Athos 5: Orthodox Monasteries

Churches dominate monasteries in western Europe. A magnificent church is the largest building: cloister, chapter house, refectory, library and dormer cluster around it, commonly are dwarfed by it.

This pattern is well seen in the baroque abbeys of southern Germany: Ottobeuren, Kempten, Benediktbeuren, Vierzehnheiligen, and others; each attesting the consequences of abbots being also bishops and princes, able to set tithes, rents and taxes, and decide their expenditure.

Here in England we have only the ruins of the great mediaeval monasteries, after their dissolution by Henry the Eighth. But we see the same pattern, the church is the dominant ruin.

The church is not the largest building in the four monasteries I stayed in on Mount Athos: IM Agiou Paulou, IM Grigoriou, IM Karakoullou, and IM Koutloumousiou. Their churches are central in a courtyard surrounded by the monastery buildings, usually higher then the church, which may not easily be seen from outside.

[IM stands for Iera Muni - Holy Church - the title of respect for the monasteries and sketes on Athos.]

This image of IM Karakallou shows the layout. The central red-ochre building is the church. The tower and fortified west front were built to protect from pirates.

This the view of IM Karakallou from the approach road. The church is hidden by the monastery.

And this is an image of IM Karakallou church, as seen in the courtyard.

These orthodox churches are aligned east-west, but are not overtly cruciform. A domed central area carries a cupula or lantern, with slit windows. Other roof cupulae admit light to other parts.

Inside they appear small, high and dark, by comparison with British churches. Lights - usually candles on Athos - reveal a wealth of furnishings - icons, gold and silver fittings, and vestments.

Only Greek Orthodox had free admission to the churches in the monasteries I visited: for non-orthodox admission is by invitation, in the company of monks. Photography is not possible. I could attend service only in the ante-chamber - the Narthex.

This is the interior of the small church of Hagia Marina, which we visited on the way to Ouranopolis.

And this diagram shows the features of an Orthodox church - with thanks to Wikipaedia and Phiddipus.

This English Physician found the Athos monasteries fascinating and strangely moving. I am attracted to Orthodoxy, but still sceptical, and suspicious of being manipulated by tradition, beauty, and the radiant confidence of the faithful. A monk I spoke to had no problems with the proposition that Christianity might enter through the emotions, if the intelligence demurs.

That is a concept I need to ponder at length.

Athos 4: The Wine-Dark Sea

Oinops pontos - the wine-dark sea - is a favourite epithet of Homer's.

It surely applies to the seas around the Athos peninsula - a crisp blue in sunshine, from a boat or shore, darkening to indigo from higher angles, in certain lighting conditions.

This happens because the water is very clear; it has little particulate material in suspension to scatter light passing through. In harbours the sea bed is easily visible to considerable depths - I would guess at least 20 feet.

This lack of suspended particles may be attributed in part to relative stillness of the sea. There are no strong tidal flows around Athos; diurnal ebbs and flows are minor, with a tidal rise of maybe one foot - scarcely noticed by visitors. So there are no strong currents or eddies to stir up sediment.

But another factor is infertility of the sea: there is little or no growth of plankton to cloud surface waters, nor of algae and seaweeds near shores. Algae and plankton are the base of the food chain, consequently there is not the abundance of barnacles, limpets, and other molluscs which is familiar on British shores.

Blue waters, bare rocks, low biological productivity.

Here is a picture of rocks near Grigoriou monastery: the absence of attached algae and molluscs is striking.

Fish also seem to be relatively few around Athos. I saw few sea birds - occasional cormorants and gulls. I saw no seals, and no dolphins [OK - human predation may have exterminated seals, and dolphins come and go]. Shoals of small fish are seen in harbours.

But the general infertility of the seas at Athos contrasts with the abundant life in comparable British waters.

Why should this be? I suspect deficiency of essential nutrients, especially iron. This is an oligotrophic environment.

