Epilepsia, 47(3):652–654, 2006

Blackwell Publishing, Inc.


C 2006 International League Against Epilepsy

Socrates and Temporal Lobe Epilepsy: A Pathographic Diagnosis

2,400 Years Later

∗ †Osamu Muramoto and †Walter G. Englert

∗ Department of Neurology, Kaiser Permanente Northwest Division and Northwest Permanente Medical Group; and †Department of
Classics, Reed College, Portland, Oregon, U.S.A.

Summary: Purpose: Some enigmatic remarks and behaviors was a child, and it visited Socrates unpredictably. Moreover, we
of Socrates have been a subject of debate among scholars. We found at least two descriptions of Socrates’ unique behavior that
investigated the possibility of underlying epilepsy in Socrates by are consistent with complex partial seizures (CPSs). The fact
analyzing pathographic evidence in ancient literature from the that Socrates had been experiencing both SPSs and CPSs peri-
viewpoint of the current understanding of seizure semiology. odically since childhood makes the diagnosis of temporal lobe
Methods: We performed a case study from a literature survey. epilepsy (TLE) likely.
Results: In 399 BCE, Socrates was tried and executed in Conclusions: We hypothesize that Socrates had a mild case
Athens on the charge of “impiety.” His charges included the of TLE without secondary generalization. This is the first re-
“introduction of new deities” and “not believing in the gods of port in 2,400 years to present a pathographic diagnosis of TLE
the state,” because he publicly claimed that he was periodically in Socrates based on specific diagnostic features in the ancient
and personally receiving a “divine sign,” or daimonion, that di- textual evidence. Our study demonstrates that the knowledge of
rected him in various actions. We found textual evidence that modern epileptology could help understand certain behaviors of
his daimonion was probably a simple partial seizure (SPS) of historic figures. Key Words: Temporal lobe epilepsy—Partial
temporal lobe origin. It was a brief voice that usually prohib- seizure—Socrates—Philosophy—Religion.
ited Socrates from initiating certain actions. It started when he

Socrates has been listed occasionally as one of many lowing quotes from Plato represent Stephanus numbers,
“famous epileptics”(1,2), but no evidence has been pre- which are commonly used among classical scholars.
sented from the ancient sources to substantiate the claim.
We analyzed pathographic evidence in ancient literature in Case history
light of the current understanding of seizure semiology. Since childhood, Socrates experienced recurrent visits
of voices that he variously called “divine sign,” “spiritual
sign,” “my prophetic power,” or, in Greek, the “daimo-
METHODS nion.” He describes this experience:
Socrates left no written documents. Some of his
This began when I was a child. It is a voice, and whenever
younger contemporaries, including Plato and Xenophon, it speaks it turns me away from something I am about to do
are the main sources of information about the his- . . .(Apology 31d)
toric Socrates. We surveyed the dialogues of Plato and
Xenophon’s four socratic writings for descriptions of Whereas the “daimonion” addressed Socrates unex-
Socrates’ behaviors and remarks that may suggest his pectedly about trivial matters, it did not give him advice
unique neurologic and psychiatric condition. We analyzed when he was facing serious decisions and might have ex-
those descriptions in English translations (3) and in the pected some assistance. Socrates gives his reasons, based
original Greek texts, paying close attention to meaning on the failure of his divine sign to appear, for now con-
and usage. The numbers and letters attached to the fol- cluding that death is not an evil:
At all previous times, my familiar prophetic power, my spir-
itual manifestation, frequently opposed me, even in small
Accepted October 15, 2005. matters, when I was about to do something wrong, but now
Address correspondence and reprint requests to Dr. O. Muramoto
at Department of Neurology, Kaiser Permanente, Interstate Office
that, as you can see for yourselves, I was faced with what one
East, 3550 N. Interstate Avenue, Portland, OR 97227, U.S.A. E-mail: might think, and what is generally thought to be, the worst of
[email protected] evils, my divine sign has not opposed me, either when I left

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SOCRATES AND TEMPORAL LOBE EPILEPSY 653

