Charles Darwin’s (1809–1882) illness – the role of post-traumatic stress disorder

A trauma hypothesis

Does this finding explain all of Darwin's symptoms? Examination of those listed in the Appendix shows many symptoms such as ‘hysterical crying’ or ‘I felt as if my body was gone & only my head left’ that are psychological in character. Perhaps Darwin also suffered from post-traumatic stress disorder (PTSD). Stressful episodes from his life are compared with diagnostic criteria for PTSD to assess the validity of this hypothesis. Psychological trauma had not been formulated as a concept or diagnosis then but medical records from the Crimean War ⁵¹ and from civilian hospitals including the Salpêtrière Hospital in Paris, ⁵² which specialised in the care of patients with hysteria, provide descriptions that align with current criteria for PTSD. Nineteenth-century attitudes to these conditions will be explored.

Characteristics of PTSD

Table 3 lists the main characteristics of PTSD.^53–58 Symptoms, both psychological and physical, in PTSD may be manifold and therefore either not recognised for what they are or misdiagnosed as due to another condition.

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Table 3.

Main characteristics of PTSD.

Categories	Description	Examples from Darwin’s life
The traumatic incident	This is, or is perceived to be, horrifying, overwhelming and life-threatening.	His mother’s painful death.
Memories	Persistent, distressing and intrusive, such as flashbacks and nightmares.	Seeing operations performed without anaesthetic.
Avoidance	This is of reminders of the trauma – memories, the place, sounds. Social isolation may occur to avoid triggers. There may be numbing of feelings, dissociation and amnesia.	Avoiding visiting his daughter’s grave for 12 years.
Arousal	This may present as anxiety, irritability, insomnia, hypervigilance or concentration problems.	Anxiety, insomnia, ‘hysterical crying’ and inability to concentrate.
Chronicity	May persist for many years. Its onset may also be delayed months or years after the traumatic incident.	His illness persisted for most of his adult life.

Stressful times

Darwin lived a comfortable life of privilege – he was rich, happily married, the doting father of 10 children, owned Down House with its spacious grounds and was celebrated worldwide for his theory of evolution. Surely there were no traumas in his life? The reality, however, was otherwise. (Trauma-related symptoms are indicated in italics.)

A death in the family

The story of Darwin’s traumas begins with the death of his mother, Susannah (1765–1817). This event is often given little weight in the literature perhaps because Darwin said he remembered little of her:

My mother died in July 1817 when I was a little over eight years old, and it is odd that I can remember hardly anything about her except her death-bed, her black velvet gown and her curiously constructed work-table. ⁵⁹

It is indeed strange. Darwin was old enough to remember such a momentous event and his younger sister, Catherine (1810–1866), recalled it clearly. ⁶⁰ Furthermore, their mother’s death was fraught with suffering. Catherine Wedgwood (1774–1823), Susannah’s sister, wrote to her brother, Josiah II:

It is impossible to have a worse account than I have to give you. The Dr. has not the slightest hope & her suffering is terrible. The pain indeed is gone that was her first illness, but she has such severe vomittings, [sic] & sickness that he says he does not think her sufferings much lessened … The Dr. has just been to tell us he does not think she will pass the night. ⁶¹

Today she would be diagnosed as having an acute abdomen. Likely causes include a perforated stomach ulcer or acute obstruction from a twisted bowel or cancer causing intense, painful colic and vomiting. The ill person experiences extreme suffering. Such conditions were then a sentence of death. It would be hard for Darwin to forget such a dramatic ending to his mother’s life and the unspoken feelings of horror and fear in the adults around him. He was not allowed to see her but perhaps he heard her groans of pain. It was July when Susannah was laid out so that visitors could pay their last respects and the smell from the decomposition of the body in the heat would have permeated the house. The only reason he ‘forgot’ such awful experiences is that it was too painful for him to remember – traumatic amnesia.

Then, a void: his mother was gone. Any 8-year-old would feel a visceral sense of abandonment in such circumstances. This was compounded by the absence of his father, Robert Darwin (1766–1848), on the day after his wife’s death. Sarah Wedgwood, (1776–1856), another of Susannah’s sisters, ⁶² writes

[The Doctor] is obliged to go tomorrow to Denbigh to see a patient who is very dangerously ill, he will return on Saturday evening: he thinks the journey and being obliged to think of other things will do him good.

