Yesterday [personal profile] tanyahp and I were talking about the American diagnostic manual of mental illnesses, the DSM-IV, and how some of the listings are pure pathologizing of “weird” (usually sexual) behavior, some seem to represent recent culturally based phenomena (which doesn’t necessarily mean they aren’t “real,”) and some others have a far longer history.

I mentioned that there’s a speech in Shakespeare’s Henry IV, Part I, written around 1597, in which Lady Percy speaks to her warrior husband, who’s often away fighting and is about to go lead a rebellion, and that she hits virtually every one of the DSM-IV’s diagnostic criteria for PTSD - in iambic pentameter.

For your amusement and/or enlightenment, here’s Lady Percy’s complete speech, annotated with the DSM-IV criteria.



Criterion A: stressor

The person has been exposed to a traumatic event in which both of the following have been present:

1. The person has experienced, witnessed, or been confronted with an event or events that involve actual or threatened death or serious injury, or a threat to the physical integrity of oneself or others.

2. The person's response involved intense fear, helplessness, or horror.


1 is definitely true. He’s a famous warrior. We don’t know about 2, but while he seems quite enthusiastic about warfare, it’s not too much of a stretch to think that he might have had at least a couple of moments of fear or horror, but ignored or repressed them.

LADY PERCY: O my good lord, why are you thus alone?
For what offense have I this fortnight been
A banished woman from my Harry's bed?

Criterion C (avoidant/numbing): Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma). You need at least 3 of a set of 7.

Hotspur’s lack of interest in sex, with the implication that this is abnormal, suggests

• Markedly diminished interest or participation in significant activities

Avoiding sex with his wife could be the result of another one from C:

• Feeling of detachment or estrangement from others

Tell me, sweet lord, what is't that takes from thee
Thy stomach, pleasure, and thy golden sleep?

“Stomach and pleasure” (ie, normal pleasure in life) repeat the ones I mentioned above. Also, insomnia and/or troubled sleep:

Criterion D: hyper-arousal

Persistent symptoms of increasing arousal (not present before the trauma)
(You need at least two of these)

Difficulty falling or staying asleep.

Why dost thou bend thine eyes upon the earth,
And start so often when thou sit'st alone?

Suddenly staring at the ground, and jumping at apparently nothing. This could be one of two criteria, or possibly both; it’s hard to tell from Lady Percy’s outside observation. He could be having flashbacks:

Criterion B: intrusive recollection

The traumatic event is persistently re-experienced in at least one of the following ways:

• Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated).


Or he could be very easily startled, which is another from Criterion D:

Exaggerated startle response

Why hast thou lost the fresh blood in thy cheeks
And given my treasures and my rights of thee
To thick-eyed musing and cursed melancholy?

Looking pale and sickly, refusing to have sex and generally ignoring his wife, obsessing (in context, about the rebellion), and depression. I’d say that hits another from Category C:

Restricted range of affect (e.g., unable to have loving feelings)

Depression is not a criteria, but it’s very common.

In thy faint slumbers I by thee have watched,
And heard thee murmur tales of iron wars,
Speak terms of manage to thy bounding steed,
Cry 'Courage! to the field!' And thou hast talked
Of sallies and retires, of trenches, tents,
Of palisadoes, frontiers, parapets,
Of basilisks, of cannon, culverin,
Of prisoners' ransom, and of soldiers slain,
And all the currents of a heady fight.

Another one from Criterion B:

Recurrent distressing dreams of the event.

Thy spirit within thee hath been so at war,
And thus hath so bestirred thee in thy sleep,
That beads of sweat have stood upon thy brow
Like bubbles in a late-disturbèd stream,
And in thy face strange motions have appeared,
Such as we see when men restrain their breath
On some great sudden hest.

Sweating and making weird faces while dreaming of battles comes under Criterion B:

• Physiologic reactivity upon exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

O, what portents are these?
Some heavy business hath my lord in hand,
And I must know it, else he loves me not.