The rocks of Athos are limestones, and generally white or grey. Calcium is in abundance, which may exacerbate the effects of iron deficiency. The north-eastern slopes are covered with sweet chestnut forest - and the chestnut grows well on the white chalk downs of England, another calcium-rich, iron-poor environment.

This picture shows blue sea and white rocks near the southern tip of the peninsula. The erosion at the base of the rocks illustrates the low tidal rise and fall.

Oinops pontos - the wine-dark sea; wine-dark because it is a hungry, infertile sea. Its blue waters and white beaches attract tourists, but disappoint the naturalist.

Finally, this is Cape Pennes, the southern tip of the peninsula.

The Reality of Ruin

Kataphusin lay awake contemplating the coalition, seeing political pygmies tactically tinkering with the reality of ruin; in deliberate denial of a broken, bursting, bankrupt, balkanized Britain; industrially devastated, commercially conquered, socially shattered, economically exhausted; colonised by its colonials; in disrepute after stupid wars.


Kataphusin concludes the threat to the future of Britain may be different in 2010 to the threat in 1940, but is of comparable magnitude.
'Cometh the hour, cometh the man' - but where is a Churchill, waiting for the call?


The prognosis is bad.

Paracelsus: The Incomparable Physician

Einsiedeln is a small town in Switzerland. It is best known for its huge baroque basilika housing a black madonna, which attracts thousands of pilgrims annually.

But it was also the birthplace of one of the most original and colourful of all physicians - Paracelsus.

His true name was Phillippus Aureolus Theophrastus Bombastus von Hohenheim. Notoriously a braggart, he took the pseudonym Paracelsus, meaning 'Beyond Celsus' - the classic Roman encyclopaedist of medicine.

Paracelsus was self-taught. He wrote about his own observations and interpretations. He travelled widely.

He studied the properties of minerals and worked in mines. He is recognised as perhaps the first systematic botanist. He pioneered the study of the medical uses of salts and minerals. 

He documented the diseases of miners, and recognised the association of cretinism [the consequence of thyroid failure in babies] with endemic goitre [swelling of the thyroid gland in people living where iodine is deficient in the soil - usually mountain districts]. He wrote about diabetes mellitus.

He made important improvements to the surgery of wounds, based on his own experience, not the classic writers.

He is credited with original work in psychology.

He was a mystic. His universe is a complex single organism, whose life-giving creator spirit is God - a view towards which my own thoughts are trending.

Unfortunately his writings are obscure and difficult to read and understand. He practised astrology and alchemy, using symbols, ideas and allegories familiar to practitioners of those cryptic specialties, but impenetrable to the modern reader. He is also prone to extravagant and boastful claims.

So obscure is his vocabulary that a student wrote a Dictionarium Paracelsicum to help those struggling to elucidate his writings.

Paracelsus enraged the medical establishment. He wrote and taught in German, not Latin. He spoke of his own knowledge and ideas, ignoring the approved classics. He was forced to flee Basel, where he was briefly town physician, and spent his last decade a wanderer.

He was accused of keeping low company, and hard drinking. 

In Einsiedeln today there is this memorial to Paracelsus, beside the great square in front of the basilika.

Here is the  inscription on the base. 

Here is a translation.

In memory of the physician, researcher and philosopher THEOPHRASTUS PARACELSUS:

medical reformer;

father of chemotherapy;

promoter of biology and wound management;

saviour of those benighted in spirit;

champion of medical ethics;

independent thinker and humble follower of Christ;

friend of the poor.

Born at the end of 1493 near the Devil's Bridge at Etzel, he died after a Faustian life on 24 September 1541 in Salzburg.

Remembered in Einsiedeln, his home.

The right base carries his brief autobiography.

Which translates something like this - the German is dialect and archaic. His disclaimer of rhetoric must be considered ironic!

Because I can by no rhetoric or subtlety declare myself, but only in the language of my birth and dialect, I am from Einsiedeln region a Swiss.

