‘She Wanted to Kill’: Jean Clemens and Postictal Psychosis
Laura Skandera Trombley

In late October 1906 when Jean Clemens was twenty-six years old, she recorded how emotionally devastating it was for her to leave her sister and father to move away and live in a Katonah, New York epileptic colony: [1]

It was desperately hard to leave Father and Clara in order to come out to a totally strange place. I tried my hardest not to cry before them, but as the time of departure began to approach I found it growing more and more difficult to restrain myself, especially when Clara began to cry, too, then it was really hopeless. Poor little Father seemed to feel badly, too, and the whole business was perfectly horrible to me. I wanted to cry hard whenever I spoke to anyone and yet at the same time I wanted to refrain from showing my feelings too plainly. [2]

Isabel Van Kleek Lyon, personal secretary and companion to Mark Twain, accompanied the weeping Jean to the train station, with Jean’s personal maid Anna in tow, secured their luggage and saw them off safely. Father and sister did not accompany Jean to the station, choosing instead to remain at home in their leased townhouse in New York City. Jean’s departure from her family was part of a tragic scenario that had been unfolding for a decade, and her leaving resulted in the surviving members of the Clemens family leading separate and increasingly estranged lives during Twain’s last years.

Mark Twain’s life consisted of episodes of success and failure, and his family doubtlessly realized that with the mercurial and risk-taking Twain as their patriarch their lives would also be unpredictable. Despite this self-knowledge on their part, a series of events occurring around the turn of the century may have made the family suspect that they were being haunted by misfortune. In 1894, at age fifty-nine, after years of battling crippling financial reverses, Twain entered into voluntary bankruptcy. That same month, he reluctantly signed a lecture tour contract, and on May 11, 1895 the Clemenses sailed from Southampton, England to New York beginning an around-the-world-tour intended to rescue the family from their monetary woes. Daughters Jean and Susy remained in the United States. Over a year later, the three Clemenses, Twain, wife Olivia and middle daughter Clara, sailed into Southampton, England from Capetown, South Africa on July 31, 1896. Before the family could be reunited, their oldest daughter Susy died from meningitis at the family’s home in Hartford. After her funeral, the heartbroken family remained in Europe in deep mourning for four years. The homesick Clemenses finally returned to the United States in 1900. Olivia Clemens, whose health had always been delicate, began a slow decline that ended in 1904 on a warm June evening in Florence, Italy. Losing Olivia foreshadowed the ending of their sense of family, and the three remaining Clemenses would drift ever further from functioning in an emotionally stable, healthy manner. They would habitually react to each other, often in great anger, as individuals who competed for love and attention. Isabel Lyon seemed to recognize this predilection for Clemens family disaster in a daily reminder entry in 1905:

There seems to be a tragic some-thing hanging near; <& who can say. Oh to be able to protect the ones that you love. I have the feeling that I must scream at the> ^Some^ Fate that is Coursing along in their blood, & waiting to drop with a clutch at their hearts.[3]

Of all the Clemenses, Jean occupies a special place within that familial pantheon of illness and tragedy. A constant undercurrent to all the family’s trials was the critical issue of her health. As early as 1896, when Jean was fifteen, she had begun to experience blackouts that eventually were diagnosed as epileptic seizures. Twain tried to explain his daughter’s condition to his close friend Henry Rogers in a letter written when Jean was in her twenties: “Jean’s head got a bad knock when she was 8 or 9, by a fall. Seven years ago she showed capricious changes of disposition which we could not account for; and four years ago the New York experts pronounced her case epilepsy…”[4] Twain’s attribution of the cause of Jean’s ailment was in agreement with the prevailing medical wisdom at the time. A late nineteenth-century medical textbook, Diseases of the Nervous System; or, Pathology of the Nerves and Nervous Maladies, that Jean’s doctors likely used as a reference, provides an exhaustive list of causes for epilepsy including “fright, anxiety, grief, over mental exertion, dentition, indigestion . . . blows on the head, falls, sunstroke.”[5]

