Bottle of bromocarpine nerve tonic, Paris, France, 1870-1930
Drawing a line between mental and physical illness only troubled European physicians from the 1600s. Previously, humoral diagnoses such as spleen and vapours had made sense of persistent pains, exhaustion and other elusive chronic illnesses. These traditional explanations gradually yielded to the idea that some sicknesses were simply rooted in the nerves. This shift was partly inspired by early anatomical investigations of the brain and nervous system.
The nervousness of the English
The diagnosis of ‘nerves’ became fashionable among the upper classes. Popular and medical opinion linked nervous sensitivity to delicacy and refined sensibilities. A Scottish physician dubbed nervous illnesses ‘the English malady’ in 1733, and traced the causes to moist air, fickle weather, heavy food and activities that reflected a society with too much time and money. However, the idea of ‘nerves’ persisted. It allowed people with nervous symptoms to avoid the stigma and prejudice associated with mental health problems. ‘I’m not ill, but I’m nervous,’ King George III assured his worried court.
A plague of nerves?
Industrialisation and urbanisation spread in the 1800s. Nervous illness became more than an English problem. Men and women across Europe and North America struggled with debilitating but elusive physical symptoms. Some suffered such pain and exhaustion that they were bedridden for weeks or months. Eminent Victorians such as Charles Darwin and Florence Nightingale were disabled at various points in their lives by mysterious illnesses. Doctors and patients struggled to make sense of this widespread problem. It was given the names hysteria, nervous breakdown and neurasthenia among others.
Office treatments and home remedies
Neurologists specialising in nervous illnesses argued they were disorders of the body, not the mind. This meant patients avoided the hopelessness associated with asylums. Popular neurological treatments included hypnosis, electrotherapy and the rest cure.
They were carried out in doctors’ offices, health spas or patients’ homes. Some therapies were criticised - women’s rights pioneer Charlotte Perkins Gilman was a rest-cure patient and described her experiences in her chilling short story ‘The Yellow Wallpaper’.
These expensive therapies gave neurologists wealth and prestige. There were also more affordable but risky treatments, such as nerve tonics. Another popular and relatively safe treatment for neurasthenic men was vigorous outdoor exercise. American President Theodore Roosevelt battled neurasthenia throughout his life, and was impressed by nature’s therapeutic effects. Roosevelt championed the founding of the USA’s national parks, expanses of government-owned wilderness set aside for later generations.
From nerves to neurosis
In the German-speaking world, neurasthenia figured alongside hysteria and trauma into political debates about degeneration.In the early 1900s critics of Germany’s pioneering welfare system alleged that increased nerve-related pension claims proved the working classes were degenerating. German nerve doctors adapted to these highly charged politics by distinguishing neurological diseases from neurosis - neurological diseases had a proven anatomical basis; neurosis was neither clearly physical nor clearly mental. Diagnoses such as neurasthenia, nervous breakdown and hysteria were eclipsed by neurosis in the early 1900s, partly thanks to the prestige of German medicine.
A physical basis for neurosis was never found. An alternative understanding based on psychoanalysis emerged in the early 1900s. It argued neurosis was rooted in unconscious emotional conflicts, not weak nerves. By the 1930s, treating neurosis became the domain of psychoanalysis and psychiatry. This was especially true in the United States, where many of Freud’s followers exiled from Nazi Germany ended up. Nervousness was now a problem of the mind, not the body.
Now-obsolete diagnoses such as ‘nerves’ and neurasthenia still offer instructive parallels with illnesses worldwide. These include shenjing shuairuo in China, nervios in Latin America, dhat syndrome in India and hwa byung in Korea - illnesses that blur the line between mind and body. Such culturally specific diagnoses may suggest non-Western medical traditions place less emphasis on drawing a line between physical and mental illness than biomedicine. In this era of globalisation they also represent ways societies worldwide resist the dominance of Western psychiatry and multinational pharmaceutical corporations.
Related Themes and Topics
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M Gijswijt-Hofstra and R Porter (eds), Cultures of Neurasthenia from Beard to the First World War (Amsterdam: Rodopi, 2001)
E Green Musselman, Nervous Conditions: Science and the Body Politic in Early Industrial Britain (Albany, NY: State University of New York Press, 2006)
J Oppenheim, Shattered Nerves: Doctors, Patients, and Depression in Victorian England (Oxford: OUP, 1991)
V Roelcke, Krankheit und Kulturkritik: psychiatrische Gesellschaftsdeutungen im bürgerlichen Zeitalter (New York: Campus, 1999)
A term for a mental illness caused by too much black bile (one of the four humours) in the body. Used from Greek medicine until the 1700s. Those experiencing spleen had restlessness, anxiety, solitude, sudden fits of anger and laughing or crying without reason to.
The name given to the medical practice that is based on the sciences of the body, such as physiology (the functioning of the body).