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Understanding Biblical Patients : Medical History Of King Saul

SCIENCE REINFORCING FAITH. Understanding Biblical Patients : Medical History Of King Saul. David Katerndahl, M.D.,M.A. University United Methodist Church.

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Understanding Biblical Patients : Medical History Of King Saul

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  1. SCIENCE REINFORCING FAITH UnderstandingBiblicalPatients:Medical History Of King Saul David Katerndahl, M.D.,M.A. University United Methodist Church

  2. “The biggest disease today is not leprosy or tuberculosis, but rather the feeling of being unwanted, uncared for and deserted by everybody.” --Mother Teresa (1910-1997)

  3. Health In Ancient Israel Demographics Many children, few elders Life expectancy = middle-aged, high infant mortality Morbidity-mortality (see Lev 26 & Deu 28) Communicable disease Maternal-infant disorders Dramatic disorders over-represented in Scripture Skin & neuropsychiatric disorders Public health issues particularly important

  4. Medicine As Seen In The Bible Disease linked to sin (OT) or demons (NT) Variety of medical practices/treatments presented Public health & quarantine measures Healers recognized & valued Physicians rarely seen but plentiful?

  5. Physicians In Scripture Negative Viewpoint “no value” (Job 13:4) Failed King Asa (2 Chr 16:12) Failed Tobit (Tobit 2:10) Bleeding woman “endured many physicians” (Mark 5:26) “even good physicians go to hell” (Talmud) Luke’s failures Epaphroditus (Phi 2:30) Timothy (1 Tim 5:23) Trophimus (2 Tim 4:20) Paul (2 Cor 12:7) Positive Viewpoint (Ecclesiasticus) God’s agents (38:1-3) Responsible for using the gifts God gave them (12-14)

  6. Benefits Of Understanding Medicine Behind Biblical Stories Bible provides a glimpse of health care in ancient Israel Most stories of Biblical “heroes” involve medical issues; to understand the stories, we must understand the medicine Medicine is part of the sequential & recurrent messages in Scripture Furthers medicine-religion & spirituality-health discussions

  7. How did the humble warrior Saul become the homicidal king of Israel? Objectives: • Discuss approach to interpreting ancient texts • Review the differential diagnosis for King Saul’s behavior • Review the possible treatment of King Saul’s presumed illness • Understand King Saul’s story based upon his medical diagnosis

  8. THE STORY • Background • Tribe of Benjamin (SmallestTribe) • Ancestors “Wealthy” • FatherKish • Lived in Gibeah, north of Jerusalem • PhysicallyTall and Handsome • EmotionallyHumble • GrownYetSearching for Donkeys • AsksServantBoy for Advice • HidesamongBaggage • Described as “thinkinglittle of himself”

  9. THE STORY • Anointed King (1st King of Israel) (1047 BC) • Encounters Prophet & Judge Samuel • First Act – Rescue of Jabesh-Gilead • Cleaves Oxen into Pieces as Recruitment Tool • Successfully Lifts Siege

  10. THE STORY • Battle of Michmash (Philistines) (1040 BC) • Told to Wait for Samuel to Sacrifice • But Conducts Sacrifices Himself • Battle • Son Jonathan Attacks from Rear • In Resulting Confusion, Saul Makes Frontal Attack • Aftermath • Orders Jonathan’s Execution for Not Fasting

  11. THE STORY • Series of Attacks Against Enemies • Amalekites • Instructed to Slay Every Person & Animal • But Spares Amalekite King & Livestock • Samuel Leaves & Anoints David Privately • “Evil Spirit” Attacks Saul • David Recruited to Play Lyre for Saul

  12. THE STORY • Philistines & Goliath Return (1020 BC) • David Responds to Goliath’s Challenge • Aftermath • Public Acclaim of David → Jealousy & Paranoia • Saul Appoints David as Commander • Offers 2 Daughters as Wives

  13. THE STORY • Public Acclaim of David → Jealousy & Paranoia • Personal Assaults (≥ 2 Spears) • Armed Pursuits (≥ 5 Episodes) • Stopped due to Saul’s “Seizure” • 2 Stopped due to Philistine Attacks • 2 Saul’s Change of Heart in Wilderness

  14. THE STORY • Battle of Mount Gilboa (1007 BC) • Saul Seeks Council from Witch • Hears Spirit of Samuel • When Battle Lost, Commits Suicide • Ends 40-Year Reign

  15. What Do You Think Was Wrong With King Saul?Why Did God Select Saul To Be King And Then Afflict Him?

  16. SCRIPTURAL INTERPRETATION • Written In Hebrew • Words Have Multiple Meanings • Use Multiple Translations • Lack Of Mention ≠ Lack Of Presence • Dramatic Symptoms, Greater Attention • Recognize Cultural Perspective • Assume Nothing Is Superfluous

