The Founder of Mormonism/Appendix 2

The diagnosis of an apparent epilepsy in Smith's visionary seizures is difficult for three reasons:—first, the descriptions come from incompetent observers; second, the paroxysms present great diversity of form; third, there is an absence of definite pathological stigmata. There are no photographs extant from which cranial malformations might be observed; yet all the portraits of Smith show an inferior cranial angle, and an overdeveloped cerebellum.

But the prognosis is assured from the antecedents of the patient. The case is not idiopathic; there are known causes furnishing an almost complete etiology. Foremost is heredity. Joseph's maternal ​grandfather had 'fits.' The hallucinations of Solomon Mack at the age of seventy-six, have been already traced to temporary causes, such as rheumatism. Of Solomon's many ailments and accidents, three have especial bearing on the problem. Some time before 1757, at about the age of twenty-two, he writes, 'I had a terrible fever sore on my leg, which had well-nigh proved fatal to my life.'^[2] This is to be noticed only because Joseph had a similar trouble, at a somewhat earlier age. Again Solomon relates that while visiting his son, who was cutting trees, 'A tree fell on me and crushed me almost all to pieces, beat the breath out of my body, my son took me up for dead, I however soon recovered, but have not to this day recovered the use of my limbs, which was thirty-four years ago. . . . I lay sixty days on my back and never moved or turned to one side or the other, the skin was worn off my backbone one end to the other.'^[3] This story is corroborated by the account of an eyewitness at Royalton, Vermont, who portrayed Solomon Mack as 'an infirm old man, who used to ride around on horseback, on a side-saddle.'^[4]

These two episodes are perhaps immaterial, but the third is not. Solomon again says, 'Soon ​after this I was wounded by a limb falling from a tree upon my head, which again nearly deprived me of life. I afterwards was taken with a fit.'^[5] The date of this affliction is extremely significant. It happened about a year before the birth of Lucy Mack, Solomon's last child and the mother of the prophet.^[6] This fit, attributable to traumatic lesion, is thus described by the patient himself:—'I afterwards was taken with a fit, when traveling, with an axe under my arm, on Winchester hills, the face of the land was covered with ice. I was senseless from one, until five P. M. When I came to myself I had my axe still under my arm. I was all covered with blood and much cut and bruised. When I came to my senses I could not tell where I had been nor where I was going . . . was under the doctor's care all the winter.'^[7] Alcoholism, as a provocative of epilepsy, cannot be causally connected with these seizures. Solomon had been an army sutler for twenty-seven years,^[8] but his acknowledged drunkenness came only after the Tunbridge episode. As a sailor on the Atlantic, he confesses to a chronic intoxication and adds, 'the devil had got hold on me and I served him well.'^[9]

​Of the other branch of this first generation much less is known. Joseph's paternal grandfather, Asael Smith, nicknamed 'crook-necked' Smith, at the age of eighty-six, is spoken of as 'just recovering from a severe fit' and of 'weak mind.'^[10] There is nothing more to be made of this than mental failure due to senility.

Returning to the more significant maternal line, Joseph's grandmother Lydia Gates Mack, at the age of forty-seven, had 'a severe fit of sickness. She was so low that she, as well as her friends, entirely despaired of her recovery.'^[11] She was however alive in 1815, aged eighty. Proceeding to the second generation, of Joseph's father, only two slight illnesses are recorded,^[12] one of them was, curiously enough, at the time of Joseph's first real seizure. But to leave the ascendants, it is noticeable that the collaterals on the male side were uniformly healthy. Of Joseph's uncles, Jason, Daniel and Solomon (2d) nothing is said; Stephen is described as robust, and as being ill but four days before his death. It is different with the female side. Of Lydia, no pathological details are given, but Lovisa, despite her 'miraculous recovery' died of consumption within ​two years, and Lovina succumbed to the same disease after lingering three years.^[13]

As to the mother of the prophet, her hallucinations have already been described; the coincident sickness is like that of her sisters. At the age of twenty-six, after the birth of Alvin and Hyrum, Lucy 'took a heavy cold, which caused a severe cough. . . . A hectic fever set in, which threatened to prove fatal, and the physician pronounced my case to be confirmed consumption.' Of the course of recovery there is no information, but, in middle life, judging from her ability for hard work, Lucy appears to have been in good health. But immediately before the birth of Joseph, in 1805, his mother was in indigence, if not positive want.^[14] It was, however, not until 1811, that Joseph, senior's mind 'became much excited upon the subject of religion'; his seven visions then followed at the rate of one a year. His death, at seventy, was said to be due to the 'eruption of a blood vessel.'^[15]

