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Thursday, July 16, 2009 - Notable Historical Figures May Have Experienced PTSD

In my previous post, I discussed my observations on public attitudes over the last 20 years toward psychological health issues in general and post-traumatic stress disorder (PTSD) specifically. In my experience, there has been a significant increase in how frequently these issues are publicly discussed, even though the same issues have probably existed for thousands of years. In an article I published with Dr. Philip A. Mackowiak, titled “Post-Traumatic Stress Reactions before the Advent of Post-Traumatic Stress Disorder: Potential Effects on the Lives and Legacies of Alexander the Great, Captain James Cook, Emily Dickinson, and Florence Nightingale,” we share that some of society’s most celebrated historical figures may have experienced PTSD.>

Alexander the Great (356-323 BCE): At the age of 22, Alexander crossed the Hellespont with an army of just over 30,000 men to conquer the “known world.” After 10 years of bloody battle, enduring near-fatal wounds and seeing legions of comrades perish, Alexander subjugated the Persian Empire of Darius III, becoming “Lord of Asia.” Upon reaching Western India, Alexander’s exhausted troops refused to march further, forcing him to return to his new capital at Babylon. During his return from India, Alexander began to experience disturbing changes in his character. The once brave, adventurous, adaptable, ingenious and considerate leader drove his army through the Gardosian Desert, where two-thirds of his troops perished from dehydration, starvation and hypothermia. Alexander then began executing lieutenants and satraps who had served him as middle managers of the empire during his conquests to the east. Alexander spent the last months of his life drinking heavily and had become pathologically suspicious and easily alarmed.

Capt. James Cook (1728-1779): The most famous navigator of his time, Cook discovered and chartered coastlines for Britain from the Arctic region to the Antarctic region and from the east coast of Australia to the west coast of North America, as well as hundreds of islands in between. During his numerous voyages, Cook’s ship nearly wrecked several times, he encountered cannibalism, he lost men due to sickness and two of his children died while he was away. The pressures started to weigh on him. On a voyage in 1776, Cook was cruel, irritable, and profane, whereas he had previously been known for being gentle and moderate. Although he had been known for being a concise and precise seaman, he now changed plans easily and repeatedly took reckless risks. He died after provoking Hawaiian warriors from which he might easily have escaped had he made any effort to flee his attackers.

Florence Nightingale (1820-1910): Nightingale was born to a socially elite British family and was educated at home at a time when universities admitted only men, and British society had little interest in educating women. Nightingale decided to take up nursing despite it being a masculine vocation. In 1854, in her middle thirties, she traveled to Skutari, (now Uskudar), Turkey to care for British soldiers fighting the Russians in the Crimea. With only 38 nurses under her, she provided care to troops experiencing frostbite, gangrene, dysentery, and other diseases, in very close quarters. Her own quarters were cramped and infested with rodents and vermin. She worked 20 hour work days and took the most severe cases herself. She developed a near fatal illness and despite being urged to return to England, she stayed with her troops. When she eventually did return to England she appeared hardened and aged by illness and exhaustion. She complained of fever, anorexia, fatigue, insomnia, irritability and host of other ailments, taking to her bed for nearly three decades. Finally in her sixties, her symptoms began to abate and she changed from being interpersonally difficult to a gentle matron, never returning to nursing.

After extensively reviewing biographical information on each of the figures as well as asking expert scholars on each figure to fill out the PTSD Checklist from the perspective of the individual studied, we believe that all three of these famous figures exhibited many of the cardinal features of PTSD in the aftermath of repeated potentially traumatic events. Although there are obvious methodological limitations to such a study of historical figures, we believe that the findings point to PTSD as a likely cause of the striking changes in behavior for each of these three individuals. Other diagnoses are also possible, however, and must be considered, either as alternatives to PTSD or as possible co-occurring conditions.

For further reading, please check out the complete article:

Mackowiak, Philip A. & Batten, Sonja (2008). Post-Traumatic Stress Reactions before the Advent of Post Traumatic Stress Disorder: Potential Effects on the Lives and Legacies of Alexander the Great, Captain James Cook, Emily Dickinson, and Florence Nightingale. Military Medicine, 173, 1158-1163.

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