Frédéric Chopin's music was moving and expressive. But the Polish composer and pianist was a frail and sickly man who died young; his life ended just 39 years after it began.
Over the years, experts have proposed a variety of diagnoses for Chopin's health woes, ranging from bipolar disorder to pulmonary tuberculosis. A new analysis adds another theory.
Regular hallucinations, bouts of melancholy and other symptoms point to epilepsy, the researchers say. Their findings may offer new insight into a gifted man and his brief life.
"The hallucinations of Chopin were considered the manifestation of a sensitive soul, a romantic cliché," said Manuel Várquez Caruncho, a radiologist at the Xeral-Calde Hospital Complex in Lugo, Spain. "We think that to split the romanticized view from reality could help to better understand the man."
The results of Chopin's autopsy have long been lost, but plenty of scientists and historians have written about the composer's health.
Born in 1810, Chopin suffered throughout his life from breathing troubles and fevers. He was emaciated, coughed often and had frequent lung infections. He had diarrhea as a teen and severe headaches in adulthood. Melancholy plagued him.
The most commonly proposed diagnoses for Chopin's problems are cystic fibrosis and alpha 1-antitrypsin deficiency, a genetic lung disease. There have also been speculations of depression, bipolar disorder and heart disease.
A lung condition is certainly what killed Chopin. But as Várquez Caruncho read through the composer's biographies and letters with his own medically trained eyes, he noticed symptoms that seemed to describe a seizure disorder -- a condition that had never been mentioned regarding Chopin.
Intrigued, he dug deeper. Already a music-lover who is particularly fond of Chopin's work, Várquez Caruncho pored through papers and books, including "The History of My Life," by George Sand. A female French novelist, Sand had a decade-long affair with Chopin starting in the mid-1830s.
As the radiologist read about the composer, he kept his eyes open for anecdotes and scenes that fit within known seizure symptoms.
He found quite a few. In a letter to Sand's daughter, for example, Chopin described why he abruptly left the room while playing his Sonata in B flat minor during a concert in 1848. "I was about to play the March," he wrote, "when suddenly, I saw emerging from the half-open case of my piano those cursed creatures that had appeared to me on a lugubrious night at the Carthusian monastery."
Sand wrote about "terrors and ghosts" that Chopin could not overcome. She mentioned "the anxiety of his imagination." Chopin himself described feeling "far away -- as usual in some strange region of space."
Várquez Caruncho noticed some patterns in descriptions of the composer's hallucinations. They were, for example, complex, purely visual and recurring. They lasted from seconds to minutes, and Chopin could remember them in detail. His visions sometimes made him feel disconnected from reality. And they often happened in the evenings or along with fevers.
Because Chopin did not hear voices and his mental state remained stable, it was unlikely that he had schizophrenia, major depression, bipolar disorder or other forms of psychosis, according to the new paper, which Várquez Caruncho published with neurologist Francisco Brañas Fernández in the journal Medical Humanities. Based on the features of his hallucinations, the researchers also ruled out migraines with auras and toxicity from medications.
Instead, they proposed that Chopin had temporal lobe epilepsy, which can produce brief and visual hallucinations preceded by fear, anxiety, sleeplessness and depression. Convulsions aren't necessarily part of the disease.
The condition, which is the most common form of partial epilepsy and affects just one part of the brain, hadn't yet been described during Chopin's lifetime. A British neurologist first defined it more than a decade after his death in 1861.
Given Chopin's symptoms, a diagnosis of temporal lobe epilepsy is plausible though there are still other possible explanations, said Barbara Dworetzky, Chief of the Division of Epilepsy, EEG and Sleep Neurology at Brigham and Women's Hospital in Boston.
He apparently took opium drops as one of his medications, for example, and opium can cause hallucinatory experiences. It's also possible that Chopin's lung condition could have deprived his brain of oxygen, leading to hallucinations.
If the new theory is right, Chopin wouldn't be the first famous person to have had temporal lobe epilepsy. Joan of Arc and Vincent Van Gogh are both thought to have suffered from the condition.
Whether his epilepsy affected the content his art is an open question. Chopin's acquaintances often saw his hallucinations as expressions of genius and examples of his sensitive nature. Instead, the new findings suggest that these episodes were simply a medical symptom of an unrecognized disorder.
Seizures are facts of life for people with epilepsy, Dworetzky added. But seizures don't necessarily define their lives.
"Most people with epilepsy are whoever they are, and then they also have seizures," she said. "It's not the epilepsy that makes them brilliant or genius."