Inner demons. Composer Frédéric Chopin has a wary look in his eye in this portrait. Who knows what epilepsy-induced hallucinations he was seeing?

Credit: Close up from a painting by Eugène Delacroix

In 1848, Polish composer and piano virtuoso Frédéric Chopin was performing at a house in Paris when he suddenly stopped in the middle of a piece and left the stage. In a letter to a friend, Chopin later wrote:

"I was about to play the [Funeral] March 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. I had to leave for a while in order to recover myself, and after that I continued playing without saying a word."

Although Chopin's family and friends interpreted such episodes as the colorful workings of a sensitive and brilliant mind, a new paper offers another hypothesis: Chopin suffered from temporal lobe epilepsy, which caused him to have frequent hallucinations.

"Our aim was to split the romanticized cliché from reality in order to better understand his life," says Chopin fan and lead author of the study, radiologist Manuel Vásquez Caruncho of Xeral-Calde Hospital in Lugo, Spain.

Perhaps because of the tortured artist archetype and his well-documented poor health, Chopin, who died in 1849 at the age of 39, has been a popular subject for posthumous diagnoses. Originally reported to have died of tuberculosis, the composer probably fell victim to cystic fibrosis or liver disease, according to extensive research by medical historians. However, researchers have paid little attention to his neurology; doctors during Chopin's time knew little of psychosis and nothing of epilepsy.

In their analysis, Caruncho and his co-author, neurologist Francisco Brañas Fernández, drew heavily from descriptions of Chopin's behavior by his friends and pupils and from his own writings. Their vivid recollections report finding the composer late at night, "pale in front of the piano, with wild eyes and his hair on end," unable to recognize them for short periods. He spoke often of a "cohort of phantoms" that haunted him, of seeing his friends as the walking dead, and feeling "like steam."

Only a handful of neurological disorders produce the phantasmagoria that tormented Chopin, who didn't abuse drugs or alcohol. The visions he described, such as demons crawling out of his piano, are now known as Lilliputian hallucinations: detailed visions of people or objects that are much smaller than they are in life. The authors rule out schizophrenia and other common psychoses because Chopin's hallucinations were visual, not auditory, and because he lacked other telltale symptoms such as eye problems or migraines. His short hallucinatory episodes are a hallmark of temporal lobe epilepsy, the team reports online today in Medical Humanities.

Without the ability to observe Chopin himself, the authors admit that it is difficult to be conclusive, although Caruncho says that testimonies from witnesses are key in diagnosing epilepsy even today. Eric Altschuler, a physician and neurologist at New Jersey Medical School in Newark, says that although the study is interesting, at this point it's not convincing. "Historical diagnoses should be pretty straightforward; this one is subtle," he says. "But it's a good, thought-provoking proposal. Epilepsy is very, very common. It's quite possible."

Caruncho hopes the analysis will lead to more research on Chopin's diseases. In the meantime, he is continuing his hobby of researching the medical history of other musicians such as Beethoven. Says Caruncho, "I guess I'm a pathological music lover."