Then I have wandered through the lands and become a foreigner in my time, alone and strange and other. There, O God, you have grown patiently your art under the breath of the fearful wind with pain in me.

And on the left base there are these quotations.

Let no man be other who can be himself.

Each one remains as a rock in his being.

The child needs no stars and no planets: his mother is his planet and his star.

Blessed and more than blessed is the man to whom God gives the grace of compassion.

The right door of medicine is the light of Nature.

The highest plane of medicine is Love.

Incomparable - there has been no other physician like him. But he is an example of an important principle.

No matter how original and important your observations and ideas may be, they are valuable only if you explain them clearly, simply and fluently.

Epilepsy: Difficult Judgements.

A case of epilepsy is in my experience the most searching test of a physician's skill. This case is perhaps an extreme example, but the management of epilepsy is never easy.

Gail was 19 when she first came to my out-patients' clinic. She was a student at a local college.

She had suffered two major epileptic fits two days before, a Sunday. On the Friday before she had drunk to considerable excess at a party, so much that she could not remember how she had got back to her student lodgings, and she had stayed in bed most of Saturday.

As a young child she had suffered a number of fits, indeed she had a substantial folder of hospital notes generated during attendances in the paediatric department. Extensive investigation at age 5 had shown only minor anomalies on the electro-encephalogram. She had taken anti-convulsant tablets until the age of 12, but had then stopped, having been free of fits for 3 years. A repeat electro-encephalogram at that time showed no abnormality.

Off treatment she had had no more fits until the recent events. Until Saturday she considered herself to be a normal, healthy, active young woman.

Her big interest was her 500 cc motor bike. She belonged to a local motor-cycle club, and spent most of her weekends out with them. Indeed she had come to the hospital on her motor-cycle, arriving in leathers and helmet.

Examination and a set of routine tests were unremarkable. A repeat electro-encephalogram and a CT scan were each reported normal, but those results took several days to come through.

Two important issues had to be considered immediately.

1. Should she take anti-convulsants again?

2. Should she continue riding motor-cycles?

Anti-convulsant treatment is not simple. Anti-convulsants reduce the fit frequency; they do not guarantee that no more fits will occur. Anti-convulsants have a long list of side-effects, notably sedation. Gail was at college, preparing for exams. Her academic performance could well be impaired.

The drunkenness was an obvious aggravating factor. What was the risk of further fits if she took no medication but avoided alcohol, fatigue, noise, flashing lights, excitement? Probably low, but not negligible. Just 4 days had passed since the party, and 2 days since the fits: she had to be considered still at some additional risk for several days more.

I decided to recommend a 1 month course of phenobarbitone: a 30 mg. tablet at bedtime for 2 weeks, then a 15 mg. tablet for 2 weeks more.

Phenobarbitone has the advantage of long duration of effect. A single daily dose aids compliance; a bedtime dose means the worst of the sedation is during the night.

Phenobarbitone increases the metabolism of hormones and drugs. It can interfere with the effectiveness of oral contraceptives. I warned her of this; she blushed, she wasn't on the pill.

She took the tablets as prescribed. She had no further fits and stopped medication at the end of the month.

But what about the motor-cycling? I advised strongly she should not do it: I had a duty to advise her to inform the Licensing Authority. That might well mean losing her licence for a minimum of 2 years.

I also advised she should inform her insurance company, which would risk loss of cover.

She became very upset. This was her main leisure interest; her friends were in the motor-cycle club; if she couldn't ride she couldn't meet them. Tears flowed, tissues were passed.

I recorded my advice in her notes, and in my letter to her general practitioner.

I saw her for review several times over the next 3 months. No more fits occurred during this time, but she continued riding her motor-cycle, not informing the licensing and insurance people.

I repeated my advice at each visit, but she did not heed me. She reassured me she was very careful with alcohol, avoided fatigue, and felt very well.

