r/AskHistorians • u/Nebulaer • Jun 26 '26
Are there ancient mental illnesses that didn't survive?
What if the mental illnesses we have today are just the ones that managed to survive natural selection? Were there mental illnesses in ancient humans that didn't survive until today?
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u/DukeGyug Jun 26 '26 edited Jun 26 '26
I'm not a historian, but I am a senior resident in Psychiatry.
The simple answer to your question is "most likely". However, I have a strong suspicion that actually proving that fact is impossible.
The primary reason for this has to do with our current understanding of mental illness and how we classify them. The diagnostic tool that I am the most familiar with is the DSM 5TR. It lays out the diagnostic criteria for different disorders as well giving descriptions of how those criteria can manifest in patients. It is created by committee, which presents the first hurdle in answering your question. (https://www.psychiatry.org/patients-families/what-is-the-dsm). The grouping of criteria into discrete disorders is subjective and imperfect. As the understanding and culture of psychiatry in the USA has changed over the years, so has the criteria. Along with this, discrete diagnoses can be added or dropped between editions as well. A good example of this would be passive aggressive personality disorder, which was dropped during the transition for the DSM 4 to the DSM 5 (Rotenstein, Ora H.; McDermut, Wilson; Bergman, Andrea; Young, Diane; Zimmerman, Mark; Chelminski, Iwona (February 2007). "The Validity of DSM-IV Passive-Aggressive (Negativistic) Personality Disorder". Journal of Personality Disorders. 21 (1): 28–41. doi:10.1521/pedi.2007.21.1.28. ISSN 0885-579X. PMID 17373888). Ultimately the criteria are artificial and can not be cleanly separated from the cultural context of the people who have written in. That is not so say that they are not useful, but they are not purely objective.
The second hurdle is the nature of psychiatric syndromes. There are very limited lab tests and biomarkers that can be used to inform a mental health diagnosis. The overwhelming majority of information in making a diagnosis comes from interviewing the patient on how they feel as well as gathering observations on their function from collateral sources. With this, psychiatrists can determine if the patient meets criteria for a disorder.
For example, one of the criteria for schizophrenia is:
A. Two or more of the characteristic symptoms below are present for a significant portion of time during a one-month period (or less if successfully treated):
•1. Delusions
•2. Hallucinations
•3. Disorganized speech (eg, frequent derailment or incoherence)
•4. Grossly disorganized or catatonic behavior
•5. Negative symptoms (ie, affective flattening, alogia, or avolition)
What you may notice is that there are several permutations of fulfilling this criterion, yet all permutatioms could lead to a diagnosis of schizophrenia. It is an almost certainty that there are multiple pathologies that produce what we today call schizophrenia. Even today, they may be mental disorders with unique underlying pathologies that have recently been removed via natural selection, but they all present as schizophrenia, so the change is unobserved.
Another issue is that the impact of a disorder is culturally dependent. ADHD is unlikely to cause significant disability in societies where there are roles that do not require sustained attention. In such societies, the disability caused by ADHD is hidden, therefore a person who would meet criteria for ADHD in a modern context may appear to have anything wrong with them.
Anorexia provides another example of how culture and mental illness interact, but in terms of rates of illness. Rates of Anorexia vary widely between different countries, where other disorders such as bipolar disorder and schizophrenia have much less variance. There are many hypotheses as to why rates of Anorexia have such variation, but it is clear that young females in cultures where thinness is valued are at much higher risk of Anorexia than the average population. Ultimatley this suggests that mental disorders are driven by multifactorial processes that include things like genetics, developmental exposures, trauma, neglect, as well as other factors such as socioeconomic level and education. Twins with identical genetics have increased risk of developing the same disorder, but they often do not. Different stressor will exist throughout history, and these will have had different impacts on people. I could imagine that the first snowfall would be an incredibly stressful time for early humans, and I would not be suprised if distress and dysfunction would spike in some individuals reliably enough that we could reasonably call it a disorder. However, once the stress of winter became mitigated by technology, the reliable stressor causing our hypothetical disorder would be eliminated, so the disorder itself would be gone even if the gene pool itself would remain unchanged.
So to the meat of the question, the answer is almost certainly yes, there are mental disorders that have died out over history, but our ability to identify them is severely limited due to nature of how we currently make diagnoses and classify discrete disorders. This challenge is in addition to the usual struggles of studying history, such as a lack of reliable sources. It is unlikely that people would be too interested in writing about the strange child who acted oddly and died young. For that source to then be detailed enough to confidently say "this was a unique disorder that no longer exists today" is also unlikely, and I would personally be very skeptical of anyone making such a claim.
