Epilepsia, 17 :4 23-427, 1976. Raven Press, New York

A Differential Diagnosis of the Inspirational Spells of

Muhammad the Prophet of Islam Frank R. Freemon

Neurology Service, Veterans Administration Hospital, Nashville, Tennessee 3 7203, and Department of

Neurology, Vanderbilt University Hospital, Nashville, Tennessee 37232

(Received July 26, 1976)

INTRODUCTION

It is commonly asserted that certain figures of history suffered recurrent epileptic seizures and that these experiences provided emotional or inspirational value for their careers. This paper reviews the strange spells of Muhammad, the Prophet of Islam. The author concludes that if one were forced to make a medical diagnosis, psychomotor seizures of temporal lobe epilepsy would be the most tenable explanation, although historical knowledge of Muhammad’s life and scientific knowledge of brain function during altered states of con- sciousness do not permit unequivocal diagnosis. Despite this lack of diagnostic certainty, a review of Western civilization’s comments on the life of the Prophet reveals how society has viewed epilepsy through history and how misconceptions continue concerning this unique condition.

THE VISIONS OF MUHAMMAD In the year 610 A.D., Muhammad was a

moderately successful, although somewhat

Key words: Muhammad - Inspirational spells - Temporal lobe epilepsy - Complex partial seizures

dissatisfied, merchant in the city of Mecca in the Arabian peninsula. It was in this year, the 40th of his life, that Muhammad began to experience visions. A figure moved toward him to a distance of perhaps a few feet and told him to preach the word of God to the populace. Sometimes the ’vision was preceded by the sound of ringing bells; other times he only heard the voice. For about 3 years he brooded over these visions, confessing them only to his wife and immediate friends. He finally became convinced that the figure was the Angel Gabriel and the visions were communications from the one God, the God of the Christians and the Jews. Muhammad felt himself to be a prophet in the tradition of Christ and Moses, with a mission to cleanse his people and guide them to a higher life.

His early ministry in Mecca was unsuccess- ful; his wife and his close friends, but few others, accepted his visions as heavenly messages. Muhammad and his followers were forced to flee Mecca for the nearby rival city of Medina. Partly for economic reasons, the people of Medina accepted the new faith, which Muhammad called Islam after the Arabic word for submission, i.e., submission to the will of God. Medina and Mecca entered into a period of economic and, later, military strife. After

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many years of struggle, Mecca also converted to Islam. In the last few years of Muhammad’s life and in the generation after his death, the faith of Islam spread throughout the Near East and North Africa, one of the most explosive forces in history.

Muhammad described each of his visions in poetic language, presumably in the words of the Angel, and his followers carefully recorded the message. After his death the visions were gathered together into the Islamic Holy Book, the Koran. Several of Muhammad’s followers left their memoirs in the form of oral stories and these too were recorded in the following century. Because of this scholarship we know much more about Muhammad than about the founders of other religions. In particular, we have details of Muhammad’s subjective experi- ence during his spells, as given in the Koran, as well as the descriptions of different observers. One of the best descriptions is that recorded by Ibn Sa’d.

At the moment of inspiration, anxiety pressed upon the Prophet and his countenance was troubled. He fell to the ground like an inebriate or one overcome by sleep. On the coldest day his forehead would be bedewed with large drops of perspiration.. . To outward appearance inspiration descended unexpectedly, without any previous warning to the Prophet. When questioned on the subject he replied: “Inspiration cometh in one of two ways; sometimes Gabriel communi- cateth the Revelation to me, as one man to another and this is easy; at other times it is like the ringing of a bell, penetrating my very heart, and rending me.”

Muhammad’s later visions, embodied in the Koran, came from many sources. Some were overall policy statements by the civic leader of the expanding Islamic state, wrapped in the authority of the word of God. A few occurred under the condition of sleep, the most famous being his teleportation to the holy city of Jerusalem and his leap to Heaven. But the early visions gave him inspiration, drew followers to his message, and became the foundation of the Islamic religion. Could these visions have occurred during any medically identifiable state?