Still I was worried. She was epileptic. Further fits were unlikely, but not impossible.

I had visions of a fit causing an accident. On her motor-cycle she was a serious risk to herself, and, even worse, to other people. Supposing she crashed into school children at a bus-stop?

Did I have a duty to inform the Licensing Authority myself, without her consent?

I had a professional duty of confidentiality; did I have a public duty of protection?

Eventually I sought the opinion of the Regional Hospital Board's Solicitor. His advice was unequivocal. My duty was to Gail: I must advise her, and record that I had done so. It was Gail's responsibility to inform the relevant authorities. For me to do so would be a serious breach of professional confidence. On his advice I sent to Gail by recorded delivery a letter explaining the issues raised by her relapse and advising her that she a legal duty to inform the Licensing Authority, and that she must also inform her insurance company.

She did not reply, and failed to come to further appointments: I never saw her again.

Athos 3: Can Paulinus Persuade?

Why does a man become a monk? What mind-set turns a man's eyes and thoughts inward, away from the world?

One clear and forceful answer is in a latin poem by Paulinus of Nola.

The story of Paulinus and Ausonius opens Helen Waddell's study of late Latin poetry - 'The Wandering Scholars'.

Ausonius: scholar, royal tutor, consul in 379, now old and in retirement on his estate near Bordeaux.

Paulinus, his favoured student, a short-time senator, who became an ascetic christian and the founder of a small monastic settlement at the tomb of St. Felix of Nola, in Italy.

Ausonius wrote to Paulinus, begging him to visit. Eventually Paulinus replies, explaining his choice of a secluded, contemplative life devoted to religion. Paulinus was married, and not himself a monk; but went on to become Bishop of Nola, and finally a saint.

Here is Helen Waddell's translation of Paulinus' response to Ausonius [the latin is appended]. 

>>

Not that they beggared be in mind, or brutes,

That they have chosen their dwelling place afar

In lonely places: but their eyes are turned

To the high stars, the very deep of truth.

Freedom they seek, an emptiness apart

From worthless things: din of the market-place,

And all the noisy crowding up of things,

And whatsoever wars on the divine,

At Christ's command, and for His love, they hate;

By faith and hope they follow after God,

And know their quest shall not be desperate,

If but the Present conquer not their souls

With hollow things: that which they see they spurn

That they may come at that they do not see,

Their senses kindled like a torch, that may

Blaze through the secrets of eternity.

The transient's open, everlastingness

Denied our sight; yet still by hope we follow

The vision that our minds have seen, despising

The shows and forms of things, the loveliness

Soliciting for ill our mortal eyes.

The present's nothing: but eternity

Abides for those on whom all truth, all good,

Hath shone, in one entire and perfect light.

<<

For those blessed by faith and hope, this is a powerful argument, maybe a final answer. These eloquent lines resonate even in the sceptical mind of this English physician:

"by hope we follow the vision that our minds have seen'.

Siegfried Sassoon speaks for me, unsure if Paulinus describes a reality which all may enter, if he is indeed describing a reality.

>>

Redemption

I thought; These multitudes we hold in mind -

This host of souls redeemed -

Out of the abysm of the ages came -

Out of the spirit of man - devised or dreamed.

I thought; To the invisible I am blind;

No angels tread my nights with feet of flame;

No mystery is mine -

No whisper from that world beyond my sense.

I think; If throughout some chink in me could shine

But once - O but one ray

From that all-hallowing and eternal day,

Asking no more of Heaven I would go hence.

<<

Yes, that plaintive poem with its elaborate rhymes also resonates in me.

But I have received in my later years the vision of the Autopoietic Kosmos, perhaps the grandest unifying theory. It suffices.

I enjoy access to a wealth of reliable knowledge and understanding, far beyond the hopes of Paulinus or the dilemmas of Sassoon. We in our times must follow the vision that our minds have seen.

