How I Got Schooled in Ancient Psychiatry

Here I present an original translation of an ancient Babylonian text in which a physician is jilted on a fee, then is further embarrassed in his efforts to collect it. The text is an entertaining means of introducing a historical epoch otherwise little considered when studying the history of psychiatry. It is also a means of exploring just what the role of a physician was in an age without cures.

I used to think cuneiform writing was pretty cool. At an earlier stage in life (Erikson’s degenerative stage, I believe), I would spend my wanton dissertating days studying the stuff. Places with magical names, such as Sumer and Babylon, lured me with false promises of the secrets of the universe. After all, this is writing that pre-dates Latin and Greek, the Hebrew Bible, and Chinese and Sanskrit; it pre-dates Egyptian, dating back as far as the fourth millennium bc.

Cuneiform writing contains fragments of unwritten languages and mathematical systems that pre-date it. Pretty cool, right? Yes, except that for every scrap of Gilgamesh tale there are thousands upon thousands of bureaucratic inventories and receipts.

As a psychiatrist, I find myself looking backward more and more, re-engaging with “the intellectual adventure of ancient man”¹ as a proxy for understanding the “primitive” development of so many patients.

Let me share an example of a Babylonian text seemingly written for psychiatrists. I stumbled upon it years ago while researching humor in ancient Mesopotamia (don’t ask). Frankly I didn’t get it at the time.² Now that I am a physician, I totally get it.

Dating originally from around 1200 bc, written in both Akkadian and Sumerian, the text is remarkably illustrative of the conundrum faced by those of us kept distant from both a common specialized language so rigorously maintained by colleagues in other “scientific” fields, and the idiosyncratic language of many of our patients. (Sumerian, much like medieval Latin, was the scholarly language of the otherwise Akkadian-speaking Babylonian and Assyrian intellectual elite. All current Semitic languages, notably Arabic and Hebrew, are descended from Akkadian. Sumerian, a dead language by 2000 bc, is not related to any known language.) The translation, with some poetic license, is mine.

Ninurta, bitten by a stray dog, traveled to Isin, the city of Gula, goddess of healing. The physician there, Amel-ba’u, examined Ninurta, treated him, and cured him.

“May Enlil, the lord of Nippur, bless you,” said Ninurta to Amel-ba’u. “If ever you come to Nippur then I shall repay you, with a feast of finest victuals and jugs of finest beer.”

“When I am in Nippur, your city,” Amel-ba’u replied, irritated, “where is it then I should go?”

“When you arrive at Nippur, my city, you will enter by the Main Gate. You will pass a street, a boulevard, and a square. To your left will be Tillazida Street. At Tillazida Street you will find Nin-lugal. She is a farming woman. She sells produce at Tillazida, and she will show you the way.”

And so Amel-ba’u, that citizen of Isin, when he found himself at Nippur, entered the Main Gate. He passed a street, a boulevard, and a square. Tillazida Street was on his left. As he had been told, Nin-lugal, a farming woman, was there selling produce.

“Nin-lugal?” Amel-ba’u queried.

“Anni lugalmu,” the woman replied in proper Sumerian.

“What is this?” Amel-ba’u did not understand. “Why do you curse me?”

“Why would I curse you?” the woman answered in Akkadian. “I said, ‘Yes, sir. I am Nin-lugal.’”

Flustered, the physician continued, “May I ask you then to show me the way to the house of Ninurta, son of Mizidesh?”

“Namtushmen,” the woman replied in Sumerian, the scholarly tongue of the medical arts.

“Again,” Amel-ba’u did not understand, “why do you curse me with foreign tongues?”

“Again, why would I curse you?” the woman said, bemused. “I said, ‘He is not at home.’”

“Where did he go?”

“Edingirbi shuzianna sizkur gabari munbala,” the woman again tried to impress the physician with her knowledge of the physician’s tongue.

“Why, oh why, do you curse me?” Amel-ba’u did not understand.

“Why, oh why, would I curse you?” the woman said. “I said, ‘He is making an offering in the temple of his personal god, Shuzianna.’”

