American Nervousness, 1903

Tom Lutz, American Nervousness, 1903: An Anecdotal History (Ithaca: Cornell University Press, 1991).

This is a strange one, but offers and interesting and valuable perspective on neurasthenia in its heyday primarily through the use of literary sources. Lutz takes what can loosely be described as a microhistorical approach with the goal of showing how a discourse of disease can be used to negotiate cultural change.

It would be incorrect to say that Lutz really “argues” anything in this book; rather, he’s taken a selection of literature and analyzed it in the context of the discourse surrounding neurasthenia. Most of his actors use it to express very different feelings about their cultural hopes and realities.

Most of the authors Lutz includes in his study trained and lived on the east coast, though some of them did write about the West. An exception is Hamlin Garland, who was born in Illinois and died in California. It appears that a theme in his works–especially Hesper–was the freedom the West provided its occupants (and, I presume, visitors) in contrast to the east, which was tightly controlled by “the master of money.” Earlier work in a similar vein includes that of Edward L. Wheeler, in which “Eastern speculators are painted as “simply villains…[whose] iron heel[s] do not belong in the West, where every man still has the ability to be his own master.” (109-110)

The West (undeveloped and rural) was thus understood in literature of the period to be free, juxtaposed in the minds of many with the regimented and capitalistic existence the East (urban) demanded of its inhabitants. Its untamed wilderness was understood as both aesthetically pleasing and as a metaphor for the space it provided its visitors to engage in relaxation, reflection, and reconnection with an older, more natural self that the overwhelming and disconnected nature of urban life had rendered inaccessible.

The discourse of neurasthenia and its nervous economy provided both doctors and invalids with a means of describing in a tangible, somatic way the anxieties of modernity, and therapeutics that increasingly emphasized travel created an ideal opportunity for Eureka Springs’ publicists to engage with discursive work already underway. If urban spaces were pathological to their upper-class denizens, rural towns with sufficiently fashionable accommodations and other natural, health-giving attributes were their obvious remedy. And early on in Eureka’s existence, this remedy did not necessarily require the supervision of a doctor; though, as we shall see, the science of climatology would challenge that freedom more aggressively in the next decade.

Lutz discusses the interest in developing national parks and its relationship to neurasthenic discourse at the very beginning of the 20th century, largely through Theodore Roosevelt and John Muir. Muir wrote in 1902 that, “the parks were primarily visited by ‘nerve-shaken’ brain-workers from the city and that the ‘retreat into the wilderness’ afforded by these parks was designed in specific response to the neurasthenic wear and tear of modern life.” Lutz reports that Muir and his naturalist colleagues made livings out of guiding wealthy health-seekers around wilderness areas. (91-92) Proof that wilderness=healthy within neurasthenic discourse.

Touches on the prevalence of nature metaphors during the period. This seems like a weak argument, though, unless this was when “natural” took on such a culturally powerful connotation. (143)

Bit on Charlotte Perkins Gilman, well-known for her criticism of the rest-cure. She was apparently a proponent of the nature cure as well, if we can judge by a poem she published in the May 1905 issue of Cosmopolitan. Titled “Just to Be Out of Doors,” it reads: (229)

[Charlotte Perkins Gilman, “Out of Doors,” in The Latter Works of Charlotte Perkins Gilman ed. Denise D. Knight (Newark: University of Delaware Press, 1996), 146-147.]

Not sure that I can use one poem by a woman known to have been a bit counter-culture as evidence that women, too, were encouraged to get out into nature… hm.


The Nervous Origins of the American Western

Barbara Will, “The Nervous Origins of the American Western,” American Literature 20, no. 2 (1998): 293-316.

Will looks at the role that neurasthenia played in the development of the idea of the American West, specifically in its literary iteration.

Neurasthenia, as defined by George Beard and Silas Mitchell, was a disease brought on (specifically in men) by the strains of capitalism, political freedom, and technological superiority. These are good things. Modern men needed to maintain a balance, though, and engage in the kind of “struggle” that characterized his ancestors’ experiences on occasion — and they should write about it, according to Mitchell (it’s these writings that the author spends a lot of time analyzing in the second half of the article).

The disease needn’t be cured by a rejection of modernity, capitalism, etc., but rather “through a temporary and repeated entry of the urban into the rural, into a space in which the ‘sturdy contest of nature’ could be waged and these ‘stores of capital vitality’ could be replenished through the simulation of the life of ‘country men.'” (300)

Before Freud

F. G. Gosling, Before Freud: Neurasthenia and the American Medical Community, 1870-1910 (Urbana: University of Illinois Press, 1987).