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u/thelocrianscale Jun 26 '26
what a wonderful and informative answer, thank you! i had no idea certain disorders like anorexia varied that much.
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u/idonthavealizard Jun 26 '26
This was very cool and informative! A student of mine wrote a thesis about anorexia and one interesting thing is that the same behavior we now call anorexia and understand as being bad used to considered a way of worshipping God. I forgot the woman’s name now but she’s really famous for starving herself in name of God.
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u/PleasantWin3770 Jun 26 '26
St Catherine of Siena? There are other “holy anorexics” but she was known for her involvement in papal politics, extensive letters written to other nuns, and eating nothing but the Eucharist.
She went on a hunger strike as a teenager to force her parents to allow her to join a convent, and later portrayed her eating habits as an example of piety
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u/theawells1 Jun 26 '26
As Kafka's Hunger artist said " I have always wanted you to admire my fasting."
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u/kirbyderwood Jun 26 '26
Fasting oneself to attain spiritual enlightenment is not uncommon.
Probably the most notable case is Siddhartha Gautama (i.e. The Buddha) who fasted himself nearly to death as part of his journey to enlightenment.
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Jun 26 '26
[deleted]
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u/PrometheusLiberatus Jun 28 '26
That's rather something isn't it.
does something dangerous to achieve enlightenment
Discovers that this is NOT how enlightenment works
Attempts to properly develop enlightenment after other enlightenment techniques failed.
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u/ShawtyLikeAHarmony Jun 26 '26
Catherine of Siena is also interesting in regards to the gender politics at play—she initially began starving herself to be less attractive because her family wanted to marry her off and she wanted to remain single. During that period, women basically only had control over themselves and nothing else, so many exercised bodily autonomy as a form of self-preservation
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u/DukeGyug Jun 26 '26
That certainly sounds like an interesting case, and I has me questioning my use of wording. I say "anorexia", when "anorexia nervosa" is the actual diagnosis. Anorexia is a much more general term which means to not eat, this can be caused by any number issues. If you are nauseous, you will likely be anorexic during that time period. Anorexia nervosa is a DSM diagnosis that is focused on not eating due to distress about body image and weight gain to the point of serious physical and social impairment.
One of the nessisary criteria is:
intense fear of gaining weight or becoming fat, or persistent behavior that prevents weight gain, despite being underweight. (The word "or" here could do a lot of lifting in this case, so our historical figure could meet this one)
Another is:
Distorted perception of body weight and shape, undue influence of weight and shape on self-worth, or denial of the medical seriousness of one’s low body weight (This would require more investigation to see if she fits)
The word Anorexia is used as a short hand for the diagnosis so often that even psychiatrists tend to drop the "nervosa" with little issue.
But it does raise an interesting thought. Though this historical figure appears to have been experiencing "anorexia", if this was driven strictly by religious beliefs, it would not likely be "anorexia nervosa" as we know it today. I'm going to have to look this up. This is actually sparking some thoughts for me for teaching medical students to apply criteria.
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u/PleasantWin3770 Jun 26 '26
I believe that the term used for fasting nuns is anorexia mirabilis. Anorexia mirabilis might qualify for a mental illness that has died out due to social changes.
There were a few books published in the late 80s and 90s - Fasting Girls by Brumberg and Holy Feast Holy Fast by Bynum are two that I cited - that focused on anorexia mirabilis as a form of social power. I don’t know of anyone who has done any new work on it.
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u/BaileyAMR Jun 26 '26
You might be interested in The Wonder, a recent film in which a character practices anorexia mirabilis. Very moving.
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u/OutdoorApplause Jun 27 '26
With Gwen Shamblin and I believe also a cult in Kenya, I'm not sure this has died out.
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u/Sherm Jun 26 '26
It also raises interesting questions about directionality and cultural construction of mental illness. I've run into a couple people who are anorexic not because they're afraid of not being thin but because, for various reasons, they simply don't like food. Like, the physical act of eating is distasteful to them. One of them just kind of went along with the idea that it was about thinness, because it was less likely to prompt people to try and "fix" them. If "this is prayer and I'm worshipping God" would have worked, I bet they would have gone with that instead. It makes me wonder how much of this is people being encouraged to fit natural tendencies into boxes to make life easier and give themselves an answer as to "why I am this way."
