By the Rivers of Babylon

Eric Lis

We know a fair bit about what medicine was like in medieval Europe. We know that it was dominated by religious understanding, and that illness, especially mental illness, was largely attributed to gods and demons. We also know, however, that in other parts of the world, even during the so-called Dark Ages, there were always places where more scientifically-informed schools of thought held sway. Any society tends to fluctuate between rationalism and irrationalism over time, which begs the question: what about if we look way, waaay back at the dawn of human civilization? It turns out that not only do we have records of Ancient Babylonian medicine, we also have records of how they described mental disorder and neurological illness, as summarized here last year. It turns out that in some ways, the ancient Babylonians were actually better scientists than the medieval Europeans.

First, a quick word about Babylonian religion. Babylon, like the rest of Mesopotamia, was a land rich in deities. As we would expect from what is believed to have been the biggest city in the world for hundreds of years, Babylon had a rich and thriving culture of which a powerful spiritual element was only one part, and sadly, few records survive to tell us about it. We know that over the course of some two thousand years, the Babylonians had a few different deities of healing, the most prominent of which is probably a goddess variously known as Nintinugga, Bau, or Gula (there seems to be ongoing debate among historians as to whether this was one goddess or several, and I didn’t spend enough time reading the arguments to form an opinion). Her husband, Ninurta, was also a god of healing, underscoring that she by no means had a monopoly on the portfolio. Legends call her “the great physician” and “she who restores to life,” and she was also felt to be the enemy of poisoners. Some of the surviving carvings depicting her seem to portray exorcism-like rituals, but even if “magic” was used to treat mental disorder, it is at least interesting that the same deity would be invoked for physical as well as spiritual healing.

Babylonian written records of psychiatric and neurological illness date back to at least the second millennium BC, making them some of the earliest known examples of writing. While they didn’t have much understanding of anatomy and physiology and obviously didn’t understand the workings of the brain, they were, like many people, very good at observing things and describing what they saw, and this forms the basis of the writings still available to us. These writings seem to indicate that the Babylonians divided illness into two broad categories: the physical – infections, wounds, animal injuries – and that caused by evil forces. A physician, or asu, was an expert in physical ailments, and treated them using herbs, poultices, and probably less often than the Egyptians but more than the Greeks, surgeries. In spite of a fair degree of advancement and, as near as we can tell, some genuinely effective pharmacology, most illnesses also required the attentions of a priest, an asipu, who could intercede with the gods on the sick person’s behalf.

The Babylonians didn’t have a word for “mind,” and neurological disorders were generally thought to be problems of behaviour. A person’s behaviour could be affected by “persecutors,” which included spell-casters, demons, and other evil influences. Miqtu, for example, the “falling sickness,” was the Babylonian word for what we would call epilepsy. Their description was very thorough, including including descriptions of pre-seizure aura, post-seizure confusion, and things that could increase or decrease the risk of seizure, such as not getting enough sleep. Miqtu was felt to be due to a demon invading the body or, in rare cases, the gods. In contrast, the Babylonians understood sipir misitti, what we would call “stroke,” to be a physical illness, and understood some of the factors which predict how well a person will recover.

The Babylonians extensively documented psychiatric illness but seem not to have known what to make of it… as, indeed, sometimes neither do we today. Psychosis, obsessive-compulsive disorder, and several anxiety disorders are all described. Interestingly, they felt that antisocial and psychopathic behaviour was a form of illness, a belief which is sort of held today but which would have sounded utterly ridiculous to healers throughout much of history. Despite the strange and frightening ways these illnesses manifested, the Babylonians seemed unconvinced that they were clearly due to a supernatural cause. This doesn’t mean that they ascribed hallucinations to a physical sickness, but rather, Babylonian healers seem to have had an enviable willingness to say, “I don’t know, and I’m not going to pretend to be more confident than I am.” None the less, treatments included burning effigies of wood or wax in an effort to drive out demons or block witches’ spells, and were the exclusive domain of the priests. Depression seems to have been the exception, as it was viewed specifically as a person being the target of the anger of their gods, and therefore required urgent aid from a priest, who would appeal to Shamash, the god of justice, to spare the victim.

Were the Babylonians more advanced than other ancient peoples in their understanding of psychiatry? In some ways, they may have been. Egyptian medicine was probably more physically advanced, but their writings contain almost nothing about mental disorder. Greek and Roman descriptions of melancholia and other forms of suffering were sparse compared to the rich Babylonian descriptions, and they had little conception of what to do about them. In this one area of medicine, the Babylonians seem to have had a level of sophistication that was lost along with them and (outside of the writings of a few individuals) wasn’t rediscovered until the seventeenth or eighteenth century, by which time men like Freud were on hand to make things… complicated. In essence, despite being one of the most ancient civilizations, the Babylonians had a particular knack for describing what they were seeing and keeping some humility regarding what they did and did not adequately understand. This last part is a lesson that later civilizations, like the Greeks and medieval Europeans – and us – could have learned from. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on April 25, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system