Abstract
Within socio-military history, the diagnosis of post-traumatic stress disorder has aroused a lot of attention, with many scholars claiming its existence in the pre-modern world while sceptics have challenged this claim in no uncertain terms. However, the debates surrounding historic PTSD have been made without due consideration of the wider medical history debates surrounding retrospective diagnosis of biological disease. There is a fundamental methodological challenge in that psychiatric diagnoses frequently emphasise behavioural symptoms, this in turn gives historians a twofold problem: (1) Can we know whether these behavioural symptoms are predominantly characteristic of our own social normality, and thus their observation by clinicians confirms simply antithetical and undesirous behaviours in the modern day? (2) If those same behaviours appeared in another cultural sphere do they still hold the same diagnostic capabilities? This chapter will focus on one such diagnosis, post-traumatic stress disorder, and address some of the pressing methodological issues surrounding such a practice.
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Notes
- 1.
For discussion on this field of scholarship, and its tradition, see A. Cunningham, ‘Identifying Disease in the Past: Cutting the Gordian Knot’, Asclepio 54, 2002, 13–34; J. Arrizabalaga, ‘Problematizing Retrospective Diagnosis in the History of Disease’, Asclepio 54, 2002, 51–70; K.H. Leven, ‘“At Times These Ancient Facts Seem to Lie Before Me Like a Patient on a Hospital Bed”—Retrospective Diagnosis and Ancient Medical History’, in Manfred Horstmanshoff and Marten Stol (eds), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine (Leiden: Brill, 2004), pp. 369–86; A. Karenberg and F.P. Moog, ‘Next Emperor Please! No End to Retrospective Diagnosis’, Journal of the History of the Neurosciences 13.2, 2004, 143–49.
- 2.
C. Thumiger, A History of the Mind and Mental Health in Classical Greek Medical Thought (Cambridge: Cambridge University Press, 2017), pp. 2–8.
- 3.
N.M. Bark, ‘On the History of Schizophrenia: Evidence of Its Existence Before 1800’, New York State Journal of Medicine 88.7, 1988, 374–83; C.V. Haldipur, ‘Madness in Ancient India: Concept of Insanity in Charaka Samhita (first century A.D.)’, Comprehensive Psychiatry 25.3, 1984, 335–44; D.V. Jeste, R. del Carmen, J.B. Lohr, and R.J. Wyatt, ‘Did Schizophrenia Exist Before the Eighteenth Century?’, Comprehensive Psychiatry 26.6, 1985, 493–503; K. Otsuka and A. Sakai, ‘Haizmann’s Madness: The Concept of Bizarreness and the Diagnosis of Schizophrenia’, History of Psychiatry 15.1, 2004, 73–82; M.H. Stone, Healing the Mind: A History of Psychiatry from Antiquity to the Present (New York: W. W. Norton, 1997); H.A. Youssef and F.A. Youssef, ‘Evidence for the Existence of Schizophrenia in Medieval Islamic Society’, History of Psychiatry 7, 1996, 55–62; D. Fraguas, ‘Problems with Retrospective Studies of the Presence of Schizophrenia’, History of Psychiatry 20.1, 2009, 61–71.
- 4.
Erwin H. Ackerknecht, ‘Psychopathology, Primitive Medicine and Primitive Culture’, Bulletin of the History of Medicine 14.1, 1943, 37.
- 5.
E. DePoy and S.F. Gilson, Studying Disability: Multiple Theories and Responses (London: Sage, 2011), pp. 9–10, 96–97; Dana Lee Baker, The Politics of Neurodiversity: Why Public Policy Matters (Boulder: Lynne Reiner, 2011), pp. 12–5.
- 6.
O. Rees, ‘We Need to Talk About Epizelus: PTSD and the Ancient World’, Medical Humanities 46.1, 2020, 46.
- 7.
Edgar Jones and Simon Wessely, ‘War Syndromes: The Impact of Culture on Medically Unexplained Symptoms’, Medical History 49, 2005, 56.