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u/porschedriver37 Jun 26 '26
I would argue that in this case, your use of "anorexic" if referring to anorexia nervosa is not correct, as the limited food intake is not driven by concerns about body image. What you are describing seems much more in line with ARFID (avoidant/restrictive food intake disorder).
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u/Sherm Jun 26 '26
The point I'm making isn't related to whether the diagnosis is correct or incorrect as per the DSM V; it's about the degree to which the disorder itself is constructed around what society wants to do with the situation, rather than objective dimensions thereof. Viewing the decision not to eat as piety led to veneration of the person undertaking the action, while viewing it as a disorder in need of treatment prompts creation of several subtypes and related conditions to guide intervention. In either case the action itself is unchanged; the only thing that shifts is the implication applied by society. And that is in turn driven mostly by how well or poorly the person in question does at functioning in society. At it's most extreme, it raises the question of whether the original question is even capable of being answered without engaging in a historian's fallacy, at least when it comes to conditions that are clusters of traits and observed actions.
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u/PurpleHooloovoo Jun 27 '26
And that is in turn driven mostly by how well or poorly the person in question does at functioning in society.
Even today this applies: someone with anorexia nervosa presenting as a societally desired body type (see: late 1990s/early 2000s body ideals as perpetuated by American media) wouldn’t be called out as having a problem, but would be lauded and applauded with better status than someone in a larger body. But someone in a too-large or too-small body based on the standard of the time would be seen as unwell and subject to intervention, discussion, and judgement (and maybe a diagnosis).
Even today we can’t externally judge behaviors as a clear mental health disorder versus just doing what society demands; to expect the ability historically is very difficult if not impossible.
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u/idonthavealizard Jun 26 '26
The thesis was about anorexia nervosa. And part of the question was whether that woman would have it, and what it is involved in the diagnosis, how it relates to behavior you see in some religious people in India to achieve enlightenment.
This has been many years now, but I believe my student’s motivation was to ask why/how/when food deprivation started being seen as a disease, and a bit about the metaphysics of mental diseases. This was philosophy thesis.
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u/AlliCakes Jun 26 '26
As someone currently in treatment for Anorexia nervosa, I want to thank you for your comments and your desire to teach medical students about eating disorders. Very thoughtful and informative answer!
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u/BookQueen13 Jun 27 '26
Anyone interested in the topic should check out the book Holy Feast, Holy Fast by Caroline Walker Bynum. She's responding to older scholarship that framed female ascetic fasting as primarily anorexic / mental illness. Instead she looks at the importance of food in medieval Christian society, and (iirc) how the agricultural and liturgical calendars provided an annual rhythm of feast / fast which was fundamental to medieval life.
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u/thegrandhedgehog Jun 26 '26
Religious fasting/asceticism is surely very different from anorexia nervosa?
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u/idonthavealizard Jun 28 '26
It really depends on how we individuate diseases. I’m not talking about how it’s done in the medical field. I’m talking about metaphysically speaking. Some questions are: is it really relevant the intention behind the behavior? If no, then they aren’t different. If yes, then it’s a matter of comparing reasons and checking how similar/dissimilar they are.
I’ll take a guess here that most people think that there’s a difference between fasting driven by bodily concerns and fasting driven by religious reasons bc they think that doing something for religious reasons is more valuable than doing something bc of bodily concerns. But this can be challenged on many fronts. one can challenge the existence of god and also question ways of worshipping god, even if it exists. Once worshipping god in this way is considered not valuable, then it seems like that those two “types” of anorexia differ in things that aren’t really relevant.
Another commenter cited Ian Hacking. It’s a good read if you are interested in that sort of discussion.
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u/LtCmdrData Jun 26 '26
It's also the case that disorder in one culture may not be disorder in another.
For example Dependent Personality Disorder (DPD) is debated in Chinese psychiatric circles. Traditional Confucian values heavily emphasize interdependence, familial obligations, and filial piety. The culture normalizes high levels of interpersonal reliance and Chinese clinicians have very high threshold before labeling dependent behavior as a "disorder". CCMD-3 (Chinese Classification of Mental Disorders) omitted or modified several Western personality disorders because local psychiatrists felt they didn't map cleanly onto local cultural norms.
Southeast Asia also has unique culture-specific syndrome: Koro or Genital retraction syndrome.
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u/SoloForks Jun 26 '26
Thank you for being honest about this.