Darwin also wrote ‘I believe that my forgetfulness is partly due to my sisters, owing to their great grief, never being able to speak about her or mention her name … ’ ⁶³ (author’s italics). There was, then, no opportunity to talk of his loss; his feelings were locked away and remained unacknowledged. Some months later, he was sent away, still bereft, to board at Shrewsbury School. ⁶³ He retreated into an ‘isolated protective shell’. ⁶⁴

His feelings did, however, resurface many years later. When he was ill in later life, Emma (1808–1896), his wife, nursed him. He wrote to her ‘My dearest old Mammy … Without you, when sick I feel most desolate. Oh Mammy, I do long to be with you and under your protection for then I feel safe’. ⁶⁵ (author’s italics). He had regressed to childhood and his wish to be once more cared for by a loving mother. ⁶⁶ Perhaps he expressed his suppressed grief later in life through other sorrows too: he wept bitterly when his daughter, Annie, died ⁶⁷ and he described ‘hysterical crying’ accompanying his chronic vomiting. ⁶⁶

As a child, Darwin liked to be alone:

I had, as a very young boy, a strong taste for long solitary walks; but what I thought about I know not. I often became quite absorbed, and once, whilst returning to school on the summit of the old fortifications round Shrewsbury, which had been converted into a public foot-path with no parapet on one side, I walked off and fell to the ground …  ⁶³

Children day-dream but not so that they do not notice they are falling off a wall. This is an example of another defence mechanism common in trauma, dissociation, with consciousness dis-associating from the traumatic memory and feelings. The person affected may seem far away, in a trance.^68,69 Traumatised people may spend long periods in this state, as may have been the case with Darwin. And he was often alone on his long walks. People with PTSD often isolate themselves to reduce the likelihood of some trigger re-evoking their traumatic feelings.

This dissociation continued into Darwin’s adult life. In 1857 he wrote to his son, William, about how, as Secretary of the Geological Society (1838–1841), he read aloud papers to the Meeting: ‘I was so nervous at first, I somehow could see nothing all around me, but the paper, & I felt as if my body was gone, & only my head left … ’ ⁷⁰ (author’s italics).

However, Darwin was not entirely a helpless victim. When he was 16 he ‘became passionately fond of shooting … “I remember killing my first snipe, and my excitement was so great that I had much difficulty in reloading my gun from the trembling of my hands”’. ⁷¹ Browne ⁷² comments on ‘the resulting bloodbath of animals … which he killed with violent pleasure’ and continues: ‘He could wield his own power over life and death with a smoking gun’. Traumatic stress is also characterised by increased arousal which may lead to violent feelings.

The attachment bond between mother and child is crucial for that child’s healthy development. Indeed, even the development of neuronal pathways in the brain depends on this relationship. If it is ruptured by death or neglect, the consequences for that child may be disastrous. It may be experienced as a kind of death with intense feelings of loneliness, emptiness, anxiety and loss of hope. ⁷³ When animals are threatened and neither fight nor flight will save them, they go into a state of temporary tonic immobility, a ‘frozen’ state. ⁷⁴ Bereaved children may be locked into this traumatic state and become withdrawn and solitary. They seem to have adjusted – they have not.

Darwin’s experience of losing his mother was pivotal. This hidden, unresolved trauma set the scene for the future, making him vulnerable to future shocks. Such trauma may lie dormant for years, only to surface when a new crisis occurs – and one of these was Darwin’s experiences as a medical student.

Medical studies

In 1825, aged 16, Darwin went to Edinburgh to study medicine. He comments on anatomy and dissection that ‘the subject disgusted me’:

I also attended regularly the clinical wards in the Hospital. Some of the cases distressed me a good deal, and I still have vivid pictures before me of some of them. ⁷⁵ (author’s italics)

In other words, these were vivid, distressing, persistent memories, a feature of trauma. Surgery was worse:

I also attended on two occasions the operating theatre in the hospital … and saw two very bad operations, one on a child, but I rushed away before they were completed. Nor did I ever attend again, for hardly any inducement would have been strong enough to make me do so … The two cases fairly haunted me for many a long year ⁷⁶ (author’s italics).

These haunting memories are characteristic of traumatic flashbacks, sudden, intense, horrifying images of a scene from the past which are experienced as though in the present. His reaction was to avoid attending another operation. Traumatised people do everything they can to shun the scene of their overwhelming memory.

