[a form of Posttraumatic Stress Disorder (PTSD) symptoms;
also called Participation-Induced Traumatic Stress]
in Classical Literature
A book explaining PITS in more detail is Perpetration-Induced Traumatic Stress. The best price on individual copies of
the paperback version of the book can be found at Barnes & Noble.
There is also a basic explanation of PITS, a page on PITS in personal stories, notes on therapy, and a bibliography.
Act II, Scene 3, Lines 40-66
A combat veteran's wife is speaking, giving what amounts to a catalog of PTSD symptoms in Shakespearean language:
40 O, my good lord, why are you thus alone?
41 For what offense have I this fortnight been
42 A banish'd woman from my Harry's bed?
43 Tell me, sweet lord, what is't that takes from thee
44 Thy stomach, pleasure
45 and thy golden sleep?
46 Why dost thou bend thine eyes upon the earth,
47 And start so often when thou sit'st alone?
48 Why has thou lost the fresh blood in thy cheeks,
49 And given my treasures and my rights of thee
50 To thick-eyed musing and cursed melancholy?
51 In thy faint slumbers I by thee have watch'd,
52 And heard thee murmur tales of iron wars,
53 Speak terms of manage to thy bounding steed,
54 Cry "Courage! to the field!" And thou has talk'd
55 Of sallies and retires, of trenches, tents,
56 Of palisades, frontiers, parapets,
57 Of prisoner's ransom, and of soldiers slain,
58 And all the currents of a heady fight.
59 Thy spirit within thee hath been so at war
60 And thus hath so bestirr'd thee in thy sleep.
61 That beads of sweat have stood upon thy brow,
62 Like bubbles in a late-distrubed stream;
63 And in thy face strange motions have appeared,
64 Such as we see when men restrain their breath
65 On some great sudden hest. Oh, what portents are these?
66 Some heavy business hath my lord in hand . . .
ACT V, Scenes 1, 2, 3 and part of 5
For criminal homicide, the most famous case that describes PITS in classical literature is Macbeth, in which the title
character and his wife suffer breakdowns that are clearly in line with symptoms of PTSD. The nightmarish disturbances
of sleep are captured in a line Macbeth says after he has killed the sleeping king:
"Methought I heard a voice cry, 'Sleep no more! Macbeth does murder sleep' "
(Act II, Scene II, lines 49-50).
The lines from Act V, Scene II below suggest the symptom of explosive outbursts, rage, temper, that have been found
especially high in veterans who say they killed as opposed to those who do not. The lines from Scene III especially
suggest intrusive imagery -- "thick-coming fancies" -- which interfere with sleep. The first lines in Scene V indicate a
sense of numbness attached to a preceding preoccupation with horror -- again, intrusive imagery. The last lines are an
oft-quoted verbal outburst suggesting a sense of foreshortened future, the markedly diminished interest in significant
activities, and restricted range of affect of Cluster C in the psychiatric manual, DSM-IV.
Scene I. Dunsinane. Anteroom in the castle
Enter a Doctor of Physic and a Waiting Gentlewoman.
DOCTOR: I have two nights watched with you, but can perceive no truth in your report. When was it she last walked?
GENTLEWOMAN: Since his Majesty went into the field, have seen her rise from her bed, throw her nightgown upon her,
unlock her closet, take forth paper, fold it, write upon't, read it, afterwards seal it, and again return to bed; yet all this
while in a most fast sleep.
DOCTOR: A great perturbation in nature, to receive at once the benefit of sleep and do the effects of watching! In this
slumbery agitation, besides her walking and other actual performances, what, at any time, have you heard her say?
GENTLEWOMAN: That, sir, which I will not report after her.
DOCTOR: You may to me, and 'tis most meet you should.
GENTLEWOMAN: Neither to you nor anyone, having no witness to confirm my speech.
[Enter Lady Macbeth with a taper.] Lo you, here she comes! This is her very guise, and, upon my life, fast asleep.
Observe her; stand close.
DOCTOR: How came she by that light?
GENTLEWOMAN: Why, it stood by her. She has light by her continually; 'tis her command.
DOCTOR: You see, her eyes are open.
GENTLEWOMAN: Aye, but their sense is shut.
DOCTOR: What is it she does now? Look how she rubs her hands.
GENTLEWOMAN: It is an accustomed action with her, to seem thus washing her hands. I have known her continue in
this a quarter of an hour.
LADY MACBETH: Yet here's a spot.
DOCTOR: Hark, she speaks! I will set down what comes from her, to satisfy my remembrance the more strongly.
