James Poskett: Retrospective diagnosis – it’s not (all) bad

Did Julius Caesar suffer from epilepsy? Was Mad King George mad? Did Tutankhamun have Klippel-Feil syndrome?

Retrospective diagnosis, particularly of notable historical figures, makes me feel uneasy. For one, it seems to fly in the face of contemporary historiography in which diseases are recognised as influenced by the social, historical and linguistic context. Even the more contextually sensitive attempts can sometimes feel little more than a game, an historically embellished version of a multiple choice question.

So why did I read (and enjoy) The hallucinations of Frédéric Chopin, in which the authors add temporal lobe epilepsy to the Romantic composer’s lengthy list of ailments?

http://mh.bmj.com/content/37/1/5.full

Well, I enjoy ‘underdog’ historiographies – they can help to highlight problems ignored by the mainstream. For instance, the contextual turn is not without its own problems, so perhaps retrospective diagnosis can shed some light on this?

Additionally, it would be unwise to write off a whole methodological endeavour. Retrospective diagnosis might not be perfect, but with a few tweaks it may have something to contribute to the mainstream historical narrative.

To this end the authors raise some important notes:

‘We doubt that another diagnosis added to the already numerous list will help us understand the artistic world of Frédéric Chopin, but we do believe that knowing he had this condition could help to separate romanticised legend from reality and shed new light in order to better understand the man and his life.‘

Now, retrospective diagnosis is often evoked as a way of explaining genius or adding to the heroic status of certain individuals. So it is refreshing to see that, rather than romanticise the Romantic, the authors hope their diagnosis can help separate ‘legend from reality’. Contemporary historiography is also keen to avoid promoting ‘great men’ in history, so it seems retrospective diagnosis has something to contribute.

In fact, it would be nice to see this pushed further. Concentrating on Chopin has the unfortunate effect of diluting the ‘anti-heroic’ merits in this method. Perhaps, just as historians of science have considered the role of amateurs and artisans, retrospective diagnosis could concentrate on the ‘nobodies’ of history. A working class factory worker? An eighteenth-century milkmaid? By diagnosing these individuals, we may learn about the role of disease in the lives of different groups.

It also strikes me that the fashion for historical context has had the effect of diminishing the role of the individual in history. Granted, quality history recognises the divisions within groups such as classes, races and religions, but rarely down to the level of the individual. So at the very least, a nuanced retrospective diagnosis (such as that of Chopin) seems to highlight the experience and agency of the individual. The authors’ account of Chopin’s visual hallucinations in particular seems hard to fit into a contextual ontology.

Ultimately, if like me you’d be inclined to cringe at the idea of a retrospective diagnosis, I hope you will see that it cannot be written off entirely, and may even have a positive role to play.