Wednesday, 3 February 2016

The Dangers of Retrospective diagnosis

When I was writing about the activities of British sailors abroad, in discussing the use of prostitutes I examined the rates of venereal diseases amongst crews. I made a graph of the contraction rates of syphilis and gonorrhoea hoping to see the effects of various measures taken by the Admiralty. What emerged, however, made no logical sense at all. There appeared to be no pattern, and sometimes rates would shoot up in one year, with no obvious cause. Stumped, I contacted an expert in the subject, and he confirmed my suspicion, misdiagnosis. Rates were not accurate because syphilis and gonorrhoea were often diagnosed as each other. Whilst we have descriptions from surgeons (and my goodness I only made the mistake of googling one of the medical terms once) we cannot say for sure how accurate what is written is. We cannot be sure that the surgeon is not just confirming his own hunches.

This, in a rather convoluted way, brings me to today’s news story that asks ‘Did Henry VIII suffer same brain injury as some NFL players?’ ( The answer is that we will never know. But does that mean we shouldn’t answer the question? I would argue that extreme caution should be taken. In a public lecture, I heard a speaker argue that the same happened to Nelson. It was argued that historians had ‘underestimated’ Nelson’s injuries, and that a blow to the head led to his open affair with Emma Hamilton and his poor treatment of his wife. Now, I couldn’t tell you if it did or not, no one can. The fact it goes against conventional studies sets off alarm bells in itself. Yet the major worry is not that we might wrongly attribute an illness or injury that is inaccurate, but the consequences of this. By suggesting head injuries in both cases, we are removing the agency from both Nelson and Henry VIII. It suggests that they had no control over their actions. It also means that their human instincts are not taken into account. To what extent, by doing so, are we being caught up in the cult of the hero, curtailing our critical instincts? Are we so desperate to see the powerful king or the national hero that we ignore and excuse any blemish? By retrospective diagnosis in these instances, are we not removing the very nuances and contradictions of character that makes history so complex and interesting?


  1. Steven: I find your final question quite compelling [and forgive if I do not understand fully the notion of retro diagnosis]--not just in what you are asking about your particular research, but on a lager scale, what it means for historical narratives being written that seek to test understandings of the past or point out error or based in cultural assumptions, rather than research. Sometimes this new research, often supported with archival evidence, is not encouraged/supported by leaders w/in a field or by journal/book editors because it makes heroes "more human" or "less admirable" or demonstrates errors in past analysis--even if if does, in many cases, make a more complicated and therefore interesting narrative. I wonder about this barrier for the future of the disciple of history itself. Complicated, nuanced history, in my humble opinion, is what makes, and arguably will continue to make, the discipline of history dynamic. (and dynamite to be a part of :) --Annmarie Valdes

  2. Thanks for the post. I really enjoyed reading this. It reminds me of an article I read by John F. Benton (a medievalist) who tried diagnosing Hildegard of Bingen with a type of Epilepsy. Of course, such a diagnoses was supposed to provide a possible explanation for her visionary experiences and subsequent behaviour (one which, of course, could satisfy an understanding of modern medicine).

    However, I couldn't help but think that Benton had somehow missed the point. Surely the role of the historian is to present the past to the present, and not present the present to the past! Therefore, in addition to your wise words, I lay out three reasons why all historians should avoid retrospective diagnosis:

    First of all, it takes many hours, tests, visits (et cetera) with a modern medical professional to diagnose a medical condition - and even then there's room for error. So when an historian (who may have a PhD, but is unlikely to have an MD) offers a diagnosis through remaining sources from a different period - a convincing diagnosis is simply impossible.

    Secondly, (as you've brilliantly demonstrated above) there is just no way of connecting a medical diagnosis to particular human behaviour with certainty. This is especially true when the human behaviour is reported by others, (or even by the individual) in texts that may be hundreds of years old (and/or translated from another language). Such work is purely speculative, and serves no real purpose other than being able to say 'I have spotted an unlikely but possible(?) correlation between our modern understanding of [condition] and a description of [something] in a MS'.

    Thirdly (and lastly for now), retrospective diagnosis becomes a little more frustrating if the condition argued wasn't known at the time. The historian then becomes guilty of presenting the past with his modern insights, rather than presenting historical insights to the present. It may be appropriate to offer a footnote on the difference between our modern understanding of things (such as: it is unlikely that all medieval leprosy was what we now know to be 'Hans disease'), but basing an entire argument for human behaviour on a diagnosis offered not at the time, but by a modern historian, is simply absurd. It may well have been the case, but there is no certain way of knowing.

  3. Hi fellas,
    Thank you so much for this wonderful article really!
    If someone want to read more about that grey fleet software I think this is the right place for you!