"To the solid ground of Nature trusts the mind that builds for aye" - but Wordsworth speaks as a nature mystic, not intending his words to have quite the meaning I attribute them.

So once again, my favourite quotation, from Rhazes, Persian physician in 10th century Baghdad:

Human perception and cognition alone give reliable knowledge;

The way of philosophy is open to all abuses;

Claims of divine revelation are false;

Religions are dangerous.

Not even the advocacy of Paulinus will persuade me into the way of the monk.

[ Appendix. Paulinus' original latin.

Ad Ausonium

Non inopes animi neque de feritate legentes 

desertis habitare locis, sed in ardua versi 

sidera spectantesque deum verique profunda 

perspicere intenti, de vanis libera curis 

otia amant strepitumque fori rerumque tumultus 

cunctaque divinis inimica negotia donis 

et Christi imperiis et amore salutis abhorrent 

speque fideque deum sponsa mercede sequuntur, 

quam referet certus non desperantibus auctor, 

si modo non vincant vacuis praesentia rebus, 

quaeque videt spernat, quae non videt ut mereatur 

secreta ignitus penetrans caelestia sensus. 

namque caduca patent nostris, aeterna negantur 

visibus, et nunc spe sequimur quod mente videmus. 

spernentes varias, rerum spectacula, formas 

et male corporeos bona sollicitantia visus. 

attamen haec sedisse illis sententia visa est, 

tota quibus iam lux patuit verique bonique, 

venturi aeternum saecli et praesentis inane. ]

Athos 2: Leaving Aphroditi

I departed for Athos from a village east of Lamia with my two companions, Ilias and Vangelis, who had invited me to join them on their visit. Ilias is the father of my Greek daughter-in-law; Vangelis is the father of her sister's husband. Vangelis is a classical scholar and expert on Orthodox liturgy. Neither spoke much English, and I speak little Greek, but language proved to be little problem.

Ilias and Vangelis had visited Athos before, so were familiar with routes and procedures. The motor journey on the afternoon of our first day lasted some 5 hours.

A new motorway is mostly complete. From Athens it runs north past Lamia and Larissa; then, with the impressive massif of Olympos to the west, to Thessaloniki. From there the new Egnatia Odos runs east, passing two large freshwater lakes, Koronia and Volvi, the land becoming increasingly fertile and forested. After Volvi we turned off to the sea at Stauros, then south through beautiful forested hills, passing Stageira, the birthplace of Aristotle, and Nea Roda, the site of Xerxes' canal.

The road ends at Ouranopolis, Sky Town, a pleasant seaside resort, where small hotels, restaurants and souvenir shops cater to the Athos pilgrims. Prominent in Ouranopolis are shops selling icons, prayer beads, religious books and other items for the Orthodox.

Further travel into Athos is by boat.

Next morning at 0830 we were here, in the Grapheion Proskunyton, the Pilgrim's Office, with passport and 30 euros to collect the Diamonytyrion, the necessary permission to stay 4 days on Athos: an A4 sheet with the double headed eagle of Byzantium at the top left-hand.

An hour later we were on the ferry, the Agios Pantaleimon, a large landing craft. It has a vehicle deck and passenger superstructure reached across a bow ramp, lifted at sea, and dropped when the ship is brought bow first against a quay.

The sun was warm, the sea was blue, with white-crested waves whipped up by a brisk southerly. I watched monks, pilgrims and workmen coming aboard, while on the narrow quay maybe a dozen cars and small trucks queued for their turn to negotiate the ramp.

I noticed an old monk with a long white beard climbing the steps of the companion-way with difficulty, carrying two heavy plastic carriers labelled Lidl. A small group of young men were dressed for the beach - T-shirts, shorts and flip-flops: they proved to be Romanians, and they did not arrive at the monastery so clad.

Then I noticed her, an image which I shall not easily forget.