DIFFERENTIAL DIAGNOSIS

In approaching a differential diagnosis we must remember that Muhammad’s inspired followers lived closely with him in his early and unsuccessful ministry; these same individuals demonstrated brilliant leadership of the explo- sively expanding Islamic state after his death. Schizophrenic hallucinations include voices, sometimes with a personal message, but it is unlikely that the dull effect of the schizo- phrenic would have inspired the tenacious loyalty of the early followers. It is also unlikely that a person with loose associations and other elements of schizophrenic thought disorder could guide the political and military fortunes of the early Islamic state. Muhammad’s enemies, both contemporary Arab and later Christian ones, assumed that he completely fabricated his visions, duping his followers by cloaking his own ideas in the authority of the Angel Gabriel. It seems unlikely that followers intelligent enough to.-guide the expansion of Islam over thousands of miles and convert millions of people could be inspired by a clever manipulator. If Muhammad did not believe in the reality of his own visions, he could not have convinced these astute observers. The rapid, almost paroxysmal onset of these spells rules out drug-induced mental changes such as might occur after eating plants containing hallucino- genic materials. Too many of these spells occurred over too long a period of time to suggest transient ischemic attacks, and no neurologic deficits outside the mental sphere were observed. Long duration, absence of worsening, and paroxysmal onset make hypo- glycemia unlikely. Absence of vertigo rules out labyrinthitis, MeniBre’s disease, or other inner ear maladies.

After having disposed of other medical possibilities, we now consider the diagnosis of psychomotor seizures of temporal lobe epilep- sy, or, as these spells have been renamed, complex partial seizures. The most usual age of onset for idiopathic temporal lobe epilepsy today is the twenties or late teens, but the age of 40 is not untenable. The paroxysmal onset without warning suggests epileptic discharge, and, of course, falling to the ground is so characteristic that the ancient name for epilepsy is the falling sickness. Autonomic

INSPIRATIONAL SPELLS OF MUHAMMAD 425

dysfunction such as perspiration occurs in a large percentage of psychomotor seizures. Few seizures are associated with clearly defined hallucinatory repetitious imagery, but one must realize that Muhammad had to interpret the experience of the approaching figure within his own cultural milieu. Whereas only a small minority of psychomotor seizures produce feelings of mystical ecstasy, probably the number is greater than we think since many patients do not discuss religious matters with a person they perceive to be a representative of the scientific establishment.

On the other hand Arab physicians were familiar with the manifestations of epilepsy, but none of Muhammad’s contemporary opponents mentioned this possible diagnosis. The most telling evidence against epilepsy is the Koran itself, assembled from Muhammad’s poetic statements after each spell. Temkin (1971) points out:

It is hard to imagine that the Koran, a body of religious, legal, and social instruction should largely be the product of a succession of hallucinatory epileptic attacks.

Table 1 summarizes the diagnostic pros and cons.

TABLE 1. Muhammad’s spells as psychomotor seizures

Favoring the diagnosis Paroxysmal onset Failing to the ground with loss of conscious-

Autonomic dysfunction Hallucinatory imagery

Opposing the diagnosis Late age of onset Lack of recognition as seizures by his

Poetic, organized statements in immediate

ness

contemporaries

postictal period

Moslems consider that Muhammed’s mental state during the transmission of God’s message was unique to the holy situation and is not amenable to medical diagnosis or scientific

search for Muhammad’s experiences in terms of brain physiology, and psychomotor seizures seem the most possible medical explanation, admittedly unproven and forever unprovable. He does not wish to “explain away” Muham- mad’s moral message and points out that God is just as likely, perhaps more likely, to communicate with a person in an abnormal mental state as in a normal one. In the words of William James (1902):

Just as our primary wide-awake con- sciousness throws open our senses to the touch of things material, so it is logically conceivable that if there be higher spiritual agencies that can directly touch us, the psychological condition of their doing so might be our possession of a subconscious region which alone should yield access to them. The hubbub of the waking life might close a door which in the dreamy subliminal might remain ajar or open.

