Month: February 2015

“Nothing New” is “Really Bad”

In their impressive compilation of Assyrian and Babylonian medical fragments JoAnn Scurlock and Burton R. Andersen remark about the āšipu: “like intellectuals everywhere, it was not possible for him to approach a medical problem without bringing to it a bit of preconceived theory.”[1] Their observation holds true for modern intellectuals (in this case, a psychologist and a psychiatrist) just as it did for the magico-medical āšipu, as the recent “Nothing New under the Sun: Post-Traumatic Stress Disorders in the Ancient World” demonstrates. When I tweeted about this article a few days ago, I assumed it was another attempt to foist our comfortable diagnostic categories onto the past.

My skeptical tweet about this article.
My skeptical tweet about this article.

Although efforts to retrodiagnose diseases have a long pedigree, they remain fraught with difficulties.[2] Historians of medicine have argued that such efforts are fundamentally flawed, mistaking ontological categories and distorting evidence for modern purposes.[3] Along with such theoretical challenges, attempts to identify in past descriptions of symptoms our modern diseases run into the problem of evidence: the historical record is often too fragmentary and ambiguous and imprecise to justify such identification. Or rather, any number of diagnoses are plausible given the vague and patchy descriptions of illnesses in the past. These difficulties, however, seem to be no impediment for the determined “scissors-and-paste” researcher armed with a pair of sharp Metzenbaums and ready to excise choice quotations in an effort to demonstrate the timeless truths of our current knowledge.

In some ways, “Nothing New Under the Sun” confirmed my suspicions; in other ways it surpassed my wildest fears. The authors brought their preconceived theory to bear on six Assyrian medical fragments and discovered exactly what they sought: PTSD.[4] Where the article broke new ground, however, was its scholarship: the deeply problematic footnotes and the misleading interpretation of what other scholars had written. I checked the two sources readily available to me—A. Leo Oppenheim’s Ancient Mesopotamia: Portrait of a Dead Civilization (Chicago, 1977) and JoAnn Scurlock and Burton R. Andersen, Diagnoses in Assyrian and Babylonian Medicine (Urbana, 2005)—and found a number of problems. I appreciate that these are significant charges, so I offer below a catalog of the issues I consider problematic. If my interpretation of these examples is wrong, please correct me.[5]

On page 551, the authors stake their claim that “Mesopotamian sources mention earlier cases of Post-Traumatic Stress” and refer to the cuneiform texts:

Almost half a million cuneiform tablets written by the ancient Iraqis from that time until the birth of Christ have been discovered to date.[footnote 9: Jean Bottéro, Everyday Life in Ancient Mesopotamia (Edinburgh, 2001), 90] Several hundred of these tablets comprise medical texts, mainly consisting of handbooks and collections of prescriptions.[footnote 10: A. Leo Oppenheim’s Ancient Mesopotamia: Portrait of a Dead Civilization (Chicago, 1977), 294]

Page 294 Oppenheim’s Ancient Mesopotamia makes no reference to cuneiform texts, per se.

Page 294 of Oppenheim doesn’t say anything about cuneiform texts or how many might deal with medicine.
Page 294 of Oppenheim doesn’t say anything about cuneiform texts or how many might deal with medicine.

The last part of the paragraph, highlighted above, however, is a quotation from page 289 in Oppenheim’s book, though the authors never cite 289. There Oppenheim refers to the types of medical texts but not the number:

Our knowledge of the nature and the extent of Mesopotamian medicine is based on medical texts, consisting of handbooks and collections of prescriptions, supplemented by letters, references in the law codes, and allusions in literary texts.

Back to “Nothing New,” on page 552 we read:

The Ancient Mesopotamians believed that many diseases were punishments from the God(s) because of the patients’ sins or shortcomings.[footnote 13 here adds some information about Mesopotamian dynasties, not the claim just made.[6]] Leo Oppenheim suggested that the Gods, in their turn, allowed demons or ghosts of dead people to attack the sick person. The treatment of disease was holistic and usually involved a combination of religious-magical and pharmacological treatments. The cuneiform tablets discovered from the era suggest the presence of the two different professions that were necessary in order to perform diagnosis and treatment.[footnote 14: Oppenheim, Ancient Mesopotamia, 294]

While it is unclear to me where or if Oppenheim supports any of these claims, it is clear that page 294 does not corroborate them.

On page 554, the authors assert that trauma was commonplace in Mesopotamia, and that most of our medical texts on trauma concern war wounds:

More specifically, trauma was also commonplace in Iraq’s ancient civilizations. This involved not only traumata associated with daily life, industry and farming, but also traumata associated with warfare. Ašipu seemed to be working with armies, particularly in the Assyrian period (between 1300–609 BC). The majority of cuneiform medical texts on trauma were concerned with war wounds.[footnote 29: Scurlock and Andersen, Diagnoses, 345.]