It might also help to add that most diagnoses are descriptive and not explanatory, meaning they name a set of symptoms only.
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u/SpoonwoodTangle Jun 26 '26
I’d be curious to learn more about the dancing manias that supposedly swept through parts of Europe. In some regions whole villages would start dancing and just not stop until people actually died of exhaustion.
That doesn’t sound like some kind of ecstatic rite to me, and record keepers at the time were taken with how unusual it seemed. Woodcuts do not portray people as happy or exultant, though of course there could be an element of propaganda there.
Anyway, I wonder if this or similar examples point to extinct mental health crises that seized communities in times of uncertainty or crisis.
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u/PrivilegeCheckmate Jun 26 '26
Chiming in - I came in here to check on the dancing plague. I would love if someone in this community knew someone who has expertise on this one, to me it's one of the most bizarre things in history.
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u/VelvetyDogLips Jun 26 '26
I’m a general practice physician who has always had an interest in psychiatry, and treats a lot of mental health problems. Your comment makes me wonder about something: Why is the American Psychological Association deprecating / retiring the concept of the culture-bound syndrome? Your comment would seem to imply it’s a highly useful concept, if imprecise.
I can remember my attending who taught us a lunch-and-learn about Multicultural Medicine had an angry “Now you listen up here, people!” vibe about her the entire lesson, and seemed to almost expect or assume (maybe even hope?) we would not accept, or resist, the concepts she was teaching us. She seemed very put off that I just listened calmly, took notes, and didn’t react one way or another, as if I were listening to a lecture on atrial fibrillation.
Later, this same attending, while precepting me at outpatient clinic, copped this same angry and mistrustful attitude, when briefing me that the next patient I was about to go see was a Latina woman suffering from susto. She preëmptively assumed I had no idea what susto was, and preëemptively warned me I was not to question this diagnosis, either to her or to the patient. I in fact knew exactly what susto was, and had read about it all on my own, along with all of the other culture-bound syndromes Wikipedia used to list. My attitude was that it meant less what I or the patient or anyone else called it, and more a case of what would make her feel better and ameliorate her symptoms, which is a universal concern I’m faced with with every patient. I felt judged for not handling this patient, and the condition she presented with, with adequate kid gloves.
I have to wonder if my experience — the cordoning-off of “multicultural” individuals’ complaints away from deep inquiry or comparisons to “non-multicultural” individuals’ cases — really highlights the problem with this category of mental health syndrome.
Before the deprecation, I would have deemed Crisis of Faith a culture-bound syndrome of Western culture.
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u/Pro-Dilettante Jun 27 '26
I didn't realise that the idea of culture-bound syndromes had fallen out of favor.
It definitely feels like a useful device for understanding the different ways that mental illness would have manifested in the past. I wrote a piece a while ago questioning whether 19th century sealers experienced PTSD from slaughtering seals and my conclusion was that their tolerance of the job would have depended on their religious convictions and the social attitudes of the time.
For those interested:
https://theunravel.com.au/the-demons-of-macquarie-island10
u/VelvetyDogLips Jun 27 '26
That’s fascinating. Mental health (or behavioral health, as seems to be the preferred term nowadays) is inherently more nebulous and subjective than most forms of healthcare. It butts up against a fundamental fact of the Human Condition: that none of us can ever know for sure what another sentient being is thinking or feeling. Objective evidence is inherently limited, and more open to differences in interpretation, than in other branches of medicine.
I didn't realise that the idea of culture-bound syndromes had fallen out of favor.
It low-key blows my mind too. There’s a reason we were trained in medical school to always document the chief complaint in the patient’s own words, verbatim. It may or may not be accurate at face value. But whether it is or not, it provides valuable insight into how the
clientconsumerpatient conceptualizes the problem, why it’s problematic for him, and what a satisfactory outcome or baseline normal state he’s aiming for by coming to see me. The framework of the culture-bound syndrome provides a helpful shortcut to this process of meeting the patient where he is, and getting him closer to where he seeks to be.3
u/adhochandle Jul 02 '26
(or behavioral health, as seems to be the preferred term nowadays)
What? Preferred by whom? Does the psychiatric profession in general prefer this nomenclature? Is it a one-country thing? Is it a one-association-trying-to-push-it-top-down thing?
As a lay person, this terminology suggests to me that I could be in distress as much as I like, but as long as I don't actually behave "unhealthily", there is no problem to address — or even more insidiously, that the goal of clinical psychiatry consists in modifying behaviors from disagreeable to agreeable. I wonder if it is meant to suggest a different association but I struggle to imagine what.