LADY MACBETH: Out, damned spot! Out, I say! One- two -why then 'tis time to do't. Hell is murky. Fie, my lord, fie! A
soldier, and afeard? What need we fear who knows it, when none can call our power to account? Yet who would have
thought the old man to have had so much blood in him?
DOCTOR: Do you mark that?
LADY MACBETH: The Thane of Fife had a wife; where is she now? What, will these hands ne'er be clean? No more o'
that, my lord, no more o' that. You mar all with this starting
DOCTOR: Go to, go to; you have known what you should not.
GENTLEWOMAN: She has spoke what she should not, I am sure of that. Heaven knows what she has known.
LADY MACBETH: Here's the smell of the blood still. All the perfumes of Arabia will not sweeten this little hand. Oh, oh,
DOCTOR: What a sigh is there! The heart is sorely charged.
GENTLEWOMAN: I would not have such a heart in my bosom for the dignity of the whole body.
DOCTOR: Well, well, well --
GENTLEWOMAN: Pray God it be, sir.
DOCTOR: This disease is beyond my practice. Yet I have known those which have walked in their sleep who have died
holily in their beds.
LADY MACBETH: Wash your hands, put on your nightgown, look not so pale. I tell you yet again, Banquo's buried; he
cannot come out on 's grave.
DOCTOR: Even so?
LADY MACBETH: To bed, to bed; there's knocking at the gate. Come, come, come, come, give me your hand. What's
done cannot be undone. To bed, to bed, to bed.
DOCTOR: Will she go now to bed?
DOCTOR: Foul whisperings are abroad. Unnatural deeds
Do breed unnatural troubles; infected minds
To their deaf pillows will discharge their secrets.
More needs she the divine than the physician.
God, God, forgive us all! Look after her;
Remove from her the means of all annoyance,
And still keep eyes upon her. So good night.
My mind she has mated and amazed my sight.
I think, but dare not speak.
GENTLEWOMAN: Good night, good doctor.
Scene II. The country near Dunsinane.
Drum and colors. Enter Menteith, Caithness, Angus, Lennox, and Soldiers.
MENTEITH: The English power is near, led on by Malcolm,
His uncle Siward, and the good Macduff.
Revenges burn in them, for their dear causes
Would to the bleeding and the grim alarm
Excite the mortified man.
ANGUS: Near Birnam Wood
Shall we well meet them; that way are they coming.
CAITHNESS: Who knows if Donalbain be with his brother?
LENNOX: For certain, sir, he is not; I have a file
Of all the gentry. There is Seward's son
And many unrough youths that even now
Protest their first of manhood.
MENTEITH: What does the tyrant?
CAITHNESS: Great Dunsinane he strongly fortifies.
Some say he's mad; others, that lesser hate him,
Do call it valiant fury; but, for certain,
He cannot buckle his distemper'd cause
Within the belt of rule.
ANGUS: Now does he feel
His secret murders sticking on his hands,
Now minutely revolts upbraid his faith breach.
Those he commands move only in command,
Nothing in love. Now does he feel his title
Hang loose about him, like a giant's robe
Upon a dwarfish thief.
MENTEITH: Who then shall blame
His pestered senses to recoil and start,
When all that is within him does condemn
Itself for being there?
CAITHNESS: Well, march we on,
To give obedience where 'tis truly owed.
Meet we the medicine of the sickly weal,
And with him pour we, in our country's purge,
Each drop of us.
LENNOX: Or so much as it needs
To dew the sovereign flower and drown the weeds.
Make we our march towards Birnam.
Scene III. Dunsinane. A room in the castle.
Enter Macbeth, Doctor, and Attendants.
MACBETH: Bring me no more reports; let them fly all.
Till Birnam Wood remove to Dunsinane
I cannot taint with fear. What's the boy Malcolm?
Was he not born of woman? The spirits that know
All mortal consequences have pronounced me thus:
"Fear not, Macbeth; no man that's born of woman
Shall e'er have power upon thee." Then fly, false thanes,
And mingle with the English epicures.
The mind I sway by and the heart I bear
Shall never sag with doubt nor shake with fear.
Enter a Servant.
The devil damn thee black, thou cream-faced loon!
Where got'st thou that goose look?
SERVANT: There is ten thousand --
MACBETH: Geese, villain?
SERVANT: Soldiers, sir.
MACBETH: Go prick thy face and overred thy fear,
Thou lily-liver'd boy. What soldiers, patch?
Death of thy soul! Those linen cheeks of thine
Are counselors to fear. What soldiers, wheyface?
