Gastaut H, Gastaut Y
Rev Neurol (Paris). 1982;138(6-7):467-92.
All those interested in Gustave Flaubert's illness, during his lifetime as well as after his death, have agreed that he had epilepsy. The one important exception is Jean-Paul Sartre, who, in the 2800 pages of his "Idiot de la famille" claimed that Flaubert was a hysteric with very moderate intelligence who somatized his neurosis in the form of seizures. These, in Sartre's views, were moreover probably hysterical, but possibly epileptic resulting from the existence of a psychogenic epilepsy bred from the neurosis. The basis for this neurosis could have originated at the time of Gustave's birth, as this occurred between those of two brothers who both died young, and as his mother had wished for a daughter. Further development of the neurosis might have taken place during a temporary phase of learning difficulties, exaggerated and exploited by his father to make his youngest son the idiot of a family in which the eldest son was the dauphin. Destroyed in this way, Gustave would have sought refuge in passivity and could have developed a hatred for his father and for his elder brother, who he would have liked to kill before killing himself. But, unable to carry out his wishes and desiring both to die and to survive, Gustave, adolescent, might have chosen the pathway of "false deaths", as exemplified by the seizures. Modern epileptology data enables not only to confirm the epileptic etiology and to discount the hysterical nature of the fits, but also: 1. to establish precise details of the site and nature of the cerebral lesions responsible for the attacks: neonatal atrophy or vascular malformation of the occipitotemporal cortex of the left hemisphere, the only lesion capable of provoking: a) the phosphenes marking the onset of the seizures; b) the intellectual manifestations (forced thoughts or flight of ideas), affective features (panic terror), and psychosensory (ecmnesic hallucinations) or psychomotor (confusional automatism) symptoms accompanying some attacks; c) the loss of speech preceding the loss of consciousness and terminal generalized convulsions. 2. to establish the consequences of the lesion and of the temporal fits on the behaviour of the writer; a) associated hypoactivity (slowness of ideation and writing) and paroxysmal impulsiveness (violent unmotivated angry outbursts); b) disturbed verbal functions (difficulty in finding words); and c) diminished sexuality. As a conclusion, it must be admitted; a) that Flaubert suffered from an organic and not a psychogenic epilepsy, the existence of the latter currently being disputed; b) that this epilepsy modified the behaviour of the author without affecting his genius; c) that, as a result of this, the epilepsy of Flaubert, as that of Dostoïevski, should serve as a defense witness for the unfortunate epileptics thought to be destined for intellectual deterioration only because of the repetition of their seizures.
古斯塔夫·福楼拜在世期间以及去世之后,所有对其疾病感兴趣的人都一致认为他患有癫痫症。唯一重要的例外是让-保罗·萨特,在其长达2800页的《家庭白痴》一书中,他声称福楼拜是一名歇斯底里症患者,智力平平,他将自己的神经症以癫痫发作的形式表现为躯体症状。此外,在萨特看来,这些发作很可能是癔症性的,但也可能是癫痫性的,因为存在由神经症引发的心因性癫痫。这种神经症的根源可能始于古斯塔夫出生之时,因为他出生于两个早夭兄弟之间,而且他母亲原本希望生个女儿。神经症可能在他学习困难的一个阶段进一步发展,被他的父亲夸大并利用,使他这个最小的儿子成为家庭中的白痴,而长子则是宠儿。就这样,古斯塔夫的心灵受到了伤害,他可能会寻求消极逃避,并对他的父亲和哥哥产生仇恨,他可能想先杀了哥哥再自杀。但是,由于无法实现自己的愿望,既想死又想活,青春期的古斯塔夫可能选择了“假死”之路,癫痫发作就是例证。现代癫痫学数据不仅能够证实癫痫的病因,排除发作的癔症性质,而且还能:1. 确定引发发作的脑部病变的部位和性质的精确细节:左半球枕颞叶皮质的新生儿萎缩或血管畸形,这是唯一能够引发:a) 标志着发作开始的光幻视;b) 智力表现(强迫性思维或思维奔逸)、情感特征(惊恐)以及伴随某些发作的心理感觉(记忆性幻觉)或精神运动(混乱自动症)症状;c) 在意识丧失和最终全身性惊厥之前的言语丧失。2. 确定病变和发作对这位作家行为的影响:a) 相关的活动减退(思维和写作迟缓)以及阵发性冲动(无动机的暴力愤怒爆发);b) 言语功能紊乱(找词困难);c) 性能力减退。总之,必须承认:a) 福楼拜患的是器质性癫痫而非心因性癫痫,后者的存在目前存在争议;b) 这种癫痫改变了作者的行为,但并未影响他的天赋;c) 因此,福楼拜的癫痫,如同陀思妥耶夫斯基的癫痫一样,应该为那些不幸的癫痫患者充当辩护证人,他们仅仅因为癫痫发作的反复出现就被认为注定智力衰退。