She was young mother with a child in a push-chair. She stood quite still, on the seaward end of the quay, watching the loading. She was tall and beautiful, with her dark hair carefully tied back. A phrase from Virgil came into my head - his Copa Syrisca has caput Graeca redimita mitella: 'hair dressed back with a ribbon in the Greek fashion'.

[In museums you can see classical Greek statues with the same hair style.]

She wore a fitted 3/4 length sleeved dress of grey and light blue gingham. The gusty wind alternately ballooned her dress, then blew it against her body.

Standing there, Aphroditi incarnate, she seemed to challenge us.

'O what is a woman, that you forsake her?'

What drives a man to forsake the real world and bury himself in a monastery? Is he seeking or fleeing?

Why were we turning away from her into the monks' world of Athos, dedicated to a legendary virgin who became mother of God?

Questions which the learned Professor Jung may be best placed to answer. The virgin goddess is an important archetype of the collective unconscious, well known in Greek and Middle-Eastern myth long before Christianity: Artemis, for example, and Athena, to whom was built the Parthenon: Mary moved onto ground well prepared.

Or perhaps Professor Freud or one of his disciples can explain how the male libido may be obstructed, and diverted or repelled from Aphroditi.

I have heard that feminists have demonstrated on the quay at Ouranopolis. Was she there that morning by chance or design - that young woman whose questions demand an answer? 

I hope it was by design.

A Pilgrimage to Athos: 1

I first saw Mount Athos from an Airbus A321, Aegean Airways flight A3603, 3 hours out from London Heathrow to Athens. The aircraft flew the line from Sarajevo to Larissa at 36,000 feet, and the captain had announced we were now in Greek airspace with landing expected in 50 minutes.

To the left I could see we were abeam Thessaloniki. Looking further east there was a mirage: an atmospheric layer mirrored the sky, obscuring land and horizon, a pale blue reflection, against which clouds in grey silhouette gave an impression of islands in a sea.

But there, further east, maybe 200 kilometres distant, the cone of Athos was above the reflection, its white rock shining in the afternoon sun.

I could understand how it came to be Holy Mountain - Agion Oros Athos.

Athos mountain is the tip of a narrow peninsula projecting some 70 km. from the mainland. The body of the peninsula is a ridge rising maybe 500 metres, running south-east into the 2033 metre high mountain. Chestnut forest covers much of the north-east slope of the ridge; the south-west slopes are drier, with a mixed scrub of conifers and evergreen oak. The south-east shoulder of the mountain is semi-arid; I heard it called 'the desert'.

A flat sandy 2-km. isthmus connects the peninsula to the mainland. Here, 2490 years ago, Xerxes commanded a canal be dug to pass his navy west, to avoid the risk of rounding the stormy cape of Athos, which had cost his father dear. The sand collapsed and buried the canal, so there is little to see today.

Agion Oros Athos is today an autonomous province of Greece, governed by an ecclesiastical council representing the Orthodox communities of 20 monasteries and 12 sketes. [A skete is a group of monks living in a village, not a single large building cluster.] 

The only lay settlements are the capital, Karyes, a small village, and the tiny port of Dafni, about 2/3 of the way along the south-west coast.

Athos has been sacred to Mary, mother of Jesus, for much more than a thousand years. It is her paradise, her garden and her inheritance for ever, and a haven for those seeking salvation.

The holiness of Athos has been respected through many centuries, not least by the Ottomans. Exceptions include Arab and other pirate raiders, and hooligan crusaders.

Today Athos is a World Heritage Site. The monasteries have lost much of their former income from estates and patronage. The monasteries I saw need expensive maintenance and repair. I saw blue plaques recording European Union support - which no doubt has conditions attached. The traditional exclusion of women from the peninsula may not survive much longer. But there is nowhere for women on Athos, and I doubt the monasteries will provide guest facilities for women as they do for men.

Ecclesiatical control of Athos means its  beauty is protected from commercial exploitation: long may it continue.