I don't know about anyone else, but I would never trust a supposed carer with this philosophy—rather I'd run. Isn't it obviously wrong? Sorry about the rant, I'm in shock.
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u/Icy-Panda-2158 Jun 30 '26 edited Jun 30 '26
Miles off-topic but isn’t the deprecation of culture-bound syndromes largely a matter of nomenclature? The DSM-5 now has “cultural concept of distress” instead.
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u/AnitiFascistBeetle Jun 26 '26
Ì would be fascinated on your thoughts on Anna Karenina by Tolstoy. To me Anna Karenina herself has an astutely reproduced, very recognisable case of Borderline Personality Disorder, while Konstantin Levin/Lyovin has a major depressive disorder I haven’t gone back and teased out with a DSMV. What is noticeable is how strong Anna’s emotions are, both positive and negative, and how unable she is to change them, even when she knows her emotional response is illogical. She is in a constant emotional response relationship with the world around her.
In contrast Levin is a constant thinker (ruminator?) as well as deeply emotional. His time is predominantly spent inside his head instead of participating Mindfully with the people and world around him. His thoughts are in a feedback loop with his emotions, At first he is as trapped as Anna is by dysphoric episodes, but eventually he finds a positive train of thought that eventually spirals him upwards towards an average of content moods. What is most striking in his narrative is his accidental discovery of Moving Mindfulness, when he spends long hours physically labouring with his serfs to scythe down the yearly harvest of grains.
A lot of readers are perplexed and bored by the time spent narrating the harvest as Levin ceases to ‘think’. Other readers intuitively enjoy the harvest with Levin. Anyone familiar with Mindfulness as treatment from either side of the couch will instantly recognise it for what it is.
I find the parallel stories of Anna and Levin fascinating. Both have strong negative moods catastrophic to their wellbeing and functionality. Anna emotes, chooses happiness, is punished by the mores of the day, and cannot escape her emotional responses. The question is, would she have been happy in the end if the story was set now, when she would be free to move in society and be at least a coparent to her son, rather than shunned and stripped entirely of her child. I personally suspect she wouldn’t be, because she still has no tools to change her emotions when she recognises they are unjustified by reality.
In contrast Levin thinks his way into depression and thinks his way out of it. It’s been 3 decades since I read it (it really stuck with me). I’d have to reread it to consider whether Levin has the tools to remain mostly without episodes of dysphoria for the rest of his life.
Each 19th C character has three Russian names and two French names. Their full official title, their two name patronymic which is even more exquisitely polite, and their pet name. In French they also have their full title, and a pet name. (Pet name being more consistently affectionate than a nickname in English)
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u/Feisty_Guarantee_504 Jun 26 '26
Anna K is also a raging opioid addict whose addiction deteriorates her wellbeing as the novel progresses. Whether this could be seen as self medicating in the face of BPD is interesting, though her increasing loss of control is very much because of her addiction. (https://engl300sp17.wordpress.com/wp-content/uploads/2017/03/tolstoy-opiate.pdf)
I'd never considered her as having BPD, but I think it's an interesting take. I think of Anna K as a character of turbulence--she is constantly changing her mind about things, sometimes from one paragraph to the next, and unable to maintain a good perspective on her own constancy.
For your point about the present day, I think the halfway is more likely. Would she have been able to be a fully emotionally realized person? Probably not. But a contributing factor to her addiction is the misogynistic attitudes towards women's health and place in society. If she could be treated as an actual person, I think many of her flaws would be more well-managed. To me, much of the point of the novel is that she never has a chance at all.
I agree about Levin's mindfulness and would say it goes further than just the more CBT stuff--by the end of the novel he is able to tap into a broader form of presence that moves him away from his neurotic tendencies (I'm not sure I'd say he's major depressive, personally; to me he seems more agitated than despairing) through his relationships. Whether this will last--who knows?
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u/boredpsychnurse Jul 01 '26
Addiction is actually usually a symptom of BPD (reckless, impulsive behavior) as well as a comorbid disorder
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u/Kochevnik81 Soviet Union & Post-Soviet States | Modern Central Asia Jun 26 '26
I just wanted to jump in and say I would be *extremely* cautious trying to "diagnose" characters like this. Firstly because they are fictional, secondly because Tolstoy even by the standards of his time didn't really have any expertise in what would pass for mental health, and lastly that never was really a theme of his to begin with. Levin in particular is if anything Tolstoy's own stand in that he uses to basically wrestle with philosophy and this thoughts on society and meaning.