- 8.
D. Fraguas, ‘Problems with Retrospective Studies of the Presence of Schizophrenia’, History of Psychiatry 20.1, 2009, 62.
- 9.
J. Shay, Achilles in Vietnam (New York: Athenaeum, 1994), pp. 166–69; L. Tritle, Melos to My Lai (London: Routledge, 2000), pp. 57–8.
- 10.
J. Shay, ‘Moral Injury’, Intertexts 16.1, 2012, 57–66.
- 11.
D. Fraguas, ‘Problems with Retrospective Studies of the Presence of Schizophrenia’, History of Psychiatry 20.1, 2009, 63.
- 12.
In his follow up book Odysseus in America, 149, he makes the observation that combat adaptations may account of the symptoms of PTSD in the DSM, but equally advised his readers to go and read the list of symptoms themselves.
- 13.
G.E. Berrios, ‘Classifications in Psychiatry: A Conceptual History’, Australian and New Zealand Journal of Psychiatry 33.2, 1999, 145–60.
- 14.
C. Thumiger, A History of the Mind and Mental Health in Classical Greek Medical Thought (Cambridge: Cambridge University Press), pp. 72–3.
- 15.
C. Thumiger, ‘The Early Greek Medical Vocabulary of Insanity’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), pp. 61–4.
- 16.
Aretaeus of Cappadocia, On Chronic Diseases, 1.6; Aetius, Iatrika, 6.8; W.V. Harris, ‘Thinking About Mental Disorders in Classical Antiquity’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), pp. 1–2.
- 17.
D. Fraguas, ‘Problems with Retrospective Studies of the Presence of Schizophrenia’, History of Psychiatry 20.1, 2009, 64.
- 18.
J. Shay, Achilles in Vietnam: Trauma and the Undoing of Character (New York: Athenaeum, 1994), xx.
- 19.
This pan-cultural, universalist model has led at least one team of researchers to use the ancient world to argue that the same is true of treatment: ‘it indicates that modern Western approaches to the psychological treatment of trauma are not entirely culturally dependent and may be applied to the treatment of trauma with patients from different cultural traditions.’—Y. Ustinova and E. Cardeña, ‘Combat Stress Disorders and Their Treatment in Ancient Greece’, Psychological Trauma: Theory, Research, Practice, and Policy 6.6, 2014, 746.
- 20.
For a historical case study that examines the differing reception of the ‘traumatised’ warrior, see O. Rees, ‘We Need to Talk About Epizelus: PTSD and the Ancient World’, Medical Humanities 46.1, 2020, 46–54.
- 21.
A. Young, The Harmony of Illusions (Princeton: Princeton University Press, 1995).
- 22.
L.J. Kirmayer, ‘Confusion of the Senses: Implications of Ethnocultural Variations in Somatoform and Dissociative Disorders for PTSD’, in A.J. Marsella, M.J. Friedman, E.T. Gerrity, and R.M. Scurfield (eds), Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications (Washington, DC: American Psychological Association, 1996), p. 150.
- 23.
P.J. Bracken, ‘Post-modernity and Post-traumatic Stress Disorder’, Social Science & Medicine 53.6, 2001, 742.
- 24.
S. O’Brien, Traumatic Events and Mental Health (Cambridge: Cambridge University Press, 1998), p. 5.
- 25.
N. Metzger, ‘Railway Spine, Shell-shock and Psychological Trauma: The Limits of Retrospective Diagnosis’, in Eve-Marie Becker, Jan Dochhorn, Else Holt (eds), Trauma and Traumatization in Individual and Collective Dimensions: Insights from Biblical Studies and Beyond (Gottingen: Vandenhoek & Ruprecht GmBH, 2014), p. 56.
- 26.
Jason Crowley, ‘Beyond the Universal Soldier: Combat Trauma in Classical Antiquity’, in P. Meineck and D. Konstan (eds), Combat Trauma and the Ancient Greeks (New York: Palgrave Macmillan, 2014), p. 117.