VERDICT OF HISTORY

Regardless of the real origin of Muhammad’s visions, the changing opinions of Western civilization toward those spells are worthy of review because they reveal attitudes about epilepsy as much as about Muhammad. One must remember that the relationship between Christianity and Islam for most of history was chronic, constant enmity with episodes of bloody confrontation. Christian leaders at- tempted to belittle Islamic culture and prove the shallowness of its religion. The epileptic of the Middle Ages was considered an incurable wretch, suffering unpredictable falling spells with incontinence, an unclean person who might be possessed by the Devil. “A plague upon your epileptic visage!” says Kent to the despised Oswald in Shakespeare’s King Lear. Temkin (1971) attributes to the 8th century Byzantine historian Theophanes the first suggestion that Muhammad experienced epilep- tic seizures. Theophanes wrote that Muham- mad’s wife “was very much grieved that she, being of noble descent, was tied to such a man, who was not only poor but epileptic as well.”

discourse. The author feels that one must The use of epilepsy as a demeaning, almost an

426 F.R. FREEMON

accusatory, attribute of the Prophet continued throughout the 1,000-year military and social clash between Islam and Christianity. For example, the Archdeacon Humphrey Prideux of London wrote a propaganda tract in 1697 with i t s main message in the title, The Nature of Imposture Fully Displayed in the Life of Mahornet. He gave this description of Muham- mad’s visions:

He pretended to receive all his Revela- tions from the Angel Gabriel, and that he was sent from God of purpose to deliver them unto him. And whereas he was subject to the Falling-sickness, whenever the Fit was upon him, he pretended it to be a Trance, and that the Angel Gabriel was come from God with some Revela- tions unto him.

This minister accepts the diagnosis of the falling sickness, or epilepsy, but thinks that Muham- mad has conscious control over the course of the spells and can pretend to be in a religious trance. He sees epilepsy as related to malinger- ing.

In the 19th century, Islam was no longer a political or military threat to Western society. Views of epilepsy also changed. This disorder was now definitely within medical purview, denuded of its theological and moral associa- tions. Ecstatic auras were related by some patients and friendly Western interpreters of Muhammad’s life who often accepted the thesis of epilepsy, attributing to the epileptic attacks an inspirational quality. The most famous epileptic of the 19th century was Dostoevski and he frequently compared his own attacks to those of Muhammad (Alajouanie, 1963). In The Idiot, the aura to a seizure is described as “a supreme exaltation of emotional subjectivity” in which time stands still. “Probably it was of such an instant,” Dostoevski goes on, “that the epileptic Mahomet was speaking when he said that he had visited all the dwelling places of Allah within a shorter time than it took for his pitcher full of water to empty itself.”

Modern biographies of Muhammad reject the diagnosis of epilepsy but the reasons given for this rejection reveal continuing misconceptions about epilepsy. Bodley (1954) argues that Muhammad could not have been subject to

seizures because he was a robust man who went on many grueling marches, whereas it is known that epileptics are “sensitive and weak.” In reality, epilepsy afflicts persons of all constitu- tions. Another common misconception predicts that epileptics undergo brain deterioration and end life in an institution. Another modem religious academic, W. Montgomery Watt (1961), argues against Muhammad’s epilepsy by asserting that:

Epilepsy leads to physical and mental deterioration and there are no signs of that in Muhammad; on the contrary he was clearly in full possession of his faculties to the very end of his life.

