By Maria MEDNIKOVA, Dr. Sc. (Hist.), RAS Institute of Archeology
Medics of old performed this kind of surgical operations as far back as 12 thousand years ago or even more. The earliest records of this kind are found in a medical treatise of the Early Greek physician and founder of his own school of medicine-Hippocrates (c. 460-c. 370 B.C.). Ancients-the civilized people of antiquity-used surgery for a variety of reasons including therapy (craniocerebral traumas-closed and open skull fractures, removal of intracranial hematomas and foreign bodies, treatment from epilepsy, etc.) and also for magic rituals of exorcism performed over the living and the dead. On the more practical side, cranial trepanations were used for the treatment of mental disorders and this will be in the focus of our attention in this article.
The 19th-century French anthropologist, Paul Broca, pointed out that our distant forefathers believed that people with nervous disorders, who underwent surgery in their lifetime, were commonly believed to possess some peculiar "gifts". The head of a person, or his skull, was commonly believed to be the abode of his bodiless spirit, or soul, and when this person died his kinsfolk were eager to use bits and pieces of his skull as fetishes and charms to ward off evil and/or ensure good fortune.
Some ancient tribes also practiced what we call symbolic trepanations- cephalotomies on living persons which involved only cranium viscerale without affecting the deeper lying lamina interna. Such surgeries performed by North African tribes were described in detail by the Greek historian Herodotus (5th century B.C.).
On European soil-in Hungary, both symbolic and surgical cranial trepanations came to an end in the 11th century in the reign of Prince Goza and King St. Stephan. During that period the country relinquished its former pagan traditions in favor of Christianity. And although most Hungarian scholars investigating the causes of the widespread practices of cranial trepanations in the 10th century usually lay emphasis on medicinal reasons, they have to admit that operations of this kind were probably the function of a heathen religious cult destroyed by the religious reform. King Stephan put a direct ban on craneotomic practices-step which must have been prompted in our view not so much by king's concern for the health of his subjects, but rather by the heathen mysticism involved.
And, strange as it may be, "unorthodox" craniotomies are practiced to this day even in the most advanced countries of Europe. In 1965, for example, a Dutchman J. Hughes performed this kind of surgery upon himself in order "to change his own self. He was thought to be mentally disturbed, but two British aristocrats (Lord and Lady Neudpate) repeatedly submitted themselves to surgical interventions of the same kind in what were called attempts "to broaden their consciousness". It may also be interesting to note
Articles in this rubric reflect the opinion of the author. -Ed.
that attempts "to broaden the horizons of consciousness" have been demonstrated not only by people in "border mental conditions", but individuals with artistic gifts. Trepanation is becoming what one could call a common and fashionable metaphor. In this light the biological limits of human existence are seen as barriers which have to be surmounted. Ideas of this kind have been especially popular in Switzerland-the birthplace of one of the founding fathers of psychoanalysis Carl Gustav Jung (1875- 1961).
Thus being discussed again today, just as in the past, are "eternal" problems like the boundaries of consciousness, and metamorphoses of the personality. And what we call the "trepanation metaphor" becomes the archetype of transformation of our nature, of a transition into a different state, which stands aloof from the latest achievements of modern science and surgical practices. Thinking of this kind brings back to life the views of the Greek philosopher Socrates (470/469-399 B.C.) who said that the supreme blessing descends upon us when we are on our way to insanity.
According to current clinical data, changes of personality can be different depending on the localization of dysfunctions in the cerebral hemispheres and sections of the brain. Lesions of the left one manifest themselves in increased anxiety, tension, irritability and depressive moods. In cases of isolated lesions of the frontal sections patients manifest a loss of initiative, remaining for hours indifferent to things around them, having but just a few words to say and suddenly going silent if not invited to keep up the conversation. Upsets of the functions of the right hemisphere are usually manifested in placidity, or the patients ignoring their plight. Lesions of the frontal sections produce moods of euphoria and verbosity and those of the occipital parts- enfeebleness and indifference to one's condition.
But to come back to the times of antiquity. It goes without saying that the consequences of the lobotomies of that period which are now observed by archeologists have to be considered from the positions of the subsequent metamorphoses of behavioral reactions. Personality changes can result from even minor craniocerebral lesions and they manifest themselves in simplified self- appraisal, emotional decline and lack of enterprise.
