The Best Doctor Is Also a Historian
The Rootcutter's inaugural essay series aims at exploring connections between ancient and modern medicines—and not only the connections we make, but also why we make those connections and what impact they have on how we think about and conduct modern medical practices, both as healthcare experts and as service users. This series has been generously funded by the Society for Classical Studies Ancient Worlds, Modern Communities grant.
Image: Cuneiform tablet, "Atra-Hasis," Babylonian Flood Myth (7th-6th century BCE), Mesopotamia. Held by The Met Museum. Please note, this image is for illustrative purposes and is not the tablet discussed in this essay.
by Adam Howe
May 16, 2022
A cuneiform tablet describes the effects of divine anger on the abdominal-emotional system, including "heart-break" and suppressed appetite. Adam Howe reflects on what this tell us about embodied emotional states in Mesopotamian medical thought, as well as how this might connect with the concept of "eating" a taboo.
Dr. Adam Howe is a teaching associate of Assyriology at the University of Cambridge. His research focuses on the intellectual traditions of ritual, religion, magic, and medicine in first-millennium BC Mesopotamia.
The text BAM 234 is a cuneiform tablet written in the Akkadian language by a scribe named Urad-Aššur, a member of a family of exorcists living in the Mesopotamian city of Assur in the mid-seventh century BCE. The tablet contains instructions and incantations for performing a ritual against the māmītu curse, a kind of self-inflicted punishment for transgressing the divinely established order of society. The ritual uses figurine magic to materialize and destroy a personified, demonic form of the māmītu, accompanied by incantations that appeal to the sun god and divine judge, Šamaš. The text opens with an extensive description of the patient’s potential suffering, with symptoms of obvious medical concern alongside negative effects on the victim’s social standing and relationships.
If a man has contracted a misfortune and he does not [know] how he contracted it; (if) he constantly suffers from devastation and loss: loss of barley and silver […], loss of male and female slaves; (if) oxen, horses and flocks (of sheep and goat), dogs, pig[s] and people alike are constantly dying; (if) he constantly suffers from "heart-break" (i.e. extreme anxiety or emotional distress); (if he finds himself) speaking without agreement, shouting without response, choosing (his) desire according to (that of) the people (i.e. he does not obtain his own desires); (if), in his bed, he constantly becomes frightened, he suffers from paralysis; (if) his course (in life) does not bring him to god or king; (if) his insides (feel) full, his limbs are splayed (lit. poured out), he becomes frightened again and again; (if) he cannot sleep by day or night, he constantly sees frightening dreams, he suffers from paralysis; (if) he has a reduced appetite for food and drink (lit. bread and beer), he forgets anything he says: that man, the wrath of god and goddess is upon him; his (personal) god (and) his (personal) goddess are angry with him; if that man is sick with "hand of māmītu curse," ‘hand of god," "hand of humankind" (i.e. witchcraft), "sickness of sweepings" (i.e. aggressive magic); (if) the sins of father or mother, brother or sister, family, kith (and) kin have indeed seized him: in order to release (all of these afflictions) and in order that his depression (lit. darkenings) does not overcome [him].
BAM 234, obv. 1–12 (author’s translation, after edition by Maul)
The Akkadian term māmītu, conventionally translated as "curse," derives from a verb originally meaning “to swear an oath.” The concept thus has its origins in the realm of broken oaths—in this case apparently representing an assumed promise to respect the divinely established order of the universe to which every being is bound. By the first millennium BCE, when this text was written, the term māmītu had come to encompass a self-inflicted curse unleashed by transgressions against the divine order, as well as both the demon that attacked the transgressor and the illness that resulted. The phrase "hand of …" was used to describe the ultimate cause of the illness, and it is usually a god or a demon who possesses this agential hand. These formulations are common within Mesopotamian medical tablets.
In this particular case, the hypothetical patient has transgressed against the gods in some way, although this person may not even have been aware of having done so, if it had not been for the suffering that resulted. The various ways in which this suffering might manifest for the transgressor are described in the opening lines of BAM 234, including devastation, loss, heart-break, paralysis, and other such effects. What stands out in this description is the wide range of possible symptoms: social challenges, psychological and emotional problems, and more physical abdominal and digestive symptoms.
"...the term māmītu had come to encompass a self-inflicted curse unleashed by transgressions against the divine order, as well as both the demon that attacked the transgressor and the illness that resulted."
Image: Relief panel depicting deity holding a buckets and "purifier," Nimrud. The inscription written on the relief describes achievements of Ashurnashirpal (r. 883–859 BCE). Held by The Met Museum.
