Tuesday, January 15, 2013

PTSD in Antiquity

One of my most popular posts is still The Rage of Achilles and PTSD in Antiquity, where I went through some of the ancient sources I or others have linked to Post Traumatic Stress Disorder. The Iliad could just as easily be re-titled The Rage of Achilles, which makes it more comprehensible.

I was treated for PTSD, and so am overly familiar with it, but many of the accounts I've read by scholars over the years often don't quite ring true. The except is the brilliant Dr Jonathan Shay (see also), probably because he is a real doctor who has done some amazing work with combat veterans - rather than just another academic theorising from an ivory tower.

I find talking about ancient sources helps bring people out of their shell (pun intended), as in group therapy they tend to think "well if Achilles had it, and he was pretty big as a soldier, maybe it's okay if I have it too" - yes it is simplistic, but sometimes simple works best. If you want to see some of the stories I've used, then read this post - it's also about as sensible an introduction to the subject you'll find. I will revise it again soon, as so many people provided interesting feedback.

PTSD is misunderstood by the public, who associate it with gunmen going on rampages - in fact this tends to be the exception rather than the norm, and I prefer the term 'shell shock' as that better described most people who are treated.

The good news from Jonathan Eaton's blog is that Shay's work is going to be made into a documentary: Imperium Sine Fine: Odysseus in America Documentary

The documentary's web site - Odysseus in America - has several trailers, which are worth watching. I can't wait until it opens in my local theatre (might skip the popcorn and just bring Kleenex).

One point I find interesting is that Eaton has some strong views about PTSD not having been an issue in Antiquity ...

For example in Eaton's review of: Melchior, A. 'Caesar in Vietnam: Did Roman soldiers suffer from Post-Traumatic Stress Disorder?' Greece & Rome 58.2 (2011) - I strongly disagree with several points:
They need not fear suicide bombers, stray explosives or IEDs. Melchior highlights a recent study of PTSD symptoms in soldiers returning from Iraq ... The study suggests that there is a correlation between concussive injuries and the occurence of PTSD symptoms. Concussive injuries are clearly linked to the use of explosives. Concussive injuries would probably not have been a particularly common type of injury for Roman soldiers, compared to slash wounds, for example. Could this indicate that the prevalence of PTSD as a result of combat is directly linked to the use of explosives in modern warfare? 
I, for example, have never had a concussive injury ... and although PTSD tends to get bandied about a bit too loosely as a term, I was diagnosed with it by a real consultant psychiatrist (rather than a historian).

Eaton is stuck up on the point in his review of an article by Thomas Heebøll-Holm about PTSD and Medieval Knights:
recent research has tentatively suggested a link between PTSD and the use of explosives in modern warfare. Initial statistical analysis indicates that soldiers who have experienced concussion as a result of an explosive device are more likely to be diagnosed with PTSD. This would therefore make PTSD far rarer in the ancient world, when explosive devices played a much smaller role in combat operations.
Same claim, based on the same "tentative" study ... and still not, in my opinion, correct. Eaton's research might have been on the ancient army, but my experience with modern soldiers leads me to conclude the opposite. I knew a general with PTSD, who probably hadn't been near a bomb or IED in decades.

Our military is too important to be discussed in ivory towers in this way - they need treatment first, so that our men and women can aeither return to serve or be in a position to make another life choice.


David Cohea said...

Great post, glad Twitter lead me here ... This is a question I've been wondering about for a while. Maybe the question of whether the ancients suffered PTSD might be addressed from a different perspective. What PTSD is more about the craziness of peace than the insanity of war ... Whether PTSD is more the result of going crazy in a peacetime society that has become so successful at suppressing the face of war (or any other calamity) in its mainstream. Where to cry out against experienced horrors when no one wants to hear it? War-torn countries like Achilles' Greece had gods of war to sacrifice to (Herodotus' account of the Scythians is lurid); we have booze, meds, suicide. Not to say that PTSD wasn't experienced in older cultures (or in current, far more riven places like Ypres or Aleppo)--PTSD is just one of many to be swept under official mention--but can a mind plunged into the shock and awe of battle rage be successfully cooled and balmed by a culture so fundamentally, pathologically afraid of dying, and have the mature enough technologies to create a sufficient envelope of denial? I'm getting a lot of this from James Hillman's A Terrible Love of War.

