Dissociative symptoms after plague in the 15th century

Accounts of the post-traumatic reactions to plague, particularly in the Renaissance era, are scarce; here is an example in the form of Ibn taghri birdi writing about a funeral during the plague epidemic of 1429 in Cairo.

‘The child of an individual in our service named Shams ad-Din adh Dhahabi died, and we went out with him to the oratory; the boy was less than seven years old, and when we set him down to pray over him among the dead, a large number of others were brought, until their numbers went beyond counting. Then prayer was said over them all, and we went to take up the dead boy but found that someone else had taken him and left to us another one of about the same age. His family took him up but did not become aware of it; I, however, perceived this and told a number of others; but we did not inform his parents of it and said: Perhaps the one who took him will give him the best interment; there is no profit in talking about it - there would be only an increase in grief. But when the boy had been buried and the proprietors of the funeral office took up the bier they cried out and said, “This is not our bier; this is an old one and its furnishings also are worn out”. I advised them to be silent, and then one of the mamluks threatened to beat them; then they took it and went away. This occurrence was a strange and distressing one' (Dols, 1977: pp. 241-242; Gottfried, 1983: p. 39).

This is a remarkable early historical example of dissociative symptoms as a result of psychological trauma due to a medical condition. The above symptoms clearly accord with criterion B in DSM-IV for acute stress disorder (American Psychiatric Association, 1994). Most accounts of dissociative symptoms as a result of psychological trauma are from the 20th century (Jones et al, 2003). It is interesting to see that in comparison with the modern era, dissociative symptoms as a result of traumatic events are still far less common than hyperarousal symptoms, which are much better recognised.