- 27.
See for instance Thucydides, History of the Peloponnesian War 2.8, and similar sentiments expressed in the works of poets such as Pindar, fr. 110.
- 28.
Walid Khalid Abdul-Hamid and Jamie Hacker Hughes, ‘Nothing New under the Sun: Post-traumatic Stress Disorders in the Ancient World’, Early Science and Medicine 19.6, 2014, 549–57.
- 29.
J. Scurlock and Burton Anderson, Diagnoses in Assyrian and Babylonian Medicine (Chicago: University of Illinois Press, 2005), p. 349.
- 30.
Ibid., p. 351.
- 31.
L. Tritle, Melos to My Lai (London: Routledge, 2000), p. 59.
- 32.
Ibid., p. 56.
- 33.
Aislinn Melchior, ‘Caesar in Vietnam: Did Roman Soldiers Suffer from Post-traumatic Stress Disorder’, Greece & Rome 58.2, 2011, 216.
- 34.
Homer, Iliad 16.65; 16.90; 16.836; 17.194; 17.224; 19.269; 20.351; 21.86; 23.5; 23.129.
- 35.
Diodorus Siculus, Library 15.19.4.
- 36.
Plutarch, Life of Agesilaus 35.3.
- 37.
Diodorus Siculus, Library 15.50.5.
- 38.
Diodorus Siculus, Library 15.50.5.
- 39.
J. Roisman, ‘Klearchos in Xenophon’s Anabasis’, Scripta Classica Israelica, 8/9, 1985–1989, 50.
- 40.
Xenophon, Anabasis 2.6.6.
- 41.
Xenophon, Anabasis 2.6.7, 10.
- 42.
Xenophon, Cyropaedia 2.1.22 (Translator Walter Miller, 1914). He repeats this sentiment in his Hellenica, 6.1.6.
- 43.
Pericles: Plutarch, Life of Pericles 7.1. Alcibiades: Plutarch, Life of Alcibiades 18.1. Heracles: Isocrates, Helen 10.17.
- 44.
S.S. Monoson, ‘Socrates in Combat: Trauma and Resilience in Plato’s Political Theory’, in P. Meineck and D. Konstan (eds), Combat Trauma and the Ancient Greeks (New York: Palgrave Macmillan, 2014), p. 134; B. Steinbock ‘Sufferings Too Great for Tears: The Destruction of the Athenian Expeditionary Corps in Sicily’, in Melanie Jonasch (ed), The Fight for Greek Sicily Society, Politics, and Landscape (Oxford: Oxbow Books, 2020), pp. 76–8.
- 45.
Renato D. Alarcón, ‘Culture, Cultural Factors and Psychiatric Diagnosis: Review and Projections’ World Psychiatry 8, 2009, 131–39; Andrew Roderick Gilmoor, Adithy Adithy, and Barbara Regeer, ‘The Cross-Cultural Validity of Post-traumatic Stress Disorder and Post-traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review’ Frontiers in Psychiatry 10.439, 2019; Guerda Nicolas, Anna Wheatley, and Casta Guillaume, ‘Does One Trauma Fit All? Exploring the Relevance of PTSD Across Cultures’, International Journal of Culture and Mental Health 8, 2015, 34–45.
- 46.
The best discussions of this methodological issue are found in ‘Thinking About Mental Disorders in Classical Antiquity’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), and C. Thumiger and P.N. Singer, ‘Introduction: Disease Classification and Mental Illness: Ancient and Modern Perspectives’, in C. Thumiger and P.N. Singer (eds), Mental Illness in Ancient Medicine: From Celsus to Paul of Aegina (Leiden: Brill, 2018), 1–32.
- 47.
Or, as Otto Wahl observed, the common default is to portray a caricatured form of schizophrenia—Otto Wahl, Media Madness: Public Images of Mental Illness (New Brunswick: Rutgers University Press, 1995/2003), pp. 89–90.
- 48.