Their source here, Scurlock and Andersen, do mention trauma and warfare on page 345 of their book, where they say: “The armies of Assyrian kings contemporary with the bulk of the surviving medical texts were protected by shields, ….” In other words, most of our medical texts come from a period when armies had shields, helmets, and suits of armor. It seems a rather significant misreading to say “the majority of cuneiform medical texts on trauma were concerned with war wounds.” Maybe there is another source that backs up the claim made in “Nothing New,” but the page cited in Scurlock and Andersen doesn’t.

Page 345 in Scurlock and Andersen doesn’t seem to say what “Nothing New” thinks it does.
Page 345 in Scurlock and Andersen doesn’t seem to say what “Nothing New” thinks it does.

Further down the same page, “Nothing New” refers to the frequency of wars during the Assyrian period:

However, because of the frequent wars during the Assyrian period, the male population of the kingdom was exposed to significant trauma associated with the battles being fought in every third year during their military service. It was this engagement in regular fighting (which the military would describe nowadays as being high “op-tempo”[footnote 33: C.A. Castro and A.B. Adler, “OPTEMPO: Effects on Soldier and Unit Readiness,” Parameters (Autumn 1999), 86–95.]) that was probably the main cause of post-traumatic stress disorders.[footnote 34: Scurlock and Andersen, Diagnoses, 438]

The causal, “because of the frequent wars during the Assyrian period,” is again a rather significant misreading (over interpretation grounded in a preconceived theory?) of Scurlock and Andersen, who qualify their interpretation in two ways, saying: “in periods when [my emphasis] wars were frequent, a significant portion of the male population was subjected to the stress of battle in one campaign season out of every three” and “…it is likely that a portion of these draftees [my emphasis] experienced battle fatigue (post-traumatic stress syndrome)” (438).

Turning now to the evidence itself, the authors of “Nothing New” write:

Scurlock and Andersen mention three cases which they found in the series of diagnostic and prognostics.[footnote 35: Ibid. [Scurlock and Andersen, Diagnoses], 351. See René Labat, Traité akkadien de diagnostics et prognostics médicaux (Leiden, 1951).] They describe post-traumatic stress disorders as mental health manifestations of severe mental and/or physical (traumatic) stress that does not usually cause the death of the patient:[footnote 36: Scurlock and Andersen, Diagnoses, 351.]
14.34 “If his words are unintelligible for three days […][footnote 37: Square brackets denote broken entries or texts (Scurlock and Andersen, Diagnoses,
576).] his mouth [F…] and he experiences wandering about for three days in a row F…1.”
14.35 “He experiences wandering about (for three) consecutive (days)”; this means: “he experiences alteration of mentation (for three) consecu- tive (days).”
14.36 “If his words are unintelligible and depression keeps falling on him at regular intervals (and he has been sick) for three days F…]”

The text cited in footnote 36, Scurlock and Andersen, Diagnoses, 351, does discuss post-traumatic stress syndrome, but qualifies it saying the “quotes below may [my emphasis] be describing this syndrome [PTSD].” The careful qualification has been lost in “Nothing New.” Further, the highlighted section above is a word-for-word quotation without quotation marks.

Note 37 is wrong. The explanation of square brackets on page 576 refers to the tables that follow, not the translations of the texts. Square brackets and ellipsis in the translations are explained on page xvi: “An ellipsis in square brackets indicates a missing section of text whose restoration is uncertain” (Scurlock and Andersen, Diagnoses, xvi). These unrestored parts of the translation further highlight the fragmentary nature of the texts.[7]

Moving on, “Nothing New” asserts:

They furthermore list the following symptoms associated particularly with post- traumatic stress disorders as a result of military operations (military casualties):[footnote 38: Ibid. [Scurlock and Andersen, Diagnoses], 429–430.]
19.32 “If in the evening, he sees either a living person or a dead person or someone known to him or someone not known to him or anybody or anything and becomes afraid; he turns around but, like one who has [been hexed with?] rancid oil, his mouth is seized so that he is unable to cry out to one who sleeps next to him, ‘hand’ of ghost (var. hand of […]).”[footnote 39: Hands of Gods or hand of ghosts are seen by the Mesopotamians as a cause of illness; see Pangas, “La mano.”]
19.33 “[If ] his mentation is altered so that he is not in full possession of his faculties, ‘hand’ of a roving ghost; he will die.”
19.34 “If his mentation is altered, forgetfulness(?) (and) his words hinder each other in his mouth, a roaming ghost afflicts him. (If) […], he will get well.”