SUMMARY

This paper reviews the spells of Muhammad, the Prophet of Islam. During these spells, Muhammad sensed the approach of a figure whom he thought to be the Angel Gabriel. The inspirational message transmitted to Muham- mad during these spells helped form the religion of Islam. This is a review of the historical details of these spells and an attempt to reach a medical diagnosis. Although an unequivocal decision is not possible from existing knowl- edge, psychomotor or complex partial seizures of temporal lobe epilepsy would be the most tenable diagnosis. An examination of Western civilization’s views of Muhammad’s spells reveals historical and modern misconceptions about epilepsy.

REFERENCES

Alaiouanine T. Dostoevski’s epilepsy. Brain . .~

86:209-218,1963. Bodlev RVC. The Messenger: Life o f Moham-

mah (second edition).- Orientalia; Lahore, 1954,302 pp.

James W. The Varieties of Religious Experi- ence. Longmans, Green; and-Co., p 237, New York and London, 1902.

Temkin 0. The Falling Sickness (second edition). Johns Hopkins University Press, Baltimore, 1971.

Watt WM. Muhammad: Prophet and Statesman. Oxford University Press, London, 1961, 250 PP.

INSPIRATIONAL SPELLS OF MUHAMMAD 427

RESUME

Ce papier prend en consideration les accPs d e Mahomet, le ProphPte d e L’Islam. Pendant ces accGs, Mahomet sentait I’approche d’une personne qu’il pensait &tre I’Ange Gabriel. Le message inspire B Mahomet pendant ces accPs a contribue B la formation d e la Religion d e I’Islam. Le papier essaye d e considdrer les circonstances historiques d e ces accPs et d’arriver B un diagnostic medical. Cependant, les connaissances actuelles ne permettent pas d’arriver B un diagnostic certain; le diagnostic plus probable est qu’il s’agissait d e crises psychomotrices ou crises partielles complexes d’origine temporale. Une revue des points de vue de la Civilisation Occidentale sur les accPs de Mahomet met en evidence des conceptions historiques e t modernes erronees sur l’kpilepsie.

(C. A. Tassinari, Marseilles)

RESUMEN

Esta comunicaci6n estudia 10s ataques de Mahoma, el profeta del Islam. Durante dichos ataques Mahoma notaba la vecindad d e una figura que identificaba como el Angel Gabriel. El mensaje y la inspiraci6n transmitidos a Mahoma durante estos ataques contribuy6 a formar la religi6n isl6mica. Este estudio intenta revisar 10s detalles hist6ricos de dichos ataques y alcanzar un diagn6stico medico. A pesar d e que no es posible llegar a una decisi6n inequivoca, la posibilidad de considerar estos

acontecimientos como ataques psicomotores o ataques epilgpticos parciales del 16bulo tem- poral, con contenido complejo, podria ser el diagn6stico mhs aceptable. La revisi6n d e 10s conceptos que la Civilizacibn Occidental tiene d e 10s ataques d e Mahoma muestra 10s errores conceptuales hist6ricos y modernos, que han existido y existen, acerca d e la epilepsia.

(A. Portera, Madrid)

ZUSAMMENFASSUNG

Die Arbeit gibt eine Ubersicht uber die Erleuchtungen von Mohammed, dem Propheten des Islam. Wahrend dieser Erleuchtungen glaubte Mohammed, dab eine Figur sich ihm naherte, die er fur den Engel Gabriel hielt. Die Botschaft, die Mohammed wahrend dieser Erleuchtungen empfing, half, den Islam zu bilden. Die Arbeit versucht, die historischen Einzelheiten dieser Erleuchtungen zu bespre- chen. Eine unzweideutige Entscheidung ist auf Grund der bestehenden Kenntnisse nicht moglich; immerhin wurden psychomotorische oder komplexe Partialanfalle im Rahmen einer Temporallappen-Epilepsie die am.. ehesten halt- bare Diagnose darstellen. Die Ubersicht der Anschauungen der westlichen Zivilisation uben Mohamm’ed’s Eingebungen enthiillt historische und moderne Fehlkonzeptionen uber die Epilepsie.

(D. Scheffner, Heidelberg)