Social Disease

For more on the subjugation immigrants in medicine see Howard Markel, When Germs Travel: Six major Epidemics That Have Invaded America and the Fears They Have Unleashed (New York: Random House, 2004). For more on the problem of race in medicine see Rebecca Skloot The Immortal Life of Henrietta Lacks (New York: Random House, 2010). And for more information on sexism in American Medicine see Barbara Ehrenreich and Deidre Einglish, For Her Own Good: Two Centuries of the Experts Advice to Women (New York: Random House, 1978).

Barbara Sicherman, "The Uses of a Diagnosis: Doctors, Patients, and Neurasthenia," Journal of the History of Medicine 32 (1977): 35
George M. Beard, A Practical Treatise on Nervous Exhaustion (Neurasthenia): Its Symptoms, Nature, Sequences, Treatment 2nd ed., rev. (New York, 1880), 11-85.
Gail Bederman, Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880-1917 (Chicago: The Chicago University Press, 1995), 92
David M. Oshinsky, Polio: An American Story (Oxford: Oxford University Press, 2006), 66-67.
"The Malady of the Age" The Sunday Inter Ocean January 28, 1894.15
Ibid.
Sicherman, "The Uses of a Diagnosis," Journal of the History of Medicine 34 (1977): 40
Ibid. 40
Ibid. 52-53
Bederman, Manliness & Civilization. 79
Ibid. 87
Sicherman "The Uses of a Diagnosis" 35,45
Anne Stiles "Go Rest, Young Man." American Psychological Association Time Capsule 43 (2012): 32.
Ibid.
Ibid.
Ibid.
Ibid.
Charlotte Perkins Gilman, The Yellow Wallpaper (New England Magazine, 1892) accessed November 25, 2014, http://www.gutenberg.org/files/1952/1952-h/1952-h.htm
Perkins Gilman, The Yellow Wallpaper.
Ibid.
Sicherman "The Uses of a Diagnosis," 51
Sam Walburn
Dr. Kline
HIST302
December 15, 2014
Social Disease: the Influence of Social Norms on the Diagnosis and Treatment of Neurasthenia

Medical science is produced, accepted, and carried out in a set social context dependent upon time, place, values, prejudices, and culture. Throughout American history, people of color, women, and working class people have been subjugated by the structures of privilege and oppression in which the medical community function. Black women's bodies have been extorted for white men's profits, people of color and immigrants are often ignored or outright suspect in times of pandemic, and women throughout history are subject to male doctors' hands and (often sexist) diagnoses. Few diseases, however, have been so purely devoted to maintaining social structure and addressing social issues as neurasthenia. This disease was seen as the product of civilization and industrialization overtaxing the bodies of white, middle and upper class men and women. Further, the diagnosis of neurasthenia adopted mental disorder and deviant behavior under somatic medicine by means of the newly emerging field of neurology. It simultaneously explained what was seen as a decline of masculinity and reinforced gender spheres of influence. Finally, the treatment of neurasthenia sought to reinforce gender norms while condemning any gender deviant behavior as a hazard to ones health. The diagnosis, treatment, and discourse around neurasthenia illustrate the intricate relationship between social constructs and medical science.
Neurasthenia was popularized by the work of George M. Beard, a pioneer in American neurology, in 1869. He suggested that the body had a finite, hereditarily determined supply of nervous energy, when the energy was depleted it led to a physical disorder that resulted in mental and behavioral as well as physical symptoms. Noting an increase in patients with functional nervous disorders and a supposed decline of masculinity, Beard claimed that the human body had not evolved to handle the stresses of industrialization and civilization, especially, "the periodical press, steam power, the telegraph, the sciences, and increased mental activity of women." Civilized society also required the control of emotions, which savages of course could not exert, that additionally drained the finite energy. Thus the modern advancements of civilization, he postulated, led to an increased depletion of nervous energy and a virtual pandemic of Neurasthenia. And because it was a cause of modernity, people of color and the working class were not as afflicted.