Indeed, even back at the start of their evolutionary development our ancestors, as compared with other primates, possessed greater analytical and prognostication abilities. This must have been the result of what we call "active beginning" typical of the hominids of the lower and middle Paleolithic (some 35 thous. years ago)-they were excellent hunters which is especially apparent in comparison with other mammals.
In addition to their skills in the making and uses of tools, symbolic and linguistic communications, one major philosophical criterion and distinctive feature of the homo sapiens was his awareness of his transitory existence and, consequently, resort to burial rituals. Numerous archeological finds in the Minusinsk hollow, in the Altai, Tuva and other places attest to some very common practices of ritual lobotomies in the early Iron Age (beginning of 1st mill. B.C.)
Incidentally, discoveries of experts of man-made defects in the area of the great foramen (foramen magnum)
caused repeated discussions of funeral rites of the period. Lesions of excavated human remains were considered in the context of cannibalism, cults of the skull and burial rites as such. In the opinion of the German scientist Dr. H. Ulrich, ritual cannibalism as part of a certain burial rite, symbolizes not only the links of the abstract notions of life and death, but also links between the living and the dead.
At the same time ancient tribes developed an interest in the states of sleep and insanity, developed notions of symbolic death. Attempts of man to understand the mechanism of his actions, motivation of his behavior came not only as reflections of his new biological status quo,but also as a powerful motive force of social progress.
But the nervous activity of such a complex biological object as man also has its "reverse side"-the possibility of development of various neuroses. And the more "gifted" is the personality, the greater are its chances of such mental disturbances. Today some researchers regard as neuroses reversible disturbances of the higher nervous activity of different etiology. Others use the same terminology only for ailments caused by psychic traumas. And it has been proved that the latter can result not only in minor and reversible cardiovascular upsets, but also in letalities. In the latter case the cause must be a sudden discharge into the bloodstream of large amounts of catecholamines* which can cause cardiac arrests. One such classical example is the so-called voodoo-death as described by the aborigines of Australia and Africa. It occurs at once or several hours, or even days later. In any case it is preceeded by very strong vegetative excitations. Even in current medical practice there are cases when some unfortunate remark of a doctor, or a patient's mystical conviction that his life is connected with some physical phenomenon, can cause the sudden death of even healthy people.
For representatives of the traditional cultures, and even more so for the bearers of archeological cultures, the weltanschauung (world-outlook) was determined by their mythological awareness. But from the platform of his 17th-century rationalism the Dutch philosopher, theologian and scientist of Jewish parentage, Benedict Spinoza, wrote that man produces many inventions and interprets nature in such a way as if it shares and is raving in his insanity. Today we can say that belief in supernatural forces and irrational thinking largely depends on physiological peculiarities which we possess as a species. Say, the mechanism of religious feelings corresponds to the formation of a brain congestion. And superstitions are powerful irritants because of their profound links with emotions in as much as they "nest" not in the conscience, but in the area of the subconscious.
Carl Gustav Jung introduced into the scientific use the notion of the collective unconscious as an inherited impersonal psychic system consisting of archetypes. That means that in the psyche of every individual, apart from
* Natural mediators of the nervous system such as adrenalin, dophamine etc. - Ed.
Sites of cranial trepanations of nomads of the Early Iron Age: a-Mongolia, b-Tuva, с -Kazakhstan, d-Western Siberia.
Scenes of autopsy of a skull from a book of Hans von Gersdorf, Strasbourg, 1517.
the consequences of personal experience, there are present some ubiquitous notions (images, motifs lying at the basis of the universal symbolism of dreams, myths, fairytales and other fantasies).
The later classics of psychoanalysis recognized our irrationality as an indispensable function of psychic reality. At the same time one can assume that in the ancient world human abilities to control one's consciousness and behavior were developed not less, if not more, than in the modern industrial societies. In this sense religion was a powerful instrument of governing human behavior and performed the function of prophylaxis of socio-induced neuroses (although it produced at time some reverse phenomena like mass hysteria). For example, shaman's intercourse with spirits, accompanied by chanting and clanking of tambourine, helped correct the psychoemotional mood of people participating in the rite. And if one relies on purely formal analogies, shaman's relapse into trance in order to produce some visions, has much in common with psychotherapeutic techniques.
