‘A ray of darkness’: Margiad Evans's account of her epilepsy (1952)
Abstract
This column explores the links and synergies between medicine and literature. What roles can literature play in reflecting and influencing good practice, and what sorts of images of doctoring are to be found in drama, poetry, fiction, biography, electronic fora and film? The editors would be pleased to receive short papers, ranging from 500–1,000 words, on relevant topics. Those interested in contributing should email brian.hurwitz{at}kcl.ac.uk or neil.vickers{at}kcl.ac.uk
Patient, as opposed to professional, accounts of disease and its treatment are increasingly valued by medical historians, presenting as they do the perspective of the recipient, rather than the deliverers, of medical care, and hence free from the whiggish tendencies of the faculty. One such example is A ray of darkness by the Anglo-Welsh author Margiad Evans (1909–58). An acclaimed novelist of the 1930s, her experiences prompted the writing of ‘the story of my epilepsy’ which she described as ‘an adventure of body and mind’. Though published more than 50 years ago, the book addresses the diagnosis, management, and complications of epilepsy in ways which still resonate today.1 Although it has attracted literary critical attention,2–4 it is all but unknown to clinicians.
Margiad Evans's first major seizure occurred on 11 May 1950 while she was alone in her cottage in the Gloucestershire village of Elkstone:
[I] looked up at the clock … saw that it was ten minutes past eleven. The next thing I was still looking up at the clock and the hands stood at five and twenty minutes past midnight. I had fallen through Time, Continuity and Being.
Her initial wondering as to whether she may have fainted was soon banished by an awful certainty:
I felt a cold dampness and it came on me stunningly, terrifyingly, that my clothes were wet. My urine had escaped me then. Horrifyingly, in one moment, I realized the incredible, impossible, and ghastly truth – I had neither fainted nor been asleep: I had had an epileptic fit! … A horrible, perhaps incurable illness lay before me.
The first part of the book is the author's attempt to plot the antecedents of this seizure. Retrospectively, there may have been episodes dating from childhood of momentary ‘separation from my consciousness’, and more recent episodes of fits during sleep:
I seemed to remember a time in the night when my muscles had gone rigid, my teeth locked, and I was shaken by a kind of ghastly iron palsy. My arms seemed to lift, my head to jerk and my face to be covered with a grimace.
Following the first major seizure (‘The other side of the wave’), Evans saw her general practitioner, Dr Y, who, though apparently not sharing his patient's certainty as to diagnosis, immediately prescribed the anti-epileptic drug Luminal® (phenobarbital). He also arranged for an appointment with ‘Professor T at the Neurological Institute near Clystowe as soon as possible’, who was in fact Professor Frederick Golla at the Burden Neurological Institute outside Bristol.5 In the meantime Evans could but wait (‘Life was my waiting room’), irritated by ‘inexpert opinion, disbelief and the wrong sort of kind advice’ from her relatives, but grateful to friends who ‘gave me back my sense of continuity’.
‘The lonely journey’ from Elkstone to Bristol via Cheltenham was made on 8 June 1950, an electroencephalogram was performed, and the verdict delivered by Professor T: ‘he said he had no doubt whatever that it was epilepsy’:
I walked out of the Institute as a person harbouring epilepsy, it was true, but free of false hopes and quite clearly defined as myself.
A second seizure in the presence of her husband undermined her sense of security:
Ever since I have been incredulous of all things firm and material … Time has become as rotten as worm-eaten wood, the earth under me is full of trap-doors.
Other problems also became apparent. The effects of the anti-epileptic medications then available (‘luminal and epinutin’ [sic]: phenobarbital and phenytoin) were all too evident to a creative writer:
… the drugs I have to take to prevent the discharges of the epilepsy make me apathetic, have faded and dulled and dimmed the powers of imagination and concentration.
A projected work on Emily Brontë, an author for whom Evans had a longstanding interest, was abandoned.
Tiredness was also a symptom, but this proved to have another cause: by 29 September 1950 Evans reported that she was ‘4 months gone with child’:
Epilepsy and pregnancy. The shock of waking every morning to such a grim problem of life.
Although there was no family history of epilepsy, and Professor Golla thought that the seizures were due to a traumatic scar in the brain dating from a childhood riding accident, nonetheless there were concerns that the disorder might be hereditary, so much so that Evans evidently contemplated abortion, then still illegal:
People who could help me have written to me and asked me why not have it quietly removed and I have replied that since the second fit that is my wish and that if they knew of any one who would do it, please help me.
Dr Y, however, maintained all would be well, visiting Evans to read:
… a passage from Nervous Diseases by the Professor of Neurology at London University, which he said was the last and most up-to-date work on epilepsy … there was in reality only the very slightest danger of its being hereditary.
Her child was born uneventfully, but after a postpartum fit Evans was not allowed to feed her because of safety concerns.
Whereas Dostoevsky used his epilepsy for fictional purposes,6,7 Evans's aims were, at least in part, didactic. Written at a time when illness of any sort was usually concealed, and not a topic for general discussion, A ray of darkness has rightly been seen as a ‘brave and positive book’.3 Although it did not meet with the approval of the British Epileptic Association, who found the account too self-centred to be relevant to most epileptics (and indeed the subjective elements of the book may prove challenging for some readers), many patients did find the book helpful and wrote to tell the author so. Evans also broadcast a talk on epilepsy, entitled ‘A silver lining’, on the BBC Radio Light Programme (19 March 1953) which attempted to explain what happened in an epileptic fit and urged a more positive response to the disease, another example of a writer's ‘good use of epilepsy’.7
- © 2009 Royal College of Physicians
Reference
- ↵Evans M. A ray of darkness. London: John Calder, 1978 [1952].
- ↵Dearnley M. Margiad Evans. Cardiff: University of Wales Press, 1982.
- ↵Lloyd-Morgan C. Margiad Evans. Bridgend: Seren, 1998.
- Prys-Williams B. Twentieth-century autobiography. Writing Wales in English. Cardiff: University of Wales Press, 2004:32–57.
- ↵Cooper R, Bird J. The Burden: fifty years of clinical and experimental neuroscience at the Burden Neurological Institute. Bristol: White Tree Books, 1989.
- ↵Larner AJ. Dostoevsky and epilepsy. Adv Clin Neurosci Rehabil 2006; 6:26.
- ↵Iniesta I. On the good use of epilepsy by Fyodor Dostoevsky. Clin Med 2008; 8:338–9.
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