David Cohea said...

PS, the Twitter nod goes to Rogue Classicist.

Dorothy King said...

It is true in a sense what you're saying about Peace - PTSD does not set in until weeks later. Immediate treatment for trauma tends not to work, so therapy begins a week or two later. But if you skip the therapy, PTSD can set in. Also, whilst the trauma is going on most people are experiencing fight or flight responses

Mary Harrsch said...

Dorothy, thank you for a thoughful post. I, too, strongly disagree with the conclusions put forward by Dr. Eaton about PTSD in the ancient world. A recent finding that I think is significant is the results of the autopsy of one of the NFL players who recently committed suicide. The news reported that the individual had significant brain damage from repeated concussions suffered not from explosive events but from the impacts experienced during a series of football games. If you consider the repeated impacts ancient soldiers experienced in set piece battles where tight formations were used, such as Greek or Macedonian phalanxes or Roman maniples, the probability of the occurrence of repeated concussions is quite high. The news program went on to interview the football player's family and they discussed how he had deteriorated mentally from an outgoing very social individual to a sullen, withdrawn person who no longer found life fulfilling. As the spouse of a war veteran who has been permanently disabled by severe PTSD, the symptons described by the football player's family sounded all too familiar.

I also think Eaton dismisses too readily the psychological aspects of PTSD in the ancient world because of his observations that the ancient world was a far more brutal environment that we have now (outside of inner city ghettos). He points out how people were surrounded by death because of disease, accidents without proper medical treatment and entertainments that featured the orchestrated deaths of both people and animals. I propose that deaths occurring in a venue where the observer and the participants are separated both by physical barriers and social hierarchy (most human victims were criminals, prisoners of war ("Others" so to speak) or slaves (those whose social status separated them from the vast number of citizens in the audience) is distinctly different when compared to violent deaths of friends, family members and comrades fighting right beside you in a person-to-person battle scenario. We also cannot forget the medical personnel either. Following the Vietnam War, many veterans (both male and female) who served in a medical capacity were later found to be suffering from PTSD. The medical environment of an ancient treatment facility following a major ancient battle was far worse where personnel attempted to treat often thousands of wounded in a relatively short time compared to only handfuls at a time during the Vietnam conflict. Ancient physicians were surprisingly quite skilled, especially Roman military surgeons, but they had little but herbal compounds to ward off infections. Their mortality rate was much higher than the relatively low mortality rate experienced in Vietnam. So, how could they have escaped the effects of PTSD often after years of service, not "just" 6 - 12 months?

I sometimes wonder if modern scholars think that ancient people just didn't value their lives as much as we do since they did not shrink from casualties as high as 50,000 in a single military engagement or investment of an enemy city. But if you've ever looked at some of the poignant grave goods found in ancient burials or studied the reliefs on ancient funerary monuments I think you will conclude that we are only separated by time not by our shared human nature.

Dorothy King said...

Quick answer - apologies for not answering properly but I'm in Athens, and although I can post from my Blackberry, I have not yet worked out how to answer comments properly and wanted to write a proper answer.

Thank you for your comments, I fully agree with them but I am very sorry to hear about your spouse. Some vets get good treatment in the US, depending where they go, many do not; in the UK the standard is two weeks of CBT which is superficial and does not work, so many vets end up self-medicating with drugs and / or alcohol, and end up on the streets.

I hope everyone reads your very insightful post on the issue: http://ancientimes.blogspot.gr/2013/01/concussion-and-ptsd-in-ancient-world.html

And I hope to expand on the issue soon too.

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