The Victorian Diagnosis That Vanished Before It Even Began
I’ve long been struggling with feelings of fatigue, so when in one of these ‘slumps’ I thought I’d look into how fatigue was treated in the Victorian era- as you do. With any kind of struggle, I find great comfort in seeing examples from the past to remind myself countless humans have been through exactly the same things I have and, somehow, humanity still persists, so it can’t be all that bad can it? If you have even a passing interest in the Victorian era then you will probably have heard of hysteria as a genuine diagnosis, but have you heard of something called neurasthenia?
I had never heard of the term before; apparently it originated in America, so perhaps American history nerds are more aware of this brief fad. Introduced by George Beard in 1869, ‘neurasthenia’ was a diagnosis given to those with extreme physical and mental fatigue, as well as muscle weakness. This was complimented by a wide range of other symptoms, mostly stemming from the results of fatigue; depression, anxiety, a lack of concentration and insomnia. He believed that it affected male intellectuals and professionals most, as they were prone to such ‘nervous diseases’, but as other doctors adopted the diagnosis it appeared to be spread far more widely. By the turn of the century it was being deemed a ‘fashionable disease’, in the same way that tuberculous was only years prior, something that affected only the rich grasping for individuality.
John White Alexander (a diagnosed neurasthenic), ‘Repose’
Why was this the prevailing narrative? Well, for a start, healthcare was not universal. The rich could afford private doctors and therefore got diagnosed. It was used almost as a catch-all by doctors; it is believed now, by reading the case studies, that many of the complaints were signs of other issues, such as thyroid disease, anemia, anorexia and chronic fatigue. If you were poor but lucky, you could be admitted to one of the many new hospitals funded by Victorian philanthropy, and that is how we have proof of more working-class people diagnosed with neurasthenia. It was not treated as something psychological or ‘made up’ by the patients- if a person had a complaint without any valid physical reason it was seen as a good thing as these symptoms could be easily remedied in a hospital setting. It differed from insanity, and they believed that they genuinely could cure the people suffering from neurasthenia. I’m not about to go into the history of medicine, but I do find this particularly fascinating, especially in regards to how mental illness was treated in the 50s, for example, or the stigma around mental illness today.
An interesting thing to note is that diagnoses seemed to be split pretty evenly between men and women, despite women suffering from mental disorders more commonly than men. The onset was attributed to a changing world, rapid industrialisation, long working hours, more ‘mental’ work in office jobs, and even clocks were blamed. With regards to women in particular, they were on the brink of social reform and this could have played some part in the frequent diagnoses. Two sides of femininity were warring; one, the retiring, delicate creature; the other, a well-educated and empowered go-getter. While the definition of womanhood was still rigidly confined to one ideal, doctors and… well, men in general, would try to control women by placing these sorts of illnesses upon them. In my research, ‘The Yellow Wallpaper’ by Charlotte Perkins Gilman kept coming up. It’s a beautifully haunting short story, so if you haven’t read it yet I shan’t spoil it, but it centres around the prescription of a ‘rest cure’ for a woman and the effect of languishing in one room for a prolonged period of time. Neurasthenia would provide a neat little excuse for men to trap their troublesome wives or daughters in bed rest, all the while assuring them that what they were doing was the right thing.
Charles Dana’s ‘The Coming game.’ A woman wearing trousers overtakes a male athlete.
By 1930, the disease had vanished. Taylor posits that perhaps it could have been the aftermath of some viral epidemic, but the real reason is far more clear, in my eyes at least; the adoption of psychology as a legitimate study and the changing understanding of mental illness meant that this ‘catch-all’ disease was rendered obsolete. There were a million other diagnoses that could be offered, each more specific than the last, that could help suffering patients.
I do hope you found this half as interesting as I did, let me know if you have any insights or additions that I would find useful! Mental illness in the Victorian era is a favourite topic of mine, I’m hoping to do a post on female hysteria at some point and also mental hospitals from that period, as they often weren’t the horrifying torture chambers that they are portrayed as in media nowadays. Let me know which of these you’d like to see first, or any other posts you’d like me to make!
Where I got the majority of my info, some very interesting extant case studies at the end. I’m not into graphs, but it also has graphs if you want stats!
Death of neurasthenia and its psychological reincarnation by Ruth E. Taylor: https://www.cambridge.org/core/services/aop-cambridge-core/content/view/CBF3F9183ED6368E940BB0F0AB327482/S0007125000160131a.pdf/death-of-neurasthenia-and-its-psychological-reincarnation-a-study-of-neurasthenia-at-the-national-hospital-for-the-relief-and-cure-of-the-paralysed-and-epileptic-queen-square-london-18701932.pdf
Exhibit explores art, science of Victorian-era disease: https://news.stanford.edu/news/2004/november17/verge-1117.html
Tuberculosis: a fashionable disease?: https://blog.sciencemuseum.org.uk/tuberculosis-a-fashionable-disease/
The Yellow Wallpaper: a 19th-century short story of nervous exhaustion and the perils of women’s ‘rest cures’: https://theconversation.com/the-yellow-wallpaper-a-19th-century-short-story-of-nervous-exhaustion-and-the-perils-of-womens-rest-cures-92302