​Before further examination of Joseph's neuropathic antecedents, and in order to complete the tale of the generations, a word may be said concerning his progeny. From sources which cannot here be divulged, comes the significant fact that 'fits' have reappeared, not in the fourth,^[16] but in the fifth generation. The atavism in the prophet's case is clear: he stands midway in the series. As to the causes productive of the epileptic tendency, heredity has its acknowledged primacy. If one so pleases, heredity may here be taken in its broader sense of mere 'nervousness' in the ancestors. In many cases, it is asserted, the parents need not be directly responsible, for a neuropathic tendency in the family generally suffices. But this case is more pronounced; the grandsire's first 'fit' took place about the age of forty-one, the first 'vision' of the grandson about fourteen. This fulfils the condition that, 'if epilepsy is hereditary the descendants are attacked at an earlier age than the ascendants.'

Besides an inherited nervous diathesis, diseases furnished foredisposing causes. More is made of Joseph's individual vicissitudes than of all his nine brothers and sisters put together.^[17] In 1811 all ​the children had 'typhus' [typhoid ?] in Lebanon, N. H. Within a month of recovery, at the age of six, Joseph developed a 'fever sore,' first on the breast, then on the leg; the latter sore being similar to that of his grandfather Mack's. A portion of the 'bone of the leg' was removed by surgeons, without the use of anesthetics. At the age of ten, Joseph was still lame; in the forties he escaped regular military duty by pleading lameness as a disability.

If a nervous diathesis, an infectious fever, and an ulceration, may be considered likely predisposing causes, the exciting causes of the seizures are equally marked. Nervous instability, consequent on protracted religious excitement, at the time of puberty, has been elsewhere treated,^[18] but the immediate exciting cause of the boy's first seizure may be laid to fright. 'At the age of fourteen . . . a gun was fired across his pathway . . . he sprang to the door much frightened.'^[19]

​Now the first vision may be explained as a migraine, but the recurrence of this psychic aura, in a more or less stereotyped form, along with otherwise inexplicable injuries and contusions, is to be laid to a real epilepsy. Here alcoholism was first in the list of provocative causes. Joseph's confession as to the 'weakness of youth, foolish errors, divers temptations and gratifications of appetites offensive in the sight of God,'—is to be coupled with the confessions of his adherents that he sometimes drank too much liquor. The frequency of his intoxication cannot be determined; along with Joseph, senior, he was charged by his enemies with public drunkenness; the Mormons themselves acknowledge at least two of the counts. There is no truth whatever in the statement that both parents drank; the neuropathic condition of the mother was transmitted. That alcoholism did but little to debilitate Joseph is proved by his general good health after thirty. It was, however, a provocative agent of his second attack at eighteen, for only the slightest stimulation was necessary to bring about a repetition of the first attack.

The two earliest seizures may be now examined in conjunction. As already suggested, the theophanic portion of the visions may be largely explained as an ophthalmic migraine. Whether this is to be associated with a partial sensorial epilepsy, is determinable, in one case, by what precedes, in the ​other by what follows. Collecting the terms there are the following expressions: 'a pillar of light exactly over my head, above the brightness of the sun, which descended gradually until it fell upon me.' In the second vision the details are fuller and more exact: 'On a sudden, a light like that of day, only of a far purer and more glorious appearance and brightness burst into the room; indeed the first sight was as though the house was filled with a consuming fire. . . . I saw the light in the room begin to gather immediately around the person of him who had been speaking to me, and it continued to do so, until the room was again left dark, except just around him, when instantly I saw, as it were, a conduit open right up into heaven, and he ascended up till he entirely disappeared, and the room was left as it had been before this heavenly light had made its appearance.' This manifestation was repeated twice that night, once on the following day, and also throughout the series. As usual the apparent objective manifestations were actually subjective symptoms. Their similarity is due to the fact that in ophthalmic migraine periodical attacks tend to be similar in the same patient. The visual disturbance is ushered in by a dimness or blindness, then a scintillating scotoma occupies the outer portions of the visual field. Patients experiencing this symptom for the first time cannot give ​an exact account of it, more than that it is a dazzling comparable to that observed in looking at the sun. But with repetition there comes a more accurate envisagement, as in the second vision of Joseph. 'The luminous ball of fire enlarges; its centre becomes obscure; gradually it passes beyond the limits of the visual field above and below, and the patient sees only a portion of it, in the form of a broken luminous line, which continues to vibrate until it has entirely disappeared. Then follows a phase of exhaustion and sometimes somnolence.'

