In 1953, in an article intended for the general practitioner, Denis Hill made a brief reference to the chronic paranoid psychoses which may develop in association with temporal lobe epilepsy. He described the condition as likely to come on when the seizures were diminishing in frequency, as appearing gradually with onset in middle age, and as resembling a paranoid schizophrenic state. In 1957, D. A. Pond, from the same department of applied electro-physiology at the Maudsley Hospital, gave a more detailed account of the clinical features. He described the psychotic states as closely resembling schizophrenia, with paranoid ideas which might become systematized, ideas of influence, auditory hallucinations often of a menacing quality; and occasional frank thought disorder with neologisms, condensed words and inconsequential sentences. There were, however, also some points of difference, of a quantitative rather than qualitative kind: a religious colouring of the paranoid ideas was common; the affect tended to remain warm and appropriate; and there was no typical deterioration to the hebephrenic state. All the patients had epilepsy arising from the temporal lobe region with complex auras; occasional major seizures occurred in sleep only. EEG foci, always present, were sometimes only to be demonstrated in sleep-sphenoidal records. The epilepsy began some years before the psychotic symptoms, usually in the late teens or the twenties; and the latter often seemed to begin as the epileptic attacks were diminishing in frequency, either spontaneously or with drug treatment.

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The ‘religiosity’ of the epileptic has been recognized since the time of Esquirol (1838) and Morel (1860). These, and later French workers (including Marchand and Ajuriaguerra, 1948), have sought to explain the epileptic's religiosity as being the result of his disability, social isolation and his enhanced need for the consolation of religion. A specific conversion experience after a fit was reported by Howden (1872–73). The patient believed that he was in Heaven. He would appear to have been depersonalized, as it took three days for his body to be reunited with his soul. ‘He maintained that God had sent it to him as a means of conversion, that he was now a new man, and had never before known what true peace was…. He assured me that he was a converted man and that he was convinced he would have no more fits.’ Howden also reported on John Engellerecht who, after many years of depression, attempted suicide and appeared to die. After visiting Hell and Heaven, he cast off his depression, and acquired a state of religious ecstasy accompanied by visual and auditory hallucinations. Boven (1919) mentions a 14-year-old boy who after a seizure ‘saw the good God and the angels, and heard a celestial fanfare of music’. He regards the religiosity of the epileptic character as being due to experiences acquired in the course of an epileptic aura and in the subsequent confusional state. Eventually the patient becomes preoccupied with a cure which he believes depends entirely on God, and this belief is the basis of his euphoria. Boven stresses the intensified piety of the epileptic after a severe seizure.

MEDIBALITJURNAL 11The occurrence of a mass hysterical reaction shows not that the population is psychologically abnormal but merely that it is socially segregated and consists predominantly of young females.Our reassessment has been possible only because of the generous help we have received from the medical, administrative, and nursing staff of the Royal Free Group of Hospitals. We would like to place on record our appreciation of this co-operation, which has been truly unstinting. Our views are, of course, entirely our own.