Arts & Culture The Aib Issue

How my journey with depression goes back thousands of years

"My body felt like it was not my own; like it was a corpse I was inhabiting while I dragged my soul in tow."

By Dr. Moudhy Al-Rashid

Just before dawn, I plodded across three grass lawns from my high school dormitory to our high school infirmary. I was 16-years-old. Covered in a thin layer of white frost, the grass crunched under my flip-flops, and with every step tiny crystals of ice sprayed against my heels. My breath frosted as it met the air. The haze hung suspended before me, blurring my vision just enough to make me feel like I was dreaming. My feet shuffled across the frozen grass more quickly, despite not knowing exactly why, until they came to a stop in front of the single-storey, red brick building.

Using my whole body to fight the wind tunnel created in the small corridor of the entrance, I leaned against the infirmary’s front door and found myself before a reception desk that glowed under pale lights, illuminating a solitary woman with short, grey hair. Suddenly embarrassed —what was I doing there, after all —I paused for long enough that she asked, “What’s wrong, hon?” she asked.

“I…don’t…” and then a sob erupted from my lips. I had wanted to say, “I don’t know.”

I thought that there was no word for how I felt; a constellation of experiences for which I could not quite find the right words. I felt different, detached, sad, alone and ashamed. My body felt like it was not my own; like it was a corpse I was inhabiting while I dragged my soul in tow.

Twenty years and hours of therapy later, I now study thousands of year old texts from the Ancient Middle East to reconstruct the oldest known words for describing this fundamental experience of human suffering I myself was unknowingly suffering from in my teens: depression.

“My body felt like it was not my own; like it was a corpse I was inhabiting while I dragged my soul in tow.”

There is a power in naming a collection of medical phenomena and experiences, a moral and social recognition of an experience of disease. An illness label can bring terror, yes, but also relief; it can begin the process of healing. And, albeit stigmatized in some cultures, depression is a label with a long, diverse history.

Akkadian is the oldest known Semitic language, inscribed onto clay tablets using a writing system named Cuneiform. The various states, languages and cultures of Ancient Mesopotamia and its immediately neighbouring regions all had Cuneiform in common.

Cuneiform tablet from Nuzi (modern Yorghan Tepe, Iraq). Image: Shutterstock.

Of the hundreds of thousands of Cuneiform tablets that have survived from antiquity, thousands of these are medical texts. They describe experiences as varied as epileptic seizures, strokes, sexual dysfunction, miscarriages, snake bites, fevers and a host of symptoms familiar to anyone whose mental health has suffered.

Heartbreak (??p libbi) is one condition from which Assyrians and Babylonians suffered from that encompasses aspects of depression and anxiety. It appears not only in medical texts, but in literature and letters. In the Old Babylonian story of the flood, Atra-Hasis, for example, the protagonist and archetypal Noah suffers a broken heart in despair at the thought of abandoning his townspeople. In a letter to a Neo-Assyrian king, found in the (Tablet III, ii) . Letters from Assyrian and Babylonian Scholars, the scholar Nabû-tabni-u?ur complains, “I am dying of a broken heart. I have been treated as if I did not keep the watch of the king, my lord; my heart has become exceedingly troubled, heartbreak has seized me, I have become exceedingly afraid.”

Medical diagnostic and therapeutic texts, such as those found in the Corpus of Mesopotamian Anti-Witchcraft Rituals, provide a more detailed picture of how Heartbreak, depression and related symptoms were experienced and recorded:

Tablet III, ii. Image: The British Museum.

“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…”

As in the words of Nabû-tabni-u?ur, fear and anxiety are regularly categorised with Heartbreak, as well as other words for depressed states. One Akkadian word in particular, ašuštu, regularly appears in medical and other scholarly contexts to refer to depression.

Lovesickness is an illness that appears in diagnostic texts, such as the Sourcebook for Ancient Mesopotamian Medicine, and its symptoms include ašuštu, sighing, indigestion and restlessness.

Other descriptions of mental health issues center on depression as a core experience:

“If a man eats (and) drinks, but it does not sit well; he is sometimes pale, sometimes red; sometimes his face becomes darker and darker; he is worried; he is depressed; his heart is not up to speaking; he is depressed.” – Corpus of Mesopotamian Anti-Witchcraft Rituals

Some of these descriptions are paradigmatic of suffering in general and may not represent a single illness. However, the language still provides clues as to how experiences of mental distress were organised and described in culturally coherent ways. Reliance, for example, on bodily metaphors like that of the heart (libbu), suggests that there was no separate category for mental health and illness and, accordingly, that there was no special stigma attached to mental distress. The physical and mental were continuous in a way that removed the need for added stigma.

The wealth of sources for the Cuneiform medical tradition provide a unique opportunity to explore some of the earliest known expressions of human suffering and offer a reminder that we are not alone in trying to find ways to describe our own experiences of suffering, and to treat them.

Twenty years ago, when I burst into tears before a grey-haired stranger in a quiet infirmary at dawn, I thought I wanted to die. I did not realise that I just wanted to kill the emotion that was slowly killing me. I don’t know if I would have survived that winter had I continued to suffer in silence and solitude, and had I not learned that there was a word for what I was going through and a framework for addressing it.

Even if we don’t always know exactly what to call it, it is important to recognise that depression and other mental health issues are very ancient and very human experiences. There is no shame in expressing them, or in asking for help.

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Dr. Moudhy Al-Rashid is a Saudi Assyriologist and historian who is currently doing her postdoc at Oxford University.