SERVANT: The English force, so please you.
MACBETH: Take thy face hence. Exit Servant.
Seyton -- I am sick at heart,
When I behold -- Seyton, I say! -- This push
Will cheer me ever or disseat me now.
I have lived long enough. My way of life
Is fall'n into the sear, the yellow leaf,
And that which should accompany old age,
As honor, love, obedience, troops of friends,
I must not look to have; but in their stead,
Curses, not loud but deep, mouth-honor, breath,
Which the poor heart would fain deny, and dare not.
SEYTON: What's your gracious pleasure?
MACBETH: What news more?
SEYTON: All is confirmed, my lord, which was reported.
MACBETH: I'll fight till from my bones my flesh be hacked.
Give me my armor.
SEYTON: 'Tis not needed yet.
MACBETH: I'll put it on.
Send out more horses, skirr the country round,
Hang those that talk of fear. Give me mine armor.
How does your patient, doctor?
DOCTOR: Not so sick, my lord,
As she is troubled with thick-coming fancies,
That keep her from her rest.
MACBETH: Cure her of that.
Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain,
And with some sweet oblivious antidote
Cleanse the stuffed bosom of that perilous stuff
Which weighs upon the heart?
DOCTOR: Therein the patient
Must minister to himself.
MACBETH: Throw physic to the dogs, I'll none of it.
Come, put mine armor on; give me my staff.
Seyton, send out. Doctor, the thanes fly from me.
Come, sir, dispatch. If thou couldst, doctor, cast
The water of my land, find her disease
And purge it to a sound and pristine health,
I would applaud thee to the very echo,
That should applaud again. Pull 't off, I say.
What rhubarb, senna, or what purgative drug
Would scour these English hence? Hear'st thou of them?
DOCTOR: Aye, my good lord, your royal preparation
Makes us hear something.
MACBETH: Bring it after me.
I will not be afraid of death and bane
Till Birnam Forest come to Dunsinane.
DOCTOR: [Aside.] Were I from Dunsinane away and clear,
Profit again should hardly draw me here.
Scene V. Dunsinane. Within the castle.
Enter Macbeth, Seyton, and Soldiers, with drum and colors.
MACBETH: Hang out our banners on the outward walls;
The cry is still, "They come." Our castle's strength
Will laugh a siege to scorn. Here let them lie
Till famine and the ague eat them up.
Were they not forced with those that should be ours,
We might have met them dareful, beard to beard,
And beat them backward home.
[A cry of women within]What is that noise?
SEYTON: It is the cry of women, my good lord. Exit.
MACBETH: I have almost forgot the taste of fears:
The time has been, my senses would have cooled
To hear a night shriek, and my fell of hair
Would at a dismal treatise rouse and stir
As life were in 't. I have supped full with horrors;
Direness, familiar to my slaughterous thoughts,
Cannot once start me.
[Re-enter Seyton.] Wherefore was that cry?
SEYTON: The Queen, my lord, is dead.
MACBETH: She should have died hereafter;
There would have been a time for such a word.
Tomorrow, and tomorrow, and tomorrow
Creeps in this petty pace from day to day
To the last syllable of recorded time,
And all our yesterdays have lighted fools
The way to dusty death. Out, out, brief candle!
Life's but a walking shadow, a poor player
That struts and frets his hour upon the stage
And then is heard no more. It is a tale
Told by an idiot, full of sound and fury,
First Samuel: King Saul
There is not really enough information to draw any conclusion that King Saul was suffering from Posttraumatic Stress
Disorder, but if such a condition has existed throughout history, one would expect to find examples of it in the world's
literature portrayed in ways that would be inadequate to modern ways of looking at it. The presence of killing on the
part of King Saul is certainly attested (I Samuel 18:7). Others have suggested manic-depressive disorder for him, and
another proposal has been learned helplessness. These are not mutually exclusive with PITS, and in any event a
diagnosis cannot be made from a history that was not written with diagnosis in mind. All we can say is that the
expression seems to fit the idea that PITS was present, in an ancient culture with no idea of modern psychiatry.
The King James version is used here.