Social challenges are represented in the above passage by damage to property and social standing, resulting in loss of favor at the royal court and difficulties communicating with others. Such problems are an appropriate punishment for someone who has transgressed against the established social order and are particularly damaging for the elite men on whose behalf these rituals would have been performed.
Psychological and emotional problems include anxiety, pathological fear, insomnia, and reduced appetite. These symptoms are perhaps to be expected in the context of losing control of one’s life and becoming seriously ill. However, they are also closely connected to abdominal symptoms: feelings of fullness and loss of appetite are mentioned in the above passage, but other texts also associate the māmītu curse with internal wind, inflammation of the intestines, and epigastric fever. According to Mesopotamian thought, the abdominal area (Akkadian: libbu) was the center of the body and therefore a seat of the self, internal monologue, and emotions. Since they were essentially considered part of the same edifice, emotional problems and abdominal illnesses occur in close proximity throughout the Mesopotamian medical literature and in other text genres. Descriptions involving the term libbu are often ambiguous as to whether they denote a physical symptom in the abdomen or function more as a metaphor for an emotional state. In the above passage, for example, what I have translated as "the abdomen feels full" could also be understood to mean that the person’s "heart is full of anger."
"According to Mesopotamian thought, the abdominal area (Akkadian: libbu) was the center of the body and therefore a seat of the self, internal monologue, and emotions."
Image: Cuneiform tablet, list of magical stones (mid- to late- 1st millenium BCE, Achaemenid or Seleukid), Mesopotamia. Held by The Met Museum. Please note, this image is for illustrative purposes and is not the tablet discussed in this essay.
This ambiguity raises questions about the precise relationship between emotional imbalances and physical disturbances of the abdomen in the Mesopotamian worldview, including the extent to which emotions were considered embodied rather than cognitive experiences. Should symptoms like reduced appetite be interpreted within the framework of abdominal symptoms? Or as part of the general social disruption that the patient is suffering through divine punishment? Bread and beer—staples of the Mesopotamian diet that stand in here for any food or drink—were essential elements of what it meant to be civilized and socialized. Eating disturbances may be connected to other abdominal symptoms, but they also make sense as part of a divine punishment aiming to isolate someone who has transgressed against divine order. From a Mesopotamian perspective, all of these symptoms, whatever their cause, could be considered part and parcel of the gods’ punishment.
This situation is also reflected in the Mesopotamian exorcist’s holistic approach to healing: on the one hand, prayers and offerings were made to the gods to appeal for forgiveness and the lifting of the punishment, while, on the other hand, therapeutic interventions were made to treat the bodily symptoms. In the case of the māmītu curse and its abdominal symptoms, this generally involved emetics, laxatives, and enemas. Were physical treatments of the abdomen also considered effective against the emotional problems that were embodied there? This might explain why there is no evidence from Mesopotamia for psychiatric treatment as we would understand it. Instead, psychological conditions were considered the result of physical imbalances and divine anger, which could be treated with both medications and prayers.
"Were physical treatments of the abdomen also considered effective against the emotional problems that were embodied there?"
Treatments like emetics and laxatives reflect a general premise of Mesopotamian medicine that illness came from outside of the body and was caused by external forces, such as gods, demons, witchcraft, and other contaminants that entered through vulnerable points and therefore needing to be expelled, whether physically or through ritual actions, to bring the illness to an end. In a similar vein, other forms of taboo, transgression, and broken oath could be expressed in metaphors related to eating: to “eat a taboo” meant to “break a taboo.” Since the māmītu curse was conceptually related to broken oaths, it is tempting to posit a connection between this “eating” phraseology and the resultant abdominal symptoms. It has been argued by Charpin, for example, that the use of eating language in relation to curses had its origins in ritual acts of eating and drinking that accompanied oath-taking ceremonies, acting as an assurance against the breaking of the oath.
Even if the language of eating was chiefly metaphorical, it is important to remember that metaphor played a key role in ancient Mesopotamian medical discourse as a tool for explaining the workings of illness and the body, especially if there were no easily observable physical processes behind the symptoms. Understanding the māmītu curse as some sort of physical contaminant that could be “eaten” and thus enter the digestive tract would appear to provide a relatively straightforward explanation for the associated abdominal symptoms. Whether wittingly or not, Mesopotamian healers might have incorporated this sort of metaphorical thinking into their medical theories.
. . . to "eat a taboo" meant to "break a taboo." Since the māmītu curse was conceptually related to broken oaths, it is tempting to posit a connection between this “eating” phraseology and the resultant abdominal symptoms."