And this is all upsetting the hell out of his wife:

Criterion F: functional significance

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


Criterion E, duration for more than a month, is unknown: Lady Percy’s only noticed it for two weeks, but maybe she was unaware of it previously. How long it might continue is also unknown, because (SPOILER) he dies. (If it really was only two weeks, it’s technically not PTSD but Acute Stress Reaction.)

This speech is more commonly interpreted as showing Hotspur’s consuming obsession with his enemy, his honor, the upcoming battle, etc. But this is Shakespeare. Even a single line can have multiple meanings. It could be about all that and PTSD too. Obviously, it was not conceptualized yet at that time, but ideas can exist even if they're not named or codified. The idea in this case would be something along the lines of, "Soldiers sometimes come back from the war and act really strange and jumpy and ignore their wives and have nightmares."

Also, it’s not a huge stretch to consider the possibility that even if Shakespeare intended solely to illuminate Hotspur’s level of obsession with his plans for the future rather than his reaction to past events, that he might have had met or heard of soldiers who did all the things Lady Percy mentions, and put that into his play for verisimilitude.
wordweaverlynn: PTSD: Not all wounds are visible (PTSD)

From: [personal profile] wordweaverlynn


This is remarkable -- and not surprising. Human beings haven't changed that much, and Shakespeare saw human beings as clearly as anyone ever has.

PTSD also shows up in Jane Austen, of all places: here's the passage. (The speakers are Anne Elliott and her brother-in-law, Charlesd Musgrave; the subject is his sister Louisa, who suffered a nearly fatal head injury from a fall.)

"I hope you think Louisa perfectly recovered now?"

He answered rather hesitatingly, "Yes, I believe I do; very much recovered; but she is altered; there is no running or jumping about, no laughing or dancing; it is quite different. If one happens only to shut the door a little hard, she starts and wriggles like a young dab-chick in the water."
ginny_t: Give me rampant intellectualism as a coping mechanism. (rampant intellectualism)

From: [personal profile] ginny_t


Huh. I read Louisa's change as an acquired brain injury. Not that I know anything about ABI or PTSD beyond what I hear/read in various places.
mildred_of_midgard: (Default)

From: [personal profile] mildred_of_midgard


Excellent post! I've added it to my memories.

From: [identity profile] mme-hardy.livejournal.com


Have you considered expanding this and using it as a paper in your class? I think it's awesome.

From: [identity profile] rachelmanija.livejournal.com


Thanks! Maybe in grad school. The abnormal psych class doesn't require papers.

From: [identity profile] sovay.livejournal.com


For your amusement and/or enlightenment, here’s Lady Percy’s complete speech, annotated with the DSM-IV criteria.

Thank you.

From: [identity profile] shadowvalkyrie.livejournal.com


Disregarding what it was meant to signify in the text, the description is interesting in any case, because it shows that PTSD is not a contemporary condition, reliant on our specific culture*, to occur, but apparently a more universal phenomenon.

Thank you for pointing this out!

*As I've seen postulated; iirc it had something to do with how our modern western culture distances itself from death and suffering and how we are thus unable to cope when confronted with it, or any other breach of the safety we are accustomed to. Lady Percy's description would be a good argument against that thesis.

From: [identity profile] rachelmanija.livejournal.com


Are they counting "modern" as "American Civil War-era?" It was described and named back then, as "soldier's heart."

Also, check this out: http://www.vva.org/archive/TheVeteran/2005_03/feature_HistoryPTSD.htm

"The Greek historian Herodotus, in writing of the battle of Marathon in 490 B.C., cites an Athenian warrior who went permanently blind when the soldier standing next to him was killed, although the blinded soldier “was wounded in no part of his body.” So, too, blindness, deafness, and paralysis, among other conditions, are common forms of “conversion reactions” experienced and well-documented among soldiers today.

Herodotus also writes of the Spartan commander Leonidas, who, at the battle of Thermopylae Pass in 480 B.C., dismissed his men from joining the combat because he clearly recognized they were psychologically spent from previous battles. “They had no heart for the fight and were unwilling to take their share of the danger.” (Herodotus tells of another Spartan named Aristodemus who was so shaken by battle he was nicknamed “the Trembler”—he later hanged him- self in shame.)"

From: [identity profile] coraa.livejournal.com


That's fascinating.

