Journal of Affective Disorders 53 (1999) 99106

Special article

The moon and madness reconsidered

Charles L. Raison*, Haven M. Klein, Morgan Steckler
Department of Psychiatry and Biobehavioral Sciences, Neuropsychiatric Institute and Hospital, University of California-Los Angeles,
760 Westwood Plaza, B8 -241, Los Angeles, CA 90024 -1759, USA
Received 25 June 1998; accepted 8 September 1998

Abstract
Belief that the full moon is associated with psychiatric disturbance persists despite 50 years research showing no
association. This article traces the historical roots of belief in the power of the moon to cause disorders the mind, especially
insanity and epilepsy. Putative mechanisms of lunar action are critiqued. It is proposed that modern findings showing lack of
lunar effect can be reconciled with pre-modern beliefs in the moons power through a mechanism of sleep deprivation. Prior
to the advent of modern lighting the moon was a significant source of nocturnal illumination that affected sleepwake cycle,
tending to cause sleep deprivation around the time of full moon. This partial sleep deprivation would have been sufficient to
induce mania / hypomania in susceptible bipolar patients and seizures in patients with seizure disorders. The advent of
modern lighting attenuated this lunar effect, especially in modern urban areas, where most 20th century studies of lunar
effects on the mind have been conducted. The hypothesis presented in this article is open to empirical validation or
falsification. Potential tests for the sleep-deprivation hypothesis of lunar action are discussed. 1999 Elsevier Science B.V.
All rights reserved.
Keywords: Moon; Mania; Seizures; Sleep deprivation

It is the very error of the moon,

She comes more near the earth than she was
wont.
And makes men mad.
(Othello)

*Corresponding author. Tel.: 1 1-310-8259192; fax: 1 1-3102062072.

E-mail address: craison@mednet.ucla.edu (C.L. Raison)

1. Modern studies of lunar effects

The moon has been associated with mental disorder since antiquity, as reflected by the word lunacy
itself, which derives from Luna, the Roman goddess
of the moon. Belief in the moons power to disorder
the mind, especially by causing insanity and epilepsy
when full, did not perish with the ancient world, but
persisted unabated and with few challenges until well
into the 19th century. In 1833 the physician Haslam
in reviewing his new assignment as director of

0165-0327 / 99 / $ see front matter 1999 Elsevier Science B.V. All rights reserved.
PII: S0165-0327( 99 )00016-6

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C.L. Raison et al. / Journal of Affective Disorders 53 (1999) 99 106

Bethlehem Royal Hospital in London wrote Indeed

I have understood from such of these lunatics who
have recovered that the overseer or master of the
workhouse himself has frequently been so much
under the dominion of this planet (the moon) . . . that
without waiting for any display of increased turbulence on the part of the patient, he bound, chained,
flogged and deprived these miserable people of food,
according as he discovered the moons age by the
almanac (McG. Kelley, 1942). Given such practices it is not surprising to find an 1843 article in the
Lancet claiming that popular opinion still held
epilepsy and insanity to be regulated by the moon
(White, 1914). It is somewhat more surprising,
however, that a recent US survey found 43% of
respondents believed lunar phenomena altered individual behavior, and that among mental health
professionals this percentage rose to 81%, a finding
in agreement with several studies in the last 20 years
showing that mental health workers believe more
strongly in the moons effect on the mind than do
people in other professions (Rotton et al., 1985;
Wilson and Tobacyk, 1990; Angus, 1995).
Such ongoing belief in the power of the moon,
especially among mental health workers, is curious
given abundant evidence amassed over the last
quarter century demonstrating no relationship between phase of the moon and any measurable
parameter of mental functioning. Campbell and
Beets in 1978 reviewed all empiric studies on lunar
effects to that time and concluded that lunar phase
had no effect on psychiatric hospital admissions,
suicides or homicides (Byrnes and Kelly, 1992;
Gorvin and Roberts, 1994). More recent work has
confirmed this assessment and has strengthened the
argument that the few studies finding positive correlations between the moon and behavior are so
methodologically flawed as to be ruled out as
examples of type I error. Recent studies have shown
that no connection exists between moon phase and
suicide attempts, suicide completions, psychiatric
admissions, absenteeism from work, traffic accidents
or trauma (Mathew and Lindesy, 1991; Nifsten and
Willemsen, 1991; Rogers et al., 1991; Sand and
Miller, 1992; Laverty et al., 1992; Martin et al.,
1992; Angus, 1995; Vance, 1995). A 1992 review of
12 studies looking at lunar cycle and frequency of
crisis calls found no connection (Martin et al., 1992).