Contemporary medical research shows that in nearly twenty-five percent of adult sufferers, the cause of epilepsy appears to be related to microscopic scars in the brain resulting from injury possibly at birth or later. Some types of seizure disorders are inherited, and for the remainder of sufferers who do not evidence brain damage, the cause is unknown. [6] Based on descriptions in Clemens family letters and Isabel Lyon’s daily reminders, it appears that Jean suffered from idiopathic epilepsy. This form of epilepsy typically occurs in children and teenagers.[7] During Jean’s lifetime, epilepsy treatments included giving the patient “bromides of potassium, lithium, and sodium, and the oxide of zine.” Jean was given daily doses of the recommended bromide. Patients were advised to avoid alcohol, eat more “vegetable than animal food,” and to regard sexual intercourse as presenting “great danger.” Medical textbooks gravely warned that masturbation would cause “in general the greatest number of fits,” and “intellectual employment requiring deep thought is injurious.” The recommended lifestyle was clean, asexual, healthy country living with plenty of exercise including such pursuits as “gardening, horse exercise, the gymnasium, swimming.”[8] Jean and her family spent years seeking cures at various European and American sanatoriums, and they believed with a hope born of desperation that frequent osteopathic sessions would have a beneficial effect. For a time Jean received tri-weekly osteopathic treatments for her illness. Despite the family’s heroic efforts to manage the condition and find a cure, Jean suffered from both petit mal and grand mal seizures.[9] Current research asserts that if epileptic patients do not achieve seizure control through drug treatment within two years after their initial diagnosis, only a handful of these unresponsive patients will “ever achieve control.”[10] Jean, without benefit of modern drug therapy, would not be among those fortunate few, and she would spend the rest of her life trying to find a cure.

Epilepsy was little understood at the time, and those who suffered from the disease were regularly stigmatized and shunned by society. People suffering from epilepsy were routinely shunted off to mental asylums, poorhouses, and jails. The Clemenses did their best to protect their daughter from the social effects of the disease, and her condition was never publicly mentioned. Barred from ever really entering the social whirl that young women of her wealth and status would typically embrace, in accordance with medical opinion at the time, Jean spent a great deal of her time outdoors. A budding amateur naturalist, she loved hiking and spending hours in the woods. Isabel Lyon frequently wrote about the days they spent together watching black and white creeping warblers, humming birds, and field sparrows through their “opera glasses.”[11]

The death of Olivia Clemens appears to be a key juncture in the downward trajectory of Jean’s illness. When Olivia passed away, Jean suffered a seizure, the first in over a year, and for the rest of her life she would never be free from such attacks for so long a time. Stress has a direct causal relationship in increasing the severity of epilepsy, and it has been documented that the “brain is the transducer of information and experience to which the body responds and the worsening under stressful circumstances is something seen in every case of epilepsy. . . . Isolation from stressors decreases the brain’s arousal and therefore reduces the number of epileptic episodes.”[12] Jean, her mother’s beloved baby, was now dependent upon her grief-stricken father and sister to help her manage her illness.

By this time Jean had been suffering from epilepsy for approximately a decade. The onset of her disease had occurred in her teens when she began having petit mal seizures, sometimes referred to as “absence seizures.” This kind of seizure is most often observed in children and teenagers. Typically, petit mal seizures involve a brief lapse of consciousness. The seizure may last seconds or a few minutes. After the seizure concludes, normal activity can resume. About half of the children who suffer from this kind of seizure, outgrow the malady.[13] The other half will develop much more serious grand mal seizures—and this is what happened with Jean. When Jean would have a grand mal seizure, she would vomit, convulse, become unconscious, and experience muscle spasms. After the seizure ended, she would be left with a headache, confusion, and exhaustion. Usually individuals having grand mal seizures will have no memory of what occurred.[14]

In the year after her mother’s death, Jean’s seizures had dramatically increased in their frequency and severity. A characteristic of her illness was that as she grew older, Jean would often experience a cluster of seizures, sometimes three a day. On a single day in August 1905, Jean’s multiple seizures prompted Isabel Lyon to observe: “one at 11.30 – 1.20 - & 5.30 very droopy all day.”[15] Isabel Lyon carefully charted the occurrences of Jean’s seizures throughout 1905 and 1906 (in effect creating a medical history that no one in her immediate family evidently kept), and her record shows an alarming acceleration beginning in spring of 1905 and continuing into the fall of 1906.

In 1906 Jean’s family and Isabel witnessed an altogether unprecedented and alarming episode of her behavior three days after Thanksgiving. During the day, Jean had experienced seizures at three o’clock in the afternoon and eight o’clock in the evening. Sometime that evening she physically attacked Katy Leary, the family’s long-time housekeeper. At the turn of the century, the prevailing medical opinion was that there existed a direct connection between epilepsy and violence. There was widespread belief that epilepsy was one source of criminality. Obviously, that theory has since been debunked and prevailing medical opinion is quite clear in stating that there is no evidence that during a seizure the patient can make an intentionally motivated act of aggression.