  17. PHYSICAL DISORDERS? • Seizures1,2 • “…fell down naked all that day and all that night…” (1 Samuel 19:24) (Young’s Literal Translation) • “…for convulsions have seized me… (2 Samuel 1:9) (NRSV) • Demon Possession Associated with Epilepsy in New Testament 1. Preuss & Rosner, 1975 2. Rosner, 1975

  18. PHYSICAL DISORDERS? • Spontaneous Hypoglycemia1 • After Hearing Deceased Samuel’s Voice • “His strength was gone, for he had eaten nothing all that day and night.” (1 Samuel 28:20) (NIV) • Witch Feeds Him & Saul Recovers • Extreme Fasting Could Lead To Seizure • Fasting May Have Been Common With Saul • Ordered Before Michmash 1. Hurwitz, 1971

  19. PSYCHIATRIC DISORDERS? • General Descriptions by Authors • Bright (2000) – emotionally unstable, frenzies of excitement, pressure led to disturbed behavior • Christiansen (2007) – depressed & irrational • Gordon (1956) – episodic anger & violence • Massry & Smogorzewski (1997) – jealousy & depression • Zeligs (1974) – depressive episodes led to rage & aggression with paranoia & OC needs • Kottek (1992) – jealousy, furor, mania & homicidality • Preuss & Rosner (1975) – terror causing him to prophesize & rave, leading to irrational homicidal/rational suicidal behavior

  20. PSYCHIATRIC DISORDERS? • Psychiatric Symptoms Reported • Depression • Anger & Violence • Paranoia • Auditory Hallucinations • Suicide

  21. PSYCHIATRIC DISORDERS? • Disorders Ruled Out • Delusional Disorder – Paranoid Delusions “Bizarre” • Dysthymia – Presence of Psychotic Symptoms • Schizophrenia – Episodic, No Ongoing Deterioration • Prolonged, Unshared Paranoia • Schizophreniform Disorder • Brief Psychotic Disorder • Shared Psychotic Disorder

  22. PSYCHIATRIC DISORDERS? • Criteria for Major Depressive Episode • A. ≥5 symptoms during 2-week period; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. • (1) depressed mood most of the day. • (2) markedly diminished interest or pleasure in activities • (3) significant change in appetite or weight. • (4) insomnia or excessive sleeping • (5) agitation or retardation • (6) fatigue or loss of energy • (7) feelings of worthlessness or excessive or inappropriate guilt • (8) diminished ability to think or concentrate, or indecisiveness • (9) recurrent thoughts of death or suicide. • B. The symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.

  23. PSYCHIATRIC DISORDERS? • Major Depressive Disorder • “Depressed Mood” • 1 Samuel 16:14 - “Depression & Fear” (NLT) - “Evil Mood” (Knox Translation) • 2 Samuel 1:9 - “Gloomy Horror” (Septuagint) • Loss of Appetite (1 Samuel 28:23) • Fatigue (1 Samuel 19:23, 28:20) • Agitation (1 Samuel 18:10) • Sense of Guilt (1 Samuel 15:24) • Suicidal (1 Samuel 31:4)

  24. BIPOLAR DISORDER1,2 • Features of Bipolar Disorder • Family History of Bipolar Disorder – 20% • Average Age-of-Onset ~ 20 Years Old • Suicide Attempts (25-50%) Linked to Depression • Violence & Abuse Linked to Mania • Often After Life Stress • Men With Bipolar Disorder • Initiate Disorder with Mania • Similar Numbers of Depressive/Manic Episodes • Jewish Men Higher Rate of Psychosis in Bipolar 1. Ben-Noun, 2003 2. Christiansen, 2007

  25. BIPOLAR DISORDER • Criteria for Manic Episode • A. “Elevated, Expansive or Irritable Mood” • Episodic Raving (1 Samuel 18:10) • Hebrew Word = “excited to violence” • “Raving like a madman” (NLT) • “Fit of frenzy” (Jerusalem Bible) • Episodes of Sudden, Lethal Anger • Personal Attacks • David (1 Samuel 18:10, 19:1,9) • Jonathan (1 Samuel 20:30) • Priests & Populace of Nob (1 Samuel 22:17-19)

  26. BIPOLAR DISORDER • Criteria for Manic Episode • B. ≥ 3 Symptoms • No Evidence For: • “Decreased Need for Sleep” • “Pressured Speech” • “Racing Thoughts” • “Excessive Involvement in Pleasurable Activities” • “Grandiosity” • “Distractibility” • “Increased Goal-Directed Activity/Agitation”

  27. BIPOLAR DISORDER • Criteria for Manic Episode • B. ≥ 3 Symptoms • “Grandiosity” • Religious Superiority • Makes Sacrifice Instead of Samuel • Disobeys Samuel’s Order to Kill Amalekite King • Views Self as Religious Leader -Prophetic Frenzies -Building of Altars -Offers Sacrifice Instead of Samuel -Orders Fasting -Killing Priests

