History of Anxiety: From Hippocrates to Modern Psychiatry

This is controversial , hold on to your seats ! Yes Anxiety does have a history …

Ahhhh , the dulcet tones of a busy coffee shop surround me today , I love that noise , sometimes I play ‘coffee shop noise ‘ on my ambient sound background app , but the real thing is better . A large latte and a mostly eaten cake …and now Im ready to write this .

I thought about this yesterday , I was on Ancestry , looking up some records of my great……great great grandfather and came across a census from the 1800s. At the side of the census there was a section to record disabilities , of course it wasn’t called that . The column asked for details if ( excuse me nasty language ahead ) Deaf and Dumb , Blind and ( wait for it ) Lunatic , Imbecile or Idiot . On an earlier census I saw a requirement for ” those who are feeble minded”. As you can see being an anxious person or depressed or God forbid suffering from Trauma was not treated well back in the day . That started me wondering , just when did we start getting anxious , depressed or suffering Traumas ? If you believe some , this is a modern disease brought on by our lustful desires to have everything , go everywhere and be loved by everyone ( I just made that up , but it sounds true , so lets go with it ).

It may surprise you that I am not the first to ask this question , ( dam , I thought I was smart) . A smarter person than me Dr Marc-Antoine Crocq wrote in the Dialougues Clin Neurosci and article called ‘A history of Anxiety , From Hippocrates to DSM ( remember from a past post DSM is the Diagnostic and Statistical Manual of Mental Disorders). Currently we are at DSM 5 , although this has been updated in 2022 and some call it DSM 6 , but it’s 5 really ……bet you found that fascinating ………not .

Marc-Antoine Crocq and his look at the ‘history of anxiety’

The author takes us back to a time before Starbucks , before coffee probably and a little known writer called Hippocrates about 460 BC and some time after that up to 370AD . He scribed a collection of Greek Medical texts called the Hippocratic Corpus , the smarter of you will have noted the name as an oath taken by modern Drs …no one likes a smart arse so don’t gloat.

In these papers a man called Nicanor was described. He had a fear of a flute girl at a party , but only during nighttime ,there after if he heard a flute , he “could hardly bear it ” , this was described as a phobia and separately labelled a mental disorder. Later , Cicero wrote ( 106BC to 45BC) about sollicitudo or as we know call it today ..worry , he also wrote about angor or now know as anxiety. These collections made up a work called the Tusculan Disputations ( don’t worry there is no test coming ) , in it anxiety is described as a medical illness and also as a constricting disorder .Really interestingly Cicero manages to separate current immediate anxiety with being prone to anxiety.

Why is this important ?, I hear you ask , well , and this is my view , if you ask google for the history of anxiety you might get some starting in 1894 ( Munch ) or some will start in the 50s or later . But as we have already seen it was around before that time , so Im trying to challenge the view that this is only a modern disease and its only caused by our modern lifestyle , I might be wrong though so lets continue……

Cicero wrote after the death of his child Tullia , he wanted help to free himself from the effects of his pain and for Stoicism , we call some philosophers of his time today the term ….’ Stoics ‘. Another Stoic of a similar time ( 4BC ) Seneca actually wrote a book about anxiety called De Tranquillitate Animi or ” Peace of Mind” . Crocq in his paper ( really excellent by the way ) quotes from Senecas book ” He who fears death will never act as becomes a living man”. In the book ( you will find this really familiar in a minute ) …he recommends ” combining the past present and future into only one time ” …he is telling us to stay in the present moment or as we call it now Mindfulness.

Stoics and also the Epicureans ( a competitor if you like, following Epicurius 341 BC ) offered similar advice concerning anxiety , they felt that a happy life was reaching a state referred to as ataraxia , a worry free state. Epicurious was attributed with the saying ( again from Crocqs paper ) ” Men were Lords in riches and that they yet , O yet within the home still had an anxious heart which vexed life unpausingly with torments of the mind”.

I remember one of the Planet of the Apes films, there were Apes and Monkeys , now advanced and in charge of society now that he human race had destroyed itself .The new rulers were discovering new things that had long been forgotten by the declining humans . ( NO !, my coffee is empty ….hang there , talk amongst yourselves , I’m going to order another …be right back…..back now let’s continue , sorry there was a queue)

Anxiety and the Apes , yes, still talking about the history of anxiety

Now where was I ? …Oh yes , Planet of the Apes , so it was with anxiety , the gap between classical times and modern day seems to be mostly empty with. few exceptions around the 17th century , the discoveries were forgotten , lost to mankind until the modern day Psychiatry .

A blip in this time period was Robert Burtons book in 1621 ” The Anatomy of Melancholy ” ,. as you can tell this was mainly focused on depression or melancholia although this was thought to be linked with anxiety at the time .

