirsch, E., Marescaux, C., Broglin, D., Bernasconi, R. (Eds.), Idiopathic Generalized Epilepsies: Clinical, Experimental and Genetic Aspects. John Libbey & Company Ltd., London, pp. 229–251. Janz, D., Durner, M., 1997. Juvenile myoclonic epilepsy. In: Engel, J., Pedley, T.A. (Eds.), Epilepsy: A Comprehensive Textbook. Lippincott-Raven Publishers, Philadelphia, PA, pp. 2389–2400. Karenberg, A., 2014. Frederic Chopin and his neuropsychiatric problems. In: Altenm€ uller, E., Finger, S., Boller, F. (Eds.), Music, Neurology, and Neuroscience: Historical Connections and Perspectives (Prog. Brain Res. 216). Elsevier, Amsterdam, pp. xxx–yyy. Legouve, E., 1886. Soixante ans de souvenirs. Hetzel, Paris. Ollivier, D. (Ed.), 1933. Correspondance de Liszt et de Madame d’Agoult 1833–1840. Grasset, Paris.

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