The psychological defense of society were rites and rituals. The life of a member of the traditional society was strictly divided into different periods. The passage from one age and social group into another was comparable to one's death and rebirth in a new quality (initiation of teenagers, marriage). The moment of transition was associated with a trial, sometimes painful and dangerous. Our leading expert on folklore Vladimir Propp (1895-1970) was convinced that these cruelties "drove one to insanity". And being accompanied by starvation, thirst, darkness, horror, taking of psychotropic drugs, they produced temporary insanity in the "new admissions".
Symbolic cranial trepanations can be dictated by one's desire to change his appearance (in order to stress the difference of "ourselves" from the aliens). Surface- deep ritual trepanations can be regarded as tests and symbols of transition from one social category into another (initiation of teenagers, marriage, birth of children by women, mourning, etc.).
As for postmortem trepanations, charms made of skull bones became common in Europe (territory of France and Levoberezhnaya Ukraine) not later than 6th century B.C. According to P. Brock, some of these were made of the skulls of people who had been safely trepanated in their lifetime. Carefully perforated charms, made of skull bones, are also typical of Celtic tribes in the south of Germany. Round plates of this kind usually carry three perforations or the number of perforations is divisible into three.
And let me note at this point that among the Celtic tribes of Austria and Hungary a common practice was triple trepanations of the skull in the lifetime of a person. The custom of triple holes in charms made of skull bones may also be associated with the "triplication tradition". It is an interesting fact that the tomb of a "woman-surgeon" from Durrenberg included the remains of three corpses trepanated in their lifetime. It can also be mentioned that the central architectural element of a Celtic shrine in Hungarian Libenitse is a composition of three pits, in the form of a trefoil, which, to my mind, loss like the shape of trepanation holes in the skulls of Austrian and Hungarian Celts.
The custom of using bits of skull bones as charms from paralysis is mentioned in the transcripts of the Roman-Kaiser Academy of 1767. The wearing of charms is closely associated with the use of various magic concoctions. The publication of the Roman-
Kaiser Academy (Nuremberg, 1759) describes the following remedy from the "falling sickness" (epilepsy): "Take the crushed skull of a hanged person, mix the bits with aqua epileptica, prepare red corrals, and oakwood sawdust gathered at the right time..."
The tradition of wearing pendants made of human bones proved to be very viable and has been preserved to our time. In the 1930s it was traced to the residents of the Italian Umbria who used it as remedy from epileptic fits.
The period of the evolutionary establishment of the genus Homo is associated with its propagation on mountain and hilly areas (near-east hominids of the Shul-Kafzeh group, European Pithecanthropus, Neanderthals, most of the Cro- Magnons of Western and Central Europe). Being confined for long periods of time to the enclosed space of dark caves has left its traces in the psyche of the modern man. Within the context of psychoanalysis a cave personified what we call regressive desires and the subconscious. At the same time, being a symbol of a refuge, shelter, maternal womb, birth and center of the universe, caves occupied an important place in the myths and initiation rites as a personification of the life-giving forces of the earth. And it could not be accidental that Greek philosophy of the antiquity viewed the cave as a metaphor of the entire material world.
With the development of ancient civilizations and the advent of statehood, the archaic image of the cave is replaced with a semantically close symbol of the labyrinth. Its overcoming in the main religions has psychological significance linked with the initiation (enlightenment), imaginary return to the material bosom, transition across death to the resurrection.
According to Carl Jung, the collective subconscious is like an original image of the world. One of the most common archetypes appearing from its projection is an image of a demon, "the primitive tribal sorcerer or wizard, an especially gifted person in possession of magic power". Since the process of historic development is what one can call collective effort with a high degree of unawareness of every individual, "it always seemed puzzling to the common man that, instead of the trodden paths and definite objectives, someone chooses a steep and slippery path, which leads into the unknown. Therefore every such person was always regarded, if not insane, then being possessed by a demon or deity..."
In the opinion of the British scholar of the late 19th and early 20th centuries George Frazer, the institute of "sacred kings", which reached its full expression in the ancient monarchies of Peru and Egypt, takes its origin in the sects of wizards and sorcerers who were in public service.
