Chopin's hallucinations were probably caused by epilepsy

Chopin was renowned, among other things, for his frailty and sensitivity, which turned him into the epitome of the romantic artist.

While his well documented bouts of melancholy have been attributed to bipolar disorder or clinical depression, the hallucinatory episodes to which he was also prone have tended to be overlooked, suggest the authors.

They draw on the composer's own descriptions of these hallucinatory episodes, and accounts of his life, given by friends and pupils.

Chopin, who was plagued by poor health throughout his life, died at the age of 39 as a result of chronic lung disease in 1849, which has recently been attributed to cystic fibrosis, based on the composer's family history.

During a performance of his Sonata in B flat minor, in England in 1848 at a private salon, Chopin suddenly stopped playing and left the stage—an event recorded by the Manchester Guardian's music critic.

In a letter written to the daughter of George Sand in September that year, Chopin describes the moment during the performance when he saw creatures emerging from the piano, which forced him to leave the room to recover himself.

In her memoirs, George Sand recalled a trip she and the composer took to Spain in 1838. She describes the monastery where they stayed as being "full of terrors and ghosts for him," and various incidents in which Chopin appeared pale, or with wild eyes, and his hair on end. She also recounts the vivid descriptions he gave her of the visions he had had.

There are other accounts, both by George Sand, and by one of Chopin's pupils Madame Streicher, of similar incidents, and the composer's own description of a "cohort of phantoms" in 1844.

Hallucinations are a hallmark of several psychiatric disorders, such as schizophrenia and dissociative states, say the authors, but usually take the form of voices.

Migraine can also produce hallucinations, but these can last up to half an hour, while Chopin's were often brief; and migraine auras without headache mostly mainly occur in patients over the age of 50, say the authors. Charles Bonnet syndrome is also discounted as Chopin had no eye disorders.

Chopin did take laudanum to quell his various physical symptoms, but the type of visual hallucinations associated with this do not correspond to Chopin's and the composer also began experiencing them before taking this medication, say the authors.

Rather, they think that temporal lobe epilepsy is a more likely explanation as it can produce complex visual hallucinations, which are usually brief, fragmentary, and stereotyped, just like those Chopin said he experienced.

The authors acknowledge that without the aid of modern day tests, it is difficult to make a definitive diagnosis, but comment: "A condition such as that described in this article could easily have been overlooked by Chopin's doctors," adding that there was limited understanding of epilepsy at that time.

"We doubt that another diagnosis added to the already numerous list will help us understand the artistic world of Frédéric Chopin. But we do believe that knowing he had this condition could help to separate romanticised legend from reality and shed new light in order to better understand the man and his life."

Provided by British Medical Journal