I’ve recently had the joy of a dealing with a dental abscess affecting the left hand side of my mandible, and whilst I’m thankful for modern medicine I can only imagine the pain and frustration for pre-modern populations suffering with such an infection, especially those who didn’t have access to antibiotics and strong painkillers. As such I haven’t posted properly for a while, and it might be a bit longer before I do. Having had surgery to relieve the effect of the swelling and to drain the infection and remove two pesky teeth (with added complications courtesy of Fibrous Dysplasia), I’m once again learning how to chew (farewell 1st and 3rd left mandibular molars!). It has also given me the time to think about the role of disability in the archaeological record and how it is approached by modern-day researchers. What follows below is a very quick and brief overview of the main points of how disability has been approached in the archaeological sector and the changes therein. Articles of interest are noted in the bibliography.
Dettwyler famously wrote a paper entitled ‘Can paleopathology provide evidence for compassion‘ (1991: 375-384, PDF embedded) that rightly questioned the interpretations of archaeologists and osteologists on the inferred aspects of care and compassion that disabled individuals from the archaeological record may or may not have received during their lifetimes. The author cautioned that archaeologists and researchers are not ‘justified in drawing conclusions either about quality of life for disabled individuals in the past or attitudes of the rest of the community from skeletal impairment of physical impairment’ (Dettwyler 1991: 375). This was a much-needed wake up call, and rightly raised questions in the realms of archaeology and palaopathology regarding how we viewed individuals, and how we analysed them.
The majority of disability studies before the Dettwyler (1991) article focused on disabled individuals as case studies, reported in journals and rarely integrated or investigated as part of the society or cemetery population they may belonged to. Mays (2012) rightly investigated the impact of the relative value of individual case studies compared to quantitative and problem orientated population studies, and found that although the publishing gap had lessened between the two types, singular case studies still predominated. Mays (2012) main contention is that individual case studies do little to further the advance of palaeopathology, something which Larsen (1997) effectively demonstrates throughout his book and review (2002), in the consideration of how palaeopathology can indicate society or cultural wide rituals, actions or lifestyles.
Since the publication of the Dettwyler paper there has been a slew of articles, journals and books dedicated to researching disability as evidenced from the skeletal and archaeological record, both from a bioarchaeological perspective and from a theory perspective (Battles 2011, Brothwell 2010, Hawkey 1998, Kleinman 1972, Vilos 2011, Wood et al. 1992). Indeed the study of disability and the implications for affected individuals, their communities and societies, has moved on considerably since the descriptive days of Calvin Wells, especially in the consideration of the theory of ‘compassion’ as an evolutionary force in the primate family (Hublin 2009, Stewart et al. 2012), or as evidenced in other mammals (Fashing & Nyuyen 2011).
This is in accordance with the rise and debate of disability theory and studies in numerous other disciplines. This has had real life applications in many areas of modern-day life, where multi-agented approaches to understanding, recognising and implementing programs that are designed to raise awareness or life quality for disabled individuals. Two prominent examples from the UK are the 2005 Disability Discrimination Act and the 2010 Equality Law where disability itself is given a legal definition, and here we come to a prominent problem in the archaeological and palaeopathological record itself.
Disability, as we would recognise it today, can mean both a physical and/or a mental impairment that can be substantial and lifelong, and it is worth noting some problems inherent in the archaeological record. Firstly, in the archaeological record, we can only recognise physical disability when it has affected the skeletal remains of individuals, normally at a late and severe stage in the disease progression (Aufderheide & Rodriquez 1998, Waldron 2009, Wood et al. 1992). As such, a large number of individuals with diseases or traumatic injuries that only affected the flesh will go unknown, and as such are unstudied. Secondly, there is no universal or standard definition of disability that archaeologists and researchers use, it is solely up to the person/persons to define clearly and openly which definition they are using at the outset of their research (and there are a lot of definitions and models depending on which source you base your definition on). Thirdly, the usage of terminology itself, such as the very word disability, can have vastly different connotations or implications for different populations and cultures (Battles 2011).
There may have been distinct differences as to who was considered disabled or not in historic and prehistoric cultures, and we should, as researchers, always be aware of observer bias ourselves (Dettwyler 1991). As such researchers should always be clear who they are addressing, and the possible differences highlighted, where evidence is available, as to how a disabled person was treated within their culture when archaeological or cultural evidence is available.
To complicate the matter further is the ‘osteological paradox‘, as highlighted by Larsen (1997), Woods et al. (1992) and Wright & Yoder (2003) amongst others, which heavily influences the health status of skeletal remains that survive and that are then studied. Therefore it should always be understood that no skeletal sample is entirely representative of their population, that there are many caveats (Hahn 1995, Roberts 2000).