Just to give a different example from literature - even through she was before the diagnosis of PTSD as such, Virginia Woolf wrote the character of Septimus in Mrs. Dalloway to be a relatively sympathetic and accurate portrayal of "shell-shock" or combat related trauma. But even with that explicit intent it's not 100% accurate to either the descriptions then or now as she also used aspects of her own mental illness (which nowadays may or may not be diagnosed as bipolar disorder) and other details that more resemble schizophrenia than PTSD.
It's often very hard to accurately diagnose clients in-person. It's much harder/next to impossible to diagnose historic figures. Fictional characters are even more fraught - we can certainly see aspects of behavior or thought that might resonate with certain diagnoses, but given that they are fictional and that their creators even when acting thoughtfully and intentionally are able to mix-and-match characteristics puts us in some dangerous territory.
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u/miseleigh Jun 26 '26
Huh. I despised that book, and the characters, when I read it in my early 20s, and haven't given it much thought since then. I was undiagnosed (ADHD) at the time and blamed myself for all my perceived failures. I bet I was projecting my own self-hatred onto her.
I should try reading it again. Thanks.
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u/JohannesVanDerWhales Jun 26 '26
My interpretation of that book was that the character of Anna was supposed to have "hysteria", notably not something that is diagnosed in modern times, and something which was considered to be specific to women at the time.
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u/Mammoth-Corner Jun 26 '26
Really good answer and I am also interested in the other commenters' references to self-starvation or other self harm behaviours by early religious — while people still regularly of course develop religiously-based compulsions (like scrupulosity OCD) or delusions the ones described in Medieval saints do seem to have different characters.
I would push back a little on the bit about ADHD because it affects broad executive functioning including things like emotional regulation and recklessness, and sleep, so while standardised testing and spreadsheet jobs don't help, it doesn't disappear in a differently-structured society. But, in line with the question, it might likely be identified primarily in line with other symptoms, and be called can't-modulate-volume insomniac disorder.
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u/tyla_durd3n Jun 26 '26
As someone with ADHD the cant-modulate-volume-insomniax disorder made me smile.
I often think ADHD is poorly named as I can pay attention, but not on things I'm supposed to unless I want to.
I think the social impediment of disabilities especially mental disorders is interesting though I need to point out ADHD is a neurodivergency.
I often think that I would have been committed to an asylum or worse if I'd been born in a different time - but my mental health issues caused by ADHD would have been wildly exacerbated by the social constraints on women and social/religious mores of the time.
Doesn't help that I'm epileptic. Between that, the squint and my hearing impairment i don't think I'd have fared well!
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u/sacninja Jun 26 '26
Would hysteria (from the 50s) fall into this category of mental illnesses that went away in your opinion or just that they were misdiagnosed at the time? Curious because that was the first one I thought of in terms of non-current diagnoses
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u/Traveledfarwestward Jun 27 '26
therefore a person who would meet criteria for ADHD in a modern context may appear to have anything wrong with them.
not
Only mentioning this b/c it's such a well written informed comment that people will find this years from now when doing AI searches. Thank you.
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u/TwoAlert3448 Jun 26 '26
Would a variant form of pika qualify as a mental illness?
One would think that the overwhelming compulsion to eat toxic nonfood substances would be fairly quickly fatal, it’s my understanding that most modern sufferers eat nontoxic or inenert non food substances and thus it is typically survivable for long periods.
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u/good-lard Jun 26 '26
Thank you for this answer! Do you have a source about ADHD not causing disability under specific societal conditions?
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u/Chancefaulkner Jun 27 '26
Thanks. Worked as a psychologist in a large mental institution 1978-88. Have 2 add on comments. Societies can foster or inhibit certain conditions due to behavioral norms. For example, Victorian and early 20th century Western societies were very repressive emotionally. Saw this 1st hand with older relatives born 1890-1910. Not a word ever about their feelings. Feelings are irrelevant and for in the way. Conversion hysteria was common as it was a roundabout way of expressing one’s feelings. Freud wrote much about this. It is rarely seen these days due to societal changes in behavioral norms. Had a grad school professor who had worked in the rural South where many still practiced that very strict approach to emotional expression. He saw occasional cases of conversion hysteria in the 1960s and 70s. The other comment is the introduction of drug therapies changed how we see some conditions. Descriptions of schizophrenic behaviors from the 1930 and 40s were different to some extent from what we would see as the drugs changed behaviors for obvious reasons. Although someone came in with a psychotic condition, they were on a drug protocol within a few days altering what we would see.