  28. BIPOLAR DISORDER • Criteria for Manic Episode • B. ≥ 3 Symptoms • “Grandiosity” 2. Inflated Self-Esteem • Builds Monument to Himself 3. Inflated Military Prowess - Michmash • May have Provoked Attack by Raids • Outnumbered 96,000 to 600! • Out-”Gunned” – Saul & Jonathan Only Have Spears/Swords • Weakened Soldiers through Prior Forced Fast

  29. BIPOLAR DISORDER • Criteria for Manic Episode • B. ≥ 3 Symptoms • “Distractibility” or Indecisiveness • Impatient Waiting for Samuel for Sacrifice • Easily Talked out of Attacks on David • Changes Mind about which Daughter for David • Indecisively Seeking Advice • Samuel & his Spirit

  30. BIPOLAR DISORDER • Criteria for Manic Episode • B. ≥ 3 Symptoms • “Increased Goal-Directed Activity/Agitation” • Continual Military Campaigns • Bizarre Cleaving Oxen & Distributing Pieces • Murderous Pursuit of David

  31. BIPOLAR DISORDER • Criteria for Manic Episode • C. Marked Impairment • “Occupational Functioning” • Fearfulness • David • His Own Soldiers • Military Problems • Lets Battle Rest in David’s Hands Against Goliath • Michmash: Attacked with Few, Poorly-Armed Soldiers • Michmash: Fasting Soldiers could not Pursue • Jabesh-Gilead: 370,000 Troops Night Attack (Dougherty et al, 2008) • Israel • Appoints David his Successor/Worried David Prevents his Offspring Inheriting • Jonathan: Saul’s Actions “Trouble” Israel

  32. BIPOLAR DISORDER • Criteria for Manic Episode • C. Marked Impairment • “Relationships” • Almost Executed Jonathan (Heir) • Offers Daughter Merab to David, Then Gave to Adriel • Gave Daughter Michal to David, Then Gave to Palti

  33. BIPOLAR DISORDER • Criteria for Manic Episode • C. Marked Impairment • “Psychotic Features” • Belief in Spirit Possession? • Not Stated that Saul Believed • Part of Culture • Paranoid Delusions • David But Only a Youth • Conspiring Against Him - Jonathan - His Servants • Auditory Hallucination Involving Samuel’s Spirit

  34. BIPOLAR DISORDER • Supporting Evidence • Mood Swings? (Bright, 2000) • Conflicting Extremes • Loves David (1 Samuel 16:21) • Hates David (1 Samuel 18:8) • Suddenness of Evil Spirit (1 Samuel 19:9)

  35. BIPOLAR DISORDER • Supporting Evidence • “Therapeutic” Resolution of 5 Pursuits of David • Aborted After “Seizure” • Electroconvulsive Therapy Highly Effective • Case Report1 • Epilepsy & Bipolar Disorder Misdiagnosed2 • Twice Aborted When Philistines Invade • Aborted in Wilderness of Ziph – Lithium Intake • Cave – Saul’s Urination • River – Saul’s Waterjar 1. Silverstone & Fahy, 1991 2. Pascualy et al, 1997

  36. BIPOLAR DISORDER • Supporting Evidence – Ancient Therapies • Psychosis • Mental Illness – Drink From “Alkali Springs” • Lithium In High Concentrations

  37. BIPOLAR DISORDER • Supporting Evidence • Lithium in Environment • Lithium in Drinking Water/Lower Suicidality1 • Lithium in Israel2 • High in Dead Sea – Periodic Rivers Concentrate Lithium3 • Variable Throughout Israel • Along Jordan Valley • Types of Plants 1. Ohgami et al, 2009 2. Ammari et al, 2010 3. Aral & Vecchio-Sadus, 2008

  38. BIPOLAR DISORDER • Supporting Evidence • Lithium in Environment • Serum Lithium Level & Antipsychotic Response Peak in Summer1,2 • Lithium Levels Affected By:3 • Kidney Disease • Diet • Dehydration • Sweating • Exercise • Mood State 1. Wilting et al, 2007 2. Garver & Hutchinson, 1988 3. Sanborn & Jefferson, 1991

  39. BIPOLAR DISORDER • Supporting Evidence • Lithium Treatment of Mania • Most Effective in Psychotic Subtype of Bipolar Disorder1 • Response Rate = 73%2 • Median Time to Response = 21 Days • Recommended Maintenance Lithium Levels Have Varied3 • Abrupt Change in Lithium Level • More Important Predictor of Relapse than Level4 1. Swann et al, 2002 2. Bowden et al, 2010 3. Keller et al, 1992 4. Perlis et al, 2002

