Review - Cultures of Neurasthenia
From Beard to the First World War
by Marijke Gijswijt-Hofstra and Roy Porter (editors)
Rodopi, 2001
Review by Mark Welch, Ph.D.
Jul 25th 2002 (Volume 6, Issue 30)

This is one of the last books produced by the late and very lamented Roy Porter, perhaps the most eminent scholar of his generation in the history of medicine, and psychiatry in particular. It may not be the very last of course, because, as William Bynum put it in his obituary, Porter seemed to write books at the speed that most of us manage to read them.

Although Porter is only the co-editor the book bears the hallmarks of his approach to scholarship. It is a collection of essays, in this case papers developed from a workshop held in Amsterdam in June 2000 entitled “Neurasthenia and Society”, and is collaborative and wide-ranging, interweaving themes and disciplines into a rich textured and layered approach, as often as not a social history “from below” as one confronting grand narratives. It consists of 16 chapters and a lengthy introduction, and moves from the late eighteenth to the early twentieth century and considers the cultural contexts of neurasthenia in America, Britain, Germany and the Netherlands in particular. It is erudite and generous in approach, and gives the contributors the opportunity to develop conference papers into extended essays.

Although first introduced as a term in 1856 by Robert Mayne in his Expository Lexicon of Terms it was the American “neurologist and electrotherapist” George Miller Beard who really popularized and promoted neurasthenia as an explanation of, and reaction to a malaise of modernity. For Beard, neurasthenia is not only archetypically American and modern, it was also an inevitable and acceptable reaction to the fast pace of urban life and the psychological dislocation it caused. Although the heyday of neurasthenia as a diagnosis may have been in the early years of last century, and it may seem a historical curiosity, the aetiological and explanatory ideas still preoccupy us today. What is our relationship to modern culture, what does it do to our psychological wellbeing, how do we relate to one another, what do we feel we have lost? Why should this be and what does it tell us about ourselves? The parallels that are explored through these essays indicate that, in many ways, the more things change, the more they remain the same.

Neurasthenia was often considered to be a disease of the elite. Perhaps of those who had the time and the money to consider their world-weariness and to pay for the cure that often required a stay in a health spa or sanatorium. The rich would be, as a matter of course, be more highly developed and sensitive, perhaps like pure bred race horses, while the poor, who may have demonstrated many of the same symptoms, would be the donkeys of the world and be suffering more from the effects of hard physical labour, sometimes in combination with the labour of childbirth as well.

Tom Lutz in particular considers the relation of neurasthenia to the more contemporary conditions that characterize chronic fatigue syndrome. He also explores the acceptance of organic or physiological explanations of the disorder compared with psychogenic ones, and argues that this persists to the present day as an example of an “overdetermined desire” to separate psyche and soma. This has treatment consequences as well. As noted, Beard himself was an enthusiastic electrotherapist, and the list of electric belts and vibrators and proprietary cures make entertaining reading, but we should be aware of any hubris here. The practice of hysterectomies and psychosurgery is not so far from our present practice that we can afford to be smug.

One of the more interesting themes, developed by a number of authors, is the contrast in the failing popularity of neurasthenia in the mainstream culture in the West after World War One, although there was a continuing taste for it in the treatment of Veterans (although more so in America than elsewhere) and also in more recently industrialized cultures such as China, Japan and Taiwan. Again, this is seen to be as a result of a physiological explanation for the condition. Clearly, in this model, the “nerve weakness” shown by battle fatigued soldiers could be seen as extreme stress placed upon their nervous system and not any weakness of the mind, and in newly industrialized countries could be seen as a mark of the elite, after the fashion of America. However, the acceptance and use of neurasthenia was not uniform, nor necessarily predictable. Opposite social attributes, for example optimism and pessimism in fin de siecle Netherlands and Germany respectively, give rise to the same observations of being popular or not. And vice versa.

There is also the gender differentiation in diagnostic practice. Many more women than men were likely to be diagnosed. Gynaecologists were particularly fond of the diagnosis, and it is no coincidence that only the rich could afford them. There are not too many cases of backstreet midwives recommended a rest cure in the mountains. The explanation for this seems to lie in the underlying thesis of social construction.

All the authors subscribe to this position, and the way in which they marshal their arguments is impressive. There are some distinct differences in styles and sometimes this can mean that a close reading is required to note the ways in which the cultures differ in their approach to and acceptance of neurasthenia as a diagnosis. Nevertheless, although the simple premise that the different ways in which cultures account for the same behaviours and attributes must be as a result of different cultures and values is not new, but this volume adds to our understanding of how and why that may come about. Neurasthenia may be a case of old wine in new bottles, but as is pointed out, it was ever thus. The reaction of many British physicians of the nineteenth century was just as it is today – a new fangled term for an old problem. However, if the real point of history is to help to explain ourselves to ourselves, this collection of essays makes a very worthwhile contribution.

© 2002 Mark Welch

Dr Mark Welch is currently a Senior Lecturer and Postgraduate Coordinator in The School of Nursing at the University of Canberra, Australia. His PhD investigated the representation of madness in popular film, and his other research interests include the mental health of refugees and victims of torture, and the history of psychiatric epistemology.