Year : 2007 | Volume
: 10 | Issue : 3 | Page : 165--168
Epilepsy and religion
Geeta A Khwaja1, Gurubax Singh2, Neera Chaudhry1,
1 Department of Neurology, GB Pant Hospital, New Delhi - 110 002, India
2 Sant Parmanand Hospital, Delhi, India
Geeta A Khwaja
Department of Neurology, Academic Block, Room No-503, GB Pant Hospital, New Delhi - 110 002
This study has focused on the interplay between epilepsy and religion. A total of 100 patients in the age range of 15-84 years were included in the study. The duration of epilepsy in these patients ranged from 1-35 years. The majority (66%) had generalized seizures and good to complete seizure control (77%). Regarding social/religious beliefs, 6% of the patients attributed their epilepsy to the curse of God and 14% saw their affliction as a form of punishment for bad deeds committed in the current or past life. Epilepsy was regarded as contagious by 13%. After the onset of epilepsy, 7% of the subjects became skeptics and less religious, while 29% became more religious. Only 2% reported mystic experiences. There was, however, no significant impact of the duration of epilepsy or seizure type on the pattern of religiosity. In 44 cases with symptomatic epilepsy, no definite correlation was observed between the lesion site and laterality and the religious temperament. Delay in seeking treatment and poor compliance due to false religious beliefs, ignorance, and superstition was observed in 33%. However, all religious beliefs were not maladaptive and overall, 80% cases felt that religion had helped them in coping with epilepsy.
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Khwaja GA, Singh G, Chaudhry N. Epilepsy and religion.Ann Indian Acad Neurol 2007;10:165-168
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Khwaja GA, Singh G, Chaudhry N. Epilepsy and religion. Ann Indian Acad Neurol [serial online] 2007 [cited 2019 Jul 18 ];10:165-168
Available from: http://www.annalsofian.org/text.asp?2007/10/3/165/34796
The majority of the patients with epilepsy have normal intelligence and personality structure. However, interictal cognitive and personality alterations occur in some patients and may be reflected in their religious beliefs and practices. Increased religious, philosophical, and moral concerns have been reported in patients with epilepsy.  Mystical experience is also a well-recognized seizure phenomenon. Moreover, epilepsy has a historical association with religion, primarily through the concept of possession by gods or evil spirits.  Some major religious figures and prophets or founders of some religions are beleived to have had epilepsy.  The relationship between epilepsy and religion has, however, not been fully explored. Religion per se , may have a positive or negative impact on epilepsy.  Studies on the religious psychopathology of epilepsy are few in number. This study was undertaken to evaluate the interplay between epilepsy and religion.
The objectives of this study were to focus on the religious temperament and practices in patients before and after the onset of epilepsy, define any possible link between religious inclination (hyperreligiosity or hyporeligiosity) and the seizure pattern or nature of epilepsy (idiopathic vs symptomatic), and to study the impact of religion on the management of epilepsy.
Materials and Methods
This study was conducted in the Department of Neurology, G. B. Pant Hospital, New Delhi, a tertiary-care superspeciality hospital in the capital city of India. Patients with epilepsy of ≥ 1 year duration were included in the study. Patients less than 15 years of age and those with mental retardation, significant motor handicap, or associated pseudoseizures were excluded from the study.
The questionnaire designed for the study included questions on basic demographic data and details of epilepsy (etiology, duration, seizure type, frequency, control, time lapse in initiating treatment, and duration of antiepileptic therapy). For the purpose of this study, seizure control was defined on the basis of the number of seizures in the past 1 year (complete control = no seizures; good control = 1 to 2 seizures; fair control = 3 to 5 seizures; and poor control = >6 seizures). Computerized tomography (CT) head was done to differentiate idiopathic from symptomatic epilepsy. The nature, number, site, and laterality of the lesions were recorded in the case of patients with symptomatic epilepsy. The patients were questioned regarding their beliefs as to the cause of their illness (curse of God, possession by evil spirits, magic spell, and bad karmas (deeds) in current or past life, etc.). The religious temperament of the patients before and after the onset of epilepsy was evaluated in terms of prayer frequency, temple visits, pilgrimage to holy places, consultation with a priest or guru, organization of religious events, and use of amulets or tabeez for the cure of epilepsy. The role of parental influence in molding the religious beliefs of the patient was also looked into. A note was made of mystic experiences. The emotional reasons for change in religiosity were also examined in terms of whether there were feelings of fear, guilt, or insecurity generated by epilepsy. Details of the treatment (conventional or unconventional) were recorded. Whether prayer or religious practices provided solace or helped in coping with the illness was noted.