Recent research, though, has identified a related state where physical acts of aggression against other people and “behavior disturbances” do occur in epileptic patients.[16] Recent research has revealed the existence of a postictal psychotic state, specifically, a psychotic break occurring after an epileptic seizure has concluded. In fact, postictal psychosis is known as “the most common of the episodic epilepsy-related psychoses.”[17] During “the postictal period, the patient becomes psychotic, and in this case, the aggression against another person is not intentionally motivated violence. The other person just happens to be in the wrong place at the wrong time. . . . These acts are not intentionally planned by the patient, but are the response of the psychotic patient to a stimulus.”[18] For epileptic patients suffering from postictal psychosis,“there was a clear history of an increase in major seizure frequency prior to the onset of psychosis, usually as a cluster of two or three.” For the month of November 1905, Jean had a total of six seizures, with three of them occurring on the same day, six days before her purported attack on Katy. Immediately following a seizure, a patient suffering from postictal psychosis will experience a period of lethargy and confusion. This confusion resolves into an “interval of apparent normality” lasting hours or days before the onset of psychosis; in a recent study the time period of normality ranged between 2 to 72 hours. Patients then enter a psychotic state, typically lasting at least 15 hours and less than 2 months, where the patient experiences one or all of the four main forms of the disorder: “confusion, visual and auditory hallucinations, and paranoid ideation.”.[19] A 1988 British study on postictal psychoses observed: “psychosis may occur more commonly in patients with epilepsy, especially temporal lobe epilepsy, and that it usually develops 10-15 years after epilepsy onset.”[20] Jean’s medical history is consistent with a diagnosis of postictal psychosis.[21]

There are two mentions of the post-Thanksgiving attack in Isabel Lyon’s papers. On November 26, 1905, Lyon noted in her daily reminder the times of Jean’s seizures and underlined Katy’s name. Directly underneath this heading, Isabel quoted the last stanza of William Blake’s poem, “The Fly.”

Jean. 3 - pm 8 pm Katie

Then am I
A happy fly.
If I live
Or if I die.[22]

There is also a handwritten note by Isabel’s friend, Samuel Webster, included in an unpublished manuscript archived at the Mark Twain Project referring to the above entry: “This <seems to> refers to an attack on ^the maid,^ Katie <on Katie> ^Leary,^ that Miss Lyon told me about. Jean was getting dangerous, and the doctor told Miss Lyon never to let Jean get between her and the door, and never to close the door. S.C.W.”[23]

It makes sense to consider Jean’s epilepsy as a barometer of the Clemens family’s discord. After her mother’s death, Jean remained at home and was the primary witness to a growing intimacy between her father and Isabel Lyon. Of all the Clemens children, Jean was arguably the daughter closest to and most dependent upon her mother. When Olivia was alive, she was the parent who bore direct responsibility for managing her daughter’s treatment and she was Jean’s greatest comfort. After her death, Jean’s care was relegated to Isabel. The loss of her mother created a wound that would never heal, and Jean’s witnessing her father’s happy acceptance of Isabel’s overtures must have caused her extraordinary anxiety. The dysfunctional dynamics of the Clemens family, with Isabel a potent part of the mix, and the onset of Jean’s epilepsy in its most malignant form is no coincidence. Living in such an incendiary household proved to be too much for Twain’s fragile youngest daughter. Isabel Lyon realized that Jean was crumbling: “Not only has her malady increased - but her ^whole^ physical condition is at a low ebb. and the child calls <out> ^for^ great waves of love. ^from those of us who care.^ . . . In these last few days a sadness has settled over her, a gentleness that is pitiful - & you long for the masterful young creature whose powerful moods <might> spread consternation. but always back of these moods ^there are^ an individuality - a frankness of a very high order.”[24] Jean was desperately calling for help, but the people around her were absorbed by their own needs and no one understood her illness well enough to effectively answer. Dr. Edward Quintard, the family’s personal physician, regarded Jean as a physical threat and dangerous to those around her; he warned Isabel “never to let Jean get between her and the door, and never to close the door.”[25] Assuming that Isabel at least in part heeded Dr. Quintard’s advice, one can only imagine what signals she might have sent Jean through changes in her behavior toward her.

On January 1, 1906 at their leased home on 21 Fifth Avenue, Jean had a cluster of three seizures. Isabel wrote: “Jean- 11- 1.20- 7 P.m. very severe.”[26] Immediately afterward Jean entered a brief lucid state followed by increasing troubling signs of emotional distress. Twelve days after the clustered attacks, Twain tried to read an excerpt from his autobiography to an unappreciative Jean; Isabel exclaimed about his aborted attempt in her daily reminder: “but oh a disturbing element stopped it. (A mood of Jean's-).”[27] Nine days later, in the midst of a seizure, Jean fell against the radiator, burning her arm. When Twain visited her two days later, Jean was not cognizant of his presence. It was a terrible month for Jean, which would culminate in an episode that occurred on Saturday, January 27—an episode not witnessed by her father who had absented himself, this time on a trip to Washington, to attend a banquet “full of pretty women in beautiful garments” that was held in his honor.

