It is difficult to establish whether or not Joan of Arc or Hildegard of Bingen (or any other mystic displaying similar behaviour), suffered from such neurological ‘malfunctions’ as the above described illnesses. Even modern medicine does not always find it easy to diagnose temporal lobe epilepsy. The diagnosis is usually made clinically on the basis of reported or observed symptoms (although doctors rarely witness actual seizures, which are not always identified by EEGs either), and as hagiographical records provide the only evidence of the mystic’s behaviour, a clear and unbiased conclusion cannot be reached. The signs of an epileptic attack are unmistakable.
Hallucinations can occur in temporal lobe epilepsy despite an absence of physical seizures. However, an individual may experience a personality change at the onset of epilepsy, and hyper-religiosity is a common symptom. Hagiographic records show that Joan of Arc underwent a change, with her piety noticeably increasing after her visionary experience. Although some symptoms may speak for themselves (such as the strong evidence for Hildegard of Bingen’s migraines), no doctor would diagnose with confidence on the basis of the historical records – not at least, without ignoring a great deal of material to which the mystic’s contemporaries attached enormous importance.
Whilst many of the symptoms included in the criteria for temporal lobe epilepsy match the behavioural patterns of several mystics, there is one primary difference between epileptic and mystic states that cannot be ignored. That is, the symptoms of temporal lobe epilepsy are clear to see. The principal indicator of an impending episode is a ‘staring spell’, where the individual appears to lose contact with the world as their expression becomes blank. Joan of Arc reportedly kept her visions and voices secret for years, which means the question then arises: If she suffered from such an acute form of epilepsy that she experienced hallucinations, how did her other symptoms go unnoticed? Temporal lobe epilepsy also worsens over time, and considering how often Joan had visions (sometimes several times a day), it would be rational to conclude her ‘staring spells’ to be blatant. However, there are no records of this behaviour of any kind. Whether or not her blank appearance was understood as a side-effect of religious experience, surely it would have been documented.
Seizures are also a definitive symptom of temporal lobe epilepsy but there is no evidence that Joan ever suffered from convulsions. It is true that confusion is a common feature of the aftermath of convulsions, and it is also true that in an early letter she demonstrates confusion (describing herself both in the first and in the third person). This is very thin evidence for a convulsion, and no evidence at all of epilepsy. Moreover, she was hardly the only writer to employ the third-person mode of speech. Julius Caesar did the same (interestingly, his epilepsy is well-enough documented for the diagnosis to be unambiguous). The swapping from first- to third-person narrative is the only evidence, but even if she was confused, this may simply have been due to her being an infrequent, uneducated and unsophisticated writer. Although Joan testified to hearing voices many times a day throughout her imprisonment, it would not be reasonable to ‘diagnose’ Joan as ‘epileptic’. If she had been, her condition would have been at such a developed stage (revealed by her hallucinations), it surely could not have escaped notice. The diagnosis of temporal lobe epilepsy simply cannot be supported.
Despite this conclusion, Joan of Arc clearly displayed some form of unusual psychological activity. The behaviour of several other mystics has been compared to hers, although with differing diagnoses. Hildegard of Bingen is a prime example, for although some neurologists believe her visions were due to epilepsy, others have proposed that she was migraine sufferer.
Migraine n. A recurrent throbbing headache that characteristically affects one side of the head. There is sometimes forewarning of an attack (an aura) consisting of flickering bright lights or blurring of vision, which clearly up as the headache develops. It is often accompanied by prostration and vomiting…Scotoma n. (pl. scotomata) a small areas of abnormally decreased or absent vision in the visual field.
Visual hallucinations may also occur in migraine attacks, but the dazzling ‘flickering bright lights’ or sparks are technically known as phosphenes, followed by blinding scotomata, are the commoner pattern.
Hildegard portrayed visual representations of her symptoms through paintings and illuminations (termed ‘migraine art’), and they have much in common with the creations of contemporary ‘migraine artists’. It is thus tempting, when looking at her art, to attribute her world vision largely or wholly to migraines and to draw similar conclusions about her theological writings especially relating to visions. Speaking of their visions, Hildegard, (and her contemporaries), talk of ‘points of intense light’, and ‘splendid and beautiful stars’. Describing her state during visions Hildegard also speaks of vomiting and paralysis, describes scotoma vividly, and after experiencing visions says she was often left prostrated and debilitated. All these signs and symptoms amount to a classic clinical presentation of migraine. After an attack, migraine sufferers also generally experience euphoria, which Hildegard also described, although interestingly, missing from any of her accounts is a mention of headache or pain.
It was not until seven centuries after Hildegard of Bingen produced her illuminations for her painting Scivias that the first technical medical illustration of the scotoma associated with migraine was published. It is now widely believed that in at least some of her paintings Hildegard of Bingen expressed visions associated with a migraine attack. The neurologist Oliver Sachs identified ‘fortifications’ in Hildegard’s City of God, which is the term used to describe a common form of migrainous visual disturbance. He also describes Hildegard’s Head of God, as demonstrating a ‘typically migrainous fortification figure…radiating from a central point, which is brilliantly luminous and coloured’.
