Retrospective Diagnoses

A retrospective diagnosis is the practice of identifying an illness after the death of the patient using modern knowledge, methods and disease classifications. Alternatively, it can be the more general attempt to give a modern name to an ancient and ill-defined scourge or plague

Diagnosing medical conditions of a famous historical figure based on evidence found in documents, arts, and other artifacts is a small but popular genre of medical publishing. What is the diagnosis of the illness that tormented Frederic Chopin for so many years? What neurological disease did Friedrich Nietzsche suffer from for many years before he died? These are typical questions discussed occasionally in medical journals. But this activity is not without criticisms. Some serious scholars in the humanities and social sciences are not happy about this “fun escape of doctors”. First, these “hobbyist” historians are not following the methodological disciplines of historiography, literary criticism, and other relevant subject areas of the humanities and social sciences. For example, they often literally interpret the documents in translation without critically analyzing the primary source in the original language. But more importantly, as these retrospective diagnoses become more and more medically sophisticated as medical knowledge advances, these critics are increasingly skeptical about the authenticity of such highly specific and speculative diagnoses, such as alpha-1 antitrypsin deficiency in Chopin, which became known only due to the recent advancement in medical technology.

Ontological challenges of retrospective diagnosis

Behind this conundrum of identifying the present tuberculosis and the past descriptions of diseases with similar manifestations, there are two kinds of philosophical questions: one is whether Disease X which we recognize as tuberculosis today is the same and identical disease as “phthisis”, “consumption”, or whatever they called in historical time. In this conception, Disease X is one and identical but it is argued that “tuberculosis” and “phthisis” are different because they are conceptualized in a different context with different linguistic, social and cultural meanings. Even if we are dealing with the identical Disease X, biological responses are also different among historical patients due to differences in the immune system and other host factors. Recognition of Disease X by physicians is also different in different historical times due to differences in diagnostic conceptions and technologies. For all these reasons, the critics argue, it is impossible to make a retrospective diagnosis of tuberculosis. This is, however, not a question of the ontology of Disease X because its existence and persistence over historical time is not questioned. What prevent retrospective diagnosis are the differences in human experience, including naming and knowledge, of Disease X. Because this is a form of epistemic argument, I will come back to this question in the next section.

As discussed in the above Section Epistemic challenges of retrospective diagnosis, the best methodology that yields the most plausible retrospective diagnosis is syndrome; all other methodologies of diagnosis more or less require laboratory tests and are not suitable for retrospective diagnosis of historical figures. If a clinician really wants to specify the diagnosis to the level of pathological, etiological or laboratory diagnosis as opposed to syndrome diagnosis, it is more appropriate and less misleading to add a phrase such as “a clinical syndrome similar to or consistent with” before the diagnosis. 

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Regards,
Nancy Ella