Epilepsia, 49(9):1488–1490, 2008
doi: 10.1111/j.1528-1167.2008.01614.x
CRITICAL REVIEW AND INVITED COMMENTARY
Psychoses of epilepsy in Babylon: The oldest account
of the disorder
∗
Edward H. Reynolds and †James V. Kinnier Wilson
∗
Institute of Epileptology, King’s College, London, United Kingdom, and †Faculty of Oriental Studies,
University of Cambridge, Cambridge, United Kingdom
SUMMARY
We have previously published translations of Baby-
lonian texts on epilepsy and stroke, which we be-
lieve to be the oldest detailed accounts of these
neurological disorders from the second millennium
BC. We now present a short Babylonian text, which
clearly describes what are today known as interic-
tal or schizophrenia-like psychoses of epilepsy. The
text includes many of the classical symptoms of the
syndrome, for example, paranoid delusions, hallu-
cinations and mood disorders, as well as religios-
We have previously published a Babylonian neurolog-
ical text on epilepsy based on a tablet in the British
Museum, London, and a duplicate in the Archeological
Museum at Ankara, Turkey (Kinnier Wilson & Reynolds,
1990, 1991). The epilepsy tablet is numbered 26 in a se-
ries of 40 tablets which comprise an early Babylonian
treatise on diagnostic medicine known as Sa-gig (Sume-
rian) or Sakikku (Babylonian), which means “all diseases”
(Kinnier Wilson & Reynolds, 1990, 1991; Stol, 1993). The
exact date in the middle of the second century BC of the
original compilation is not known, but a revised edition was
composed during the reign of the Babylonian king, Adad-
apal-iddina, between 1067 and 1046 BC and the two sur-
viving tablets are copies, which have descended from that
time.
The Babylonians were keen observers of neurologi-
cal and medical disorders and the epilepsy tablet pro-
vides accurate descriptions of what we recognize today
as tonic–clonic, absence, Jacksonian, complex partial and
even gelastic seizures. However, they had little understand-
Accepted March 10, 2008; Early View publication May 8, 2008.
Address correspondence to Edward H. Reynolds, Institute of Epilep-
tology, Weston Education Centre, King’s College, Denmark Hill Cam-
pus, Cutcombe Road, London SE5 6PJ, U.K. E-mail: reynolds@buckles.
u-net.com
Wiley Periodicals, Inc.

C 2008 International League Against Epilepsy
1488
ity and hyposexuality, which have only been crys-
tallized in the twentieth century. The Babylonians
were remarkably good observers of human disease
and behavior but had little or no understanding of
pathology or brain function. Although they recog-
nized many natural causes of disease, epilepsy and
behavior disorders were attributed to supernatu-
ral, usually evil forces, the forerunner of the Greek
concept of the Sacred Disease.
KEY WORDS: Epilepsy, Babylon, Psychoses,
Schizophrenia.
ing of pathology and no understanding at all of the func-
tions of the brain. Seizures were thought to be due to su-
pernatural invasion of the body by demons, each seizure
type associated with the name of a particular demon, the
forerunner of the Greek concept of “the Sacred Disease”
(Temkin, 1971).
A BABYLONIAN T EXT ON E PILEPTIC
P SYCHOSES
The Babylonians were also accurate describers of hu-
man behavior and one of us (JKW) has identified a
number of older tablets, which collectively suggest that
they had a grasp of abnormal behavior amounting to
the beginnings of modern psychiatry (Kinnier Wilson,
1965, 1967). Among these is a remarkable account of
what today we call epileptic psychoses or schizophrenia-
like psychoses of epilepsy (Slater et al., 1963; Trimble,
1991).
The relevant texts are AMT 96,7 (i.e., Assyrian Medical
Texts in the British Museum) and its duplicate KAR 26 (i.e.,
Keilschrifttexte aus Assur Religiösen Inhalts published in
Berlin), which can be traced back to the first half of the
second millennium BC.
The key passage from these Babylonian texts has
been published by Kinnier Wilson (1965). By way of
illustration, we have included below the first few lines

of the text, slightly abbreviated for the sake of clarity,
which confirms its relevance to epilepsy. The lines read in
transcription:
šumma amēlu antašubbû bēl ūri. . .qāt etimmi qāt māmı̂ti. . .
eli-šu ibašši alû lemnu ireddi-šú. . .
and may be literally translated:
“If a man has been suffering from antašubbû, bēl ūri,
qāt etimmi or qāt māmı̂ti, and an alû lemnu then begins to in-
flict him with ideas of persecution. . .”
Of the terms mentioned, the first antašubbû, is a Sume-
rian loanword and has long been understood to mean “the
falling disease,” that is, epilepsy characterized by major
seizures. The term bēl ūri which follows means literally
“the lord of the roof,” and was evidently the ancient term
for an absence attack, the common rolling up of the eyes
being caused, supposedly, by a demon lurking in such a
position as the roof of a house. qāt etimmi means “the
hand (power or influence) of a ghost,” and although it may
have had a wider significance, we have suggested (Kinnier
Wilson & Reynolds, 1990) that it refers to nocturnal
epilepsy. The word māmı̂ti in qāt māmı̂ti literally means
“oath,” but was used medically to denote conditions in-
volving obsession or repeated action, as if the patient had
sworn an oath to perform a certain action and could not
be dissuaded from doing it. In the context of epilepsy, the
term may readily be understood as referring to the au-
tomatisms of epilepsy or postictal confusion. The words
alû lemnu translate, nonspecifically, to “evil demon.” For
a more detailed discussion of the translation of Babylo-
nian and modern words in relation to the various man-
ifestations of epilepsy, see Kinnier Wilson & Reynolds,
1990.