Access to Athos requires ecclesiastical permission, a visa. The number of visas is strictly limited, which limits further the human impact on this special place.

Agion Oros, AO, the alpha and the omicron: near but not quite the alpha and the omega.

[Modern Greeks pronounce Agion Oros 'with an aspirated g and s - something like 'aghyon orosh' - the g is especially difficult for an Englishman to get right.]

Managing Epilepsy

If you see someone seized by an epileptic fit, then it is a reasonable first explanation to attribute the seizure to an evil spirit or demon, which has entered and is for a time venting its fury on the patient. Some believed that a god enters the epileptic, so the fit manifests the power of the divine. Hippocrates needed specifically to deny that epilepsy is "The Sacred Disease", asserting instead that it is a physical illness.

We know now that a fit is caused by a storm of electrical activity in the brain, triggered by some focus of abnormal electrical activity. Sometimes the focus is identifiable in an area of brain damage, but often it is not, and the underlying cause remains uncertain.

A case of epilepsy in a boy is described twice in the New Testament, in graphic terms, interpreted as spirit possession. The first is in Luke's gospel, chapter 9, 38.

And behold, a man from the multitude cried, saying,

"Master, I beseech thee to look upon my son; for he is mine only child: and behold, a spirit taketh him, and he suddenly crieth out; and it teareth him that he foameth, and it hardly departeth from him, bruising him sorely."

That is a succint description of the tragedy of epilepsy in a child, made yet more vivid by the archaic language.

In Mark's gospel, chapter 9,17, the same case is described in even more telling words. In addition it seems that the boy's epilepsy is part of a more generalized brain disease, perhaps congenital, perhaps birth injury, perhaps after infection or trauma.

And one of the multitude answered him,

"Master, I brought unto thee my son, which hath a dumb spirit; and wheresoever it taketh him, it dasheth him down: and he foameth, and grindeth his teeth, and pineth away."

... And they brought him unto him: and when he saw him, straightway the spirit tare him grievously; and he fell on the ground, and wallowed foaming.

And he asked his father, "How long time is it since this hath come unto him?"

And he said, "From a child. And oft-times it hath cast him both into the fire and into the waters, to destroy him: but if thou canst do anything, have compassion on us, and help us."

"Wheresoever it taketh him" - the cruel unpredictability of this disease.

"It dasheth him down" - the fit throws the victim down violently, often causing injury.

"He foameth, and grindeth his teeth" - the convulsive champing and salivation; the blood-stained foam on the face when the tongue has been bitten.

No mention of the embarrassment of incontinence, nor of the gnawing fear of losing control and dignity in another fit.

Jesus commands the spirit to leave, and it does, after a last and very severe fit. We are not told if the boy recovered speech and hearing. Jesus says the power to cast out such devils comes through prayer and fasting. Would it were so.

We now have we a variety of drugs useful in epilepsy; but no drug cures epilepsy, or guarantees freedom from fits. Drugs reduce the fit frequency, and must be used carefully and conservatively. Side-effects are common, and treatment demands continuing supervision and adjustment. A frequent problem is that the medication is increased if another fit occurs, so that a patient prone to fits eventually may be taking several drugs in full dose, with inevitable sedation, and other undesirable consequences. Sometimes a reduction in medication is the wisest advice.

The objective, as always, is to maximise benefit and minimise harm. In epilepsy this means finding the minimum drug dose to minimise the fit frequency. This isn't easy.

Most epileptic patients and their relatives live in fear. The prospect of another fit is alarming and painful. The only acceptable fit frequency is zero. Often this cannot be achieved, and can never be guaranteed. The physician has the difficult task of explaining that more drugs will mean more problems, and a lower quality of life.

Better to suffer the occasional fit than be constantly intoxicated.

If my child had epilepsy I would resist such advice. But I hope I would remember that only an inexperienced physician believes epilepsy can be controlled without causing side-effects.

No disease challenges the skill of a physician more than epilepsy.