Neurasthenia 101
Note: In the Spring of 2023, I did my senior project for my Disability Studies degree on historical views on illness and how those have influenced modern views on chronic illness, and I focused a lot on one historical diagnosis in particular, Neurasthenia, which shared many symptoms with the conditions we today call Fibromyalgia and ME/CFS (also known as Chronic Fatigue Syndrome, though many patients prefer ME/CFS). I was going to do a new writing project on Neurasthenia, but I figured I would post it here instead, along with my other work on chronic illness and disability. So, here is Neurasthenia 101, and you can expect more posts about Neurasthenia along with my other work.
Neurasthenia 101
Neurasthenia, also called nervous exhaustion, was a common diagnosis in America in the last decades of the 19th century and the first half of the 20th century. Derived from Greek, the name translates roughly to “lack of nerve energy." As Schuster says in the introduction to the book Neurasthenic Nation: America's Search for Health, Happiness, and Comfort, 1869-1920, "Neurasthenia became a common diagnosis because it was an eminently versatile label, an umbrella term under which people included a myriad of symptoms and supposed causes. It covered ground comparable with a broad collection of twenty-first-century diagnoses, including bipolar disorder, clinical depression, chronic fatigue syndrome, fibromyalgia, post-traumatic stress disorder, anorexia nervosa, irritable bowel syndrome, migraines, environmental allergies (including hay fever), and a host of other chronic illnesses identified but not entirely cured by modern medicine."
The diagnosis had several health professionals who were interested in researching it, among the most notable were George Beard, Weir Mitchell, and Edwin Holmes Van Deusen. Treatment suggestions that were typically made by experts including Beard and Van Deusen were mild exercise, dietary changes, rest, nerve tonics, and sponge baths. Beard, Van Deusen, and Mitchell each came up with theories on the causes, the demographics most impacted, and the best treatments. As the name implies, one of the major theories was a depletion in the body's "nervous energy supply." Despite the fact that neurasthenia was diagnosed in multiple continents, it was nicknamed "The American Disease" or "Americanitis" and Beard wrote a book called "American Nervousness." The nickname of this condition reflected the public's anxiety that there was something about American society itself and the newer conditions of American life causing the illness. There was a belief that aspects of urban city life increased the frequency of the condition, although it was also thought to be very prevalent in farm wives. Oscar Wilde, Franz Kafka, Virginia Woolf, Max Weber, and Edith Wharton were all diagnosed with Neurasthenia.
Mitchell introduced the idea that the cause of neurasthenia was some sort of emotional disturbance. He noted that patients often mentioned emotional traumas and anxieties and believed these were the causes of their lack of energy and other symptoms. Mitchell encouraged his patients to avoid giving into their pain. The social isolation involved in his infamous rest cure, made famous by writer Charlotte Perkins Gilman who had a negative experience with this treatment under Mitchell’s care that became the inspiration for her short story The Yellow Wallpaper, was partially due to his belief that people with neurasthenia have a longing for sympathy that is encouraged by others. By the mid-1880's, neurasthenia became a common topic in popular culture due to increased publicity from physicians, journalists, people selling treatments, and patients themselves. It became common for treatments, such as tonics, to be advertised in newspapers and popular health manuals.
Because the cause of neurasthenia was unclear, several different aspects of society were blamed. One of these was "overwork of the mind." This is one of the reasons it was thought that neurasthenia was more common in cities than rural towns. Workers who did manual labor on farms were not thought to be at risk, as their jobs supposedly did not use as much "brain power" and they received a good amount of exercise. People in cities, however, were thought to be more likely to do work that depleted their "nervous energy" and were thus considered the perfect victims of neurasthenia. Competitive education was thought to be a public health threat because it encouraged a “sedentary lifestyle” and the use of more “mental energy.” There were gendered aspects to the theories about neurasthenia's cause. For example, Dr. Cyrus Edson theorized that "active American life wore on the nerves of women more than on those of men, because women usually exercised less, suffered the strain of childbirth, and generally had more highly wrought nervous systems." There were also racist ideas regarding who was susceptible to neurasthenia. Beard believed that Native Americans and Black Americans were not susceptible because they “lived in ignorance" and were more "primitive," making them less likely to overthink. The ways ideas about race, gender, and class influenced the diagnosis of Neurasthenia are a reminder that people in medicine hold prejudiced views that impact their work as healthcare professionals, something we should all still be concerned about today.
While different people have different theories about what neurasthenia really was, and many believe it was caused by anxiety or depression rather than a physical illness, I tend to agree with those who believe many cases were what we now call Fibromyalgia, ME/CFS (also called chronic fatigue syndrome), or a similar chronic illness. For my project, I looked at old newspapers, and I found many parallels between the rhetoric surrounding neurasthenia and the rhetoric about fibromyalgia and ME/CFS. I will look at these more in future posts.
Other Neurasthenia-related topics I'd like to cover here in the future:
How Christian Science, "The Mind Cure," and psychology killed this diagnosis
How ableist views about Neurasthenic patients resemble ableist views about people with chronic illnesses today
Narratives of patients with Neurasthenia
What newspapers said about Neurasthenia patients
Sources
Schaffner, A. K. (2016). Exhaustion: A history. Columbia University Press.
Schuster, D. G. (2011). Neurasthenic Nation: America's search for Health, happiness, and comfort, 1869-1920. Rutgers University Press.