Below we now present a translation of the text of the
whole passage.
“If a man has been suffering from seizures, absence at-
tacks, nocturnal epilepsy or automatisms, and an (or, pos-
sibly, the) evil demon then begins to inflict him with (ideas
of) persecution so that he says—although no one will agree
with him that it is so—that the finger of condemnation
is being pointed at him behind his back and that god or
goddess are angry with him; if he sees horrible, alarming,
or immoral ‘visions’ and is (consequently) in a constant
state of fear; if he engages in periodic outbursts of anger
against god or goddess, is obsessed with delusions of his
own mind, evolves his own religion, and says—although
(again) they will not allow it—that his family are hostile
towards him and that god, king, his superiors and (city)
elders treat him unjustly; if all his muscles are subject to
weakness, if his eyes are colored red, yellow and black, if
he has a condition of speech such that he forgets what he
wants to say, has no desire for female relationships and no
inclination to pursue any activity (at all) . . . ,” (details of
1489
Psychoses of Epilepsy in Babylon
the action to be taken by the ashipu, i.e. medical exorcist,
follow, but the text is broken at this point).
D ISCUSSION
In understanding the text from the Assyriological point
of view, it is important to consider what is meant by the
introductory, “If a man.” It is a general, and all-embracing,
statement applying, as it were, to everyman, for the “text-
book” manner of describing a disease with many symptoms
was to present the total picture. This is also illustrated in
other Babylonian psychiatric texts, for example, a detailed
description of an anxiety state (Ritter & Kinnier Wilson,
1980). Some details in the present text bear out this con-
clusion. Thus, it should be realized that the phrase “god,
king, superiors and (city) elders” is a stereotype phrase oc-
curring numerous times in the psychiatric texts. It repre-
sents a summation of the several kinds of “enemies,” so
familiar in paranoia, which might frustrate the patient’s in-
tentions or oppose his will. In line also with this compre-
hensive approach may be the discoloration of the eyes as
indicated in the account. Ecchymosis around the eyes is
quite rare in epilepsy, but nevertheless it claims its place in
the physician’s overall typology. Likewise, impairment of
memory may also occur in the context of epileptic psy-
choses, but an alternative explanation for “forgets what
he wants to say” may be thought block associated with
his psychosis.
The association of epilepsy and insanity has been traced
to the Greeks (Temkin, 1971). It was Hippocrates who sug-
gested that epilepsy and madness were not supernatural
but both arose in the brain. Both were thought to be in-
fluenced by the moon and in nineteenth century Europe
epileptic patients were to a great extent treated and cared
for in lunatic asylums. It was only in the late nineteenth
and early twentieth century with the evolution of neurol-
ogy from neuropsychiatry (Reynolds & Trimble, 1989) that
it became clearer that most patients with epilepsy have nor-
mal mental states. Furthermore, in those patients who ex-
hibit mental symptoms the latter can be classified into pro-
dromal, ictal, postictal, and interictal disorders (Trimble,
1991). It was only in the mid-twentieth century that the
concept of the interictal schizophrenia-like psychoses of
epilepsy crystallized with the seminal studies of Slater
et al. (1963). What is very remarkable about this Baby-
lonian text is its close resemblance to present descriptions
of schizophrenia-like psychoses of epilepsy, incorporating
paranoid delusions of persecution, visual hallucinations,
emotional instability and impulsive acts (e.g., fear, anger),
negative behavior and even including such modern con-
cepts as religiosity and hyposexuality. The latter behav-
ioral features have only been recognized in the second
half of the twentieth century as part of a wider interictal
personality disorder occasionally associated with temporal
Epilepsia, 49(9):1488–1490, 2008
doi: 10.1111/j.1528-1167.2008.01614.x
1490
E. H. Reynolds and J. V. Kinnier Wilson
lobe epilepsy (Lishman, 1987; Reynolds & Trimble, 1989;
Trimble, 1991).
This account of epileptic psychoses again illustrates the
very observant descriptions of disease by the Babylonians
as we also noted in our earlier studies of the epilepsy tablet
(Kinnier Wilson & Reynolds, 1990, 1991) and in an ad-
ditional diagnostic tablet on stroke (Reynolds & Kinnier
Wilson, 2004; Kinnier Wilson & Reynolds, 2007). Al-
though the Babylonians understood that many medical
conditions, such as dysentery, worm infections, lung and
eye diseases, wounds and injuries, had natural causes,
epilepsy, stroke, and behavior disorders were the result
of supernatural or “‘hand of God” causes. The former
were treated by an asû or medical practitioner, who used
a wide range of plant and mineral products or surgi-
cal techniques, whereas the latter was the concern of
the ashipu, or medical exorcist, who may be regarded
at least in part as history’s first psychiatrist (Kinnier
Wilson, 1965, 1967). These earliest detailed descriptions
from the second millennium BC suggest that the phe-
nomenology of these disorders may have been remark-
ably constant over 3,000–4,000 years, although our un-
derstanding of their nature and treatment have changed
profoundly.
Conflict of interest: We confirm that we have read the Journal’s position
on issues involved in ethical publication and affirm that this report is con-
sistent with those guidelines. Neither of the authors has any conflicts of
interest to disclose.
Epilepsia, 49(9):1488–1490, 2008
doi: 10.1111/j.1528-1167.2008.01614.x
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