2. Critique of possible etiologic mechanisms for

a lunar effect
What is to be made of the discrepancy between
popular belief in the power of the moon and empiric
evidence that no such power exists? Three general
answers can be given to this question. The first is
that popular wisdom is right: the moon does affect
the mind, but the studies are not capturing the
relevant variables. The moon may have effects we
are not able to measure, or may have an effect on
measured variables that is obscured by noise within
the variables themselves. For example, the association of a particular lunar phase with insanity might
not be accurately reflected in patterns of psychiatric
hospitalizations because of intra-patient variations in
time between symptom onset and hospitalization.
This line of thought, however, would not account for
the lack of connection between lunar phase and
suicide, crisis calls, or trauma, all of which are dated
from their actual occurrence, but again these very
particular types of variables may be inadequate to
capture the moons effect. Although no way exists
either to prove or disprove this argument, if the
moon possesses anything like the power ascribed to
it in the popular imagination since antiquity it seems
likely that some indication of its effects on the mind
would be visible across the wide range of variables
that have been studied.
A second, and scientifically appealing, answer to
why the moon has been associated with mental
disorder is that the association is simply false: people
have also believed the moon is made of green
cheese. The literature on lunar effects offers many
types of answers for how a false association between
the moon and madness could have arisen. For
example, White (1914), in one of the first psychoanalytic discussions of the subject, suggests that the
moon is a libido symbol which came to be associated
with insanity through its evocation of ambivalence.
Many other such ideas abound, all connected by the
premise that the association of the moon with
madness reflects not a socio-biologic reality of the
outer world but rather a mythological truth about
inner human psychological experience.
To propose that the moons effect on mental
illness is actual, but not quantifiable, or that such an
effect is perhaps in some sense mythologically or

C.L. Raison et al. / Journal of Affective Disorders 53 (1999) 99 106

symbolically true, but not actual, is to presume that

the moons ability to cause mental disorder has been
unchanging across human history. A third answer to
the question of why belief in the moons power over
the mind persists is that such belief represents a
cultural fossil a memory of an actual effect that no
longer obtains. Perhaps the moon once had a power
over the functioning of the brain that it has since
lost.
Different mechanisms have been proposed to
account for the moons effect on the brain. Pliny the
Elder voiced the popular opinion of antiquity when
he noted that the full moon gives birth to especially
heavy nocturnal dew and by extension causes the
brain to become unnaturally moist leading to both
lunacy and epileptic attacks (McG. Kelley, 1942).
More recently other mediators of lunar power have
been proposed: tidal effect, weather patterns, magnetism and polarization of the moons light (Katzeff,
1981). Arguments for each of these range from
quaint to flimsy, but there is no reason to suspect any
diminution in such forces through the ages. If they
were causative of a connection between the moon
and mental illness, such an effect would still be
empirically measurable. Therefore, none of these
possible lunar effects could account for a change in
the moons ability to cause mental dysfunction.

3. The moon as a source of nocturnal

illumination
Although the moon shone no brighter in antiquity
than it does today, the relative importance of this
light in redeeming the night for human affairs has
diminished significantly in the last 200 years. It is
hard for us to imagine the darkness of a moonless
night, even for urbanites, before the advent of gas
lighting in the beginning of the 19th century. As late
as 1791, London boasted a social group known as
the Lunar Society, not because its members had any
particular interest in studying the moon, but because
meetings were routinely held at the full moon so
members would be able to find their way home
safely after dark (Laing, 1982). That Londons
busiest thoroughfares were dark enough at night to
provide for the most intimate forms of human
congress is well described by James Boswell in his

101

London diary of 1763: I picked up a strong, jolly

young damsel, and taking her under the arm I
conducted her to Westminster Bridge, and then in
armour complete did I engage her upon this noble
edifice. The whim of doing it there with the Thames
rolling below us amused me much (Pottle, 1950).
Boswell describes seven such outdoor nocturnal
trysts in his London diary, only two of which
occurred when the moon was more than half full,
suggesting perhaps that even in that cloud-clad
climate the extra light served as a deterrent.
Boswell was able to carry out his amorous exploits
despite the fact that torches has been lit along the
streets of London every night of the year since 1735,
an amenity grown from the late medieval practice of
householders setting torches outside their dwellings
during moonless winter nights (Laing, 1982). How
much darker yet the night must have been in
antiquity when no such practice existed. Carcopino
(1941) describes the situation in Imperial Rome:
When there was no moon its streets were
plunged in impenetrable darkness. No oil lamps
lighted them, no candles were affixed to the walls;
no lanterns were hung over the lintel of the doors,
save on festive occasions when Rome was resplendent with exceptional illuminations... In normal times night fell over the city like the shadows
of a great dander... Everyone fled to his home,
shut himself in, and barricaded the entrance. The
shops fell silent, safety chains were drawn across
behind the leaves of the door; the shutters of the
flat were closed and the pots of the flowers
withdrawn from the windows they had adorned.
In response to this the Roman arose at or even
before dawn, in order to profit by every daylight
hour, whilst the evening cena was eaten, or at the
very least begun, well before dusk. In a world where
the brightest household light burned in the fireplace
this type of schedule was nearly universal and
remained so until around 1500 when wealthy Europeans began extending their domain into the night
with the use of expensive candles. The luxury of
burning the candle at both ends remained, however,
the province of a small minority, with most people
consigned nightly to domestic dimness until well into
the 19th century. Much of what brought the first