Gosling provides a history of neurasthenia before Freud entered the scene of American psychology that considers those outside the “elite” group of physicians (Beard, Mitchell, and co.) who developed the concept in the late 19th century. As a mental illness constructed by physicians and their patients, Gosling argues neurasthenia provides an excellent inroad into the “gender and class biases” that the disease served to justify.

Chapter 1: The Price of Progress

Starts with George M. Beard (how could you not), New York neurologist who came up with a new disease called “neurasthenia,” or “nervous exhaustion,” which lent legitimacy and respectability via a disease etiology to a class of people not insane (many continued to function in their jobs) but victim to an exhaustive collection vague of symptoms like “headache, fatigue, dyspepsia, [and] depression…” (9)

In Beard and his colleague’s estimation, the disease was uniquely American problem attributable to a people evolving slower than their technologies; “Arguing that cultural evolution had outstripped the pace of individual evolution, he maintained that specific features of the young American society — in particular the telegraph, the railroads, the periodical press, the sciences, and the atmosphere of political and religious liberty — had increased mental demands on Americans, especially on the urban professionals who labored with their heads rather than their hands.” (11)

Timeline — Written about by Beard in 1869, reached peak popularity in early 1900s and was fading in relevance after 1910. (13)

Goes into the history of neurology, which was (of course) modeled in America after Continental examples. First organization was the American Neurological Assocation, based on the east coast (35 people met in 1875 to form it, most of whom were from big eastern cities; “a few” lived in Chicago and St. Louis). Argues that “neurologists” were “curious blend[s] of physician, psychiatrist, and anatomist,” more like modern-day psychiatrists than neurologists “because of their emphasis on the emotions and the social origins of stress.” (16-17)

Lack of specialization in rural communities meant that GPs were treating neurasthenics. (25)

Chapter 2: Nerve Invalids All

Discusses physicians’ (not just the main ANA people) understanding of neurasthenia; when they diagnosed it, what symptoms were indicative of it.

“Many physicians believed that early intervention in cases of neurosurgery degeneration could often restore patients and prevent development of true psychosis. Though patients with pronounced mental symptoms could be trying, they could often be saved from asylums if physicians recognize the dangerous grounds on which they stood and implemented an early treatment program that incorporated mental as well as physical remedies.” (45)

Discusses sexual habits, work habits, etc., highlighting the way that genders and classes were asked different questions about their habits and had a different threshold for “overwork”; i.e., women who were engaged in activities that weren’t as culturally acceptable (going to college), this could be seen as an overexertion leading to the neurasthenic state. Men were asked more about their masturbation habits (and had diagnoses based upon them) because it wasn’t as sensitive of a subject with male patients and male doctors (it would be indelicate to ask a woman).

Therapeutics —

Treatment, based as it was on causes constructed from the patient’s class and gender, was often effectual, even if it seems extreme or stupid from a modern perspective; “Most of these patients were, in fact, ‘nervous’; they were not unwilling guinea pigs but sufferers who sought relief. If doctor and patient shared faith in a particular remedy — be it surgery, drugs, or applications of electricity — the patient was often truly benefited, though relief may have been temporary.” (62)

Understood as very idiosyncratic, based on a “thorough examination of the patient with complete family history, appropriate medicinals, and various psychological measures…” They were not often thought to work overnight, but required “tact, patience, judgement, and true sympathy” from doctor to patient. They often required close supervision from the doctor over a lengthy period of time. (67)

Chapter Three: On the Verge of Bankruptcy

Journal literature was extremely widespread; beginning with Beard’s enumeration of the disease, publications began appearing in the 1870s, had become a “flood” by the mid-’80s, and “reached a peak between 1900 and 1910.” (78)

Overwhelming variety of symptoms were placed into categories by Beard’s colleagues and successors, one of which was “digestive.” Seems to have included constipation and dyspepsia. (80) It was understood, however, that oftentimes the physical symptoms were the result of underlying mental distress. (83)

Usually diagnosed among the middle- and upper-classes because the neurologists developing the disease etiology treated mostly wealthy patients and because physicians often made distinctions between patients of different classes (their clinical vs. private practices). Working-class diagnoses were often attributed to muscular overwork, which could manifest in a form of the disease called “spinal congestion” (83-84)

Believed to be hereditary, leading to ideas of “constitutional nerve capacity,” and physicians encouraging patients to “live within their means of nervous energy.” (85-88)

Tried to acquire and air of scientific legitimacy via the “waste versus despair” theory and the diathesis concept — playing into electro-physics and physiology. Didn’t do much real research though. (88-89)

Modern transportation as pathological —
Survivors of railway and steamship accidents could have a sort of 19th century techno-induced PTSD – “Railway spine” (91-92)

Discussion of “overwork” in the context of middle-class white collar workers (92-95)
“Neurasthenia attributed to overwork occurred most often in men of the ‘better sort’ whose natural ambition and competitive environment drove them to the breakneck pace and assumption of too many responsibilities that all too often led to nervous exhaustion.”