We can form an idea of what operations then were like from an account by the London surgeon, John Flint South (1797–1882). In 1813, he began attending operations in the St Thomas’s Hospital operating theatre. These operations were ‘for some time a very hard trial for me,’ he wrote

 … so long as the patient did not make much noise I got on very well, but if the cries were great, and specially if they came from a child, I was quickly upset, had to leave the theatre, and not infrequently fainted … the atmosphere [was] almost stifling. ⁷⁷

Dr EA Barton (1863–1953) ⁷⁸ recalled the scene in the old operating theatre in University College Hospital when he was in training in 1884. He remembered

 … the operating coats of the staff. These were mostly old frock coats, stiff and stinking with pus and blood … Beneath the table may be seen a wooden box … filled with sawdust. This box can be kicked … to any place where most blood is running … 

No wonder Darwin was horrified by what he saw. It is possible, too, that the screams and smells triggered in him memories of his mother’s last illness. This, however, was not his last encounter with suffering in a child.

The death of Annie Darwin

Three of the Darwins’ 10 children died in childhood. This was a heavy burden of grief. The death that affected him most was of his favourite, Annie (1841–1851). On 27 June 1850, Emma Darwin wrote in her diary: ⁷⁹ ‘Annie first failed about this time’. She had begun to complain of feeling sick.^80,81 For several months she was treated at home but did not improve.

On 24 March 1851, Darwin took Annie to Malvern to be treated by Dr Gully whose Water Cure had helped him previously. Annie developed a fever and bilious vomiting. Darwin sat with her, supported by Fanny Wedgwood (1800–1889), his sister-in-law. ⁸² Annie’s illness, though fluctuating daily, advanced inexorably and Darwin’s letters to Emma chart his emotional peaks and troughs. ⁸³ Annie developed severe diarrhoea. ‘As she lay writhing helplessly, his own stomach gave way, and he ran from the room, convulsed and retching’ ⁸⁴ (author’s italics). She died on 23 April. Emma wrote simply ‘12 O’clock’ in her diary. ⁷⁹ Gully certified Annie’s death as ‘Bilious Fever with typhoid character’. ⁸⁵

Darwin asked Fanny to arrange Annie’s funeral; she was buried in the Priory Churchyard on 25 April. Darwin was not present – he had returned home the day before to be with Emma who was heavily pregnant.

Any parent can sympathise with the extreme distress Darwin felt as he watched his beloved Annie dying. Before, it had been his mother who died; this time it was his treasured daughter. It is not surprising he wept so intensely. ⁶⁷

Darwin’s own retching had clearly been set off by his emotional distress. When the psyche is overwhelmed by a horrifying scene it may express its attempt to be purged of the unbearable – toxic – images physically through vomiting. ⁸⁶

Darwin felt unable to attend the funeral of his own daughter. We might wonder at his seeming lack of feeling. However, a feature of chronic trauma is the drive to avoid the place that triggers the painful memories. ⁸⁷ It was to be a further 12 years before he first visited her grave, after Emma had rediscovered it ‘covered with trees & looks so green and old’. ⁸⁸

The medical note

On 20 May 1865, Darwin wrote a note about his medical condition for Dr John Chapman. The years had not treated him well. True, he was the celebrated author of On the Origin of Species but in private he was a sick man and exhausted by his ailments. ‘Age 56–57,’ he began, as if making scientific notes:

– For 25 years extreme spasmodic daily & nightly flatulence: occasional vomiting; on two occasions prolonged during months. Extreme secretion of saliva with flatulence. Vomiting preceded by shivering, hysterical crying dying sensations or half-faint. & copious very palid [sic] urine. Now vomiting & every paroxys[m] of flatulence preceded by singing of ears, rocking, treading on air & vision. focus & black dots All fatigues, specially reading, brings on these Head symptoms?? nervousness when E. [Emma Darwin] leaves me. ⁶⁶ (author’s italics)

Darwin had been experiencing these strange symptoms on and off from before his voyage round the world in The Beagle – about 35 years. The acute had gradually become chronic and resisted his attempts at cure. He was trapped, circling in a vortex from which he could not escape.

Many of his symptoms, such as vomiting, abdominal pain and flatulence, as well as the relapsing nature of his illness could be explained by a physical cause, perhaps Crohn’s disease ⁴² or MELAS syndrome. ⁴¹ Some, however, are clearly emotional in character – hysterical crying, dying sensations and nervousness when Emma left him alone. Furthermore, his vomiting had an emotional element too as was the case when he was sitting with Annie as she was dying.