I would, with no basis whatsoever but guesswork, hypothesize that PTSD is one of those things where the stressor might vary culturally but the disorder itself is pretty universal. Like, a modern, urban child might very well have a traumatized response to seeing an animal slaughtered; a medieval, rural child very probably would not.

But I'd also guess that 'seeing a lot of people around you dying' and 'being in acute fear for your life' are, if not universal, than very culturally common traumatic stressors.

From: [identity profile] rachelmanija.livejournal.com


I went to a talk on PTSD by a guy who's an expert in the field, and he had the quite radical proposal to eliminate criterion A: exposure to an extreme stressor.

Everyone in the audience went, "WTF? But that's the entire conceptual basis for the very existence of PTSD!"

He explained that the problem isn't conceptual, but has to do with insurance companies. The existence of Criterion A means that traumatized, suffering people have to prove that they were exposed to a traumatic event. Frequently they either can't prove that it happened at all (like rape) or that it was sufficiently and objectively traumatic (like your "animal slaughter" example, as people do indeed get traumatized by things that might bnot be traumatic to every person in every circumstance).

No other disorder requires proof of an experience, only proof of the illness. His solution was to eliminate the "event" criterion and go solely by symptoms.
ext_2507: Green-jacketed library books (Default)

From: [identity profile] rosefox.livejournal.com


*raises hand* Symptoms of PTSD since early childhood, no known cause.

From: [identity profile] lady-ganesh.livejournal.com


I remember someone speculating that Hercules might have murdered his children/wife due to PTSD.

From: [identity profile] rachelmanija.livejournal.com


I am reading a novel right now, a YA-ish Greek fantasy in which Persephone falls in love with a female Hades, and the Elysian Fields are actually miserable because the dead heroes all have PTSD for all eternity!

(The Dark Wife, it's quite good so far and also only $2.99 on Kindle.)

From: [identity profile] kateelliott.livejournal.com


This is great. And I totally agree with you.

From: [identity profile] foibos.livejournal.com


The word "awesome", though overused, is very appropriate here.

I'm so taking this text to my depression/suicide support group next week (giving proper credit, of course).

From: [identity profile] foibos.livejournal.com


Short answer: they liked it a lot. They agreed that PTSD was very likely and it launched a discussion of PTSD in general and in ages past.

Longer answer: I printed your post, but since I'm in Sweden I thought it would be a bit daunting to present it as a three-page English text. I chose to make a compressed one-page Swedish version by pasting together the (public domain) 19th century translation of the passage and the Swedish Wikipedia text on DSM-IV criteria for PTSD (slightly abridged) and interspersing the criteria with condensed versions of your comments. I read the Swedish text aloud and left the English text on the table for further reading (and it didn't stay on the table for long).

I believe it was an interesting eye-opener for all present.

From: [identity profile] rachelmanija.livejournal.com


Fascinating! Thanks for letting me know. Did anyone have any historical examples I didn't mention here?

From: [identity profile] foibos.livejournal.com


Nothing specific. An example we didn't discuss is the Swedish "allotment system" army (http://en.wikipedia.org/wiki/Swedish_allotment_system). In this army, tenemented soldiers who were unfit for duty lost their crofts, and this transaction needed to be duly documented in records which often survive to this day. As a result, there is quite a bit of documentation about Swedish soldiers who had become too disturbed to be useful.
ext_2507: Green-jacketed library books (Default)

From: [identity profile] rosefox.livejournal.com


I love this.

I've been reading a number of Regency romances recently where the heroes or side characters have PTSD from the Napoleonic wars or other action. One manly man comes completely undone during a storm, when the thunder reminds him of the sound of cannons; another was chained to a companion who died, and now he can't bear to be touched because it all makes him think of his friend's dead body lying against him; and there are the usual head injury/amnesia storylines. I saw this mostly as metaphor for current events (or an excuse to write Yet Another Amnesia Romance) but it's good to know that there's historical basis for it.

From: [identity profile] jinian.livejournal.com


Oh, that Hotspur. Am I embarrassed or pleased to have thought of Wilce's traumatized Hotspur first?
.

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