These sequelæ appear in the second vision, but to turn to the prodromata of the first. Joseph says that in this time of great excitement his mind was in a state of 'great uneasiness,' his feelings 'deep and pungent,' and he 'kept himself aloof.' These are the remote premonitory symptoms of an attack, when the patient labors under a singular oppression two or three days beforehand and is irritable, sad and secretive. The real seizure does not follow, unless there are immediate premonitory symptoms. These are not lacking in Joseph's case; the 'thick darkness' may be explained as a migrainous scotoma, but fuller explanation is needed of Joseph's additional statements: 'I was seized upon by some power as to bind my tongue; I was ready to sink into despair, until I found myself delivered from the enemy; I saw two personages, whose brightness and glory ​defy all description, one of whom spake unto me.' Taken in order and with proper terminology these phenomena appear to constitute the real epileptic aura. After the gradually increasing melancholic depression, the patient manifests: first, a sudden terror; second, violent palpitations of the heart, accompanied by a difficulty in breathing and a constriction of the larynx; third, along with these symptoms are complex visual and auditory hallucinations of corporeal figures, such as of fantastic personages who carry on a conversation or deliver a message. More marked, psychic, sensitive and sensory prodromata are manifest in the second vision. Whether this first psychic paroxysm was followed by a real seizure, is undeterminable. It is not, at any rate, the classic major attack. There is loss of consciousness—'when I came to myself'—but nothing from which general convulsions can be inferred. Nevertheless the sensorial migraine is an equivalent for convulsive paroxysms. Again, in the major attacks, there is often lacking the initial cry, tongue biting, and evacuations. The character of Joseph's seizures, whether they are the mild type, the transitional form, or merely epileptoid, is to be gathered only from the whole series, for in individual cases, manifold diversities are found, even in the features of the full epileptic attack.

Turning to the second seizure, it represents the ​more essential features of mental and motor disturbance,—a verbal deafness and feebleness of the limbs, followed by exhaustion and somnolence. The vision proper took place the night before the real seizure. As there was no apparent loss of consciousness, it may be considered merely as the immediate premonition. Moreover, this vision, like the first, was preceded by anxiety and disquietude—'I often felt condemned for my weakness and imperfections.' As an immediate prodroma, it is marked by more exact details. The parallel account gives these extra data. The celestial messenger's appearance was like 'fire,' and 'produced a shock which affected the whole body.' These may be explained as the sensory aura of red color (rothen flammenschein) and the sensitive aura of numbness (engourdissement).

It is now in order to examine alternative explanations. Joseph's second vision is not to be explained as a vertigo, in which either the patient feels himself turning, or external objects seem to move to one side. This night vision resembles a particular variety of epilepsy denominated 'intellectual aura.' It begins with color projections, followed by 'seeing faces'; the auditory sensation-warnings being, in turn, succeeded by 'hearing voices' (Hughlings-Jackson). There is not always loss of consciousness but a state of semi-conscious​ness with reminiscent dreams. (Compare:—'I lay musing on the singularity of the scene, when I discovered the same heavenly messenger again.') The manifestation occurred thrice that night. Such hyperideation was a precursory sign of the real seizure which occurred on the following day. The lad's mother says, 'Joseph stopped quite suddenly; seemed to be in a very deep study.' Being hurried by his brother he 'went to work again and after laboring a short time, he stopped just as he had done before. This being quite unusual and strange, his father discovered that Joseph was very pale.'

Thus far the case appears to be one of those attenuated epileptic attacks, designated vacuity, which is limited to a loss of consciousness with temporary pallor, but the patient does not fall or utter a cry. 'Immovable, with his eyes fixed, and a strange air, he remains as if unconscious, seeing nothing, hearing nothing, in a sort of ecstasy. Perhaps he executes certain automatic movements. It all lasts only several seconds. The patient shortly returns to himself, takes up the conversation at the point where he had left off or returns to his work' (Dutil). Joseph's version of this episode is as follows: Arising 'shortly after' the night vision, he found his 'strength so exhausted' as rendered him 'entirely unable' to work; his father told him to go home, but in attempting to cross the fence his ​'strength entirely failed'; he 'fell helpless on the ground, and for a time was quite unconscious of anything.' The previous night's hallucination of the messenger and the message is then repeated. This reproduction of the seizure under the apple-tree was followed by restlessness and exhaustion. Joseph says, 'I left the field and went to the place where the messenger had told me the plates were deposited.' His mother adds, 'The ensuing evening Joseph made known what passed between him and the angel while he was at the place where the plates were deposited. Sitting up late that evening, together with overexertion of mind had much fatigued Joseph.' Thus the after effects of the attack of September 24th, 1823, took the usual form of nervous exhaustion, a veritable nervous discharge leaving behind a state of collapse corresponding to the intensity of this discharge. In fact these are the prominent sequelæ of all the fully recorded visions. After the fifth, he was 'much exhausted and very tired'; after the sixth, 'he returned to the house, weeping for grief and disappointment;' after the seventh, he was 'altogether speechless from fright and the fatigue of running,' and 'threw himself upon the bed.'