I Samuel 16:14-19, 23
But the Spirit of the Lord departed from Saul, and an evil spirit from the Lord troubled him. And Saul's servants said
unto him, Behold now, an evil spirit from God troubleth thee. Let our lord now command thy servants, which are before
thee, to seek out a man, who is a cunning player on an harp; and it shall come to pass, when the evil spirit from God is
upon thee, that he shall play with his hand, and thou shalt be well. And Saul said unto his servants, Provide me now a
man that can play well, and bring him to me. Then answered one of the servants, and said, Behold, I have seen a son of
Jesse the Bethlehemite, that is cunning in playing, and a mighty valiant man, and a man of war, and prudent in matters,
and a comely person, and the Lord is with him. Wherefore Saul sent messengers unto Jesse, and said, Send me David
thy son, which is with the sheep . . . And it came to pass, when the evil spirit from God was upon Saul, that David took
an harp, and played with his hand. So Saul was refreshed, and was well, and the evil spirit departed from him.
I Samuel 19: 9-10
And an evil spirit from the Lord was upon Saul, as he sat in his house with his javelin in his hand; and David played
with his hand. And Saul sought to smite David even to the wall with the javelin; but he slipped away out of Saul's
presence, and he smote the javelin into the wall: and David fled, and escaped that night.
The "evil spirit" which came upon Saul and was obvious to others could be melancholy, or intrusive imagery and
flashbacks, or the related panic attacks. That music would help end these episodes is suggested in the studies of those
trying to figure out therapies. The violent outburst against David, often attributed to Saul's growing jealousy, would also
be consistent with someone whose PTSD comes from having killed. A study of U.S. government data on Vietnam
veterans, along with observations of those who have worked with them, find the outbursts to be especially high in those
who had killed as opposed to those who got PTSD in other ways.
Book 12, Lines 125-130
Must you have battle in your heart forever?
The bloody toil of combat? Old Contender,
will you not yield to the immortal gods?
That nightmare cannot die, being eternal
Evil itself -- horror, and pain, and chaos;
there is no fighting her . . .
All that avails is flight.
Homer, Odyssey. Trans. Robert Fitzgerald. New York: Anchor Doubleday, 1975.
Edgar Allan Poe
"The Imp of the Perverse"
This is the end portion of the story. The beginning is an extensive philosophical explanation of the imp of the perverse.
Another Poe story, "The Tell-Tale Heart," similarly deals with the symptom of intrusive imagery.
It is impossible that any deed could have been wrought with a more thorough deliberation. For weeks, for months, I
pondered upon the means of the murder. I rejected a thousand schemes, because their accomplishment involved a
chance of detection. At length, in reading some French Memoirs, I found an account of a nearly fatal illness that
occurred to Madame Pilau, through the agency of a candle accidentally poisoned. The idea struck my fancy at once. I
knew my victim's habit of reading in bed. I knew, too, that his apartment was narrow and ill-ventilated. But I need not vex
you with impertinent details. I need not describe the easy artifices by which I substituted, in his bed-room candle-stand,
a wax-light of my own making for the one which I there found. The next morning he was discovered dead in his bed, and
the Coroner's verdict was -- "Death by the visitation of God."
Having inherited his estate, all went well with me for years. The idea of detection never once entered my brain. Of the
remains of the fatal taper I had myself carefully disposed. I had left no shadow of a clue by which it would be possible to
convict, or even to suspect, me of the crime. It is inconceivable how rich a sentiment of satisfaction arose in my bosom
as I reflected upon my absolute security. For a very long period of time I was accustomed to revel in this sentiment. It
afforded me more real delight than all the mere worldly advantages accruing from my sin. But there arrived at length an
epoch, from which the pleasurable feeling grew, by scarcely perceptible gradations, into a haunting and harassing
thought. It harassed because it haunted. I could scarcely get rid of it for an instant. It is quite a common thing to be thus
annoyed with the ringing in our ears, or rather in our memories, of the burden of some ordinary song, or some
unimpressive snatches from an opera. Nor will we be the less tormented if the song in itself be good, or the opera air
meritorious. In this manner, at last, I would perpetually catch myself pondering upon my security, and repeating, in a low
undertone, the phrase, "I am safe."
One day, whilst sauntering along the streets, I arrested myself in the act of murmuring, half aloud, these customary
syllables. In a fit of petulance, I remodeled them thus; "I am safe -- I am safe -- yes -- if I be not fool enough to make
No sooner had I spoken these words, than I felt an icy chill creep to my heart. I had had some experience in these fits of
perversity . . . and I remembered well that in no instance I had successfully resisted their attacks. And now my own
casual self-suggestion that I might possibly be fool enough to confess the murder of which I had been guilty, confronted
me, as if the very ghost of him whom I had murdered -- and beckoned me on to death.
At first, I made an effort to shake off this nightmare of the soul. I walked vigorously -- faster -- still faster -- at length I ran.