home at dawn, or when I came into court, or at any time that SOCRATES: Well, now, what shall we say about love? Does
I was about to say something during my speech. Yet in other it belong to the class where people differ or to that where they
talks it often held me back in the middle of my speaking, but don’t? PHAEDRUS: Oh, surely the class where they differ.
now it has opposed no word or deed of mine. (Apology 40a-b) Otherwise, do you think you could have spoken of it as you
did a few minutes ago, first saying that it is harmful both to
Elsewhere, he describes an example of a trivial appear- lover and beloved and then immediately afterward that it is
ance of the voice and how it affected his actions. the greatest good? SOCRATES: Very well put. But now tell
me this – I can’t remember at all because I was completely
I was sitting by myself in the undressing room just where you possessed by the gods. Did I define love at the beginning of
saw me and was already thinking of leaving. But when I got my speech? PHAEDRUS: Oh, absolutely, by Zeus, you most
up, my customary divine sign put in an appearance. So I sat certainly did. (Phaedrus 263c-d)
down again, and in a moment the two of them, Euthydemus
and Dionysodorus, came in . . . (Euthydemus 272e-273a)
Although those episodic voices are mostly subjective
In the Phaedrus, after Socrates delivers his first speech experiences, objective descriptions of unusual behaviors
on love, he promises Phaedrus that he will not give any are also reported by his friends. In the beginning of Plato’s
more speeches on the topic. Socrates is about to cross Symposium, Socrates is walking to Agathon’s house for a
the river near where they are speaking and take his leave, dinner party (symposium). On his way, Socrates meets
when, all of a sudden, he receives the daimonion. one of his close friends, Aristodemus, and urges him to
join the party even though he was not invited. As they
My friend, just as I was about to cross the river, the familiar walk to Agathon’s house, Socrates lags behind, as if lost
divine sign came to me which, whenever it occurs, holds me in thought. When Aristodemus arrives at Agathon’s home,
back from something I am about to do. I thought I heard Agathon greets him at the door and asks where Socrates
a voice coming from this very spot, forbidding me to leave is. Aristodemus looks around, and Socrates has vanished.
until I made atonement for some offense against the gods.
Agathon sends a slave to search for Socrates, who returns
(Phaedrus 242b-c)
and gives the following report:
Socrates then renounces the first speech entirely as “Socrates is here, but he’s gone off to the neighbor’s porch.
an “offense” and “false story.” This leads to the second He’s standing there and won’t come in even though I called
speech, which is the antithesis of the first speech. However, him several times.” “How strange,” Agathon replied.” “Go
Socrates seems to become confused and amnesic about back and bring him in. Don’t leave him there.” But Aristode-
this sudden conversion. After the two speeches, Socrates mus stopped him. “No, no,” he said. “Leave him alone. It’s
instructs Phaedrus about rhetoric, discussing two classes one of his habits: every now and then he just goes off like
of words, more concrete words such as “iron” or “sil- that and stands motionless, where he happens to be. I’m sure
he’ll come in very soon, so don’t disturb him; let him be.”
ver,” whose meanings people agree about, and more ab-
(Symposium 175a-b)
stract words such as “just” or “good,” about which people
differ. Agathon then ordered the slaves to start the dinner.

TABLE 1. Semiology of Socrates’ temporal lobe epilepsy

Seizures Textual Source Semiolgical Description

Simple partial seizure ∗ Childhood onset, repetitive and recurrent Apology 31d, Theages 128d
∗ Voice commanding to stop Socrates’ action Apology 31d, Theages 128d
∗ Voice indicating Socrates’ duty Apology (Xenophon) 12
∗ Irrelevant to the importance of context Apology 31d, 40a-c
∗ Unexpected and abrupt occurrence Phaedrus 242b-c, Euthydemus 272e-273a
∗ Brief duration Euthydemus 272e-273a
∗ Felt unique to Socrates or rare to others Republic 6 496c
∗ Provocation by initiating action and speech Phaedrus 242b-c, Euthydemus 272e-273a
Complex partial seizure ∗ Habitual and sporadic occurrence Symposium 174e-175c
∗ Socrates goes off and stands motionless
∗ Unresponsiveness
∗ Predictable and spontaneous recovery
Amnesic confusion ∗ No memory of speech Socrates just delivered Phaedrus 263c-d
∗ He felt “completely possessed by the gods”
∗ Occurrence close to an episode of SPS
Complex partial status ∗ Standing outside all day, no eating or sleeping Symposium 220c-e
∗ Appeared to try to solve a problem
∗ Disconnected and unresponsive to environment
∗ Onlookers were mystified

Epilepsia, Vol. 47, No. 3, 2006

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654 O. MURAMOTO AND W. G. ENGLERT