Through identifying neurasthenia as a product of civilization Beard did three things: first, he made neurasthenia specifically a white disease of the middle and upper class, as social Darwinism said that by definition people of color and lower classes were less civilized and therefore their nervous energy could not be depleted by the demands of an industrialized world. It "scarcely exists among savages or barbarians or semi barbarians or partially civilized people." This of course means that neurasthenics are of Anglo Saxon decent. This racial component of diagnosis is by no means specific to neurasthenia, in fact, it can be seen in the 1920's and 1930's polio outbreaks, it was thought that people of color could not contract the virus. Second, he addressed the issue of a cultural fear of the feminizing effect of civilization on masculinity. German Psychologist Dr. Erb was quoted in The Sunday Inter Ocean as saying "The consequence [of civilization] is that the race of men is slowly but surely degenerating toward the condition of hysterical women." By diagnosing the decline of masculinity as a temporary (if treated) bout of sickness of the body rather than a moral degradation or decline in virility, Beard could explain the feminizing of "the race of men" acting as "hysterical women" not as a failure of white manhood, but a physical illness. And third he adopted the psychiatric into the somatic, deviant behavior was no longer a characteristic of moral failings or feeble minds; it was a physical disorder of the affluent. It is telling that the sub heading to the Sunday Inter Ocean piece was "Neurasthenia, a disease of the educated class."
The ability of physicians to locate the diseases of the mind within the body and attribute behavioral symptoms to physical ills was contingent upon the rise of neurology. As Sicherman notes in The Uses of a Diagnosis: Doctors, Patients, and Neurasthenia, Beard was part of the pioneering generation of neurologist working to gain credibility in the United States in beginning in the 1870's. The field of neurology, which worked to explain mental ills through somatic means, faced "resistance from general practitioners…and outright hostility from the medical superintendents of asylums for the insane who since the 1840's had claimed exclusive authority over the care of the mentally ill." This illustrates that a definite shift was occurring in medical thought and practice, and like any major change it gave rise to dissidents. By diagnosing someone with a physical ailment rather than one of hysteria or mania, the doctor avoided attaching the life long stigma of insanity and could seek other methods of treatment outside the grotesque asylum system. However, this was a diagnosis of white, upper class men and women, thus the poor and people of color were not protected from such stigma or incarceration. This ability to diagnose behavior created a space for physicians to replace priests as the arbiters of social mores. No longer were depression or anxiety or obsessive behavior a sign of moral degradation; they were now symptoms of an illness. Therefore priests were not the ones to rectify the behaviors people instead turned to physicians. This, as we shall see, meant that doctors had the power to codify social structures of race, class, and gender into diagnoses.
The causes for neurasthenia were very different for men and women and often reinforced societal impositions of appropriate gender spheres of influence. In men, the understanding of the cause of neurasthenia was that the masculine demands of civilized world and the manly suppression of emotions and desires resulted in a feminizing effect of depletion of nervous energy. As Gail Bederman points out in Manliness & Civilization, "Only a well-developed character--the strength born of total self-mastery--could make the boy strong enough to be a real man." Not only was civilization causing overtaxed bodies and leading to neurasthenia, so was a key aspect of masculinity itself. And not only was civilization threatening the health of white men, it was threatening their manliness as well. As Bederman points out "Indeed, Civilization's demands on men's nerve force had left their bodies positively effeminate." Societal demands of occupation and manly suppression of emotion rendered middle and upper class men not only susceptible to a depletion of nervous energy resulting in neurasthenia, but also had a feminizing effect on middle and upper class white men of civilization.
In women the causes of neurasthenia were equally tied to gender norms and aimed at reinforcing strict gender spheres of influence in the face of expanding female access to the public sphere and education. As noted above, one of the main causes of neurasthenia in women was the increased mental activity they exercised in a civilized, industrialized world. An increase in formally educated women meant that these women struggled to exert their newfound independence in pursuit of a career while society simultaneously demanded they marry and have children and remain in the home. Thus increased access to the public (male) sphere could cause women to overtax their bodies, which were not evolved to the point that they could withstand such a task, leading to neurasthenia. In fact, this view deeply upheld the social ideal that women belonged in the home, codifying it into medical science by explicitly stating that their deviation from gendered expectations could lead to physical illness. Both men and women who suffered from neurasthenia were victims of societal pressures, men faced a new burden to achieve occupational success in a competitive market economy, women faced Victorian social values requiring they start a family. However, men often contracted neurasthenia due to their own masculine tendencies of emotional repression, women were prone to the disease if they deviated from gender norms and sought to refuse their feminine duties for the male sphere and/or education.