This was a tragic day - I came in from a shopping expedition for Jean & others - & when I went into her room for Tea, she told me that a Terrible thing had happened. In a burst of unreasoning rage she struck Katie a Terrible blow in the face - The significance of it is what is so terrible, for now she has done what I have seen in her <unescapable> & feared she would do. <She is distressed poor child> - She described the wave of passion that swept over her as being that of an insane person. She knew she couldn't stop - she had to strike. & she said that she wanted to kill. /& was sorry she hadn't - to her mind it doesn't seem right not to finish any job you have begun & she had wanted to kill Katy/[28]

Isabel’s attempt to character the episode as somehow being a longstanding personality trait may not be terribly productive. What is clear is that Jean, in behavior consistent with that of one enmeshed in the throes of a postictal psychotic state triggered by the cluster of epileptic seizures she suffered at the beginning of the month, had attacked Katy Leary a second time. Isabel’s interpretations of Jean’s desire to “finish” any “job” and kill the housekeeper was in keeping with the delusional state of postictal psychosis. Isabel’s usage of the phrase, “unreasoning rage,” is particularly consistent with the fact that sufferers in such a condition do not experience intentionally motivated acts of aggression. Katy again was in the wrong place and the unfortunate recipient of Jean’s response to internal stimulus she alone was aware of. The next day, January 28th, Jean experienced another cluster of seizures at 12:30 p.m. and 9:30 p.m. for a total of six seizures in a month’s time.[29] Susan Crane, Jean’s aunt and Olivia Clemens’ older sister, arrived soon after from Elmira, New York to help care for her troubled niece.[30] Her father would not return home until two days later on Tuesday January 30th.

At the beginning of the week, with Twain still en route, a worried Isabel visited the family’s personal physician, Edward Quintard, who had been treating Jean. On Friday morning, February 2, Isabel finally spoke to Twain about his daughter. Confronted with the urgent nature of his daughter’s situation, Twain unleased a torrent of angry rhetoric:

I had a very plain talk with Mr. Clemens this morning about Jean's condition. & told him how on Tuesday I had talked with Dr. Quintard. The dread-fulness of it all swept over him as I knew it would. and with that fiercest of all his looks in his face, he blazed out against the Swindle of life - & the <awf> treachery of a God that can create disease & misery & crime. create things that men would be condemned for ^creating-^ that men would be ashamed to create. <And you agree with him - you have to->[31]

Later that same day, Jean had another cluster of three seizures, 9:00 a.m., 6:00 p.m., 10:00 p.m. Her father, once again, wasn’t there to witness them or to comfort her, as he had a previous engagement. He was out having dinner with the Gilders, wearing white tie and what he laughingly described to Isabel as a “pair of ratty old daylight pants—but when I tell the Gilders they’ll overlook it…”[32] Twain also would have had little time to check on Jean over the weekend as he visited Frank Fuller and his wife on Saturday, lunched with Mr. and Mrs. John W. Alexander and Maude Adams on Sunday, and entertained Mr. Montague and Mr. and Mrs. Loomis at teatime the same day. Isabel magnanimously absolved Twain of any responsibility for his family, explaining that he “keeps away from anything that wrings his heart. He has too many speeches to make, too many people to see in these days & he must remain cheerful.” [33]

On Monday, February 5th, Isabel and Jean went to visit Dr. Frederick Peterson, “who is going to have charge of her case - her pitiful malady - if he feels that he can benefit her. She has been running down rapidly & looks badly - & is ill - really very ill-“[34] Dr. Peterson was a full professor in psychiatry at Columbia University and the most prominent epilepsy specialist in the country. Well known as a pioneer in psychiatry and neurology, he was widely regarded as a mental health advocate. He had served as president of the New York Neurological Society from 1899-1901 and would be elected president of the American Neurological Association in 1924. Dr. Peterson considered the social ostracism of epileptics as cruel and undeserved and founded Craig Colony, the second epileptic colony established in the United States, where severe epileptics could receive treatment and lead full and meaningful lives. Dr. Peterson’s research on epilepsy and insanity was voluminous with over two hundred publications, including one work that would prove particularly apt in relationship to Jean Clemens’ affliction, Epileptic Insanity. Dr. Peterson also had a literary side that must have appealed to his new patient and her father; he was an accomplished poet with a special interest in Chinese poetry and art and had published four books of poetry under his pseudonym, Pai Ta-Shun. The visit to Dr. Peterson proved to have a palliative effect upon the household. Jean would go over a month without a seizure.

