Fyodor Dostoevsky (1821–1881).
Dostoevsky was one of the greatest writers of the 19th century, who overcame both physical and mental problems in pursuit of his art. His writing is characterised by interwoven psychological, religious, and existential themes. Fyodor Mikhailovich Dostoevsky was born in 1821, the son of a Moscow physician and the second of seven children. He was admitted to the Military Engineering Institute of Saint Petersburg in 1838, graduating 5 years later. By this time both his parents had died and he had experienced his first epileptic fit. Arrested and convicted of political offences in 1849, he was sentenced to death. Following a last-minute reprieve this was commuted to 4 years’ hard labour in Siberia. The conditions were harsh and he was kept in shackles for the whole of this time. Unsurprisingly, this experience had a profound effect on his work.1
His first wife Maria died in 1864. Three years later he met Anna Grigoryevna Snitkina, a young stenographer, who helped him complete the novella The Gambler in record time to meet the deadline set by his publisher. They married and had four children. Two died in infancy and 3-year-old Alexsey died during a prolonged epileptic fit. Anna began to manage his financial affairs, paid off his debts, and encouraged him to stop gambling after a series of heavy losses. Dostoevsky, despite his epilepsy, was able to settle down and write his masterpiece The Brothers Karamazov (1880).2
EPILEPSY
Epilepsy featured in five characters of his novels. Fyodor’s own epilepsy became worse in captivity and he suffered frequent fits for the rest of his life. The main features of these fits were an unusual aura, described as ecstatic, often followed by a generalised seizure.
The most likely retrospective diagnosis is either a type of temporal lobe epilepsy or ecstatic seizures of the insular cortex.3–5 He complained of extreme lethargy after a fit and frequent memory problems that made writing difficult.
It is likely that Dostoevsky became addicted to gambling in 1862 during a trip to Paris. His addiction became worse after further visits to Europe. There is a theory that gambling and epilepsy may be linked.6 Fyodor certainly seemed to have typical features of a gambling disorder including the near-miss effect,7 the gambler’s fallacy (an inaccurate belief that, if something happens more frequently than normal during a certain period, it will happen less frequently in the future), and the illusion of control. The narrator in his short novel The Gambler, Aleksey Ivanovich, soon becomes addicted to gambling, stating: ‘As sure as I am alive I will win it back’, which is typical of the loser chasing losses.8
The unforgettable Prince Myshkin in The Idiot (1868) arrives unannounced as a Christ-like figure, compared by some to Don Quixote. This was Dostoevsky’s most personal novel, based on several real-life events and, most notably, his epilepsy. Myshkin describes an aura that finishes with ‘an ecstatic and prayerful fusion in the highest synthesis of life’. The Prince is highly intelligent, humble, and empathetic but he has an illness that makes him vulnerable. No ‘holy fool’, he loves in a platonic way, struggling with competing divine and human values, making it difficult to live in the world.
The Brothers Karamazov features the unscrupulous epileptic villain Smerdyakov (‘son of the “reeking” one’). In this novel Dostoevsky tackles the monumental questions of faith and doubt, suffering, redemption, and moral responsibility. The concept of free will is challenged in the chapter ‘The Grand Inquisitor’.
DEATH
Once Dostoevsky had finished The Brothers Karamazov he felt that his life’s work was complete. In January 1881 his health was failing and he had recurrent haemoptysis. His beloved family gathered around him and he requested a reading from his New Testament. He died on 9 February 1881 at his home in Saint Petersburg aged 59. Three days later a huge crowd gathered outside his apartment and the cortège walked slowly and quietly for 2 hours before arriving at the Alexander Nevsky Monastery for the night service.1 Fyodor Dostoevsky was buried in the monastery grounds the following day. It was said that Russia had never seen such a funeral before; a fitting tribute to a literary genius who was able to transform his condition into such an advantage in his art.
- © British Journal of General Practice 2019
