This review revisits the infamous Salem Witch Trials by adopting a neuro-historical framework to examine how the reported behvioral symptoms historically considered as evidence of witchcraft and grounds for execution could have been due to underlying unaddressed neuro-psychiatric ailments. 

The Salem Witch Trials of 1692 are amongst the most widely discussed events in history, culminated in the wrongful execution of 20 individuals, purely based on the speculative claims of supernatural afflictions due to the misinterpretation of reported ‘erratic’ behavior, including convulsions, hallucinations, transient cognitive deficits as well as sensory and perceptual disturbances. This review argues that these unfortunate persecutions occurred due to neurological misdiagnoses, thus underpinning the importance of evidence-based care in current times.

A scoping literature review across relevant databases was conducted and supplemented with historical accounts of prominent figures persecuted in the trials to understand the reported symptomatology. These accounts were subsequently analyzed in conjunction with modern diagnostic criteria and contemporary academic literature to identify potential neurological explanations for the reported behaviors.

The literature posits that although the reported behaviors must be considered within the socio-political and cultural context of 17^th century New England, there is considerable overlap between the reported symptomology and modern diagnoses. Cases of convulsions and ‘fits’ resemble the clinical presentation of epilepsy and psychogenic non-epileptic seizures (PNES). Functional neurological disorder (FND) and anti-NMDAR encephalitis are amongst other possibilities postulated. Additionally, ergot poisoning from contaminated rye offers a biological explanation for the reported psychotic symptoms, with mass hysteria and social contagion postulated as exacerbating factors.

Revisiting the Salem Witch Trail through a neuro-historical lens presents compelling evidence of the progress made in understanding complex neuropsychiatric symptomatology while also serving as a cautionary tale about the consequences of misdiagnoses and subjective diagnostic error, especially when symptoms are attributed to supernatural causes.