In the spring of that same year, Isabel and Twain left New York for the distant climes of Upton House in Dublin, New Hampshire, arriving on May 15th. Jean had happily abandoned New York for Dublin two weeks earlier with Katie, Anna, her maid, and Mary, the cook. Once again, Jean’s epilepsy continued to worsen despite the quiet, pastoral surroundings, and she was particularly frustrated by her inability to establish a romantic relationship with Gerome “Gerry” Brush, son of artist George de Forest Brush. She became practiced at being able to predict the onset of some of her seizures, although the severity of her illness and its capriciousness continued to frustrate her best efforts to keep it at bay. In a 1906 diary entry, Jean described a particularly difficult day:

As soon as I wakened, by five o’clock, I realized that I was going to be ill, but I hoped, after yesterday’s result, that the attack would pass off in a few petits-mals early in the morning. I didn’t take the pills quite as promptly as perhaps it would have been well to do so, because I hate to get into the habit of taking drugs like that when I feel a thing coming on. The petits-mals were fearfully long, many of them, but toward eleven o’clock I went down the hill with Anna & was fairly well during the walk. I had times of being very bad indeed & fairly well, all day long. After lunch I took a nap & when I first wakened felt well. . . . Katie really tho’t the danger of an attack was over, & so did I but we were wrong. It finally came right after my supper, about eight o’clock. It was a medium one.[35]

By the end of the summer upon Dr. Peterson’s recommendation, Jean began to explore the possibility of moving to Katonah, New York to live in an epileptic colony. She was astonished to hear from Katy that Clara was upset, “the same way as Mother’s death,” when she learned about Jean’s “Katonah plan.”[36] Jean had supposed that Clara was indifferent to her fate because of her preoccupation with her singing career. A few days later Jean and Isabel Lyon paid a visit to the grounds and found it acceptable with some beautiful trees scattered across the grounds. Due to another seizure cluster Jean was unable to depart on the day when she had originally planned, but had to delay her leaving taking by a day. Concerned as she may have been initially, in the end Clara stayed at home and waved good-bye to her sister. Jean would be a resident at Katonah for fifteen months.

Jean was well aware of her family’s complicated dynamics and knew that Dr. Peterson, with his strong opinions about placing her in an epileptic colony, must have appeared as a godsend to her sister and father. She remarked with some bitterness in her 1907 diary about her family’s apparent relief:

While I know that neither one of them would admit being glad to have me away & therefore relieved of the presence of an ill person, I am sure that they must feel so. . . . I am sure [father] is fond of me but I don’t believe that he any more than Clara, really misses me. . . . I don’t really miss either of them.[37]

In January 1908, an ecstatic Jean left Katonah and moved into a home in Greenwich, Connecticut with the Cowles sisters and a young friend Marguerite Schmidt, who were supposed to serve as her nurses. In April, Jean moved with the Cowleses to Gloucester, Massachusetts, however, the dynamics with the Cowleses proved to be unworkable. Soon Dr. Peterson was advocating that Jean be sent to Germany to be treated by a German specialist, Professor Hofrath von Reuvers. She sailed on September 26, 1908 with friends Anna Sterritt and Marguerite Schmidt. Twain, unexpectedly, summarily requested that she return to the United States on January 9, 1909. Dr. Peterson apparently disapproved of Jean’s treatment and had suggested she return home. At Dr. Peterson’s direction, Jean was then relocated to a sanitarium in Babylon, Long Island, and, after an unhappy short stay, she moved again to a smaller facility, “Wahnfried,” in Montclair, New Jersey. In April 1909, Dr. Peterson agreed that Jean could visit her father at his new home, “Stormfield,” in Redding, Connecticut. On April 26, 1909 after an absence of two years and four months, Jean returned home and stayed there. Her visit had become permanent and her lonely sanatorium days were over.

Jean’s tragic destiny was fulfilled on the morning of Christmas Eve 1909, eight months after her return. According to Katy Leary, in a memoir published in 1925, Jean’s custom was to wake early and take a cold bath at seven a.m. When Jean did not reappear, Katy ran into the bathroom and found her lying in the bathtub.[38] Hamlin Hill reported in God’s Fool that in an account published in the New York American the next day, the examining physician of the county attributed Jean’s death to drowning. The common assumption is that Jean suffered a seizure while bathing, passed out, and drowned. This though, may not have been how Jean died.

Jean was very sensitive to the nuances of her disease and on July 17, 1906, she described her careful process of bathing: “I began to be absent-minded as soon as I started to take my bath, so I hurried with it & after partially dressing, I lay down on my bed. But my bedroom was so desperately hot that I decided to try & get some fresh air by coming down onto the porch.”[39] In a 1989 American Neurological Association article, researchers reported that “sudden unexpected death without obvious cause accounts for a substantial portion of reported deaths among epileptics; however, this phenomenon is still not widely recognized nor appreciated.” In a more recent article entitled, “Sudden Death in Epilepsy,” published in the winter 1997 issue of The Medical Journal of Allina, epileptic patients who had never been able to achieve complete seizure control, who had suffered from epilepsy for years possibly from the result of a head injury and who were between 20 and 40 years of age and in excellent health except for epilepsy were viewed as high risk for sudden death. Jean falls within these parameters.

