In Chapter 33 of Charles Dickens’s Oliver Twist (1838), a tall lurking man in a ferocious rage advances towards Oliver ‘as if with the intention of aiming a blow at him,’ but collapses ‘violently on the ground: writhing and foaming in a fit.’1 This is Oliver’s first impression of his criminal half-brother, Monks.Dickens does not directly refer to Monks as epileptic. However, the fit in question — along with those featured in some of his other novels such as Bleak House (1852) — accurately portrays what is today referred to as a tonic-clonic seizure. These are the convulsive seizures most associated with epilepsy, in which the muscles stiffen and jerk and the person loses consciousness. The seizure itself is triggered by electrical activity in the brain. While the condition is sometimes linked to genetic factors or brain damage, in most cases doctors cannot establish its root cause.In Victorian England (where the novel is set) epilepsy was understood as a condition of the mind, similar to mental illnesses such as hysteria. In the year that Oliver Twist was published the physician John Elliotson was performing public demonstrations at University College Hospital in London, in which he attempted to cure his patients of their epilepsy by using hypnosis to access what he believed to be the new state of mind that seizures induced. In two of his patients, the sisters Jane and Elizabeth O’Key, he interpreted their epilepsy as ‘convulsions chiefly of the face, and trunk’,2 during which a polite manner was overtaken by violence and aggression.In the context of this poor medical understanding, and at a time when studies tended to focus on captive epileptics already in psychiatric hospitals for more extreme conditions (thereby skewing the research), epilepsy also came to be associated with insanity in the Victorian imagination. As the nineteenth century wore on, psychiatrists such as Henry Maudsley (1835–1918), a senior physician at the West London Hospital, sought to establish a formal link between epilepsy and insanity3 — a link already quickly established by sensationalist press. In the 1840 murder trial of Alexander McClachan Smith, Smith pleaded insanity because he was supposedly seized by a fit at the time of the crime. Caleb Williams, a surgeon at the Retreat Asylum in York, provided medical witness in support of the defendant, claiming that the ‘mania produced by epilepsy is most frequently violent’, and further witnesses testified that Smith was known to have had fits in the past, after which he was ‘rageous’ for a few days (Bradford Observer, 23 July 1840).Epilepsy, of course, predates the Victorian Era. Since ancient times it has been associated with inner evil and sin.4 However, whilst in the 19th century understandings of this condition moved away from the divine or the demonic, the practice of treating epileptics as the ‘other’ endured.Today, representations of epilepsy still play upon perceptions of violence and inner evil, particularly in film. The dramatic nature of seizures make them an easy subject to sensationalise, with the aim of evoking fear and emotion in the viewer. In supernatural films, such as Possession (1981) and The Exorcism of Emily Rose (2005), seizures represent demonic possession — characters are shown to collapse in the same way as Monks, ‘writhing and foaming’, to represent the uncontrolled violence of the evil within them. Through these portrayals of seizures as scary, and epileptics as ‘other’ and dangerous, the legacy of Victorian perceptions of epilepsy are still to be found in popular culture, perpetuating the lack of understanding of the condition.A 2018 study by Epilepsy Action found that although most people had a positive view of epileptics, some had reservations about being alone with those with the condition or allowing them to care for their children.5 People may now not see epileptics in the same light as the characterisation of Monks — as criminal and violent — but the view that epileptics cannot be safe in the same way as others, the idea that they are not in control of their minds and bodies, is yet to fully fade.