Through comparison between Hildegard’s painting and modern day representations of migraine art, I agree with the theory that she suffered from migraines. In particular an unusual strain, known today as ‘Migraine Aura without Headache’, also referred to as Ocular, or Silent Migraine. This condition refers to a migraine attack that does not include a headache, while the term Migraine Aura is used to describe many of the other symptoms that are connected to it; usually referring to visual symptoms. These include seeing ‘zigzags’ and flashing lights, both of which were documented by Hildegard. It is estimated that only about fifteen percent of sufferers of migraines experience this ‘aura’.
Migraine Aura Art is a vent through which migraine sufferers can try and explain what they experience during an episode. There is a flourishing and creative migraine art movement, which has developed into a whole artistic world. Drawings, paintings, and photography all detail migraines and migraine aura that usually cannot be documented due to their ineffable nature. It is not known when the first migraine sufferers began to express their symptoms artistically, but it is likely that their symptoms infiltrated many paintings that originally focused on other subjects. Though migraine cannot explain all her visions, I believe that St. Hildegard expressed both religious beliefs and migraine auras through her art – symptomatic of silent migraine.
We are as accustomed to seeking rational, scientific explanations for the unusual as our medieval forebears were to seek a religious one, and for many, the former have entirely supplanted the latter. We suffer from the handicap that it is impossible to unlearn the advances of the last seven centuries, and to reach an understanding of what happened then through medieval eyes demands an almost impossible leap of imagination. No doubt twenty first century perspectives will seem alien and remote to future generations. My reading has not led me to think that later approaches should supplant earlier ones, because we are not comparing like with like. We can say with certainty that Galileo supplanted the flat-earthers, but we are on much less certain ground if we say that we now “know” that there is a medical explanation for what was once thought to be purely spiritual experiences. With one exception, I conclude from the studies in this investigation that the mystics’ experiences were primarily religious, although modern medicine throws interesting sidelights on them. The exception is Hildegard of Bingen; it seems overwhelmingly likely from her art that she did suffer from migraines – but migraine is a quite inadequate explanation of her religious experience.
In an attempt to draw a conclusion a primary question arises regarding whether or not it can be accepted that overarching medical diagnoses exist that are neither culturally nor socially bound. Unfortunately however, it is not possible to arrive at a definite conclusion. Modern interpretation can and has been effectively ascribed to historical study, although any analysis, claim, or diagnosis must not disregard cultural and social context. It may be wholly accepted that, ‘medieval people gave theological significance to behaviour that psychiatrists and doctors today see in secular terms’, but the theological significance should not be overlooked. When studying any period in history it seems as though a choice is presented: to approach the task from a cultural and historical context; or to apply modern methods of analysis.
There are advantages to both approaches. Modern interpretation arguably affords a greater and more rational understanding of human behaviour and psychology. However, it could be said that any contemporary, scientific understanding is inherently biased towards modern society – the theories are based on modern people, and are intended for the same audience. On the other hand, cultural contextual analysis provides an understanding of personal motives and social influences that are appropriate to the time. One cannot ignore the advantages of modern science, nor deny the fact that mental illness existed in the Middle Ages, yet any effective understanding or diagnosis of these historical and religious figureheads must incorporate some textual analysis. Such a comprehensive approach would provide a ‘deeper understanding of what the ideas and lives of medieval women really meant [which] not only helps us explain why they were as they were, it also rescues them from oblivion and illuminates their humanity’.
Despite all the material available involving female mystics, there is no definitive evidence to warrant modern-day diagnoses being ascribed to them. It is clear that the women experienced symptoms fitting with contemporary illnesses and may well have suffered from psychological maladies, but it is impossible to be sure whether they were unwell or hyper-religious, as medical definitions and testing had not been invented in medieval times. It would be too convenient to mould a mystic’s ‘symptoms’ to fit a contemporary diagnosis, and I do not believe it can, or should be done. Instead, as a relationship between religious and psychotic states cannot be proved, since religion and religious feeling are not tangible, the mystic’s visions and experiences should be understood in a religious context as they were intended. Even if it could be proved that many mystics suffered from anorexia, schizophrenia, or any other psychological disturbance, modern scholarship is in no position to doubt the legitimacy of the experiences of divine revelation they claim to have had. Religion is intensely personal, and holy experiences generally have deeply profound effects on the individual. The lives of the women I studied were defined by the experiences they had and I believe they should be read as divine, rather than pathological, especially considering psychotic and mystic states are not mutually exclusive.
 The Epilepsy Association describes such an episode thus: “People's perceptions can be changed: some think things are bigger or smaller than they really are; others experience hallucinations. This does not only mean seeing things that are not really there, it can also mean smelling non-existent odours or hearing something that others cannot” (http://www.epilepsy.org.uk). The November 1998 edition of Neurology magazine “The seizures and their effects on the patient become more severe over time [the effects on the patient include] psychological and social consequences due to the inability to drive, perform adequately in school, gain useful employment or have meaningful relationships because of the direct effect of the seizures or the stigma associated with them.”
 E. A. Martin, ed., Concise Medical Dictionary, 7th edition
 Oliver Sacks, Migraine, (London: Picador, 1995)
 Christian Ruete, Textbook of Ophthalmology, (Netherlands: Springer, 1845).
 Seymour Diamond and Mary Franklin, Headache Through The Ages, (Oxford: Blackwell, 2005).
 Bynum, C, Holy Feast and Holy Fast The Religious Significance of Food to Medieval Women, p.195.
 Ibid. p.302.