Conclusive evidence as to Jean’s cause of death will likely never be known, although the details of the course of her disease are well documented. Her affliction was severe and unresponsive to available treatment. It does appear in retrospect, that Dr. Peterson in his work with epilepsy and insanity may have been the first physician to recognize what we now call postictal psychosis without actually identifying it as such. In the fall of 1907, Dr. Peterson’s prognosis of Jean’s condition offered no comfort for her despairing father. As interpreted by Isabel:

the epileptic temperament rarely improved, but that it grew worse, & that Jean must never live with her father again, because her affection might easily turn into a violent & insane hatred & she could slay just by the sudden & terrible & ungovernable revulsion of feeling. The one bounding out of the other & the person never knowing that he is passing from one ^condition^ to the other.[40]

After she had attempted and failed to revive Jean, Katy ran to roust Twain from his bed. Gazing at his dead daughter laying on the bathroom floor, Twain reportedly said to Katy: “She’s happy now, she’s with her mother and sister; and if I thought I could bring her back by just saying one word, I wouldn’t say it.”[41] After living with Jean for several months and finally seeing first-hand how ill she really was, we forgive Twain if he felt a sense of relief about his daughter’s death. In a reprise of Jean’s departure a few years earlier, Twain did not accompany his daughter to her final resting place at the family gravesite in Elmira, New York. Instead he stayed home and entrusted her care to Katy Leary, the target of Jean’s aggression. If, indeed, the anger and aggression of the sufferer of the disease is stimulated by the emotional attachment between attacker and victim, then it may be pleasant to think that Katy honored her duty. Jean’s sister, Clara, remained in Europe.