The treatments of neurasthenia were just as gender specific as the causes. They worked to rectify the effects of the gender regressive behavior on the body by reinforcing behavior that was appropriate for the gender of the patient based on a set of social values. Neurologist Silas Weir Mitchell, a pioneer alongside Beard in the field, is known for his treatment of neurasthenia through two very gender specific treatments of neurasthenia, the "Rest Cure" and the "West Cure." Both of these cures sought to remove the individual from the stresses and pressures of civilized, industrial society and reverse the gender regressive behavior. Through isolation and reinforcement of societal notions of masculinity and femininity as treatment, this disease created an arena where doctors strengthened gender roles and bolstered Victorian ideals of masculinity and femininity through treatment.
In order to rectify both the feminizing and physical effect of civilized society upon the American white man, the treatment of neurasthenia in men was constructed around the reinforcement of Victorian ideals of masculinity and removal from the cause of gender regression and illness; that is civilization. The so-called "West Cure" created by Silas Weir Mitchell involved sending neurasthenic men to the frontier for extended periods of time to act as cowboys amoung other men. These men were told to engage in rigorous physical activity and document their experience, this would reinstate manliness necessary to defeat the feminizing effects of civilization, cure nervousness, and build the body back to masculine strength. Therefore the cure for the feminizing effects of civilization and the neurasthenia that accompanied it was literally a resurgence of masculinity, engaging in quintessentially masculine tasks away from modern civilization to replenish the body's nervous energy. This is illustrated in one of Mitchell's most high profile success stories, Theodore Roosevelt. He arrive in Mitchell's care a feminine, unimposing presence that "provoked comparisons to Oscar Wilde," but went on to represent the pinnacle of American manliness. In fact, because men such as Walt Whitman, Owen Wister, and Theodore Roosevelt endured the "West Cure", it had a distinct impact on American culture. From the birth genre of the American Western after Wister's The Virginian based on his time in treatment, to American foreign policy (Roosevelt's "speak softly and carry a big stick" is a direct impact of the lessons of the frontier) this cure and resurgence of the emphasis on masculine values changed American history.
For women, however, the cure was much less heroic, yet no less founded in the idea that men and women should occupy the appropriate gender sphere for their own health. For women Mitchell created the "Rest Cure," a paternalistic treatment with a specific diet, therapy, and weeks or months of bed rest during which women were unable to read, write, or exercise their brain in any way. Charlotte Perkins Gilman describes her time under the "Rest Cure" in The Yellow Wallpaper, which explains the paternalistic care and disbelief of many male physicians, including her husband and brother, that she was sick at all. Her bout of neurasthenia was brought on shortly after her marriage and the birth of her child, reinforcing the idea that Victorian demands of family conflicted with liberation of educated women from the domestic sphere. She comments many times in the piece that she must put away her writings because her husband, nurse, or physician is returning to the room with the ugly, peeling, yellow wallpaper remarking that her husband "hates to have me write a word." She eventually comes to believe that women are trapped in the wallpaper she loathes so much and she must release them, mimicking her own feelings of imprisonment and oppression and the desperation to liberate herself from the room that taunts her and the social impositions that brought about her condition in the first place.
Pagepulp.com/2161/the-yellow-wallpaper/

As the image above suggests, the rest cure was a way to maintain the proper place of a women in a patriarchal society steeped in gender stereotypes and cultural anxieties of the result of women shedding the shackles of domesticity. As Sicherman points out "The paternalism of this therapy may help to explain why charlotte Perkins Gilman and Jane Addams—woman who temperamentally rejected the subordinate role assigned to their sex—were among Mitchell's most conspicuous failures." Whereas the cure for neurasthenic men was to go experience the freedom of the West and reclaim masculinity, the cure for women was to reject any type of freedom, to maintain their sphere of domesticity and refrain from any use of pen or brain. Both of these treatments reinforced the gender ideology of the time, condemning any gender deviant behavior as a health hazard.
Diagnosis, treatment, and cures always exist within the social structure of the time and place in which they occur, this is made extremely clear through a close examination of the disease of neurasthenia. Using this disease as a tool to locate behavior and mental issues within somatic medicine and bodily ills, neurologists, most notably George M. Beard, codified a set of racial, class, and gendered understandings of social Darwinism into medical diagnosis. The disease blamed recent social developments such as industrialization, increased education of women, and new societal pressures as causes for a physical disease that corrupted masculinity and overtaxed the body. Simultaneously, it reinforced the subjugation of non Anglo Saxon people and lower class people to savages who could not explain away their deviant behavior through somatic means, therefore refusing to extend the protection of diagnosis to their behavioral or mental differences. Its treatments upheld the ideology of appropriate gender spheres of influence and occupation and condemned any deviation from them, though allowing leeway for men by attributing American loss of manliness to individual masculinity itself. