Why the Long History?

The heating in my office is back on, the students are returning to the flats next door, and the new academic year is rapidly advancing. Over the last few days I have found myself looking back over my summer of writing and thinking about my project as a whole, as I attempt to gather my thoughts and preserve my ideas, in the knowledge that until at least December, I will have precious little time to dedicate to writing chapters about migraine, as I turn my thoughts to teaching modules about Australia, migration and convicts.

British Library Royal 12 D XVII (Bald’s Leechbook) f. 7

Even since the beginning of the summer, the scope of my project has expanded far beyond my already stretched comfort-zone. Somewhat to my surprise I found myself spending much of July working on a chapter that begins in the tenth century with four remedies for ‘half’s heads ache’ in Bald’s Leechbook, and ends in the fifteenth century, with William Dunbar’s fantastic poem.

In early September I presented some of my work on migraine to the bi-annual European Association for the History of Medicine and Health conference, on the theme of ‘Cash and Care’. It was in many respects an excellent event – particularly the hospitality of our hosts – but I was shocked at how few papers considered any period before a very modern era, not least given the significance of the ‘medical marketplace’ scholarship over recent years. I began my own paper by talking about Linda Ehrsam Voigts’ work on the fifteenth-century banns of an itinerant medical practitioner, and joked that I had accidentally found myself working on the medieval period.

In the questions, a member of the audience commented that they had never heard of anyone trying to write a thousand year history of an illness before.

There is, perhaps, a reason for that.

And so since then, I have been thinking about this chronology: what am I trying to do? And why has this long time span come to matter so much to me, when many of my colleagues would consider it naively ambitious at best, if not simply impossible? Certainly, I cannot imagine a funding committee would have endorsed such a proposal when I began…

Historians have, of course, long advocated for paying attention to the longue duree. Fernand Braudel famously described events as ‘the ephemera of history’, as ‘surface disturbances, crests of foam that the tides of history carry on their strong backs’ . More recently, in their much-debated History Manifesto, the historians Jo Guldi and David Armitage argued that “historians once told arching stories of scale but, nearly forty years ago, many if not most of them stopped doing so. For two generations, between about 1975 and 2005, they conducted most of their studies on biological time-spans of between five and fifty years, approximating the length of a mature human life”. Guldi and Armitage identify a shift in our historical horizons. They have begun to expand once more, this time with the turn to ‘deep’ history. Medical historians have been among those diving in. In 2011 Monica Green urged historians of health to ‘go deep’ as well as ‘go global’ if we are to compete with the historical insights being produced in fields such as genomics & bioarchaeology.

My scale is not quite that expansive. For me, it is the availability of digitised material that has driven this chronology, sending a project that I had initially conceived as modern in scope, creeping ever further back through the centuries. A stream of highly fragmented, but extremely rich sources, has become navigable through online catalogues, digitisation projects and Google searches. Alongside bread-and-butter archival research, images of glittering medieval and early modern manuscripts – now freely available in high resolution – have repeatedly demanded my attention.

I will write more about the digital challenge soon, suffice to say that I have become acutely aware of the inbuilt distortions inherent to digitization that reinscribe hierarchies of class, race, gender & wealth privilege even while purporting to make archives ‘open to all’. My own project is geographically focused on Britain and Ireland, with glances across the English Channel and Atlantic to France and America. In the few cases where I discuss ‘global’ knowledge, I am aware that these are often ideas that have been appropriated by observers and collectors of the exotic in only the most superficial of ways.

Mediaeval surgeon trepanning. 13th century.

Attempting a project of this chronological scale has proved a real challenge – not least in the amount of reading required to come even to the most basic understanding of any new era. As a colleague pointed out to me as I began to make plans, “You are not Owsei Temkin”. He was referring to Temkin’s magisterial Falling Sickness – his classic study of epilepsy, first published in 1945, which took readers on an odyssey through two millenia from ancient Hippocratic texts to John Hughlings Jackson, the nineteenth century ‘father’ of modern neurology. Temkin’s scholarship is staggering, but there are good reasons for looking at topics such as migraine over a long period, even if our attempts are on a far more modest chronological and intellectual scale than Temkin.