In the same manner the state of coma in the series is uniform in occurrence, though varying in degree. In the first, it was expressed by the words—'when ​I came to myself'; in the second,—'I was quite unconscious of anything'; in the third, 'he was overcome by the powers of darkness and when he recovered, the angel was gone'; in the sixth, 'he did not get home till the night was far spent'; in the seventh, 'he dislocated his thumb, which, however, he did not notice until he came within sight of the house.'

Loss of consciousness, as a chief criterion of epilepsy, has been here emphasized. Yet the classic convulsive symptoms are by no means lacking, hence it is largely from their effects and after marks that they are to be inferred. There must, however, be taken into account the lack of clinical data, for, with the exception of the episode in the field which 'attracted the attention of his father,' the seizures took place away from observers. Now if the fact that the most elaborate of the hallucinations was nocturnal excites suspicion of epilepsy, the fact that most of the attacks were ambulatory attacks, away from home, furnishes cumulative evidence of true epileptic convulsions.

To anticipate the answer to an important question: Were any of these true major attacks? The second main seizure and the immediate falling 'helpless to the ground' bespeak a spasmodic innervation of the limbs. Furthermore the dislocation of the boy's thumb in the last attack points to that common ​epileptic symptom of the thumb being forcibly flexed into the hand. If there were any instances of grand mal, the tonic and clonic spasms cannot be distinguished. The former, as sometimes occurs, are here wanting, unless such be the dislocation of the thumb. But the more rapid and violent convulsions, with consequent wounds and excoriations of the skin, are to be gathered from collateral information. The form of the hallucination varies, but these accounts agree as to the after affects. One reads, 'When Joseph got the plates, on his way home, he was met by what appeared to be a man, who struck him with a club on his side, which was all black and blue.'^[20] The other states, 'As he returned and was getting over the fence. one of the devils struck him a blow on his side, where a black and blue spot remained three or four days.'^[21] These ecchymoses are symptomatic of rather severe convulsions. The variety in the terms of explanation—'devils struck, angels chastised, assassins assaulted' him—as in the case of his grandfather, shows the inability of the patient to explain his self-inflicted injuries. Again in the grand mal the prodromata are lacking in half the cases, as here, but unconsciousness outlasts the ​spasm. Joseph on the other hand appears to have been conscious of a series of 'shocks' over the whole body. In the third seizure, according to his mother, 'he was hurled back on the ground with great violence'; again, according to a reported statement of his father, 'he felt something strike him on the breast, which was repeated a third time, always with increased force, the last such as to lay him on his back.'

The evidence in Joseph's case is now in. It remains, if possible, to locate it among the various forms of epilepsy:—1. grand mal; 2. petit mal; 3. transitional; 4. irregular; 5. epileptoid and epileptiform (Northnagel). The classic form of the epileptic attack is not immutable, yet it would be pressing the argument from silence, to identify the omissions in the text, with the occasional omissions in the grand attack. There is the lack, not only of those symptoms already mentioned, but also of the cry, which is more often absent than present; and in particular of consciousness, which is rarely completely retained. Joseph's case is not in the first category, grand mal, for 'the major convulsive attack, with loss of consciousness, presents this constant characteristic,—that it leaves no trace in the memory of the patient.' This amnesia varies in duration. 'Many patients remember the remote premonitory phenomena and even the sensations of ​the aura. Some retain the memory of the first convulsive movements' (Féré). At the same time, it should be allowed that the epileptic attack does not always occur in the same manner; in the same patient it may vary infinitely in aspect, intensity and duration; moreover incomplete attacks may alternate with grand attacks. For all that, there is no single experience of Joseph's which completely fulfils the classic formula:—premonitory symptoms remote and immediate, with both mental and motor disturbances; the attack proper, with its two periods of tonic and clonic convulsions; the after-stage of gradual return to consciousness, with abnormally deep sleep; and the sequelæ—of wounds, bruises, excoriations.