So, they went ahead and started eating, but there was still no The table summarizes our findings and interpretation.
sign of Socrates. Agathon wanted to send for him many times, We could not find any indication that Socrates had a
but Aristodemus wouldn’t let him. And, in fact, Socrates came secondarily generalized seizure, nor could we find evi-
in shortly afterward, as he always did – they were hardly dence of chronic progressive cognitive decline. We there-
halfway through their meal. (Symposium 175c) fore suspect that Socrates’ TLE was mild, stable, and rel-
One more description of a similar prolonged unrespon- atively benign.
siveness is found in the Symposium. Alcibiades, one of In the 2,400 years since Socrates’ death, few com-
Socrates’ friends and admirers, talks about his experience ments have been made on epilepsy and Socrates. Ac-
with Socrates when they were on military campaign to- cording to Temkin’s history of epilepsy (1), the 17th
gether years before. century French physician Jean Taxil quoted Aristotle as
mentioning Socrates as an epileptic among many oth-
One day, at dawn, he[Socrates] started thinking about some ers, including Empedocles and Plato (4). Taxil’s thesis
problem or other; he just stood outside, trying to figure it out. was that all “demoniacs” were epileptic, and he used the
He couldn’t resolve it, but he wouldn’t give up. He simply word “epileptic” very loosely. Taxil apparently misinter-
stood there, glued to the same spot. By midday, many sol-
preted a passage from the Aristotelian Problems (5), which
diers had seen him, and, quite mystified, they told everyone
that Socrates had been standing there all day, thinking about
listed those philosophers as “melancholic.” Temkin con-
something. He was still there when evening came, and after cluded, “ . . . there is no reason to assume that Empedocles,
dinner some Ionians moved their bedding outside, where it Socrates, and Plato suffered from epilepsy.” Our study of-
was cooler and more comfortable[. . .], but mainly in order fers evidence for reconsidering this conclusion regarding
to watch if Socrates was going to stay out there all night. Socrates. In modern epilepsy literature, Lennox (2) quoted
And so he did; he stood on the very same spot until dawn! Symposium 174d-175c in his textbook of epilepsy, com-
(Symposium 220c-d) menting, “Was this temporal epilepsy or was Socrates only
‘lost in thought’?” Lennox, however, stopped short of in-
DISCUSSION
vestigating this possibility and did not analyze all of the
Since childhood and throughout his adult life, Socrates textual evidence.
experienced brief, recurrent, and stereotyped voices that The main reason that Socrates’ TLE has never been rec-
were often triggered by certain actions such as speak- ognized is that the notion of epilepsy has been associated
ing, standing up, and walking. Voices came irrespective almost exclusively with the “falling sickness,” or gener-
of Socrates’ expectation and the importance of the matter alized convulsive epilepsy. Hippocrates, a contemporary
at hand. In Phaedrus, the visit of the voice was followed of Socrates, wrote a treatise on epilepsy titled The Sacred
by a confused and amnestic period in which Socrates was Disease (6), but he never considered the existence of a
unable to recall the speech he just delivered. We hypoth- nonconvulsive form. TLE was recognized only toward the
esize that the voice is probably a simple partial seizure end of 19th century. Patients with mild cases of TLE, in-
(SPS) of temporal lobe origin, possibly in the left lateral cluding Socrates, who only have sporadic SPSs and CPSs,
temporal lobe. The accompanying amnestic period might and who seldom or never have a secondarily generalized
be a brief complex partial seizure (CPS) after an SPS. seizure, were recognized only after EEG became available
We could not find Socrates describing any specific words as a routine diagnostic tool in the late 20th century. Our
spoken by the voice. This suggests that the content of his study demonstrates that the knowledge of modern epilep-
SPS was rather vague. We speculate that the main reason tology can help achieve a deeper understanding of history
Socrates may have interpreted the voice as directing him and the humanities.
to change his course of action was that the episode was
often associated with the initiation of certain actions, or
possibly precipitated by exercise, movement, or speaking, REFERENCES
rather than that the voice itself had any specific content.
1. Temkin O. The Falling Sickness; A History of Epilepsy from the
He also had episodes of prolonged unresponsiveness Greeks to the Beginnings of Modern Neurology. 2nd ed. Baltimore:
such as the one he experienced after he walked briskly to Johns Hopkins University Press, 1971.
the party in the Symposium. His friend testified that this 2. Lennox WG. Epilepsy and Related Disorders. Boston: Little, Brown,
1960.
was just “one of his habits,” indicating this was also a re- 3. Cooper JM, ed. Plato: Complete Works. Indianapolis: Hackett Pub-
current symptom. The Symposium also states that a similar lishing, 1997.
episode happened years before in the military camp. We 4. Taxil J. Treatise on Epilepsy, a Malady Commonly Called, in the
Provence Region, Infantile Gout. [in French]. Lyon: Robert Renaud,
hypothesize that these episodes were probably CPSs, and 1602.
the prolonged episode could have been a complex partial 5. Aristotle. Book XXX Problems connected with thought, intelligence
status. and wisdom. In: Aristotle: Problems. Cambridge: Harvard University
Press, 1970.
The presence of both SPSs and CPSs in Socrates sug- 6. Hippocrates. The Sacred Disease. Cambridge: Harvard University
gests he probably had temporal lobe epilepsy (TLE). Press, 1923.

Epilepsia, Vol. 47, No. 3, 2006