C. Thumiger, A History of the Mind and Mental Health in Classical Greek Medical Thought (Cambridge: Cambridge University Press, 2017), p. 48.
- 49.
B. Simon, ‘“Carving Nature at the Joints”: The Dream of a Perfect Classification of Mental Illness’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), p. 37.
- 50.
S. Minsky, W. Vega, T. Miskimen, M. Gara, and J. Escobar, ‘Diagnostic Patterns in Latino, African American, and European American Psychiatric Patients’, Arch Gen Psychiatry 60.6, 2003, 637–44.
- 51.
Jason Crowley, ‘Beyond the Universal Soldier: Combat Trauma in Classical Antiquity’, in P. Meineck and D. Konstan (eds), Combat Trauma and the Ancient Greeks (New York: Palgrave Macmillan, 2014), pp. 111–12.
- 52.
B. Liddell and L. Jobson, ‘The Impact of Cultural Differences in Self-representation on the Neural Substrates of Posttraumatic Stress Disorder’, European Journal of Psychotraumatology 7:1, 2016, 1–13, https://doi.org/10.3402/ejpt.v7.30464, accessed 22 December 21.
- 53.
Arousal response: K.G. Martinez, J.A. Franco-Chaves, M.R. Milad, and G.J. Quirk, ‘Ethnic Differences in Physiological Responses to Fear Conditioned Stimuli’, PLoS One 9, 12, 2014, e114977, http://dx.doi.org/10.1371/journal.pone.0114977, accessed 22 December 21.
Amygdala: B. Derntl, U. Habel, S. Robinson, C. Windischberger, I. Kryspin-Exner, R.C. Gur, and E. Moser, ‘Culture But Not Gender Modulates Amygdala Activation During Explicit Emotion Recognition’, BMC Neuroscience 13, 2011, 54; J.Y. Chiao, T. Iidaka, H.L. Gordon, J. Nogawa, M. Bar, E. Aminoff, N. Sadato, and N. Ambady, ‘Cultural Specificity in Amygdala Response to Fear Faces’, Journal of Cognitive Neuroscience 20.12, 2008, 2167–74.
- 54.
American Psychological Association, Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry (2013 edition), 7.3: ‘it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.’
Bibliography
Abdul-Hamid, Walid Khalid, and Jamie Hacker Hughes, ‘Nothing New under the Sun: Post-traumatic Stress Disorders in the Ancient World’, Early Science and Medicine 19.6, 2014, 549–57.
Ackerknecht, Erwin H., ‘Psychopathology, Primitive Medicine and Primitive Culture’, Bulletin of the History of Medicine 14, 1943, 30–67.
Alarcón, Renato D., ‘Culture, Cultural Factors and Psychiatric Diagnosis: Review and Projections’, World Psychiatry 8, 2009, 131–39.
American Psychological Association, Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry (2013 edition), 7.3.
American Psychiatric Association, Diagnostics and Statistical Manual of Mental Disorders-5 (Washington: American Psychiatric Association, 2019).
Arrizabalaga, J., ‘Problematizing Retrospective Diagnosis in the History of Disease’, Asclepio 54, 2002, 51–70.
Baker, Dana Lee, The Politics of Neurodiversity: Why Public Policy Matters (Boulder: Lynne Reiner, 2011).
Bark, N.M. ‘On the History of Schizophrenia: Evidence of Its Existence Before 1800’, New York State Journal of Medicine 88.7, 1988, 374–83.
Berrios, G.E., ‘Classifications in Psychiatry: A Conceptual History’, Australian and New Zealand Journal of Psychiatry 33.2, 1999, 145–60.
Bracken, P.J., ‘Post-modernity and Post-traumatic Stress Disorder’, Social Science & Medicine 53.6, 2001, 733–43.
Chiao, J.Y., T. Iidaka, H.L. Gordon, J. Nogawa, M. Bar, E. Aminoff, N. Sadato, and N. Ambady, ‘Cultural Specificity in Amygdala Response to Fear Faces’, Journal of Cognitive Neuroscience 20.12, 2008, 2167–74.
