JMS Pearce
Hull, England

We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.
—Shakespeare, The Tempest IV.1

Dreamy states are well known as brief aberrations of awareness and of altered thought that are a commonplace, normal experience. As a manifestation of epilepsy, they have been recorded by famous literati as well as by afflicted physicians. Hughlings Jackson noted that the so-called “intellectual aura” (I call it “dreamy state”) is a striking symptom. This is a very elaborate or “voluminous” mental state. One kind of it is a “Reminiscence”, a feeling many people have had when apparently in good health.

Jackson quoted Dickens’s David Copperfield (chapter 39):

We have all some experience of a feeling which comes over us occasionally, of what we are saying and doing having been said or done before, in a remote time—of our having been surrounded, dim ages ago, by the same faces, objects, and circumstances—of our knowing perfectly what will be said next, as if we suddenly remembered it.

Alfred Lord Tennyson described, “A kind of waking trance I have frequently had, quite up from boyhood, when I have been all alone.” Crichton-Browne believed Tennyson’s attacks were probably epileptic. In his Early Sonnets we can read:

As when with downcast eyes we muse and brood,
And ebb into a former life or seem,
To lapse far back in some confused dream
To states of mystical similitude…

Fyodor Dostoevsky related a dreamy ecstasy in his epileptic attacks:

I feel such happiness that it is impossible to realize at other times, and other peoples cannot imagine it. I feel a complete harmony within myself and in the world, and this feeling is so strong and so sweet that for a few seconds of this enjoyment I would readily exchange ten years of my life – perhaps even one’s whole life.¹

Dreamy states occur in diverse physiological and pathological mental conditions. And as Huglings Jackson described, they feature in epileptic attacks arising in the temporal lobes.

It is not very uncommon, he wrote, “for epileptics to have vague and yet exceedingly elaborate mental states at the onset of epileptic seizures…The elaborate mental state, or so-called intellectual aura, is always the same, or essentially the same, in each case.” Old scenes revert. “I feel in some strange place. A dreamy state.”² The French physicians Falret, Voisin, Trousseau, and Theodor Herpin described these dreamy states as intellectual aurae, a term Jackson disliked. Gowers³ too, described several cases with elaborate visual and auditory warnings. Among them was a patient who saw beautiful places, large rooms, and heard at the same time beautiful music.

Hughlings Jackson first described the “dreamy state” in 1876. In Neurological Fragments,⁴ he describes the now familiar hallucinations of taste and smell, the epigastric aura and lip smacking, which he related to lesions often seen in the uncus; he therefore adopted the term uncinate epilepsy. Hogan and Kaiboriboon provided an excellent summary of dreamy states with quotations.⁵

He described⁶ the sense of strangeness, unreality, and dreamy states defined as over-consciousness, or a heightened intellectual state. He described associated crude sensations of smell and taste, an unusual epigastric aura, chewing, and postictal symptoms. He used the term reminiscences rather than déjà vu. He gave the history of a thirty-seven-year-old man whose attacks began with an olfactory sensation and then began to think of things from boyhood days. Jackson recognized that such symptoms were of focal origin, shown at postmortem as “coarse” diseases of the brain that he later localized as “uncinate group of fits.”

Afflicted doctors

Of particular interest was Jackson’s patient, a doctor (Case 5, Dr. Z.) recorded in his paper On a particular variety of epilepsy (“intellectual aura”). A highly educated medical man,* Dr. Z. reported the symptoms himself under the pseudonym of Quaerens (the seeker):

I first noticed symptoms which I subsequently learnt to describe as petit-mal when living at one of our universities, 1871…. I was waiting at the foot of a College staircase, in the open air, for a friend who was coming down to join me. I was carelessly looking round me, watching people passing, etc., when my attention was suddenly absorbed in my own mental state, of which I know no more than that it seemed to me to be a vivid and unexpected “recollection” — of what, I do not know. My friend found me a minute or two later, leaning my back against the wall, looking rather pale, and feeling puzzled and stupid for the moment. In another minute or two I felt quite normal again, … I could give no distinct account of what had happened, or what I had “recollected”.

During the next two years a few similar but slighter attacks occurred, involving mental states which struck me as like to the first and to each other…

In 1874 I first had a haut-mal, preceded by the mental condition I had felt in petits-maux…⁷

Dr. Z. goes on to describe in detail, covering six pages of Jackson’s article, both the mental and physical symptoms of these attacks, generally lasting no more than ten to fifteen seconds.^8,9 When he died of chloral overdosage, Jackson attended his necropsy where Dr. Colman showed a small lesion in the right uncus of the temporal lobe. Jackson had seen about fifty such cases, some of which had come to autopsy.

A.B., another member of the medical profession who after life threatening septicemia had spells when he acted strangely and with apparent lapses of memory, consulted Jackson in 1899. With Purves Stewart he described A.B.’s epileptic attacks with a warning of a crude sensation of smell and with the intellectual aura (dreamy state) in a patient who had symptoms pointing to gross organic disease of the right temporo-sphenoidal lobe; no operation or necropsy were performed.¹⁰

Many wild theories exist about the cause of déjà vu and related symptoms. To some, the sense of unworldly strangeness causes notions of spirituality, an alternative universe, or a previous existence.

End note

• * It emerged that Dr. Z was Dr. Arthur Thomas Meyers, MA MD Cantab LSA, FRCP. (1851-1894) a physician at the Belgrave Hospital in London. He played in the tennis quarter-finals at Wimbledon in 1878, and played cricket for Cambridge university He is wrongly named Alfred Thomas Myers in several publications.

References

1. Alajouanine T. Dostoiewski’s epilepsy. Brain 1963; 86:209-18.
2. Jackson JH. In: Taylor J, ed. Selected writings of JH Jackson vol 1., London: Staples Press, 1958:400-5.
3. Gowers WR. Epilepsy and other chronic convulsive diseases. London: Wm Wood, 1885.
4. Jackson JH. Neurological Fragments. Oxford Medical Publications, 1925:174-9.
5. Hogan RE, Kaiboriboon K. The “Dreamy State”: John Hughlings-Jackson’s Ideas of Epilepsy and Consciousness. American Journal of Psychiatry 2003;160(10):1740-7.
6. Jackson JH. On temporary paralysis after epileptiform and epileptic seizures: A contribution to the study of dissolution of the nervous system. Brain 1881;3:433-51.
7. Quaerens: A Prognostic and Therapeutical Indication in Epilepsy. Practitioner, May 1874:284.
8. Jackson JH. On a particular variety of epilepsy (“intellectual aura”), one case with symptoms of organic brain disease. Brain 1888;11:179-207.
9. Taylor DC, Marsh SM. Hughlings Jackson’s Dr Z: The paradigm of temporal lobe epilepsy revealed. Journal of Neurology, Neurosurgery, and Psychiatry, 1980:43, 758-67.
10. Jackson JH, Purves-Stewart J. Epileptic attacks with a warning of a crude sensation of smell and with the intellectual aura (dreamy state) in a patient who had symptoms pointing to gross organic disease of the right temporo-sphenoidal lobe. Brain 1899;22:534-49.