A total of 100 patients were included in the study. There were 62 males and 38 females, the male: female ratio being 1.6: 1. Age of the patients ranged from 15-84 years with a mean age of 26.4 years. The professed religious faith was Hinduism in 77, Islam in 18, Sikhism in 4, and Christianity in 1. The majority belonged to either the lower (73%) or the middle (27%) socioeconomic strata. Seventeen percent were illiterate, while 49% had attended school, but not completed high school. The remaining 34% were graduates or professionals.
The duration of epilepsy ranged from 1-35 years, with a mean duration of 26.4 years. Seizure types were generalized tonic-clonic seizures (GTCS, 59%), myoclonic (5%), absence (2%), simple partial seizures (SPS, 7%), complex partial seizures (CPS, 6%), and simple partial seizures with secondary generalization (21%). Seizure control was poor in 15%, fair in 8%, good in 26%, and complete in 51% of the cases.
Regarding social/religious beliefs and superstitions, 6% of the patients attributed their epilepsy to the curse of God and 14% to bad deeds (karmas) in current or past life. Epilepsy was regarded as contagious by 13%. After the onset epilepsy, 29% became more religious, 7% became skeptics and less religious, while 64% did not report any change in their religious temperament or practices. Hyperreligiosity was encountered with all seizure types (19 patients with GTCS, 8 with SPS, and 2 with CPS). Interestingly, out of the 29 cases with increased religiosity, 22 patients had become more religious due to the influence and beliefs of their parents. Overall, 25% reported an increase in prayer frequency and 26% an increase in temple visits. Twenty-nine percent had consulted a religious priest and 26% wore amulets to ward off evil spirits. Around 15% had undertaken a pilgrimage, while 6% had organized special prayers ( havans ) in the hope of a cure. Eighty percent of the patients felt that religion provided an anchor and helped them in coping with the stress of epilepsy.
The time lapse in initiating treatment ranged from 1 week to 7½ years, with the average delay being more than 6 months. In 33% of the cases, the delay in seeking treatment and poor compliance was found to be due to false religious beliefs regarding the cause of epilepsy; all these cases had tried some form of unconventional nonmedical therapy or spiritual healing before reporting to the hospital.
CT scan could be performed in 80 cases. Out of these, 44 had symptomatic epilepsy (5 had tuberculomas, 17 had neurocysticercosis, 19 had calcified granulomas, and 3 had lacunar infarcts). Out of these, 18 had right-sided, 18 had left-sided, and 8 had bihemispheric lesions. The site of the lesion was the parietal lobe in 26 patients, frontal lobe in 5, temporal lobe in 3, occipital lobe in 2, and the basal ganglia in 2; 6 patients had multiple lesions.
Out of 29 patients with hyperreligiosity, CT imaging was available in 27 cases, of which 12 (44.4%) had structural lesions. Parietal granulomas were seen in 11 (4 right-sided, 5 left-sided, and 2 bilateral) and a right-sided basal ganglia infarct in one. Out of 7 patients with hyporeligiosity, CT imaging was available in 6, of which 4 patients (66.6%) had structural lesions, 2 with right-sided and 2 with left-sided granulomas (parietal lobe-3 and temporal lobe-1). Out of 64 cases with no change in religiosity, CT imaging was available in 47 cases, of which 28 (59.6%) had structural lesions. Of these 26 had inflammatory granulomas (11 with right-sided, 9 with left-sided, and 6 with bilateral granulomas), while one patient had a left parietal lobe infarct and one case a left basal ganglia infarct. The location of the granulomas was frontal in 5, parietal in 11, temporal in 2, occipital in 2, and bilateral or multiple in 6. No definite correlation was observed between religious temperament and the site of the lesion or laterality.
