Déjà Vu and Epilepsy

The term "reminiscence” also has its history. It is associated with the long and (im my view) rather unfortunate connection between déjà vu and what is known in the medical literature as temporal lobe or psychomotor epilepsy. This chapter in the history of déjà vu began in 1870 when, in a short, two paragraph paper in "The Practitioner", a young medical doctor using the pseudonym "Quaerens” wrote that he had often had déjà vu experiences as a boy, but that these had become "more intense and more frequent than usual" just preceding his first epileptic attack. He mentions that the latter had been triggered during a time of overwork, which suggests that fatigue was also possibly involved as a precipitator. He said that on two occasions an incident of déjà vu was followed the next day by an epileptic seizure. Thus he surmised that there might be some connection between the two and that déjà vu could be indicative of an epileptic disposition.

The matter might have rested there, but ten years (and some fifteen seizures) later he became a patient of Dr John Hughlings Jackson, probably the leading neurologist of his day, certainly in matters dealing with epilepsy. It was Jackson who coined the term "dreamy state” {which, according to Bing1ey [1958], “is practically identical with the modern concept of psychomotor seizure” [p. 102]). Déjà vu, or any inexplicable feeling of familiarity, was called by Jackson (1876) "reminiscence" (probably borrowed from Plato), and was included in what was known as "intellectual aura" or warnings which could precede or comprise an epileptic discharge.

He had another patient, also a medical doctor, whom he designated "Z", who had similar symptoms. He called his "reminiscence" recollection and described it as

"what is occupying the attention is what has occupied it before, and indeed has been familiar, but has been for a time forgotten, and now is recovered with a slight sense of satisfaction as if it had been sought for ... At the same time, or ... more accurately in immediate sequence, I am dimly aware that the recollection is fictitious and my state abnormal. The recollection is always started by another person's voice, or by my own verbalised thought, or by what I am reading and mentally verbalise; and I think that during the abnormal state I generally verba1ise some such phrase of simple recognition as 'Oh yes -I see' 'Of course -- I remember', etc. but a minute or two later I can recollect neither the words nor the verbalised thought which gave rise to the recollection. I only find strongly that they resemble what I have felt before under similar abnormal conditions” (p. 202) (Our thanks to Oxford University Press for permission to quote from Brain 1889, 11:179-207.)

I have presented here this rather extensive quotation because I believe that this is probably characteristic of the familiarity feelings which occur sometimes in connection with temporal lobe epilepsy, and to show that the tone of it is strikingly different from accounts of déjà vu among those not afflicted with the "divine disease". I am personally inclined to believe that Quaerens had both déjà vu experiences and epilepsy, whereas Z had false familiarity feelings during his epileptic seizures. It may be of interest that it was later shown in autopsy that Z had, in fact, a "very small lesion of the left uncinate gyrus" within or upon the temporal lobe (Jackson, 1898).

In 1876, Jackson said, "It is well known that such sensations of 'reminiscence' are not uncommon in healthy people, or in trivial disorders of health."(p. 702) Moreover, in 1889, "I should never, in spite of Quaerens's case, diagnose epilepsy from the paroxysmal occurrence of 'reminiscence' without other symptoms, although I should suspect epilepsy, if ... (it) should occur very frequently" (p. 186).

Despite such admonitions. Sir James Crichton-Browne in his 1895 Cavendish lecture before the West London Medico-Surgical Society on "Dreamy Mental States" maintained that occurrences of "reminiscence" must be seen as pathological. From the literary quotations he presented (from twelve different writers!) it is clear that he was referring primarily to déjà vu. He said that it was difficult obtaining information about such experiences because those having had them were disinclined to talk about them, "from a not unwarrantable suspicion that they are somehow morbid in their nature." He quoted Quaerens and some of Dr Jackson's patients, as well as some of his own, to show what sort of epilepsy he was considering. He went on to point out that Scott, Dickens, and Rossetti all died of brain disease. though he neglected to mention which variety. He finished by saying that such disturbances should be watched for in young people and treated as one would "cerebral neurasthenia and epilepsy". (p. 75) He especially recommended "rest and liberal nourishment", the 1atter being vegetarian, if possible. Dr Foster in his 1911 paper, seems to have adopted these views in toto.

Thus it is that today if one speaks of déjà vu to a medically trained person, especially to a neurologist or psychiatrist, his first reaction is to think of possible temporal lobe epilepsy. Not only did Jackson include déjà vu with false familiarity in his concept of reminiscence, but others following him have tended to form their diagnoses on the basis of such historical accidents and anecdotes, rather than on scientific statistical evidence.

Even early studies, however, contradict this. In 1933, Lennox and Cobb studied 1359 cases of aura in all types of epilepsy of whom 56.2% had focal auras, sometimes more than one: of the 1059 auras analyzed only four had déjà experience. Thus, compared with the incidence in "normal" people, the incidence of déjà vu as part of an epileptic attack is amazingly low. In another early study of tumors of the temporal lobe, Keschner et al published a study in 1936 of 110 cases and found no déjà vu in connection with this affliction. They did have two cases, though, where "dreamy states" were noticed.