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C.L. Raison et al. / Journal of Affective Disorders 53 (1999) 99 106

dazed visitors to the gaslit entertainment palaces of

the 19th century London was the brilliant lighting
itself (Laing, 1982).
Before 1800 the monthly ripening of the moon
provided a significant reprieve from nights oppression, especially in the three days around full moon
when the lunar light is twelve times stronger than at
half-full (Luby et al., 1960). The full moon must
have allowed for many activities impossible during
the months darker nights: outdoor gatherings, simple work such as plowing, hunting in open areas,
travel along roads. Even reading is possible under a
full moon, a fact I discovered with some surprise on
a camping trip several years ago when I accidentally
forgot my flashlight but nonetheless was able to sit
on an exposed rock and read the front page of a
newspaper. The end result of moonlight, allowing as
it did the colonization of otherwise impenetrable
night, would have been that on average people
stayed up later and slept less during the full moon
than at other times of the month.

4. The effects of moonlight on the mind: sleep

deprivation in the genesis of mania and seizures
If the full moon deprived people of sleep in the
millennia before gas lighting, could this have served
as a possible mechanism for the moons effect on the
mind? Many studies in this century have shown that
prolonged sleep deprivation (i.e. more than 72 h)
induces cognitive changes in normal controls, especially mood symptoms and auditory and visual
hallucinations (Tyler, 1955; Luby et al., 1960; Ross,
1965). More germane to any possible effect of the
moon, however, is more recent work demonstrating
that even partial sleep deprivation over the course of
a single night can induce mania, both in previously
healthy but presumably vulnerable individuals and in
patients with pre-existing bipolar disorder (Wehr et
al., 1982; Wehr, 1992; Wright, 1993). Wehr et al.
(1982), in studying the sleepwake cycle of rapidcycling bipolar patients, found that a night of partial
sleep loss nearly always preceded spontaneous switches to mania or hypomania. When the researchers
intentionally deprived these patients of sleep 75%
switched from depression into mania or hypomania.
These induced manic / hypomanic episodes lasted

from 1 to 50 days, with approximately 50% of the

patients reverting to depression after one nights
sleep. This last finding is consonant with work by
Nowlin-Finch et al. (1994) showing that the length
of manic episodes, especially in first-break patients,
was inversely correlated with the number of hours
slept during the first night in hospital: the more that
patients slept the faster their symptoms resolved.
These finding have prompted the hypothesis that
sleep deprivation may be a final common pathway in
the genesis of mania, and that the ongoing sleep
disturbance of mania may function as a self-sustaining positive feedback loop once a manic episode has
begun (Wehr et al., 1987). As Wehr (1992) points
out, many of the factors believed to play a role in
inducing mania interfere with sleep. Disruptions of
routine connected with travel or various types of
emergencies may preclude sleep. Emotional reactions to people and events, such as excitement,
anxiety, fear, grief, and despair, commonly cause
insomnia. Indeed, Jauhar and Weller (1982) have
shown an association between west to east (i.e.
overnight flights) air travel and hospitalization for
mania.
To this diverse array of events and situations that
induce mania through sleep deprivation we might
add moonlight, not in the modern world where
sleepwake cycles have been disengaged from the
sun and the moon (Wehr et al., 1995), but in times
past when moonlight or its absence dictated whether
the night was usable or impenetrable. In the Wehr et
al. (1982) study of the effect of sleep deprivation on
manic patients, it should be remembered that nearly
50% recovered with one nights sleep. This suggests
that the effect of moonlight on many people would
have been time-limited, further strengthening an
association between the period of the full moon and
manic excitement and / or psychosis.
We have thus far argued that the full moon may
have increased the incidence of mania and hypomania before the advent of modern lighting. A recent
study, however, suggests an opposite, but not incompatible, mechanism for lunar effects on the mind: the
dark of the moon may have protected against the
development of insanity. Recently researchers successfully treated a patient with rapid cycling bipolar
disorder by artificially increasing time spent in bed in
the dark to 14 hours a day. The patients typical