I think we have all heard that during the Middle Ages anxiety was attributed to witchcraft , possession and should be treated by religious figures . Peter Dinzelbacher in his 1996 book Angst im Mittelalter showed that fears and anxiety both imagined or factual were in fact very common in Medieval Times. They had the same sort of fears as we now do however also had fears of monsters, strange creatures , the dark , dangerous forests . In the late middle ages it was a common thought that the population were surrounded by demons . Anxiety might have led to the horrific blood bath in the fifteenth and sixteenth centuries against people thought to be witches. In the book Perter D also point out that anxiety was often cultivated by the early church , fear was introduced about the devil and afterlife. This became more intense in the late Middle Ages. Fear was cultivated by clerics in the later Middle Ages by depicting the avenging angels as instruments of Gods punishment to sinners , they might drown , burn strangle or devour sinners. Peter D shows that medieval people experienced anxiety and fear through a catalog of sins and sinful behaviours set up by the church.

Tracey Dennis -Tiwary University of New York in her 2022 paper ” How Anxiety evolved Through the Middle Ages in Early Modern Europe” she says that the word anxiety meant nothing like the modern description , she says it was used like the latin word angere or to choke , or to be painfully restricted. She points out that it was the church that changed its use by using the word anxiety as a reaction of the suffering of the soul entrapped by sin, terrified of the eternal tortures of hell. Treatment for what was described as anxiety became the job of the clergy , it was spiritual after all, catholic priests treated anxiety with prayer ,confession and penance. Dennis quotes Saint Augustine and his teachings ” God can relive your troubles only if you in your anxiety cling to him”. Dennis also ads that the Roman Empire in fact before this time also saw anxiety as a spiritual condition requiring divine relief , this spanned the whole Roman Empire of the time, preceding medieval times showing this was not a new idea.

More on Anxiety and History

This then takes us back to Robert Burton as mentioned above and his book The Anatomy of Melancholy. He took a more scientific view , he observed people being ” amazed and astonished with fear”. This book transformed the thoughts of anxiety into a disease . This was the age of reason , the power of the church was waining and anxiety was now thought to be from the mind and not the soul.

Dennis points out something that surprised me , at least from the point that I thought anxiety was a modern disease . She shows that suicide rates skyrocketed in that period of the 18th century , in England anyway . Society in England the most liberal modern society in the world at the time was described as ” sick with anxiety and indecision ” by Chateaubriand .

Now society realised the mind was separate to the soul , we needed a whole new profession to treat them …alienists or mentalists became the early psychiatrists.

Moving on to the 19th century we had Sigmund Freud who believed anxiety was caused by repressed emotions and unresolved conflicts . Another influence at the time Pierre Janet born in 1859 developed the idea that anxiety could be caused by subconscious fixed ideas. Further work of Emil Kraepelin described anxiety as inner tension with a kind of anhedonia ( an inability to feel pleasure).He said ” It completely permeates both the body and the mental state”, he also linked anxiety with manic depressive illness.

As we move into the 20th century , we have a more modern and enlightened view of anxiety , terms such as Generalised Anxiety Disorder ( DSM-111) , previously known as neurasthenia but now split into GAD and panic disorder. After the 1950s ( so quite recently really ) electro shock treatment ( I kid you not ) became less popular with the exception of severe cases of anxiety. Desensitisation began to become a popular treatment as was the use of anti-depressants , this began in the sixties. Anxiety disorder was first termed in the 1980s and became part of the DSM -III , including phobias and Obsessive compulsion disorder.

Anxiety has been with us for centuries ,

If we pick up a newspaper ( haven’t done that for years ) or watch TV ( haven’t done that for years either )….OK if you stream the news it seems that Anxiety is new , its increasing and we all have it . However is that true , well we’ve seen that Anxiety is far from new , its centuries old . Honestly it’s difficult to work out if anxiety is worse now than it was in say medieval times . I know you think this is a cop out but that is why I dragged you through the history lesson above ….see there was a point ! The point is , how can we compare like for like , its only the DSM-III that clarifies what we would describe as anxiety in modern times , compare that with the witch trials of medieval times , its not really possible. Different methodology and cultural effects makes cross country comparisons difficult . Its also near impossible to take out possible comorbidity or wrongful diagnosis when looking at past cases. There something called the Berksons paradox , it shows that a patient will be more likely to get medical help when they have two disorders at the same time , if this is true now it has probably always been true. The University of California reports that almost one in three adults will experience an anxiety disorder at some point during their lives. Medical News Today ,claims that millennials are the most anxious generation , they claim that several studies show a rise in mental disorders in the West.

Well we have been on a journey in this post , a journey in time , we have found that anxiety has been around far longer than some might think . As to the question of anxiety worse now than ever before , thats unanswerable I think. Yes we have so many stresses in out modern life , but unless you are very unlucky you are not likely to be burned at the stake for being a witch .I don’t think life in the 13th to 19th century was easy and may have been very frightening ,black death , monsters the fear of the church probably caused much anxiety but its impossible to measure.Before the introduction of the psychiatric classification system who can tell what was anxiety . We must not forget that genetics and epigenetic play their part and that may well be a stable occurrence through the generations as well as a fluctuating and smaller population.

I must say Im sorry this paper has been centred on the west , I would love to have found more data about other parts of the world , Asia , Africa , India for example but `I could not find the data , so sorry for that , its important we remember that this affects us all .

Thanks for spending g time with me , I really appreciate it , I hope I find you in a good place , if not reach out to a healthcare professional and remember you are not alone.