Beyond scientific medical discourse, we also tend to think about the impact of socially transgressive actions in terms of their embodied effects. For instance, the physical experience of guilt includes abdominal pain or discomfort. Yet, since the sufferer of the māmītu curse does not know their particular transgressions, it is hard to imagine what they might feel "guilty" about in any straightforward sense. The physical symptoms would have been the first indication of divine displeasure, and it was these embodied sensations that provided the impetus for them to seek professional help in the first place. We cannot therefore map a straightforward causal chain from an underlying cause to an abstract illness and its resulting symptoms. This is not surprising in a world in which a person’s health and wellbeing was so intimately connected to their relationship with the gods. The Mesopotamian approach to illness and medicine attends not just to the condition of the body and mind but also to an individual's interaction with the surrounding world. The individual body in Mesopotamia functions as part of a larger whole, in terms of both human society and the wider cosmos. This contrasts with many modern Western conceptions that regard the body as self-contained and detached from its environment. If the close connection between emotional problems and corporeal parts seems strange to us, maybe we should instead ask whether it is stranger to have treated psychological and physical illness as distinct phenomena, or either of these as separable from the worlds in which they are enmeshed.
The Cuneiform Digital Library Initiative, a database that contains details and photographs of cuneiform tablets in museum collections around the world, includes a partial transliteration of the Akkadian text. The tablet itself is now in the Istanbul Archaeological Museums. A translation and brief commentary in English can be found in E.K. Ritter and J.V. Kinnier Wilson, "Prescription for an Anxiety State: A Study of BAM 234," Anatolian Studies 30 (1980): 23–30.
The obverse of this tablet was originally published in hand-copy in F. Köcher, Die babylonisch-assyrische Medizin in Texten und Untersuchungen (= BAM), Vol. 3, Berlin: 1964, No. 234. The tablet has recently been published in full in S.M. Maul, Bannlösung (nam-érim-búr-ru-da). Die Therapie eines auf eidliche Falschaussage zurückgeführten. Leidens, 2 vols, Wiesbaden: 2019, Nr. 3.
Scurlock, J. & Andersen, B.R. (2005). Diagnoses in Assyrian and Babylonian Medicine: Ancient Sources, Translations, and Modern Medical Analyses. Urbana: University of Illinois Press.
Scurlock, J. (2014). Sourcebook for Ancient Mesopotamian Medicine. Atlanta: SBL Press.
Charpin, D. (1997). "«Manger un serment»," in Lafont, S. ed., Jurer et Maudire: Pratiques politiques et usages juridiques du serment dans le proche-orient ancien. Paris: L'Harmattan, pp. 85–96.
Heeßel, N.P. (2007). "The hands of the gods: Disease names, and divine anger," in Finkel I.L. and Geller M.J. (eds), Disease in Babylonia, Leiden and Boston: Brill, pp. 120–130.
Said, M. (2018). "Mesopotamian Magic in the First Millennium B.C.," in Heilbrunn Timeline of Art History. New York: The Metropolitan Museum of Art.
Steinert, U. (2020). "Pounding Hearts and Burning Livers: The 'Sentimental Body' in Mesopotamian Medicine and Literature," in Hsu S.-W. and Llop Raduà J. (eds), The Expression of Emotions in Ancient Egypt and Mesopotamia. Leiden and Boston: Brill, pp. 410–469.
Wee, J.Z. (ed.) (2017). The Comparable Body: Analogy and Metaphor in Ancient Mesopotamian, Egyptian, and Greco-Roman Medicine. Leiden and Boston: Brill.
Wee, J.Z. (2021). "Medicine, Mesopotamia," in Oxford Classical Dictionary online.
Westenholz, J.G. and Sigrist M. (2006). "The Brain, the Marrow and the Seat of Cognition in Mesopotamian Tradition," Journal des médecines cunéiformes 7, pp. 1–10.
What is more surprising—to treat emotional problems such as somehow separate from the body, or to talk about anxiety, heartbreak, and depression as digestive issues?
Can we interpret the consequences of the māmītu curse as a single disease known within a modern, biomedical framework, such as anxiety or IBS? What are the advantages and disadvantages of this kind of retrospective diagnosis?
We tend to assume that naturalistic medicine (i.e. drugs, surgery) is separate from religious healing practices (such as prayers), but ancient Mesopotamian healing traditions do not seem to have treated these two approaches as separate. How can we observe naturalistic and religious understandings of illness at play in the curse tablet examined here? What motivates a society to separate or integrate naturalistic and religious approaches to health? Are there examples that you can think of even within a modern medical framework where a naturalistic understanding of the disease becomes entangled with moral or religious concerns?
