Joan of Arc and DSM III

What caused Joan of Arc's neuropsychiatric symptoms? Medical hypotheses from 1882 to 2016

Between 1882 and 2016, the medical literature offered a variety of etiologic hypotheses to explain Joan of Arc's voices, visions, and unwavering belief that she was the instrument of God. Although Joan lived from 1412 to 1431, there is extensive primary documentation of her life, including transcripts of her testimony during the Trial of Condemnation. Once this source material was compiled and made available, physician-authors began to theorize about Joan's neuropsychiatric symptoms in the context of her remarkable achievements. This article summarizes all papers written by physician-authors about Joan of Arc. The historical flow of diagnostic speculation in the medical literature reflects the cultural context in which it was produced as well as the emergence of novel ideas and new technologies in psychiatry, neurology, and neuropsychiatry. The early literature offered psychological theories and addressed the question of whether Joan was sane. The later literature focused on the possibility that Joan might have had epilepsy, with discussions of seizure etiology and possible cerebral focus, and also reflections on the purview of science as well as spirituality and the brain. This article offers the first comprehensive review of the medical literature about Joan of Arc, making this scholarship more accessible.

Joan of Arc: Sanctity, witchcraft or epilepsy?

OBJECTIVE

The objective of this article is to describe whether Joan of Arc had epilepsy and how that may have influenced her sense of mission and ability to encourage thousands of people to help her to chase the English out of France.

METHODS

Documentation of her Trial of Condemnation in 1431 provides a description of her episodes of experienced voices and visions.

RESULTS

From the age of thirteen, Joan of Arc experienced frequent episodes of auditory hallucinations associated with elementary or complex visual hallucinations (e.g., a great light or human faces). These had sudden onset, lasting seconds or minutes at most, and occurred when awake or during sleep, arousing her. Some could be triggered by an auditory stimulus. She had no disorganized thought between the episodes.

CONCLUSIONS

The semiology of the episodes is very suggestive of epileptic seizures, which have been considered as ecstatic by some authors or as partial epilepsy with auditory features by others, which seems more concordant with the ictal symptoms. The auditory and visual hallucinations could have had a religious content because during her childhood and adolescence, she was brought up in a religious environment, insomuch as this content first undefined only appeared after a few seizures. We can suppose that such hallucinations, without the knowledge of their medical origin, gave her a sense of divine mission, hence, a real strength to try to accomplish the orders she heard during the episodes. Her role during the Hundred Years' War and her narration of her strange episodes led her to be burned for heresy at the age of nineteen, yet rehabilitated 25 years later and to be canonized for her achievements in 1920. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

"I heard voices...": from semiology, a historical review, and a new hypothesis on the presumed epilepsy of Joan of Arc

PURPOSE

Some consider the "voices" of Joan of Arc to have been ecstatic epileptic auras, such as Dostoevsky's epilepsy. We performed a critical analysis of this hypothesis and suggest that the "voices" may be the expression of an epileptic syndrome recently described: idiopathic partial epilepsy with auditory features (IPEAF).

METHODS

Joan's symptoms were obtained from the documentation of her Trial of Condemnation. We investigated Joan of Arc from a strictly semiologic point of view, focusing on symptoms and possible trigger factors.

RESULTS

From ages 13 to 19, the episodes were characterized by a prevalent auditory component, followed by "a great light" or images that Joan identified as saints. Sometimes, the visual component was missing and replaced by comprehension verbal disturbance. The spells were sudden, brief in duration, and frequent, and also occurred during sleep. In some cases, the sound of bells could trigger the "voices."

CONCLUSIONS

Joan's spells were characterized by a constant auditory component, complex, spontaneous, or evoked by sudden auditory stimuli, that could be associated with an inconstant visual component, sometimes simple and, more often, complex, and comprehension verbal disturbance. These spells differ from ecstatic epilepsy with respect to clinical features and involvement of cerebral regions. The negative family history, the ictal semiology, and the possibility that the spells were triggered by acoustic stimuli suggest IPEAF, and the search for the epitempin/LGI1 gene or other new gene mutations on a hair of the Maid of Orléans may enhance our knowledge about her presumed epilepsy.