For a start it reveals surprising continuities. In many cases, medieval descriptions of the symptoms of ’emigranea’  as a piercing pain associated often with problems of eyesight seem closer to our own modern understanding of migraine with aura, than do eighteenth-century discussions in which migraine is associated with dizziness, unease, and seems to be – for want of a better word – altogether more fuzzy.

When we stretch out to a thousand years we see also that our current gendered pre-occupations, are far from inevitable – more of a blip, than the status quo. This is not to say that these assumptions are not deeply entrenched or that they will be easy to challenge. Far from it.

Taking the long view seriously, and populating the medieval, early modern, and modern period with a whole variety of people who experience, treat and discuss migraine takes us way beyond the old cliche of trepanation. It puts women back into the story as creators of knowledge, puts men back into the story as sufferers. Far from simply serving to reinforce a modern sense of superiority by highlighting the inadequacies of past knowledge, and the barbarity of practices long since abandoned, a long time span humbles our own knowledge, putting it into historical context. It emphasises the contingent nature of medical understanding, and the fragility of consensus.

Most of all, it is really really fascinating. I can’t wait to pick the chapters up again with a fresh set of eyes, when I get the chance.

Oliver Sacks and Migraine’s ‘Strange and Riddling Landscapes’

We learnt earlier in the week of the death of the neurologist and prolific author Oliver Sacks. In February Sacks had announced that nine years after being diagnosed with an ocular melanoma, the tumour had spread, and that he now faced death.

There have been many heartfelt tributes to Sacks, who had a rare gift of writing about neurology in a way that appealed to millions. In studies on music, hallucinations, deafness, sleeping sickness, and migraine he mingled history, personal memoir and medical science to ponder the mysteries and marvels of the human brain.

I have only come to Sacks’ work relatively recently. No-one can spend much time on migraine without reading his seminal account, first published in 1970, and revised a number of times since. For Sacks, migraine was a disorder which struck particularly close to home. In 2008, in a blog for the New York Times Sacks talked of how he had experienced migraines, and particularly migraine auras, for most of his life. After experiencing his first aura at the age of 3 or 4, the young Oliver was reassured by his mother, a doctor, who shared her own experiences with her son. Years later, he went on to work in a migraine clinic, where he discovered more people who saw the same patterns that he did. Sacks mused that  perhaps “the geometrical hallucinations of migraine allow us to experience in ourselves not only a universal of neural functioning, but a universal of nature itself”. Such a comment reflected his fascination with the cultural importance – in art, folklore and religion – of neurological quirks, and the creative potential of ‘defects, disorders and disease’.

Sacks’ writings were united by his empathy for patient selfhood, his eye for a good story, and his ability to take meaning and wonder from the real-world lives of the people he encountered during his practice, lives so often assumed to be marred by loss, deficit and inadequacy.

In the revised version of Migraine Sacks added an epilogue in which he wrote:

“For every patient with migraine there is A Long Road, and a Short Cut. The Short Cut is a diagnosis, a pill, a pat on the head. It takes all of five minutes. There is nothing wrong with this. The only thing is – it doesn’t usually work. Hence the necessity, for many patients, to take the Long Road. The Long Road is the road of understanding – an understanding of the heart no less than the mind.”

Sacks certainly received criticism – from other neurologists and disabled people – for his ‘popular’ approach, and for the way he transformed medicine into literature. But the centrality of Sacks’ patients to his writing (Migraine, alone, contains over 80 case histories), and his appreciation for their journeys, sticks with me. As I continue to make my own way through the history of what Sacks’ called migraine’s ‘strange and riddling landscapes’ it is patient stories that I, too, hope will be at the centre of my work.