[1] I would like to express my appreciation to Lisa Specht, Pitzer College trustee, for introducing me to Dr. Peter Whybrow, Director of the Neuropsychiatric Institute at UCLA. I would also like to thank Dr. Whybrow and Dr. John Milton, William Rand Kenan Jr. Professor in Computational Neuroscience at The Claremont Colleges, for their generosity in sharing their time and expertise with me.
[1] October 25, 1906; 1906 Diary, Huntington Library.
[1] July 16, 1905; 1905 Daily Reminder #2, Mark Twain Papers.
[1] Mark Twain’s Correspondence with Henry Huttleston Rogers, ed. Lewis Leary, Berkeley, 1969: 430.
[1] Albert H. Hayes, M.D. Boston, 1875: 74-75.
[1] The Merck Manual—Home Edition. Chapter 73: Seizure Disorders.
[1] According to Peter C. Whybrow, Director of the UCLA Neuropsychiatric Institute, “in late adolescence a ‘pruning’ of the neurons in the brain takes place, as the nervous system matures. . . . one of the developmental genes responsible for that pruning may be abnormal (at variance from the usual gene structure) in people who suffer idiopathic epilepsy.” Personal correspondence, Laura Trombley, August 10, 2004.
[1] Diseases of the Nervous System; or Pathology of the Nerves and Nervous Maladies: 76.
[1] Petit mal seizures begin with electrical discharges in a small area of the brain, and the discharges remain confined to that area. The person experiences abnormal sensations, movements, or psychic aberrations, depending on the part of the brain affected. Convulsive seizures (or grand mal seizures) usually begin with an abnormal electrical discharge in a small area of the brain. The discharge quickly spreads to adjoining parts of the brain, causing the entire area to malfunction. In primary generalized epilepsy, abnormal discharges over a large area of the brain cause widespread malfunction from the beginning. In either case, a convulsion is the body's reaction to the abnormal discharges. In these convulsive seizures, a person experiences a temporary loss of consciousness, severe muscle spasms and jerking throughout the body, intense turning of the head to one side, clenching of teeth, and loss of bladder control. Afterward, the person may have a headache, be temporarily confused, and feel extremely tired. Usually, the person doesn't remember what happened during the seizure. The Merck Manual—Home Edition. Chapter 73: Seizure Disorders.
[1] John R. Gates, M.D. “Sudden Death in Epilepsy.” The Medical Journal of Allina, 2002, 6.1.
[1] June 21, 1903, 1903 Daily Reminder Vassar; June 15, 1903, 1903 Daily Reminder Vassar.
[1] Peter Whybrow, M.D., August 10, 2004, Personal correcpondence, Laura Trombley.
[1] “Petit Mal Seizure,” www.mayoclinic.com, September 2004..
[1] The Merck Manual—Home Edition. Chapter 73: Seizure Disorders.
[1] August 12, 1905, 1905 Daily Reminder #2, Mark Twain Papers.
[1] S.J. Logsdail and B.K. Toone, "Postictal Psychoses A Clinical and Phenomenological Description." British Journal of Psychiatry, 1988, 152: 246-252.
[1]C. Christodoulou, M. Koutroumanidis, M.J. Hennessy, R.D.C. Elwes, C.E. Polkey, B.K. Toone, “Postictal psychosis after temporal lobectomy.” Neurology, 2002, 59: 1432-1435.
John Milton, William Rand Kenan Jr. Professor in Computational Neuroscience at The Claremont Colleges; email dated September 8, 2004.
[1] O. Devinsky, H. Abramson, K. Alper, L.S. FitzGerald, K. Perrine, J. Calderon, D. Luciano, “Postictal psychosis: A Case control series of 20 patients and 150 controls.” Epilepsy Research, 1995, 20: 247-253.
S.J. Logsdail and B.K. Toone, "Postictal Psychoses A Clinical and Phenomenological Description." British Journal of Psychiatry, 1988, 152: 251.
[1] I shared the record that Isabel kept of Jean’s attacks with John Milton, William Rand Kenan Jr. Professor in Computational Neuroscience at The Claremont Colleges, and Peter C. Whybrow, M.D. and Director of the Neuropsychiatric Institute at UCLA. Both concur that Jean’s aggressive behavior is the result of a psychotic state (i.e. postictal psychoses) directly linked to her epilepsy.
November 26, 1905; 1905 Daily Reminder #2, Mark Twain Papers.
[1] Samuel Webster, handwritten document included in the Webster typescript under the date: November 26, 1905, Mark Twain Papers.
[1] January 5, 1906; 1906 Daily Reminder #1 Mark Twain Papers.
[1] November 26, 1905; Samuel Webster, Webster Manuscript, Mark Twain Papers.
[1] 1906 Daily Reminder #1, Mark Twain Papers.
[1] January 13, 1906; 1906 Daily Reminder #1, Mark Twain Papers.
[1] January 27, 1906; 1906 Daily Reminder #1, Mark Twain Papers.
[1] January 28, 1906; 1906 Daily Reminder #1, Mark Twain Papers.
[1] Lyon actually give two dates for Susan Crane’s arrival. In her entry for January 31, she wrote: “<Lovely> Mrs. Crane arrived this afternoon.” The next sentence is crossed out: “<Two or three days ago>” Susan Crane could have arrived as early as the 28th. 1906 [1] Daily Reminder #1, Mark Twain Papers.
[1]1906 Daily Reminder #1, Mark Twain Papers.
[1]February 2, 1906; Notebook #5, Mark Twain Papers.
[1] April 9, 1906; Notebook #1, Mark Twain Papers.
[1] 1906 Daily Reminder #1, Mark Twain Papers.
[1] May 4, 1906; 1906 Diary, Huntington Library.
[1] October 18, 1906; 1906 Diary, Huntington Library.
[1] January 14, 1907, 1906-07 Diary, Huntington Library.
[1] Ed. Mary Lawton, A Lifetime with Mark Twain, New York: Harcourt, Brace, 1925: 321.
[1] 1906 Diary, Huntington Library.
[1] Isabel Lyon, Otober 5, 1907, Notebook #4, Mark Twain Papers.
[1] Ed. Mary Lawton, A Lifetime with Mark Twain, New York: Harcourt, Brace, 1925: 322.