Addressing an annual assembly of the Imperial Military-Medical Academy in 1897, the great Russian neurologist, psychiatrist and psychologist, Prof. Vladimir Bekhterev, spoke of the role of suggestion in public life. He drew a line between logical conviction as influencing personal comprehension (the consideration and understanding of new information) and the suggestion as penetrating the psychic sphere, leading "directly into the inner chambers of
Methods of cure of different ailment from the treatise of Sharafeddin Sabodzhu-Ogly.
our soul" through emotional and convincing oratry, gestures and mimicry. The scientist regarded suggestion as "mental pest or plague". Like hypnosis, it was nothing but an artificially induced modification of normal sleep. As has now been proved by experiments, the special state of one's consciousness, which is most conducive to suggestion (hypnosis, autohypnosis) is associated with increased activity of the right cerebral hemisphere which has a key role to play in the organization of the psychic unconscious. At the same time logical thinking and conscience are limited as based upon the functional potential of the left hemisphere.
Herbal preparations were often used in the historical past for altering awareness and control of one's behavior. The German scholar H. Leiner published an article in 1970 on the historical role of magic plants and attending preparations in which he discussed the problem of what he called toxic ecstasy in subarctic and European space. Describing various cases of using herbal preparations for magic purposes, he singled out several main psychotropic preparations, including hallucinogenic mushrooms (Fliegenpilz and Amanita pantherina), producing "flight sensation" and also cannabis, preparations of medieval witches and the "elixir of oblivion" mentioned in the old Irish tales. It is interesting to note at this point that we know from medical practice the clinical picture of acute poisoning caused by hallucinogenic mushrooms: after 3 hours there comes diarrhea, intense sweating and "dizzy" condition; after two hours of sleep there develops a picture of psychosis-excitement, senseless speech, various religious visions, hallucinations and destructive actions. Patients of this kind regard the medical staff as Christ, satan, etc. After 20 hours the effect of the mushrooms dies down with motor excitation being replaced with atonia, and 30 hours later the patient fully recovers. It was these mushrooms that were used by Scandinavian berserks and wizards during Greek mystery performances. The term "berserk" (from 'bear' plus 'shirt') used in Scandinavia in 870-1030, defined an ancient Scandinavian warrior, frenzied in battle and held to be invulnerable to pain or cold. He remained in this condition for nearly one day and then relapsed into apathy and weakness. For three centuries berserk warriors influenced the social and political life of the Vikings before fading away in the 12th century. They were chased away from Norway like pirates and robbers in 1013. In 1123 it was written in the Christian Legal Code of Iceland that
persons acting like berserks were to be banished for three years. Men who joined them also had to be banished if they did not stop the bandits.
Ancient authors also described the uses of hashish for magical purposes. The Greek historian Herodotus in his fourth book described the use of this drug by the Scythians (ancient tribes in the pre-Caucasus and Northern Prichernomorye in 7th century B.C. - 3rd century A.D.). The Roman historian Pliny (Gaius Plinius, 23 or 27-79 A.D.) mentioned that Bactrians* added to their wine Celotophyllus.
Also of interest is the cult of the khaoma potion (soma). Like the berserks, there also appeared in the Zo-roastrian cultural-historical environment what are known as male unions. Their warriors ("two-legged wolves") stole cattle and were in association with witches and magicians. They used black magic, drunk such potions before going to bed and could speak the language of oracles who served this deity, the evil side of Mitra.
In that historical period the magic uses of hallucinogenic potions was associated with the existence of the "black cult" of witches. The main ingredients of the witch potion were red and panther fly-agaric and similar mushrooms.
Thus the traditional activities of surgeons of antiquity should be regarded within the context of general actions of magic-therapeutical nature based on the physiologically conditioned need for altering human conscience. It appears that manifold attempts to alter human conscience and behavior accompanied religious and magical activities, \\kys of influencing human psyche were based on observations obtained through intuitive introspection and also abundant empirical knowledge about natural components of herbal origin. Cases of cranial traumas could have started observations for the altered behavior of compatriots who survived such traumas. It could well be that such cases were also regarded as manifestations of "divine insanity". This possibility was discussed, among others, by the German scholar H. Grimm who studied the aftereffects of depressed (impression) skull fracture of a Bronze Age individual (2nd century B.C.) from Sauschwitz. Even after the surface healing of the injury this person suffered from what was called uncontrolled speech and strange behavior.
As a most radical therapy, cranial trepanation could not only be used as a healing technique, but also help deal with the "irregular" behavior of a patient, or promote the appearance of new qualities in healthy persons who had been specially chosen for certain reasons.
* Bactria-region in Central Asia in the middle and upper reaches of the Amu-Darya- existed from the 1st half of the 1st millennium B.C. till the 2nd century A.D.- Ed.
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