He also described a strange behaviour: ‘rocking, treading on air’. Body rocking is a way that children soothe themselves when distressed. It also occurs in disturbed children. Ames, ⁸⁹ in a study on Romanian orphans adopted in Canada, found 84% of the children repeatedly rocked while sitting, or shifted from foot to foot. Darwin, then, appears to have regressed during his crises and his body unconsciously adopted these comforting movements. It makes sense that he felt ‘nervousness when E. leaves me’, especially with his ‘dying sensations’. He had become a troubled child comforted only by his ‘dearest old Mammy,’ for ‘then I feel safe’. ⁶⁵

Other stresses

Darwin faced many stressful events during his years of chronic illness: the contrast between his agnosticism and Emma’s Christian beliefs, his anxieties about the hereditary consequences for his children of his marrying his first cousin, the mental strain of his work, ¹⁰⁶ the controversies, both religious and scientific, following the publication of On the Origin of Species, and his shock when Alfred Russel Wallace’s essay on survival of the fittest anticipated his own. Vulnerable from his early trauma and his chronic symptoms, he struggled to contain his sufferings, the origins of which neither he (the author of Origins) nor his doctors could fathom.

It is clear, then, that Darwin suffered from traumatic symptoms in all the categories shown in Table 3. This does not, however, exclude other aetiologies. His PTSD could have co-existed with any of the other putative diagnoses shown in Table 2. Indeed, a feedback loop may have occurred: the stress of symptoms including his chronic vomiting from a physical cause may have aggravated his traumatised state which itself worsened his vomiting – as was the case when his daughter, Annie, died. Furthermore, the symptoms of the various psychological diagnoses previously proposed (Table 2), such as anxiety, depression and panic, may be encompassed within the ambit of the multifaceted manifestations of PTSD.

Hysteria

When Darwin wrote of ‘hysterical crying’ and Emma, in her diary entry ⁷⁹ of 18 October 1864, described Charles as having ‘bad hysteria,’ they were, perhaps, closer to the traumatic truth than they knew.

Nineteenth-century Europe was fascinated by hysteria ⁹¹ and by the dramatic stories emerging from La Salpêtrière Hospital in Paris of women with intermittent paralyses, mutism, blindness and other outlandish symptoms. Under the aegis of Charcot, ⁵² some of his patients, including Augustine Gleizes whose photographs show her seized by contorting ‘hysterical attacks’, ⁹² became famous and all Paris flocked to see Charcot’s demonstrations of induction of hysteria in his subject patients.

It was Charcot who pioneered the study of hysteria and also described ‘hystero-traumatic paralysis’ ⁹³ which, he asserted against opponents who said hysteria only appeared in women, occurred commonly in men. Sigmund Freud attended Charcot’s lectures. Impressed, he returned to Vienna and reported on his case studies of young women. ⁹⁴ He found in ‘every case of hysteria there are one or more occurrences of premature sexual experience, occurrences which belong to the earliest years of childhood … ’, in modern parlance, the trauma of sexual abuse. It is now recognised that violence and neglect are equally potent causes of developmental trauma. Freud later privately repudiated his theory, unable to believe that child rape was endemic among the respectable burghers of Vienna. Today we have less difficulty.^95,96 Augustine Gleizes, for example, had been brutally raped when she was 13. ⁹⁷

War

Darwin was 44 when the Crimean War (1853–1856) began. He would have known of its terrible human cost. The soldiers had not only to endure the dangers of disembowelling and dismemberment or death in battle but also the appalling conditions in Scutari Hospital. A correspondent reported seeing

poor fellows … dying fast of their wounds, dysentery, etc. I saw 72 bodies put into a pit, and men trampling on the lower rows, as to make room for others. ⁹⁸

Reid ⁵¹ has documented features of PTSD described in accounts by soldiers fighting in the Crimean War: anxiety, dread, depression, a conviction of dying soon, paranoia, numbing of feelings, alcoholism, hypervigilance and fear of insanity. Florence Nightingale (1820–1910) was herself affected by the horrors she witnessed. Mackowiak and Batten ⁹⁹ argue that her chronic ill health after her return to England was due to PTSD.

Records of traumatic reactions after battles go back to the third millennium BC. ¹⁰⁰ In Darwin’s time Da Costa, ¹⁰¹ a surgeon in the American Civil War (1861–1865), called it ‘irritable heart’. A century was to pass after Darwin’s death before the American Psychological Association ¹⁰² in the 1980 third revision of its manual, recorded PTSD as a ‘mental disorder’, a consequence not just of war but of all the troubles to which humanity is heir.