[1] I would like to express my appreciation to Lisa Specht, Pitzer College trustee, for introducing me to Dr. Peter Whybrow, Director of the Neuropsychiatric Institute at UCLA. I would also like to thank Dr. Whybrow and Dr. John Milton, William Rand Kenan Jr. Professor in Computational Neuroscience at The Claremont Colleges, for their generosity in sharing their time and expertise with me.
[2] October 25, 1906; 1906 Diary, Huntington Library.
[3] July 16, 1905; 1905 Daily Reminder #2, Mark Twain Papers.
[4] Mark Twain’s Correspondence with Henry Huttleston Rogers, ed. Lewis Leary, Berkeley, 1969: 430.
[5] Albert H. Hayes, M.D. Boston, 1875: 74-75.
[6] The Merck Manual—Home Edition. Chapter 73: Seizure Disorders.
[7] According to Peter C. Whybrow, Director of the UCLA Neuropsychiatric Institute, “in late adolescence a ‘pruning’ of the neurons in the brain takes place, as the nervous system matures. . . . one of the developmental genes responsible for that pruning may be abnormal (at variance from the usual gene structure) in people who suffer idiopathic epilepsy.” Personal correspondence, Laura Trombley, August 10, 2004.
[8] Diseases of the Nervous System; or Pathology of the Nerves and Nervous Maladies: 76.
[9] Petit mal seizures begin with electrical discharges in a small area of the brain, and the discharges remain confined to that area. The person experiences abnormal sensations, movements, or psychic aberrations, depending on the part of the brain affected. Convulsive seizures (or grand mal seizures) usually begin with an abnormal electrical discharge in a small area of the brain. The discharge quickly spreads to adjoining parts of the brain, causing the entire area to malfunction. In primary generalized epilepsy, abnormal discharges over a large area of the brain cause widespread malfunction from the beginning. In either case, a convulsion is the body's reaction to the abnormal discharges. In these convulsive seizures, a person experiences a temporary loss of consciousness, severe muscle spasms and jerking throughout the body, intense turning of the head to one side, clenching of teeth, and loss of bladder control. Afterward, the person may have a headache, be temporarily confused, and feel extremely tired. Usually, the person doesn't remember what happened during the seizure. The Merck Manual—Home Edition. Chapter 73: Seizure Disorders.
[10] John R. Gates, M.D. “Sudden Death in Epilepsy.” The Medical Journal of Allina, 2002, 6.1.
[11] June 21, 1903, 1903 Daily Reminder Vassar; June 15, 1903, 1903 Daily Reminder Vassar.
[12] Peter Whybrow, M.D., August 10, 2004, Personal correcpondence, Laura Trombley.
[13] “Petit Mal Seizure,” www.mayoclinic.com, September 2004..
[14] The Merck Manual—Home Edition. Chapter 73: Seizure Disorders.
[15] August 12, 1905, 1905 Daily Reminder #2, Mark Twain Papers.
[16] S.J. Logsdail and B.K. Toone, "Postictal Psychoses A Clinical and Phenomenological Description." British Journal of Psychiatry, 1988, 152: 246-252.
[17] C. Christodoulou, M. Koutroumanidis, M.J. Hennessy, R.D.C. Elwes, C.E. Polkey, B.K. Toone, “Postictal psychosis after temporal lobectomy.” Neurology, 2002, 59: 1432-1435.
[18] John Milton, William Rand Kenan Jr. Professor in Computational Neuroscience at The Claremont Colleges; email dated September 8, 2004.
[19] O. Devinsky, H. Abramson, K. Alper, L.S. FitzGerald, K. Perrine, J. Calderon, D. Luciano, “Postictal psychosis: A Case control series of 20 patients and 150 controls.” Epilepsy Research, 1995, 20: 247-253.
[20] S.J. Logsdail and B.K. Toone, "Postictal Psychoses A Clinical and Phenomenological Description." British Journal of Psychiatry, 1988, 152: 251.
[21] I shared the record that Isabel kept of Jean’s attacks with John Milton, William Rand Kenan Jr. Professor in Computational Neuroscience at The Claremont Colleges, and Peter C. Whybrow, M.D. and Director of the Neuropsychiatric Institute at UCLA. Both concur that Jean’s aggressive behavior is the result of a psychotic state (i.e. postictal psychoses) directly linked to her epilepsy.
November 26, 1905; 1905 Daily Reminder #2, Mark Twain Papers.
[22] Samuel Webster, handwritten document included in the Webster typescript under the date: November 26, 1905, Mark Twain Papers.
[23] January 5, 1906; 1906 Daily Reminder #1 Mark Twain Papers.
[24] November 26, 1905; Samuel Webster, Webster Manuscript, Mark Twain Papers.
[25] 1906 Daily Reminder #1, Mark Twain Papers.
[26] January 13, 1906; 1906 Daily Reminder #1, Mark Twain Papers.
[27] January 27, 1906; 1906 Daily Reminder #1, Mark Twain Papers.
[28] January 28, 1906; 1906 Daily Reminder #1, Mark Twain Papers.
[29] Lyon actually give two dates for Susan Crane’s arrival. In her entry for January 31, she wrote: “<Lovely> Mrs. Crane arrived this afternoon.” The next sentence is crossed out: “<Two or three days ago>” Susan Crane could have arrived as early as the 28th. 1906
[30] Daily Reminder #1, Mark Twain Papers.
[31]1906 Daily Reminder #1, Mark Twain Papers.
[32] February 2, 1906; Notebook #5, Mark Twain Papers.
[33] April 9, 1906; Notebook #1, Mark Twain Papers.
[34] 1906 Daily Reminder #1, Mark Twain Papers.
[35] May 4, 1906; 1906 Diary, Huntington Library.
[36] October 18, 1906; 1906 Diary, Huntington Library.
[37] January 14, 1907, 1906-07 Diary, Huntington Library.
[38] Ed. Mary Lawton, A Lifetime with Mark Twain, New York: Harcourt, Brace, 1925: 321.
[39] 1906 Diary, Huntington Library.
[40] Isabel Lyon, Otober 5, 1907, Notebook #4, Mark Twain Papers.
[41] Ed. Mary Lawton, A Lifetime with Mark Twain, New York: Harcourt, Brace, 1925: 322.