Did Alexander the Great suffer from CTE?

The following are some thoughts on this article, which, in short, suggests that the personality changes over the course of Alexander the Great’s reign could have been caused by Chronic Traumatic Encephalopathy (CTE) perhaps caused by his shorter than average height. In other words, to quote Jake Nabel, Alexander the Great “often got bonked on the head.”

The thrust of the article is as follows: Alexander the Great was short and was therefore closer to his opponents and was struck in the head by at least glancing blows in the sources with some regularity. As has been a topic of concern in the arena of football, repeated head trauma can lead to CTE, which manifests with symptoms such as altered personality, uncommon susceptibility to alcohol, blackouts, extreme emotional swings, paranoia, and violence. All of these symptoms are attributed to Alexander and CTE provides an explanation that accounts for the greatest number of symptoms, ergo Alexander had CTE.

Some of the points made in the article are provocative and worth consideration. The focus on CTE could be poo-pooed as a flash-in-the-pan contemporary concern brought on by modern athletics, but ought to be taken into account in how we think about ancient warfare. Our medical data from antiquity is, effectively, non-existent, but human physiology hasn’t changed that much.

That said, I am skeptical of the larger argument.

First, I think that Alexander’s shortness, while a generally accepted fact, is a bit of a red-herring, not only because he was frequently fighting from horseback, but also because I wonder whether the difference in height would have made a significant difference over, say, his recklessness. Then, is it necessary to single out Alexander from the other Macedonians whose bodily harm receive less attention?

Second, the author implies that Alexander’s men also became more violent as Alexander’s head trauma grew worse. The implication is that they were following Alexander’s orders, but I am mistrustful of such a direct causal relationship, particularly because the author (following the model of the ancient sources) chooses to focus directly on Alexander’s erratic behavior. This is not a problem unique to this article, but is endemic in the thinking about Alexander the Great’s campaigns.

Third, the author too readily accepts the ancient sources at face-value, something which has been called into question, particularly on the issue of wounds (see particularly: Riginos, JHS, 1994). I happen to believe that Alexander the Great was wounded fairly regularly and sometimes severely, but hinging an argument on the specifics of the wounds is problematic, to say the least. This approach sees the symptoms and then goes looking for the wounds to support the thesis, without questioning whether those wounds might not have actually existed.

Fourth, and building from the issues of sources, all of which were composed or written hundreds of years after Alexander died, the article in question seemed to me to downplay any political, social, or literary explanation for the changes in Alexander’s behavior. On the one hand, this is the rhetoric of a journal article, but, on the other, it ignores how a Roman philosophical context shaped the accounts of Alexander murdering Cleitus just as much as it ignores the strains placed on the court by Alexander’s appointing Persian nobility to important positions, thereby challenging the supremacy of the Macedonian elite.

The author concludes by invoking the unsolved mystery that is Alexander’s death and suggesting that Alexander’s greatness should be read in terms of disability because of how long he functioned with a deteriorating brain. (I assume this differs from the alcoholism thesis because the latter is self-inflicted.) Such post-facto, blind diagnoses are deeply problematic, good for a headline, but light on substance.

Like many theories about the ancient world, the idea that Alexander suffered from CTE or a comparable type of trauma cannot be discounted because there is not enough evidence one way or another. The author is certainly correct that a surface-value reading of the evidence does supply evidence for CTE, and I like this explanation better than an anachronistic attribution of “alcoholism.” And yet, it is also necessary to pull back to see where this fits within the larger context rather than looking to isolate CTE as a universal explanation for the changes in Alexander’s behavior.

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