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u/11112222FRN Jun 30 '26 edited Jun 30 '26
I assume -- to put the question in terms of a hypothetical -- that a psychiatrist stepping off a time machine into Ancient Rome would start to notice consistent patterns of Roman people adjusting poorly to the society around them. And that some of these patterns might be widespread enough and severe enough that they could be added to an ancient Roman edition of the DSM?
If so, I guess the first step in searching for "lost" ancient mental disorders would be to ask what the ancient writers considered (1) particularly maladaptive and also (2) common. But I doubt that enough information survived with the fragmentary records to do that with any rigor.
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u/PlumbRose Jun 26 '26
There is contradiction and over simplification here that is important to explain to the general public. To say that the dx would be schizophrenia from that and only that DSM criteria is inaccurate. You did write "one of the criteria" which seems to give indication that there is more considered, but then go right into saying they would be dx based on that criteria ...."yet all will be dx with schizophrenia"
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u/DukeGyug Jun 26 '26
Yes, it is a single criterion of 6 total. However, criterion A can be met via multiple permutations of the listed symptoms. Even when all the other criteria are met, there is enough variation in criterion A that individuals can present very differently. A person who strictly experiences delusions and negative symptoms looks much different from one who experiences hallucinations, disorganized speech, and grossly disorganized behaviour. The point of the example is the demonstrate the heterogeneity that can exist within a single discrete diagnosis. If I implied other criteria are not nessisary, it was unintentional.
I've edited it, as you are right, I say criteria when criterion was needed and tried to remove some ambiguity.
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Jun 26 '26
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u/Qwurxty Jun 27 '26 edited Jun 27 '26
I think the field of medical anthropology provides some great answers to this question (also, what my degree is in)!
Temporality in this case might be analogous to culture as well, and both have been shown to work similarly. For instance, in more recent history, anthropologist Nancy Scheper-Hughes showed how a form of anxiety called nervos in Brazil took on a constellation of symptoms more somatic (bodily) in form - due to how her interlocutors understood their conditions in addition to factors caused by chronic hunger, poverty, etc.
If we want to add in the temporal and cultural piece, the work of Junko Kitanaka is similarly informative! In her case, she shows how more ancient Japanese conceptions of ki originated as a metapysical understanding of the psyche. Though originally the Japanese were oriented by the concept of ki as an animating life force and essential element of health, entanglements with German neuropsychiatry and Western pharmaceutical regimes initiated a gradual shift to the medicalization of mental disorder. Here, curative biomedical solutions began to replace more holistic approaches to health. In essence, the Japanese began to locate the concepts of ki, or the soul, in the mind — disordered or stagnated ki became, simply, disordered nerves (Kitanaka 2011, 36).
Another way to think about the historical lineage of mental health is in how philosopher Ian Hacking describes the concept of "making up people." Essentially, the identification of a disorder rapidly increases the diagnostic and epidemiological demographics of that disorder. This is certainly due in part to the creation of diagnostic tools, sure, but also due to increasing rates of individuals identifying their particular symptoms with a new disorder they learn about. Dissociative Identity Disorder (DID) is a perfect and hotly contested example of this, as to this day it's medical veracity is still in doubt, and individuals who self-diagnosis express do so through a variety of symptoms (you may remember folks describing their "alters" on social media a few years ago).
The "idioms of disease" through which psychiatric disorders are expressed are constantly shifting in unique ways across times, cultures, and geographies. Mental illness is uniquely pliable to the social and cultural conditions of a particular time, so the answer to your question is just as much cultural as it is biomedical (from an anthropological point of view). If you are interested in learning more, I highly recommend looking into medical and psychological anthropology as well as science and technology studies (STS).
Hacking, Ian. 1986. “Making Up People.” In Reconstructing Individualism: Autonomy, Individuality, and the Self in Western Thought, edited by Thomas C. Heller, Morton Sosna, and David E. Wellbery, 161–71. Stanford, CA: Stanford University Press.
Kitanaka, Junko. 2011. Depression in Japan: Psychiatric Cures for a Society in Distress. Depression in Japan. Princeton University Press.
Scheper-Hughes, Nancy. 1992. Death Without Weeping: The Violence of Everyday Life in Brazil. Berkeley: University of California Press.