Mystical experiences, in the form of sacred dreams, were reported by 2 cases. One 40-year-old female with a right parietal tuberculoma and left focal motor seizures reported seeing images of the goddess Durga on 5 occasions over a span of 3 years. Another case, a 36-year-old male with left parietal neurocysticercosis and right focal motor seizures with secondary generalization dreamt of lord Shiva, who instructed him to visit a nearby temple. Both these cases became more religious after their experience.
It has been suggested that epilepsy and religion are closely related. The early Greeks viewed epilepsy as a visitation from the gods and thus a sacred disease.  Christians during medieval times followed the biblical belief that epilepsy was the result of demonic possession.  The ancient American cultures of the Aztecs and Incas also strongly associated epilepsy with magic and religion, as evident from their ideas about the pathogenesis and treatment of epilepsy. 
The special relation between epilepsy and religion was also recognized by Hippocrates, who discounted claims that epilepsy was the result of a curse of the gods or that epileptics possessed prophetic powers.  Although the last several decades have witnessed an explosion of knowledge in the field of epilepsy, popular folk beliefs and superstitions regarding the causes and cure of epilepsy still abound in different cultures all over the world. Many African cults still believe in and practice magic and voodoo for the cure of epilepsy.  In India too, epilepsy has been linked with religion, though epidemiological studies and data are lacking. Our study focused on the interplay between epilepsy and religion. Epilepsy was thought to be contagious by 13%. Six percent of the cases attributed it to the curse of god, and 14% to bad karma. Around one-third of the patients had resorted to spiritual healing before seeking medical help. Since epilepsy may be due to an underlying intracranial pathology, this trend is alarming, because in such a scenario definitive therapy gets delayed, with serious consequences for the patient. The fact that all our patients were from the lower to middle socioeconomic strata and were either illiterate or school dropouts (66% cases), probably accounts for the prevalence of these false beliefs. The idea that the disease was a form of punishment also reflects the presence of feelings of guilt, low self-esteem and a negative self-image; this needs to be addressed.
With regard to the impact of epilepsy on the pre-existing religious temperament, the majority (64%) did not report any change, implying that epilepsy does not necessarily alter behaviour or religious inclination. Geschwind had identified an interictal personality pattern in patients with temporal lobe epilepsy (TLE), characterized by increased preoccupation with philosophical, moral, and religious issues.  Hyperreligiosity however, is not a consistent feature among patients with epilepsy. A small subgroup may have unusually strong religious beliefs and an even smaller fraction may have ecstatic seizures. , In our study, 29% cases became more religious after the onset of epilepsy. However, the religious preoccupation and deepened religiosity were possibly due to feelings of insecurity, guilt, and fear of epilepsy than due to any true awakening or deepening of religious faith. Most of these patients felt that religion served as an anchor when coping with the stress of epilepsy. Interestingly, the majority of the patients (80%), including those without any change in their religious temperament or convictions after the onset of epilepsy, felt that religion acted as a support system. Therefore, the assumption that all religious beliefs are maladaptive or undesirable is dangerous and unjustified. Since religion provides solace and support, the basic core of religious conviction should not be eroded while counseling or challenging the false religious beliefs of patients with epilepsy. The responsibility for this rests with the treating physician. Moreover, parental influence plays a vital role in molding religious beliefs. Twenty-two percent of our patients had become more religious due to their parents' influence and belief system. Counseling is therefore required not just for the patient but for the family as a whole. A distinction also needs to be made between normal religious beliefs and excessive or inappropriate religious expression.