Pages 429–430 cited in note 38 say nothing about PTSD or military operations. Instead, there is a rich discussion about ancient efforts to name disease patterns. The reference in note 39 may or may not be accurate, but it does not apply to the quotation, which is on Scurlock and Andersen, Diagnoses, 438. The other two quotations, which receive no reference, are from Scurlock and Andersen, Diagnoses, 439. In their zeal to find PTSD, the authors of “Nothing New” seem to over interpret these quotations. Scurlock and Andersen group these three quotations in a section on ghosts, though they do say that some of these symptoms “are compatible with this stress syndrome [PTSD].” When Scurlock and Andersen offer a modern diagnosis, however, they are more cautious: attributing 19.32 to “nightmare,” 19.33 to “mental status change,” and offering no diagnosis for 19.34.[8] When the authors of “Nothing New” gesture to ghosts, their citation is again wrong:

It looks as if, in the case of military casualties, the responsible ghosts were usually assumed by the treating ašipu to be the ghosts of the enemies whom the patient had killed during military operations.[footnote 41: Scurlock and Andersen, Diagnoses, 429.]

Page 429 of Scurlock and Andersen’s Diagnoses mentions ghosts among gods, goddesses, demons, demonesses, and demonic forces, e.g., curses and sorcery, but nothing about the ghosts of killed enemies. In fact, warfare and enemies are absent from that page, and the following one.

After checking a third of the notes in “Nothing New,” I am suffering from Post-Traumatic Article Disorder, which prevents me from finding the other scholarship cited and checking the references to it. Of the sixteen notes I was able to check, nine are wrong or problematic (another three or four are worrisome, but not egregious). I don’t want to impute malfeasance to the authors of “Nothing New.” I will, however, deplore the scholarship that doesn’t rise to the level I would demand of an undergraduate. If my reading of this article and its notes is accurate, I cannot understand how or why a history of science journal accepted and published it.

  1. JoAnn Scurlock and Burton R. Andersen, Diagnoses in Assyrian and Babylonian Medicine (2005), 429.  ↩

  2. I have worried about those difficulties in the past, see Retro-Diagnosing Fictional Plagues and Paleopathology and Retrodiagnosis. To be fair, some efforts to analyze past diseases are really interesting and produce interesting information, whether or not it helps us understand the past or deal with the present.  ↩

  3. See, for example, Charles Rosenberg “Disease in History: Frame and Frames” in C. Rosenberg and J. Golden, Framing Disease (1989), 1–16 or Andrew Cunningham’s “Transforming Plague: The Laboratory and the Identity of Infectious Disease” in A. Cunningham and P. Williams, The Laboratory Revolution in Medicine (Cambridge, 1992), 209–44 or Roger French et al., The Great Pox<Yale, 1997>.  ↩

  4. The title is, I suspect unintentionally, funny. In addition to its claim that PTSD is “Nothing New,” “Nothing New” also describes the contents of the article, which extracts from Scurlock and Andersen’s volume the three fragments that they, Scurlock and Andersen, already group under the heading “Post-Traumatic Stress Syndrome” and suggest “may be describing this syndrome” (351).  ↩

  5. The authors bear the bulk of the responsibility for the sloppy scholarship. It worries me that nobody else bothered checking the notes more carefully.  ↩

  6. The author’s claims about disease being punishments for sins seems to be at odds with what JoAnn Scurlock argued in Magico-Medical Means of Treating Ghost-Induced Illness in Ancient Mesopotamia (Leiden, 2005), at least according to Scott Noegel’s review of that book in Journal of Hebrew Scriptures, where he writes:

    Perhaps the most important contribution of these volumes is that they offer a healthy corrective to many long-held assumptions concerning the Mesopotamian medical profession. For example, they illustrate that disease was only rarely viewed as a punishment for personal action (A, pp. 73–74)—indeed, “sin” (especially in the Christian sense), is a concept that would have been wholly foreign to ancient Mesopotamians.  ↩

  7. The authors of “Nothing New” are probably not responsible for the wonky formatting in these quotations, e.g., [F…] and F…1, but they should have checked the page proofs more carefully. They are, however, probably responsible for the missing half brackets ( and )19.32 and 19.33  ↩

  8. The latter portion of the book includes tables relating ancient diagnoses to modern for the many quotations. For 19.32 see Scurlock and Andersen, Diagnoses, 643, #83–85; for 19.33 see Scurlock and Andersen, Diagnoses, 651, #47a; for 19.34 see Scurlock and Andersen, Diagnoses, 651, #53–54.  ↩