Irritable Heart: Treating Fictional Trauma Survivors in the 19th Century
Author Nancy Bernhard discusses irritable heart, nostalgia, and more whilst treating fictional trauma survivors in the 19th century.
We’ve learned a lot about how the brain and nervous system respond to trauma in the last 30 years, but people suffered violence long before we had functional MRIs and eye movement desensitization therapies. When creating my character Doc, an underground medical practitioner treating rape survivors for my novel The Double Standard Sporting House, I looked into how the symptoms of a trauma disorder were understood in her time, the 1860s.
Women of the demimonde, prostitutes, and brothel owners like Doc, rarely appear in historical records, but they surely knew a lot about sexual assault. Aligning research into 19th century medical history with some 21st century counterpoints, I imagined how rape survivors in 1868 might have improvised their own healing.
People in the 1860s used 4,000-year-old Greek words like mania, melancholia, or dementia to describe what we now call a trauma disorder. Sometimes it was characterized as a religious loss, with a survivor becoming dis-spirited, or demoralized, echoing our present-day concept of moral injury. Nostalgia, a word with many meanings, was the name for what we call clinical depression, translated as “home-ache.”
Likewise, the main symptoms of trauma disorders had different names. We speak of flashbacks. Survivors’ brains have difficulty converting their trauma from short-term into long-term memories, so those moments can erupt into the present, and feel like they’re still happening. But flashback is a cinematic term, and cinema is a 20th century invention. In the 19th century, survivors said they saw ghosts. Doc gently prompts one Civil War veteran to speak to the friend whose death haunts him.
Survivors are often hyper-vigilant, and startle easily. We see this as a persistent activation of the sympathetic nervous system, our “fight, flight, or freeze” response. In 1871, while studying Civil War veterans, physician Jacob DaCosta named this condition irritable heart. He believed it was caused by an overstimulation of cardiac nerves, which he treated with opium, digitalis, belladonna, and cannabis. Indeed, many survivors self-medicate: numbing behaviors are another major diagnostic criterion for a trauma disorder. Doc understands that this is not therapeutic in the long run.
The diagnosis of shell-shock began to describe the effects of both percussive brain injury and post-traumatic stress in the 1920s, in the aftermath of World War I. Not until the Vietnam War and the creation of the PTSD rubric in the 1970s did medicine begin sustained research into the physiology and psychology of trauma.
It took even longer to connect the effects of combat to those of sexual assault. The silence surrounding rape and domestic violence on the part of male physicians compounded the difficulty of naming those effects. Dr. Judith Herman’s revolutionary 1992 book Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror, based on decades of research, made connections between public and private trauma, and the kinds of violence suffered predominantly by men and by women.
Since antiquity, warriors have performed rituals to purge themselves of their wartime experiences and ease their return to everyday life. They took time in solitude, went to sweat lodges and purifying baths, undertook periods of prayer and reflection. There are no established rituals for survivors of rape or forced prostitution, because acknowledging those experiences would have implicated perpetrators. But survivors certainly improvised coping strategies and passed them along. I set my novel in an elite brothel because many of the women working there would have been survivors. They had resources and lived as a community of women.
Having helped many women and girls through the aftermath of sexual trauma, Doc has strategies. She knows it’s important for a survivor to tell the story of what happened, but at the right time. Forcing a girl to relive the experience too soon or too many times can re-injure her.
But waiting too long is also a mistake. Doc encourages girls to give voice to their experiences for several reasons. Specifying the details of their injuries encourages them to take agency in their physical healing. Sharing the story reduces the crippling shame that often accompanies rape and allows friendship and support to flow. Finally, naming their experiences allows survivors to see them within longer and more redemptive story arcs.
Such stories can be vital to healing. Physicians working with Civil War veterans began to understand that soldiers who believed in Union or abolition could justify and absorb their sacrifices better than those with no connection to a cause. Doc likewise intuits that some girls might see their trauma as a sacrifice for a greater good—girls who baited their fathers to keep them away from their sisters, girls who’d have done anything to escape home, girls willing to pay a price for their independence. This practice echoes present-day narrative therapies.
Doc’s purpose in creating the Double Standard Sporting House is to give girls first and second chances. Prostitution is the only way to fund her free clinic, and the house serves as a conduit to other opportunities. Everyone from cooks and maids to the most sought-after harlots protect and uplift one another. In the novel’s main action, the house becomes the unlikeliest refuge for a young victim of a trafficking ring, and the catalyst to her revenge and redemption.
Trauma studies may be a new field, but people have been healing from trauma for millennia. The Double Standard Sporting House imagines how it might have gone in 1868 New York.
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