Intense religious experience or ecstatic visions have also been reported in patients with TLE. , Vivid psychic auras and experiences are probably ictal in origin. Epileptiform discharges have been documented during a religious ecstatic seizure.  Persons with epilepsy have themselves often explained their seizures as religious experiences, particularly the feelings associated with the depersonalization, derealization, and autoscopy of TLE.  Dostoyevsky has provided an eloquent autobiographical account of an epilepsy-related religious experience.  In one study, religious aura or premonitory periods lasting hours or days, with heightened religiosity, were reported in 52 of 1325 patients with epilepsy.  Sudden religious conversions have also been reported in patients with epilepsy.  In some cases, there is a temporal relationship between conversion and the first seizure or an increased seizure frequency.  Less often, there is a marked decrease in seizure frequency before conversion.  Saint Paul's ecstatic vision, leading to his sudden conversion to Christianity, is now being attributed to the psychic and perceptual experience of a temporal lobe seizure.  In our study, hyperreligiosity could not be linked to either the seizure type, seizure frequency, seizure control, or the duration of epilepsy. Moreover, none of our patients reported religious auras or ecstatic visions or experiences during the seizures. Two of our cases however, did report mystic experiences in the form of sacred dreams in which they saw vivid images of the goddess Durga and lord Shiva. Both reported these experiences to be profound life-changing events which deepened their religious faith and conviction. Neither of these patients, however, had TLE. Both had parietal granulomas (right-sided lesion in one case and left-sided in the other) with partial motor seizures. Schneider has reported that it is not rare for patients to see a god, devil, or an angel, or a magnificently religious scene, in the twilight state after a psychomotor or grandmal seizure.  Our patients however, reported mystic dreams that were unrelated to ictal events. Mystic experiences related to epilepsy have been documented since ancient times.  To explain this finding it was hypothesized that repeated seizure discharges in the temporal lobes resulted in the establishment of increased functional connectivity between the temporal neocortex and limbic structures. This sensory-limbic hyperconnection produces deepened emotional associations to overtly neutral events.  Further, religiosity was regarded to be specific to left temporal foci.  One relatively recent study of 76 patients with complex partial seizures (51 with left and 25 with right temporal lobe seizure focus), however, failed to support this hypothesis.  In our study the number of patients with complex partial seizures is too small (6% only) to comment on any such phenomenon. Moreover, only 2 of these patients had hyperreligiosity.
Structural CT lesions were observed in 44.4% of the cases with hyperreligiosity vs 66.6% cases with hyporeligosity and 59.6% cases with no change in religiosity. The majority of these patients had parietal granulomas with no particularly marked laterality. Moreover, the majority had generalized seizures (66% cases) and good to complete seizure control (77% cases). No definite correlation was observed between seizure type, degree of seizure control, or duration of epilepsy and the pattern of religiosity. The argument that hyperreligiosity and seizures may both be symptoms of the same underlying cerebral pathology or dysfunction has not been refuted. Hyperreligiosity and TLE may co-occur in a few individuals, but it is not a consistent interictal trait.  The question as to whether hyperreligiosity is attributable to cerebral dysfunction or reflects the sociocultural belief system and the social stigma of epilepsy needs to be answered. In a small percentage of cases, particularly in those with TLE, hyperreligiosity may directly relate to the nature of the epilepsy per se , as pointed out in literature, but this statement cannot be generalized. In our study the religiosity was affected more by the sociocultural beliefs and the stress of epilepsy per se , rather than by the site and laterality of a structural lesion or the lack of it. Most of the patients with hyporeligiosity had feelings of disgust and anger against God for inflicting them with epilepsy.
False religious beliefs and superstitions regarding epilepsy are still very much a part of Indian culture and were encountered in 33% of our patients. Poor socioeconomic status, illiteracy, ignorance, and cultural factors may play a vital role in fostering such beliefs and may adversely affect the clinical management by causing a delay in seeking treatment, as was observed in one-third of our cases. However, all religious beliefs are not maladaptive. There is a need for better insight in patients as well as treating physicians, regarding these aspects, so that the information can be positively utilized to improve the management of epilepsy.
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