Thursday, January 17, 2013

Concussion and PTSD in the Ancient World


The Ludovisi Battle Sarcophagus depicting Roman conquest
of Barbarians, 2nd - 3rd century CE.  Photographed at the 
Palazzo Altemps, Museo Nazionale Romano, in Rome Italy
by Mary Harrsch.
After I suggested in my review of "Semper Fidelis  that the antagonist in Ruth Downie's novel, a brutal Centurion named Geminus, may have been suffering from PTSD, Ruth  sent me a link to a very thoughtful post by Dr. Dorothy King  entitled  "PTSD in Antiquity"

In my review, I cited a post by Dr. Jonathan Eaton who had basically dismissed the possibility that ancient soldiers did not suffer from PTSD because modern research points to PTSD being most prevalent in soldiers experiencing explosive events (like IEDs, land mines or booby traps).  He theorizes that since gunpowder or other explosive material was generally not used in ancient warfare, such explosive events did not occur so the probability that PTSD could develop was quite low.  He also pointed to the death-filled environment of the ancient world as something that he felt would desensitize ancient peoples to the trauma of warfare.

Dr. King disagrees pointing to the fact that she, a diagnosed victim of PTSD, had never experienced an explosive event and she knew of a military general diagnosed with PTSD that had never been near explosive devices either.  She was particularly impressed with the research of Jonathan Shay summarized in his book " Achilles in Vietnam: Combat Trauma and the Undoing of Character . 


Shay's work has now been made into a poignant documentary entitled "Odysseus in America".  King includes three trailers in her post but this is my favorite.  The voiceover sounds like the highly respected actor, David Strathairn.




Then I followed King's link to an earlier post entitled "The Rage of Achilles and PTSD".  In it, King discusses what she feels (and I concur) are clear examples in the ancient texts.  Her post opens with a moving passage from Homer:


Then said Achilles, "Son of Atreus, king of men Agamemnon, see to these matters at some other season, when there is breathing time and when I am calmer. Would you have men eat while the bodies of those whom Hector son of Priam slew are still lying mangled upon the plain? Let the sons of the Achaeans, say I, fight fasting and without food, till we have avenged them; afterwards at the going down of the sun let them eat their fill. As for me, Patroclus is lying dead in my tent, all hacked and hewn, with his feet to the door, and his comrades are mourning round him. Therefore I can think of nothing but slaughter and blood and the rattle in the throat of the dying."
Iliad 19.226
Then she goes on to examine descriptions of the behaviors of such ancient military men as a Greek warrior at Marathon, Leonidas at Thermopylae, Alexander the Great and Gaius Marius, all supported by quotes from the ancient sources.

So, I was gratified to find another scholar with personal experience with PTSD who also disagrees with Eaton.   I would like to take her observations just a few steps farther and point to even more recent findings that I feel debunk the "explosive events as the primary cause of PTSD" theory.

I think the results of the autopsy of one of the NFL players who recently committed suicide is particularly significant.  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 similar to those experienced by modern football players 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 than 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 than in a modern field hospital.  Ancient surgeons 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 (and honey if the Romans listened to the Egyptian physicians) 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 - more than enough to trigger PTSD in modern warfare?

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 and inscriptions on ancient funerary monuments I think you will conclude that we are only separated by time not by our shared human nature.


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