If Joseph's case is not grand mal, it is also not petit mal. He had in the first half of the series premonitions, and in the last half spasms. Again, to anticipate, the depth of his exhaustion and of his unnerved and bruised state militate against the penultimate class,—the so-called irregular forms, in which the epileptic delirium is mild; and in greater degree against the last class,—the epileptoid and epileptiform seizures. These are slight and incomplete and do not comprise violent acts of ambulatory automatism in which the patient senselessly wounds himself. Possibly Joseph's last recorded seizure, with the long flight from home, may be one of ​those irregular forms, in which convulsions are replaced by running.

On the whole, out of the five given varieties, the third, from its inclusive character, best describes Joseph's case. Of course different forms of attack occur jointly, and, like the undefined visions of 1825 and 1826, mental disturbances may arise in place of the whole attack. But if any exactness of definition is required, Northnagel's transitional form of epilepsy fairly includes the variant forms of Joseph's seizures. In general, in the transition-forms, there is loss of consciousness with local spasms. Unlike the rarer petit mal this may occur without any visible outward spasms. The above mentioned variety in Joseph's terms of explanation—he was 'struck, chastised, assaulted'—is in accord with the transitional type of spasmodic phenomena, for the locality, intensity and nature of these are subject to the greatest variation. As to further permutations, it happens but seldom that tonic and clonic spasms appear together, or in succession, as in the major attacks; as a rule there is in this form only one or the other kind. Thus it may happen that certain fingers are rigidly bent or stretched—as Joseph's dislocation of thumb in the last seizure,—or a slight tremor runs over the whole body—as Joseph's 'a shock that affected the whole body.' This latter detail, for fear of mutiplying the number ​of real seizures, has been already considered a mere premonitory symptom. Further discussion of the transitional attack proper is unnecessary, for, as has been said, 'it is quite unprofitable to undertake to enumerate here all the possible multifarious varieties of the picture; the reality surpasses any description.'

As to the immediate consequences of the epileptic attack, besides the nervous collapse already indicated, there is to be incidentally noted the slight aphasia after the longest ambulatory seizure—'Joseph made no answer.' The more marked psychic after effects have been described in the text.

In connection with the psychiatric criteria, such as the hallucination of persecution, Joseph's inter-paroxysmal condition should be studied. The only pertinent statement is, that, previous to the seizure of January, 1827, which took place within a week or so of his marriage, Joseph was 'in good health and fine spirits.' Now this is not opposed to the general constitutional relations, 'as the constitution may be perfectly normal, so in the case of certain epileptics may all pathological appearances on the part of the nervous system be absent; i. e., many epileptics appear to be ailing only at the time of the paroxysms, exhibiting in the intervals the appearance of thoroughly and completely healthy per​sons' (Northnagel). As to the remoter consequences again but one definite fact is obtainable. About six months after the last recorded seizure, Joseph was 'nearly worn out, of gloomy appearance, constitution evidently not strong, and he would fall asleep as he was walking along.'^[22] Joseph's mother attributes this exhaustion to his grief over the loss of his first child, and anxiety as to the stolen portion of the Book of Mormon.^[23] Did this bring on other attacks? Within two months the 'angel visited Joseph'; this was soon after followed by a 'revelation.' Again on September 22, 1828, just a year after the last fully recorded vision, he received a message that 'the servants of Satan have sought to destroy you.' Whether these visitations are to be identified with epileptic seizures is immaterial;^[24] the point here is that, as regards mental manifestations, 'it is undoubtedly possible for an absolutely healthy state of mind to coexist with epilepsy.' Historical tradition tells of numerous highly gifted ​men who suffer from epilepsy, and whose deeds do not allow the recognition of any mental deterioration.

Finally, as to Joseph's relief from these seizures: there seems to have been a spontaneous cure in his twenty-third year. This recovery was facilitated positively by the infrequency of his attacks, negatively by the fact that the seizures were of the non-vertiginous variety. Whether these youthful experiences seriously affected his mind is to be determined only from a view of his whole public life, from the time he was tarred and feathered by a mob to his last days of colossal egotism. The prophet's mental soundness is a question for the alienist to decide. Nevertheless parsimony demands a cautious judgment, for in decided reaction against the opinion formerly maintained, it has been proved by statistics, that alienation occurs only if the epileptic seizures follow in unusually rapid succession.