Battles (2011) highlighted the need to move towards a more holistic approach to disability, to take advantage of different fields (including physical anthropology, sociocultural anthropology, experimental studies and archaeology itself) to understand disability at archaeological sites and affected individuals, to a model that integrates the data and insight of the various fields. In particular Battles (2011) makes the salient point of noting the individuals (largely females and sub-adults) that historically have been under-studied in archaeological and population analyses.
An important methodological update has been the advancement of a ‘Bioarchaeology of Care‘, as espoused by Tilley & Oxenham (2011), where a four stage assessment of an individual produces an assessment of the care needed for the disabled individual found in a Neolithic Vietnam community. The stages are: (1) describing, diagnosing and documenting the individual and site, (2) identify the clinical/functional impacts of disease or trauma, and determine if care was needed, (3) produce a model of care, and finally (4) interpret the implications for the individual and society, as well as possible indications for the identity and nature of both (Tilly & Oxenham 2011: 36). It could be argued that other researchers have espoused the same sentiments (Roberts & Manchester 2010, Vilos 2011), but it is the clear initiation of the applying the model to individuals who fit the criteria that will hopefully produce further studies and elicit meaningful result which highlight this recent study as one to watch. The Tilley & Oxenham (2011) model is particularly useful for prehistoric cases where there are no written or documentary sources.
Hawkey’s (1998) study of musculoskeletal markers (MSM’s) of a disabled individual from a New Mexico Pueblo culture highlighted the worth of applying existing osteological techniques to disabled individuals in order to assess the quality of bodily movement. The modelling of the movement capable for this individual suggested that bodily manipulation, feeding, and the cleaning of this person was likely carried out by members of his culture (possibly family relatives, although this is conjecture) due to the severity of his disability (Hawkey 1998: 330). Craig & Craig (2011) make extensive use of modern medical imaging to diagnosis a specific disease (fibrous dysplasia) in the case of a sub-adult from an English Anglo-Saxon site. The striking bone expansion in the mandible is discussed within the social sphere of the community that the individual belonged. The implications, via the the inference of position of the body within the grave, grave goods and grave location, and studies into Anglo-Saxon culture and social stratification give rise to the theory that the individual was not treated any differently due to his disability, although it is unknown if the disease led to the early demise of the individual (Craig & Craig 2011: 3).
Craig & Craig’s (2011) case study, and the above studies, highlight the use of modern medical literature and imaging technology in establishing a likely disease diagnosis, yet Brothwell (2010) rightly highlights the dangers of the differential diagnosis of diseases in skeletal remains at a macroscopic level. Waldron’s (2009) palaeopathology handbook presents an ideal source on how to identify diseases that can lead to disability, but highlights the value of the differential diagnosis when the osteologist cannot be exactly sure of the disease.
The battery of scientific techniques used in archaeological investigations, including aDNA analysis, trace chemical analysis, and isotopic analysis amongst others, have become significantly refined within the past two decades, and are now allowing for a more nuanced understanding of individual and population dynamics (Brown & Brown 2011). This includes the ability to analysis the movement of a person in a landscape within their lifetime (Marstellar et al. 2011), and to understand the changes in diet and the effects of diet on the body (Larsen 1997, Roberts 2000, Roberts & Manchester 2010). It also includes the ability to indicate the likely exposure of populations to various chemicals and diseases (Barnes et al. 2011), and exploration of how social structure (Bentley et al. 2012), and hence the role of the population or of the individual, changed through time.
Perhaps what the above studies cannot show, especially in prehistoric societies, are the actions of the disabled individuals themselves. It is most likely that we will never know if they took an active interest in their society, if they took part, or how they felt as disabled individuals, or even if they saw themselves as disabled (Battles 2011, Hahn 1995). Compassion itself cannot be excavated (Dettwyler 1991), but with careful examination of the available evidence results can be produced that suggest that severely disabled individuals did survive past natural limitations.
The progress continually being made in the hard sciences and in the humanities continues to advance our knowledge of past populations via their skeletal remains and their cultural context. The understanding of disability within an archaeological and osteological context provides the opportunity to investigate of how individual’s survived, and whether care was a key component (Hawkey 1998, Kleinman 1978, Tilley & Oxenham 2011). This is a burgeoning area of bioarchological research, and when combined with a multidisciplinary approach, it opens up a wide range of interesting and diverse approaches and avenues.
Case Studies, Theories and Further Information:
Full articles are linked where possible, although a number hide behind Journal pay walls.
Aufderheide, A. C. & Roderiquez-Martin, C. 1998. The Cambridge Encyclopedia of Human Palaeopathology. Cambridge: Cambridge University Press.
Barnes, I., Duda, A., Pybus, O. G. & Thomas, M. G. 2011. Ancient Urbanization Predicts Genetic Resistance to Tuberculosis. Evolution. 65 (3): 842-848.
Battles, H. 2011. Toward Engagement: Exploring the Prospects for an Integrated Anthropology of Disability. Explorations in Anthropology. 11 (1): 107-124.