Crowley, Jason, ‘Beyond the Universal Soldier: Combat Trauma in Classical Antiquity’, in P. Meineck and D. Konstan (eds), Combat Trauma and the Ancient Greeks (New York: Palgrave Macmillan, 2014), 105–30.
Cunningham, A., ‘Identifying Disease in the Past: Cutting the Gordian Knot’, Asclepio 54, 2002, 13–34.
DePoy, E., and S.F. Gilson, Studying Disability: Multiple Theories and Responses (London: Sage, 2011).
Derntl, B., U. Habel, S. Robinson, C. Windischberger, I. Kryspin-Exner, R.C. Gur, and E. Moser, ‘Culture But Not Gender Modulates Amygdala Activation During Explicit Emotion Recognition’, BMC Neuroscience 13, 2011, 54. https://doi.org/10.1186/1471-2202-13-54
Fraguas, D., ‘Problems with Retrospective Studies of the Presence of Schizophrenia’, History of Psychiatry 20.1, 2009, 61–71.
Gilmoor, Andrew Roderick, Adithy Adithy, and Barbara Regeer, ‘The Cross-Cultural Validity of Post-traumatic Stress Disorder and Post-traumatic Stress Symptoms in the Indian Context: A Systematic Search and Review’, Frontiers in Psychiatry 10.439, 2019, 1–24.
Haldipur, C.V., ‘Madness in Ancient India: Concept of Insanity in Charaka Samhita (1st century A.D.)’, Comprehensive Psychiatry 25.3, 1984, 335–44.
Harris, W.V., ‘Thinking About Mental Disorders in Classical Antiquity’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), 1–23,
Jeste, D.V., R. del Carmen, J.B. Lohr, and R.J. Wyatt, ‘Did Schizophrenia Exist Before the Eighteenth Century?’ Comprehensive Psychiatry 26.6, 1985, 493–503.
Jones, Edgar, and Simon Wessely, ‘War Syndromes: The Impact of Culture on Medically Unexplained Symptoms’, Medical History 49, 2005, 55–78.
Karenberg, A., and F.P. Moog, ‘Next Emperor Please! No End to Retrospective Diagnosis’, Journal of the History of the Neurosciences 13.2, 2004, 143–49.
Kirmayer, L.J., ‘Confusion of the Senses: Implications of Ethnocultural Variations in Somatoform and Dissociative Disorders for PTSD’, in A.J. Marsella, M.J. Friedman, E.T. Gerrity, and R.M. Scurfield (eds), Ethnocultural Aspects of Posttraumatic Stress Disorder: Issues, Research, and Clinical Applications (Washington, DC: American Psychological Association, 1996), pp. 131–63.
Leven, K.H., ‘“At Times These Ancient Facts Seem to Lie Before Me Like a Patient on a Hospital Bed”—Retrospective Diagnosis and Ancient Medical History,’ in Manfred Horstmanshoff and Marten Stol (eds), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine (Leiden: Brill, 2004), pp. 369–86.
Liddell, B., and L. Jobson, ‘The Impact of Cultural Differences in Self-representation on the Neural Substrates of Posttraumatic Stress Disorder’, European Journal of Psychotraumatology 7.1, 2016, 30464. https://doi.org/10.3402/ejpt.v7.30464, accessed 22 December 21.
Martinez, K.G., J.A. Franco-Chaves, M.R. Milad, and G.J. Quirk, ‘Ethnic Differences in Physiological Responses to Fear Conditioned Stimuli’, PLoS One 9,12, 2014, e114977. https://doi.org/10.1371/journal.pone.0114977, accessed 22 December 21.
Metzge, N., ‘Railway Spine, Shell-shock and Psychological Trauma: The Limits of Retrospetcive Diagnosis’, in Eve-Marie Becker, Jan Dochhorn, Else Holt (eds), Trauma and Traumatization in Individual and Collective Dimensions: Insights from Biblical Studies and Beyond (Gottingen: Vandenhoek & Ruprecht GmBH, 2014), pp. 43–61.