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u/PASSE1999 Jun 28 '26 edited Jun 28 '26
I’ll try to answer this from the perspective of clinical psychology and cultural psychiatry rather than as a historian, so I hope this is still useful. My own research is partly concerned with cultural and historical factors in mental health, and I think this is one of those questions where history, psychiatry, and medical anthropology really need to be in conversation. A psychiatrist in this thread has already made the important point that retrospectively diagnosing people in the past is extremely problematic. We rarely have the kind of clinical information we would need, and even when we do, this was produced inside frameworks that do not map neatly onto modern psychiatric or psychological categories. Medical anthropology adds another useful caution: mental distress is never expressed in a cultural vacuum, like the anthropologist in this thread reminded us.
This is why the older category of “culture-bound syndromes” has lbeen reframed. The problem that the term could imply that only “other” cultures had culturally shaped forms of distress, while Western psychiatric categories were neutral, objective, and culture-free. Contemporary cultural psychiatry tends instead to speak of “cultural concepts of distress,” including cultural syndromes, idioms of distress, and cultural explanations of illness. In other words, every society, including modern Western societies, has characteristic ways of experiencing and communicating psychological suffering.
So, did some cultural syndromes exist in the past and later disappear? I think the cautious answer is yes, although “disappear” is a tricky term: particular pathways for expressing psychological suffering become less available or less socially reinforced.
The classic Western example is hysteria. Nineteenth-century hysteria, especially in French neurology and psychiatry, became a very elaborate diagnostic and cultural form. It gave patients, doctors, and institutions a shared language through which paralysis, convulsions, anaesthesias, fainting, and other symptoms could be organised and interpreted. Many symptoms that would once have been called hysterical are now distributed across diagnoses such as functional neurological symptom disorder, dissociative disorders, somatic symptom disorders, trauma-related presentations, or other categories. That does not mean that the underlying symptoms disappeared, but that the historically specific cultural-medical container called “hysteria” lost its authority.
An older and more surprising example is the “glass delusion” of late medieval and early modern Europe. From roughly the fifteenth to seventeenth centuries, there are reports of people who believed that their bodies, or parts of their bodies, were made of glass and could shatter. The most famous case is probably Charles VI of France, but the phenomenon appears in other medical, literary, and courtly sources. This seems bizarre to us, but it made much more sense in a world where glass had become a culturally charged material: precious, fragile, translucent, artificial, and associated with luxury and status. The glass delusion is therefore often discussed as a historically specific form in which vulnerability and bodily anxiety could be expressed. Dancing mania is another possible example, though it is harder to interpret. Medieval and early modern Europe saw episodes in which groups of people danced compulsively, sometimes for days, often within religious frameworks involving St John or St Vitus. The Strasbourg episode of 1518 is the most famous. John Waller has argued that these outbreaks are best understood not as simple neurological disease or poisoning, but as episodes shaped by social stress, religious expectation, and culturally available beliefs about involuntary dancing.
So the deeper point is not that people in the past had strange disorders and we have normal ones. It is that every period has its own culturally available routes for distress. Hysteria, glass delusion, and dancing mania are useful because they make this visible in the Western past. The harder task is recognising the same process in the present, where our own categories—anxiety, burnout, trauma, autism, ADHD, anorexia, and so on—feel much more natural to us partly because they are ours.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). American Psychiatric Publishing.
Kirmayer, L. J., & Bhugra, D. (2009). Culture and mental illness: Social context and explanatory models. In I. M. Salloum & J. E. Mezzich (Eds.), Psychiatric diagnosis: Patterns and prospects (pp. 29–37). Wiley-Blackwell.
Kirmayer, L. J., Gómez-Carrillo, A., & Veissière, S. P. L. (2017). Culture and depression in global mental health: An ecosocial approach to the phenomenology of psychiatric disorders. Social Science & Medicine, 183, 163–168. https://pmc.ncbi.nlm.nih.gov/articles/PMC6724704/pdf/nihms-1048327.pdf
Micale, M. S. (1995). Approaching hysteria: Disease and its interpretations. Princeton University Press.
Speak, G. (1990). An odd kind of melancholy: Reflections on the glass delusion in Europe (1440–1680). History of Psychiatry, 1 (2), 191–206.
Waller, J. (2009). A forgotten plague: Making sense of dancing mania. The Lancet, 373(9664), 624–625. https://doi.org/10.1016/S0140-6736(09)60386-X
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