Women’s neurasthenia more often attributed to the biological, resulting from “the upsetting of their more delicate nervous equilibrium.” Believed to be more numerous and more likely to be neurasthenic.

Gosling argues that literature from medical journals indicate a widespread and relatively consistent idea of what neurasthenia was — they use similar terms, even when they’re debating about the specifics. “…this knowledge was as available to country doctors and general practitioners as to urban neurologists; there were no significant differences between ANA members, independent neurologists, and non-neurologists in their perceptions of neurasthenia.” (105)

Chapter 4: Not the Physic but the Physician

Much less agreement as far as treatment went; usually aimed at treating symptoms, falling into major categories — “rest, regulation of the diet, exercise either active or — in a form such as hydrotherapy — ‘passive,’ and drugs to aid digestion, enervate the nervous system, or induce sleep…” Often employed several methods. (108-109)

More doctors recommended travel as the century wore on (second most popular treatment option after rest in 1900) (108)

Sometimes suggested exercise, which would improve appetite, digestion, increase muscle tone, and distract the sufferer from his/her problems. (120) Passive exercise was recommended for patients too weak or in pain for physical activity; hydrotherapy was a popular option and included the use of methods as wide ranging as “enemas to sponge baths…[and] hot and cold packs to the spine.” (122)

“Exercise ‘dissociated from one’s vocation,’ changes of scenery, and new associations” were believed to break “habitual patterns of behavior,” providing a refreshing change. These changes helped establish healthier lifestyles and modes of thinking. Less based in physiology/hard science, this kind of ‘mental therapy’ grew in popularity toward the end of the 19th century. (132)

One “excellent example” of this trend is climatotherapy; physicians and specialists began prescribing travel “to a more healthful environment to replenish… nerve stock.” Concedes that there was some debate about what kinds of environments/climates were especially salubrious, but mountains were definitely up there. (133)



Exhaustion and the Pathologization of Modernity

Anna Katharina Schaffner, “Exhaustion and the Pathologization of Modernity,” Journal of Medical Humanities 37, no 3 (2016): 327-341.

Argues that “exhaustion,” typically paired with other, varying symptoms, has factored into medical discourse in the 18th, 19th, 20th, and 21st centuries, and has functioned as a medicalized critique of technological advancement. Looks at works by George Cheyne, George Beard, Richard von Krafft-Ebing, Sigmund Freud, Alain Ehrenberg and Jonathan Crary.

On Beard and American Nervousness —
Sets backdrop by discussing the idea of nervous energy as finite
“The causes of neurasthenia were firmly attributed to the external world, to technological and social changes that drained the limited energy reserves of modern men and women. The modern environment, particularly the urban environment, was thought to generate too many stimuli such that the senses were incessantly assaulted by noise, sights, speed and information. Beard feared that the sensitive nervous systems of the modern subject would be unable to cope with this sensory overload.” (331)
Discusses the fact that the disease was held to be particularly prevalent in the upper-classes and argues that Beard constructed neurasthenia to more of “a badge of honor than a disease.”
“In his account, neurasthenia is construed as a marker of evolutionary refinement and social and intellectual status, a condition signalling sensitivity, industriousness and sophistication,” as well as a sign of American-ness (adding a patriotic dimension). (332)
“As a wound inflicted by modernity, exhaustion could be borne as proudly as a battle scar.” (333)

New line of argument for thesis; people came to the springs to escape the city, which was understood as overly stimulating and unhealthful. Discourse at the springs had to emphasize the opposite; relaxing, slow-moving, natural, a-scientific. Prove by finding language of neurasthenia in testimonials.
Doctor’s role? Playing into neurasthenic discourse as well, also providing testimonials asserting the springs’ efficacy in nervous illnesses (and by extension dyspepsia). Are doctors talking about this in local publications? If not, this speaks to the clout vernacular audiences had in establishing medical meanings at the springs.

Climate, Medicine, and Peruvian Health Resorts

Mark Carey, “Climate, Medicine, and Peruvian Health Resorts,” Science, Technology, and Human Values 39, no. 6 (2014): 795-818.