Minsky, S., W. Vega, T. Miskimen, M. Gara, and J. Escobar, ‘Diagnostic Patterns in Latino, African American, and European American Psychiatric Patients’, Arch Gen Psychiatry 60.6, 2003, 637–44.
Monoson, S.S., ‘Socrates in Combat: Trauma and Resilience in Plato’s Political Theory’, in P. Meineck and D. Konstan (eds), Combat Trauma and the Ancient Greeks (New York: Palgrave Macmillan, 2014), pp. 131–62.
Nicolas, Guerda, Anna Wheatley, and Casta Guillaume, ‘Does One Trauma Fit All? Exploring the Relevance of PTSD Across Cultures’, International Journal of Culture and Mental Health 8, 2015, 34–45.
O’Brien, S., Traumatic Events and Mental Health (Cambridge: Cambridge University Press, 1998).
Otsuka, K., and Sakai, A., ‘Haizmann’s Madness: The Concept of Bizarreness and the Diagnosis of Schizophrenia’, History of Psychiatry 15.1, 2004, 73–82.
Rees, O., ‘We Need to Talk About Epizelus: PTSD and the Ancient World’, Medical Humanities 46.1, 2020, 46–54.
Roisman, J., ‘Klearchos in Xenophon’s Anabasis’, Scripta Classica Israelica, 8–9, 1985–1989, 30–52.
Scurlock, J., and Burton Anderson, Diagnoses in Assyrian and Babylonian Medicine (Chicago: University of Illinois Press, 2005).
Shay, J., Achilles in Vietnam: Trauma and the Undoing of Character (New York: Athenaeum, 1994).
Shay, J., ‘Moral Injury’, Intertexts 16.1, 2012, 57–66.
Simon, B., ‘“Carving Nature at the Joints”: The Dream of a Perfect Classification of Mental Illness’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), 27–40.
Steinbock, B. ‘Sufferings Too Great for Tears’: The Destruction of the Athenian Expeditionary Corps in Sicily’, in Melanie Jonasch (ed), The Fight for Greek Sicily Society, Politics, and Landscape (Oxford: Oxbow Books, 2020), pp. 73–98.
Stone, M.H. Healing the Mind: A History of Psychiatry from Antiquity to the Present (New York: W. W. Norton, 1997).
Thumiger, C., ‘The Early Greek Medical Vocabulary of Insanity’, in William V. Harris (ed), Mental Disorders in the Classical World (Leiden: Brill, 2013), pp. 61–95.
Thumiger, C., A History of the Mind and Mental Health in Classical Greek Medical Thought (Cambridge: Cambridge University Press, 2017).
Thumiger, C., and P.N. Singer, ‘Introduction. Disease Classification and Mental Illness: Ancient and Modern Perspectives’, in C. Thumiger and P.N. Singer (eds), Mental Illness in Ancient Medicine: From Celsus to Paul of Aegina (Leiden: Brill, 2018), pp. 1–32.
Tritle, L., Melos to My Lai (London: Routledge, 2000).
Wahl, Otto, Media Madness: Public Images of Mental Illness (New Brunswick: Rutgers University Press, 1995/2003).
Young, A., The Harmony of Illusions (Princeton: Princeton University Press, 1995).
Youssef, H.A., and F.A. Youssef, ‘Evidence for the Existence of Schizophrenia in Medieval Islamic Society’, History of Psychiatry 7, 1996, 55–62.
Acknowledgements
My thanks to my fellow editors for their feedback on this chapter, and also to Dr Jo Edge who read an earlier draft and gave me invaluable comments.
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Rees, O. (2022). Post-traumatic Stress Disorder: An Ancient Greek Case Study in Retrospective Diagnosis. In: Rees, O., Hurlock, K., Crowley, J. (eds) Combat Stress in Pre-modern Europe. Mental Health in Historical Perspective. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-031-09947-2_2
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