Bentley, R. A., Bickle, P., Fibiger, L., Nowell, G. M., Dale C. W., Hedges, R. E. M., Hamiliton,. J., Wahl, J., Francken, M., Grupe, G., Lenneis, E., Teschler-Nicola, M., Arbogast, R-M., Hofmann, D. & Whittle, A. 2012. Community Differentiation and Kinship Among Europe’s First Farmers. Proceedings of the National Academy of Sciences Early Edition. 1-5. (Early View).
Brothwell, D. 2010. On problems of Differential Diagnosis in Palaeopathology, as Illustrated by a Case from Prehistoric Indiana. International Journal of Osteoarchaeology. 20: 621-622.
Brown, T. & Brown, K. 2011. Biomolecular Archaeology: An Introduction. Chichester: Blackwell Publishing.
Churchill, S. E., Franciscus. R. G., McKean-Peraza, H. A., Daniel, J, A. & Warren, B. R. 2009. Shanidar 3 Neandertal Rib Puncture Wound and Palaeolithic Weaponry. Journal of Human Evolution. 57: 163-178.
Craig, E. & Craig, G. 2011. The Diagnosis and Context of a Facial Deformity from an Anglo-Saxon Cemetery at Spofforth, North Yorkshire. International Journal of Osteoarchaeology. (Early View doi: 10.1002/oa.1288).
Dettwyler, K. A. 1991. Can Palaeopathology Provide Evidence for “Compassion”? American Journal of Physical Anthropology. 84: 375-384.
Fashing, P. J. & Nguyen, N. 2011. Behaviour Towards the Dying, Diseased, or Disabled Among Animal and its Relevance to Palaeopathology. International Journal of Palaeopathology. 1: 128-129.
Hahn, R. A. 1995. Sickness and Healing: An Anthropological Perspective. New Haven: Yale University.
Hawkey, D. E. 1998. Disability, Compassion and the Skeletal Record: Using Musculoskeletal Stress Markers (MSM) to Construct an Osteobiography from Early New Mexico. International Journal of Osteoarchaeology. 8: 326-340.
Hublin, J. J. 2009. The Prehistory of Compassion. Proceedings of the National Academy of Sciences. 106 (16): 6429-6430.
Kleinman A. 1978. Concepts and a Model for the Compassion of Medical Systems as Cultural Systems. Soc Sci Med. 12: 85-93.
Knusel, C. J. 1999. Orthopaedic Disability: Some Hard Evidence. Archaeological Review Cambridge. 15: 31-53.
Larsen, C. 1997. Bioarchaeology: Interpreting Behaviour from the Human Skeleton. Cambridge: Cambridge University Press.
Larsen, C. S. 2002. Bioarchaeology: The Lives and Lifestyles of Past Peoples. Journal of Archaeological Research. 10 (2): 119-166.
Marstellar, S. J., Torres-Rouff, C. & Knudson, K. J. 2011. Pre-Columbian Andean Sickness Ideology and the Social Experience of Leishmaniasis: A Contextualised Analysis of Bioarchaeological and Palaeopathological Data from San Pedro de Atacama, Chile. International Journal of Palaeopathology. 1 (1): 23-34.
Mays, S. 2012. The Impact of Case Reports Relative to Other Types of Publication in Palaeopathology. International Journal of Osteoarchaeology. 22: 81-85.
Roberts, C. A. 2000. ‘Did They Take Sugar? The Use of Skeletal Evidence in the Study of Disability in Past Populations’. In Hubert, J. (ed) Madness, Disability and Social Exclusion: The Archaeology and Anthropology of Difference. London: Routledge. 46-59.
Roberts, C. & Manchester, K. 2010. The Archaeology of Disease. Stroud: The History Press.
Stewart, F.A., Piel, A.K., O’Malley, R.C., 2012. Responses of Chimpanzees to a Recently Dead Community Member at Gombe National Park, Tanzania. American Journal of Primatology. 74: 1–7.
Tilley, L. & Oxenham, M. F. 2011. Survival Against the Odds: Modelling the Social Implications of Care Provision to the Seriously Disabled. International Journal of Palaeopathology. 1 (1): 35-42.
Vilos, J. D. 2011. Bioarchaeology of Compassion: Exploring Extreme Cases of Pathology in a Bronze Age Skeletal Population from Tell Abraq, U. A. E. Master’s Dissertation. Las Vegas: University of Nevada.
Waldron, T. 2009. Palaeopathology. Cambridge: Cambridge University Press.
Wood, J. W., Milner, G.R., Harpending H. C., & Weiss, K. M. 1992. The Osteological Paradox: Problems of Inferring Prehistoric Health from Skeletal Samples. Current Anthropology 33: 343-370.
Wright, L. E. & Yoder, C. J. 2003. Recent Progress in Bioarchaeology: Approaches to the Osteological Paradox. Journal of Archaeological Research 11 (1): 43-70. (**An extensive bibliography of articles can be found in the bibliography of this article**).