Carey tells the story of Jauja, a health resort developed in mid-nineteenth century Peru. He argues that, through the veil of medico-scientific (and more specifically, climatological) discourse, physicians and other authority figures advocated for the development of the resort for economic, political, racialized, and local cultural reasons. Carey holds the science and medicine to be almost entirely socially constructed, and as such it serves as a lens through which to view the real motivations and influences that affected the development of the region.
I’m not quite as hard of a social constructionist as Carey, and while I will incorporate culturally-produced climates, I believe the science/medicine to be a little bit more independently operated than his argument would have it.

In abstract:
“The historical case about the evolution of Juaja reveals how science and medicine are shaped by distinct spatial forces that illuminate a geography of science… as well as the ways in which climate is culturally constructed in specific sites, by different peoples, and at distinct points in time.”

Arguing against the concept of “universal knowledge” — it’s all bound spatially, and I would argue by class, profession, race, education level, etc.

“A second theoretical concern focuses on how climate is culturally constructed in a specific place and time. Some scholars have argued about the importance of examining the cultural construction of climate and the way climate narratives have social, political, cultural, economic, and ideological values embedded in them. These and other studies thus complicate the scientific meta-narrative that construes climate solely as an atmospheric phenomenon devoid of any meaning. Studies increasingly monstrance that climate cannot be decoupled from its spatial and temporal constructions — its meaning has always derived from the interplay of local, national, and global forces that were both imagined and real.” (798)

Early boosters, it seems, were advocating for RR and other developments for many of the same reasons and via many of the same arguments as in Eureka. (802)

“From the 1850s to the 1920s many — but certainly not all — Peruvian physicians argued that the clean air, cool and even temperatures, consistent winds, low humidity, clear skies, and bright sunlight of Jauja supposedly made it an ideal health resort…” (803)
Almost exactly the same aspects were highlighted in ES (except landscape).

Arkansas Medical Monthly (1880)

“Eureka Springs.” Arkansas Medical Monthly 1, no. 1 (1880): 1-3.

“Notwithstanding, however, the ludicrous aspect placed upon the reputation of these springs in the eyes of the medical profession, induced by the enthusiastic exageration [sic] of the people, there is evidently something about them worthy of our attention and careful inquiry.” (34)

“We visited the place during the latter part of December last, but owing to the fact that no analysis has as yet been made of the water (or, at least, none has come under our observation), it is impossible to base a scientific opinion upon its proposed therapeutic value.” (34)

Discusses having talked to a lot of people that had been or were in the process of being cured

Water, according to the experience of the writer, has “strong laxative and diuretic properties.”

Gives altitude, says air is “proportionately rarefied,” and that this combined with the effects of the water may account for beneficial effects on consumptives — should get same results in ES as you would in the “extreme west, i.e. Colorado, California, New Mexico, etc.”

Only providing the info “in order to satisfy public curiosity” and hopeful that “a scientific investigation as to the true causes which induce so much enthusiasm in regard to the ascribed curative properties of this water.” (35)

J. J. Jones, Sr. “Letter from Eureka Springs.” Arkansas Medical Monthly 1, no. 3, ed. Jonathan J. Jones (1880): 147-149.

Jones claims he went to ES skeptical of the outlandish claims, but has found this “delusion dispelled.”

He found a lot of people cured, even some which had been pronounced incurable by “prominent members of the medical profession.” He quickly tempers that assault on his fellow doctors by claiming many uncured invalids remained so due to their “constitut[ing] themselves their own medical advisers–ignor[ing] the medical profession until prostrated or nearly dead, when, in all probability, if they had obtained timely advice from some competent physician they would have improved from the first.” (147-8).

Establishing objectivity: Jones claims to “speak from observation and experience,” stating on several occasions that he has no ulterior motives in promoting the town and that he was not enthusiastic going in to his survey.

On chemical analysis: Because the first analysis failed to adequately explain the medical effects of the water, Jones finds fault with the way it was conducted; water was taken from the springs and transported to a lab in St. Louis. “Another analysis will be made at the Springs shortly, which is the proper place for it to be made at, as probably some active ingredient may be lost or dissipated in its transit.” He leaves open the possibility, however, that analyses may be inadequate to explain the water’s properties. “Although every analysis may fail to discover its active ingredients, yet the facts are demonstrable, unmistakably so, that it produces the effects attributed to it. Thousands are here to-day ready to testify to it.” (148)

“Eureka Springs.” Arkansas Medical Monthly 1, no. 3, ed. Jonathan J. Jones (1880): 134.

Gives the analysis by Wright & Merrill (St. Louis); was evidently requested by Dr. B. M. Hughes of Eureka

“This water is remarkable for its purity, as its specific gravity, which is at 60 deg. F., only 1.000103, and the small amount of solids found, plainly indicates. In this respect it is very similar to the celebrated medicinal waters of Baden in Germany and Pfeffers in Switzerland.” (134)