And with that the farming woman thought to herself, What a buffoon this man is! Why the students ought to band together with their Sumerian practice tablets and chase him right out the Main Gate!3

Perhaps not a laugh riot, nevertheless this text is good for a chuckle. Two things are funny here: first, that a scholarly physician, specifically from the renowned academic center at Isin, would travel in an ill-advised attempt to collect a fee, and second, that he is so gullible. And what is the result? He never does collect his fee, and worse, he is made to look not only silly, but a physician’s worst nightmare, unknowledgeable. The village “crazy,” the produce lady, spouts off in Sumerian, already a long-dead language in 1200 bc, while our physician-hero is severely, if understandably, lacking in what by then was apparently already an arcane language. As a psychiatrist, I must confess, I often find myself, if not exactly crying out like Job, then in an exacerbated state that closely resembles his.

Historically, what is perhaps most interesting in this “randomized” sample text, interpretations aside, is that it comes from a time thousands of years before the “great confinement” of Foucault. It comes from a time at least centuries before the birth of “rationalism,” as advanced by the monolingual Greeks.

Hence, the theoretical-more like fairy tale-“pureness of thought” as fantasized about by Foucault and other anti-humanists should have ruled the day, before the corruption of religion and philosophy. (The humanists and anti-humanists both agree, ludicrously so, that there was absolutely no appreciable intellectual history before the Greeks.^4,5) Closer to the “truth” is that this text represents a snapshot of a sodality of “noble” savages as no Enlightenment or post-Enlightenment thinker ever envisioned.

For here is a bit of life in a neo-Capitalist dreamwork, typical of ancient city-states along the Fertile Crescent: a slave society utterly governed by a bureaucratic oligarchy ostensibly created for the service of city-god patrons, in truth maintained for the pleasure of a wealthy class most often labeled as “priestly” (a bit of a misnomer, the pseudo-religious term-ours, not theirs-should indicate more of an educated isolation from the riff-raff than any real religious function).

Here is an apparently rare light moment (there is very little to be found by researching humor in ancient Mesopotamia) in a feudal state system in which one was not confined for being crazy. Rather, one was distinctly labeled as such, ostracized, and/or ridiculed appropriately by family and fellow citizens, cursed by the gods, left to suffer the very depths of madness and, at worst, put to death in order to be eliminated as a source of everyone else’s misery.⁶ Thank goodness there was no such thing as mental illness before its social construction in the 18th century ad, or who knows what may have been the fate of so many.

But I do not wish to argue here whether mental illness is a social construct or not, whether it exists at all. In fact, the existence of mental illness was never disputed by the Ancients. These were empirical people, and it is hard, after all, to dispute the evidence before one’s eyes.

What is of interest to me is the historical role of mental illness as a proxy for the development of the healing “art,” of the historical role of the physician, the healer, the “artist,” with regard both to physical and mental illness. How did he emerge at all, and what could he do when faced with any disease in an era when cures did not exist? (Although to date there is no indication that there were any female physicians in the ancient Near East or Mediterranean, it is intriguing that our “crazy produce lady” was apparently highly educated.)

And why do I single out the relatively recently constructed “psychiatrist” from among other physicians? The psychiatrist, as currently formulated in the era of medical specialization, is really the only modern link remaining to the physician of yore, the only physician standing who has not reaped the benefits of technology, who remains without the luxury of cures. In other words, “shrinks” are yet living in the past; they are generally concerned more with “the treatment,” the process. The case to be made here, and to be elaborated on, is that before disease became curable, every physician was essentially a psychiatrist.

Disclosures:

Dr Martin recently graduated from the child and adolescent psychiatry fellowship program at Boston Children’s Hospital and is currently a staff psychiatrist at Newton-Wellesley Hospital in Newton, Mass. He has a Master’s degree in Near Eastern Languages and Cultures from UCLA, and was a high school Latin and Greek teacher before returning to medical school. He is the founder of the Yale Philosophy and Psychiatry Group and has published several articles on historical and philosophical issues in psychiatry and medicine.

References:

1. Frankfort H, Frankfort HA, Wilson JA, et al. The Intellectual Adventure of Ancient Man: An Essay on Speculative Thought in the Ancient Near East. Chicago: University of Chicago Press; 1977.

2. Reiner E. Why Do You Cuss Me? Proceedings of the American Philosophical Society. 1986;130(1):1-6.

3. Cavigneaux A. Texte und Fragmente aus Warka (32. Kampagne). Baghdader Mitteilungen. 1979; 10(1):111-117.

4. Cornford FM. From Religion to Philosophy: A Study in the Origins of Western Speculation. Mineola, NY: Dover Publications; 2004:v-x.

5. Russell B. The History of Western Philosophy. New York: Simon & Schuster; 1967:3.

6. Stol M. Epilepsy in Babylonia. Groningen, the Netherlands: Styx Publications; 1993:15.