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.

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