C.L. Raison et al. / Journal of Affective Disorders 53 (1999) 99 106

pattern of rapid fluctuation between depression and

mania subsided and his mood stabilized as he
adopted a regimen of enforced rest during daily
prolonged periods of darkness (Wehr et al., 1998).
The authors note that this result is consonant with
animal studies showing that compression of the
nightly dark period diminishes, and extension of the
dark period augments, capacity to synchronize circadian rhythms with the external daynight cycle
(Goldman and Elliot 1988). Such synchronization is
thought to protect against rapid phase jumps in
animals which resemble the types of sleep dysregulation that often precede switches from depression to
mania in bipolar patients. Through such a mechanism the extended periods of darkness around new
moon in the years before gas lighting may have
actually served a protective function against developing mania or hypomania that has been lost in the
modern world. The prevalence of bipolar illness in
general, and of rapid cycling in particular, has
increased among those predisposed to develop the
disease during the 20th century (Gershon et al.,
1987). The loss of enforced darkness during the two
weeks around new moon may represent a previously
unrecognized contributor to this increase.
Of brain disorders associated with the sleepwake
cycle, epilepsy is the most established and best
characterized. The effect of sleep on epileptic seizures was discussed by Gowers (1885) and quantitatively assessed as early as 1929 (Langdon-Down and
Brain, 1929). Sleep deprivation has long been recognized as a potent way to provoke seizures (Shouse et
al., 1996). Even previously assymptomatic individuals have been observed to seize after sleep deprivation (Friis and Lund, 1974). Epileptologists make
frequent use of sleep deprivation as a diagnostic tool,
finding it helpful not only for inducing seizures but
also for brining out EEG abnormalities in the
absence of seizures.
As in the case of mania, seizures may have
become associated with the moon through a mechanism of sleep deprivation. Rajna and Veres (1993)
found that patients with temporal lobe epilepsy were
exquisitely sensitive to even slight sleep deprivation.
Sleep decrements of only 1.5 hours from baseline
increased seizure occurrence significantly: nearly
60% of their patients seized on days following mild
sleep decreases. Because even such partial sleep

103

deprivation increases seizure risk, the moon in the

years before artificial lighting need have exerted only
modest effects on the sleepwake cycle to have
significantly increased the risk of seizures when full.
Sleep deprivation is most likely to provoke a seizure
within 48 h of its occurrence (Rodin, 1984). As in
the case of mania, the results of moonlight on
epilepsy, therefore, would have been immediate and
time limited. Most seizures would have occurred
while the full moon still hung in the sky, increasing
the likelihood of an association being made between
moonlight and epilepsy, even in the absence of
controlled observation.

5. Pre-modern evidence for a specific association

of the full moon with mania
The moons association with madness, lost now,
may have been recognized over the centuries from
repeated observations that susceptible people, the
majority of whom we would today diagnose as
bipolar, were more likely to develop manic symptoms around the full moon than at other times of the
month. The 19th century French physician Esquirol
(1845) anticipated the argument of this paper by
recognizing that the moons effect on mental functioning was mediated by its light: It is true that the
insane are more agitated at the full of the moon, as
they are also, at early dawn. But is it not the light of
the moon that excites them, as that of day, in the
morning? Does not this brightness produce, in their
habitations, an effect of light, which frightens one,
rejoices another, and agitates all?
Esquirols acumen aside, pre-modern people need
not have held accurate etiologic explanations for
their gradually developing empiric observations to
have been valid. But the argument that moonlight
caused madness by inducing mania through sleep
deprivation would be strengthened by evidence of an
understanding in pre-modern times that certain types
of insanity demonstrate sufficient cyclicity for an
association with the moon to be noticeable. In a legal
decision oddly prescient of modern psychiatric
nosology, the 18th century English jurist Lord Blackstone makes precisely this point. He differentiates
between two types of insanity (McG. Kelley, 1942).
He defines the state of non compos mentis as one