  40. BIPOLAR DISORDER • Supporting Evidence • Therapeutic Effects of Music • Patients With Variety of Serious Mental Disorders • Improves Symptoms • Depression1,2 • Psychosis3 • Social Interaction4 • Dose Response1 • Independent Of Music Type/Structure3 1. Gold et al, 2009 2. Cercone, 2008 3. Silverman, 2003 4. Ulrich et al, 2007

  41. BIPOLAR DISORDER • Supporting Evidence • Family History of Bipolar Disorder • Ancestor(s) Wealthy • Saul Describes Family as Humble • Saul is Farming after Anointed King • Jonathan Impulsive • Michmash – Attacks with Only his Armorbearer • Relationship with David • Immediately “Loves” David • Makes Covenant with David • Gives David his Armor (Recognition of David as Saul’s Heir) • Risks his Life for David

  42. RE-EXAMINING SAUL’S STORY • Background • Lived in Gibeah • FatherKish • Sadistic/Rejecting?1 • IfKish Bipolar, ThenChildhoodHighConflict/ Low Cohesion2 • Controlling? – ControlsErratic Son? • ConcernedAboutSaul (1 Samuel 10:2) • SaulEmotionallyHumble – PossiblyDepressed 1. Zeligs, 1974 2. Miklowitz & Johnson, 2009

  43. RE-EXAMINING SAUL’S STORY • Encounters Prophet & Judge Samuel • Privately Anointed King (1047 BC) • Told He Will Experience “Prophetic Frenzy” & Does • Becomes “Different Person” (1 Samuel 10:6) • Origin of Bipolar Behavior? • Dissociation? – Linked to Suggestibility in Bipolar (Yeager & Olnow, 1997) • Publicly Anointed 7 Days Later

  44. RE-EXAMINING SAUL’S STORY • Rescue of Jabesh-Gilead (1 Month Later) • Power & Anger Overcome Saul (1 Samuel 11:6) = Mania? • Cleaves Oxen into Pieces as Recruitment Tool • 370,000 Respond & Successfully Lift Siege

  45. RE-EXAMINING SAUL’S STORY • Battle of Michmash (2? Years Later) • Manic Saul Sends Jonathan To Attack Geba, Provoking Philistines • Told to Wait for Samuel to Sacrifice/Conducts Sacrifices Himself • Battle – 96,000 Armed Philistines vs. 600 “Unarmed” Israelites • Saul Orders Pre-Battle Fasting • Manic Jonathan Attacks from Rear • In Resulting Confusion, Saul Makes Frontal Attack • Fasting Israelites Cannot Pursue Philistines • Aftermath • Saul Builds Altar • Saul Orders Jonathan’s Execution for Not Fasting

  46. RE-EXAMINING SAUL’S STORY • Series of Attacks Against Enemies Over Years • Reward Sensitivity With Goal Attainment (Miklowitz & Johnson, 2009) • Amalekites • Samuel Instructs Saul to Slay Every Person & Animal • But Saul Spares Amalekite King & Livestock • Manic Saul Erects Monument to Himself (1 Samuel 15:12) • Samuel Leaves & Anoints David Privately • “Evil Spirit” Torments Saul (1 Samuel 16:14) • David Recruited to Play Lyre for Saul, Relieving His Depression

  47. RE-EXAMINING SAUL’S STORY • Philistines & Goliath Return (1020 BC) • Manic Saul Places Fate in Youthful David’s Hands • Aftermath • Jonathan “Loves” David (1 Samuel 18:1) • Public Acclaim of David → Jealousy & Paranoia • But Impulsive Saul Appoints David Commander

  48. RE-EXAMINING SAUL’S STORY • Indecisive Saul Offers 2 Daughters to David as Wives • Offers Merab But Gives Her to Adriel Beforehand • Offers Michal • Marriage Present = 100 Philistine Foreskins • Intent = David Be Killed? (1 Samuel 18:25)

  49. RE-EXAMINING SAUL’S STORY • Paranoid Saul Assaults David • Discussed Killing David with Jonathan & Servants • Twice Throws Spears at David Triggered by David’s Successes • Armed Pursuits (≥ 5 Episodes)

  50. RE-EXAMINING SAUL’S STORY • Personal Assaults • Armed Pursuits (≥ 5 Episodes) • Stopped Due to Saul’s “Seizure” • Jonathan Defends David & Saul Throws Spear at Him • Saul Kills Priests/Populace of Nob But Stopped Due to Philistine Attack • Stopped Due to Philistine Attack • Saul’s Changes of Heart Twice in Wilderness • Cave – Refrains from Killing when Saul Urinating • Samuel Died & After Giving Michal to Palti, Saul Along River – David Uses Waterjar as Proof of Ability to Kill Saul

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