I felt a maddening desire to shriek aloud. Every succeeding wave of thought overwhelmed me with new terror, for, alas! I
well, too well understood that to think, in my situations, was to be lost. I still quickened my pace. I bounded like a
madman through the crowded thoroughfares. At length, the populace took the alarm, and pursued me. I felt then the
consummation of my fate. Could I have torn out my tongue, I would have done it, but a rough voice resounded in my
ears -- a rougher grasp seized me by the shoulder. I turned -- I gasped for breath. For a moment I experienced all the
pangs of suffocation; I became blind, and deaf, and giddy; and then some invisible fiend, I thought, struck me with his
broad palm upon the back. The long imprisoned secret burst forth from my soul.
They say that I spoke with a distinct enunciation, but with marked emphasis and passionate hurry, as if in dread of
interruption before concluding the brief, but pregnant sentences that consigned me to the hangman and to hell.
Having related all that was necessary for the fullest judicial conviction, I fell prostrate in a swoon.
But why shall I say more? To-day I wear these chains, and am here! To-morrow I shall be fetterless! -- but where?
House of the Dead
Dostoevsky wrote this autobiographical novel as fiction, placing the stories in the mouth of another, as can be seen by
this introduction. He did spend a few years in prison in Siberia, and of course was a keen observer of Russian life. His
famous novel Crime and Punishment grew out of insights that he gained here, and is another case where expressions of
perpetration-induced PTSD symptoms can be found (though not as clearly in distinct quotable passages.)
Referring to fellow convicts in Siberia, the first one being a murder convict:
The convicts heard him cry out one night in his sleep: "Hold him, hold him! Chop off his head, his head, his head!"
Almost all the convicts raved and talked in their sleep. Oaths, thieves' slang, knives, axes were what come most
frequently to their tongues in their sleep. "We are a beaten lot," they used to say; "our guts have been knocked out,
that's why we shout at night."
Fyodor Dostoevsky, The House of the Dead (New York: Grove Press, no year given) translated by Constance Garnett,
Thus Spoke Zarathustra
"On the Pale Criminal"
"But thought is one thing, the deed is another: and the image of the deed still another . . . An image made this pale man
pale. He was equal to his deed when he did it; but he could not bear its image after it was done. Now he always saw
himself as the doer of one deed. Madness I call this . . . madness after the deed I call this."
Chapter 6: Hungry Joe
Hungry Joe . . . had eerie, ear-splitting nightmares that kept everyone in the squadron awake . . . Hungry Joe was too
firmly embedded in calamities of his own to care how Doc Daneeka felt. There were the noises, for instance. Small ones
enraged him and he hollered himself hoarse at Aarfy for the wet, sucking sounds he made puffing on his pipe, at Orr for
tinkering, at McWatt for the explosive snap he gave each card he turned over when he dealt at blackjack or poker, at
Dobbs for letting his teeth chatter as he went blundering clumsily about bumping into things. Hungry Joe was a
throbbing, ragged mass of motile irritability. The steady ticking of a watch in a quiet room crashed like torture against his
unshielded brain . . .
The nightmares appeared to Hungry Joe with celestial punctuality every single night he spent in the squadron . . .
Dobbs and Captain Flume were so deeply disturbed by Hungry Joe's shrieking nightmares that they would begin to have
shrieking nightmares of their own, and the piercing obscenities they flung into the air every night from their separate
places in the squadron rang against each other in the darkness romantically like the mating calls of songbirds with filthy
minds . . . Every time Colonel Cathcart increased the number of missions and returned Hungry Joe to combat duty, the
nightmares stopped and Hungry Joe settled down into a normal state of terror with a smile of relief. Yossarian read
Hungry Joe's shrunken face like a headline. It was good when Hungry Joe looked bad and terrible when Hungry Joe
looked good. Hungry Joe's inverted set of responses was a curious phenomenon to everyone but Hungry Joe, who
denied the whole thing stubbornly.
"Who dreams?" he answered, when Yossarian asked him what he dreamed about.
"Joe, why don't you go see Doc Daneeka?" Yossarian advised.
"Why should I go see Doc Daneeka? I'm not sick."
"What about your nightmares?"
"I don't have nightmares," Hungry Joe lied.
"Maybe he can do something about them."
"There's nothing wrong with nightmares," Hungry Joe answered. "Everybody has nightmares."
Yossarian thought he had him. "Every night?" he asked.
"Why not every night?" Hungry Joe demanded.
And suddenly it all made sense. Why not every night, indeed? It made sense to cry out in pain every night. . . .
Heller, James. (1955, 1961). Catch-22. New York: Simon & Schuster, pp. 51-54.
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