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C.L. Raison et al. / Journal of Affective Disorders 53 (1999) 99 106

in which a person has had an understanding, but by

disease, grief or other accident, has lost the use of
reason, and contrasts this with the condition of
being a lunatic. A lunatic is indeed properly one
who has lucid intervals, sometimes enjoying his
senses, and sometimes not, and that frequently
depending upon the changes of the moon. Today we
would recognize the state of non compos mentis as
relating to schizophrenia with its often unrelenting
decline in functioning, consistent with losing the use
of...reason. Blackstones conception of lunacy, on
the other hand, appears similar to modern conceptions of bipolar disorder with its relapsingremitting course. It is striking that in mirroring received
wisdom, Blackstone identifies these patients as vulnerable to lunar effects, because if the moon did
cause sleep deprivation before the advent of artificial
lighting those individuals most likely to be affected
would have suffered from bipolar disorder, not
schizophrenia, which is less exquisitely sensitive to
sleep disturbance.
The argument that a valid association between the
moon and insanity developed in antiquity would also
be strengthened by demonstrating that people correctly identified moon-induced madness with symptoms recognizable as manic as these are the types
of symptoms brought on by sleep deprivation. Ancient accounts do seem to support such a recognition.
Sarton (1939), in summarizing the literature, refers
to the ancient conception that the full moon
produces agitation, excitement and even maniacal
outbursts in mental patients. Paracelsus (1967),
writing in the 16th century, describes four types of
psychoses, one of which, lunacy, demonstrates a
relapsingremitting course dominated by the moon,
which stimulates the sexual passions. It should be
noted that hypersexuality remains a symptom in
current conceptions of mania, being far less common
in the psychotic exacerbations of schizophrenia.
Paracelsus adds: Mania has the following symptoms: frantic behavior, unreasonableness, constant
restlessness and mischievousness. It may be recognized by the fact that it subsides by itself and reason
returns; mania may disappear and recur several
times, or it may never recur. Some patients suffer
from it depending on the phases of the moon...
(Paracelsus, 1967). As late as 1881 a textbook of
psychiatry notes (Hering, 1881):

WORSE DURING PHASES OF THE MOON

(according to Bonninghausen and Jahr)
With full moon, increasing mania.
Great anxiety in evening in bed.
Even granted that pre-modern conceptions of mania
encompassed a broader range of agitated psychotic
behavior than is ascribed to the term today, we may
at least conclude that syndromes we would recognize
as manic or perhaps mixed were associated with the
moon, and that these symptoms tended to relapse and
remit with periods of normalcy between episodes.
Such a description is consistent with the idea that
moon-induced madness was generally associated
with symptoms and a disease course consistent with
bipolar disorder.

6. Possible methods for validating a sleepdeprivation theory of the moons effect on

mental functioning
In contrast to mythological or symbolic explanations for why the moon came to be associated with
madness and epilepsy, the proposal offered in the
paper is potentially falsefiable and may thus be
available to empirical validation. A first step would
be to demonstrate that artificial lighting dampens any
effects the moon may have once exerted. Indirect
evidence for this comes from work by Wehr et al.
(1995), showing that artificial lighting in urban
environments suppresses changes in circadian mechanisms such as release of melatonin that are otherwise highly responsive to seasonal differences in
hours of daylight. This suggests that even as significant a natural light source as the sun, let alone the
moon, is overridden by the effects of artificial
lighting in the modern world. Direct evidence that
the moon does not influence the incidence of mania
in modern urban areas comes from work done at
UCLA showing no connection between lunar phase
and hospital admissions for a diagnosis of manic
episode (Raison et al., 1996).
A final step toward testing the hypothesis presented here might come from evaluating the effect of
lunar phase on hospital admissions for mania in a
culture in which the moon still appreciably influences sleepwake cycles. Certain Native American

C.L. Raison et al. / Journal of Affective Disorders 53 (1999) 99 106

people in the southwestern United States, where

skies are typically clear and dark, might be ideal for
such a study. Most Native Americans in this region
live in isolated environments, some without electricity, others where the use of electricity is confined to
indoor illumination. Additionally, regional hospitals
serving Native Americans keep extensive psychiatric
admission and diagnostic records (May et al., 1994)
making possible an examination of the relationship
between lunar phase and hospitalization for mania. If
the proposal offered here is correct, one would
expect to find a significant effect of lunar phase on
admission, with mania presenting more often in the
week after full moon than in the week before.
Until such work is done, the proposal that the
moon came to be associated with madness and
epilepsy through gradual recognition in antiquity of a
real relationship between lunar phase and mental
disorder must remain speculative. However, when
one considers the profound effect of sleep deprivation on mania, and considers also the havoc wrecked
through history by bipolar disorder, it seems safe to
acknowledge that, as has been written of the moon,
mania is frequently identified with the night and its
problems and is taken as a symbol of energy
possessing ambivalent power for good and evil.
(McG. Kelley, 1942).

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