Ages of anxiety

06 Jul 2020

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The writer is a journalist.
The writer is a journalist.

“I AM dying of a broken heart … my heart has become exceedingly troubled, heartbreak has seized me, I have become exceedingly afraid.”

The feelings expressed in these words, familiar as they are to those who have suffered from or have any experience of anxiety and depression, don’t come from a contemporary account. These are the words of Nabû-tabni-uṣur, an Assyrian scholar who chiselled these in stone thousands of years ago while suffering from what was then called ‘Heartbreak’.

Ancient Mesopotamians knew this syndrome well: “I am continually having pain of Heartbreak, fright, fear, chills, I am constantly anxious, I am continually afraid, I continually talk with myself, I have fearful dreams.”

These words appeared in an anti-witchcraft manual for would-be exorcists, which is appropriate given that in ancient Mesopotamia, illness was the work of demons and foul spirits and thus needed not only a therapeutic, but also a spiritual response. Still, it may surprise our modern sensibilities that depression and anxiety have been a part of human existence pretty much ever since there have been humans, and that throughout the ages, it has to one extent or another, been classified as a disease. This is significant because classification is the first step in the road to developing treatments.

Ancient Mesopotamians knew this syndrome well.

In Pharaonic Egypt — another ancient center of medical advances and scholarship — while we find no specific class of doctors dealing with mental health issues, we do find a similar level of awareness of such disorders as in Mesopotamia, but rather than attribute it solely to malign spirits, mental health issues were considered to be related to a dysfunction of the heart and not (as in modern times) of the brain. Take the following passage from the Ebers papyrus: “When his heart is afflicted and has tasted sadness, behold his heart is closed in and darkness is in his body because of anger which is eating up his heart.” As significant as this is, because it marks the transition from believing depression is the work of spirits to a physical illness, what is even more remarkable is the level of public outreach.

In around 2000 BC, in response to an apparent epidemic of suicide in the Egyptian Middle Kingdom a poem in hieroglyphics was composed with the title Dispute Over Suicide which takes the form of a man who is contemplating suicide debating its pros and cons with his soul, which attempts to talk him out of it. From low self-esteem to feelings of hopelessness and helplessness, all markers of anxiety and depression are present in this poem. Interestingly, there are no judgement calls in this debate, which was likely performed in front of audiences in towns and villages, with the ‘man’ and his ‘soul’ simply laying out their arguments and inviting the reader or listener to make up his or her own mind, and scholars such as psychiatrist George Tadros believe that that this was a state-sponsored effort to control a high suicide rate and was performed in towns and villages before an audience. Is this the first known incidence of a public mental health awareness outreach?

When we come to the Greek depression, or ‘melancholia’ as they called it, was linked again to physical causes most notably an im­­balance in the four ‘humours’ of the body. Its treatment, according to Hippocrates, inclu­ded exercise, diet and a bit of bleeding. The Romans were divided in their opinions and mostly preferred — like the Mesopo­t­a­m­ians — to attribute mental illness to the influence of demons and the anger of the gods. The trea­t­ment thus was not exactly pleasant, involving shackling and starvation — an interesting parallel with how mental illness is still ‘trea­ted’ at shrines in Pakistan. In the Middle Ages, Euro­pe­­an attitudes to­­wards mental illness took a turn for the wo­­­rse, attri­buting such disorders to the work of the de­­vil, and treating those suffering from psychological issues abysmally.

However, Eastern attitudes were more enlightened at the time with the famous Persian doctor Mohammad Ibn Zakariya al-Razi (known as Rhazes in the West) establishing in Baghdad what was possibly the first-ever psychiatric ward, in line with his view that mental disorders should be treated as medical conditions and with not just diet and medication but also occupational and behavioural therapy, going so far as to provide discharged patients a sum of money to help transit back to society.

While contemporary attitudes towards me­­ntal illness are fairly progressive, where does the future of mental health treatment lie? Beyond conventional methods like talking therapy, psychoanalysis and a reduced emp­h­asis on medication, the future may lie, believe it or not, in psychedelic drugs like MDMA, LSD and psilocybe cubensis, which are the subject of very interesting research these days. But while we haven’t run out of history, we have run out of space so that discussion will have to wait for another column.

The writer is a journalist.

Twitter: @zarrarkhuhro

Published in Dawn, July 6th, 2020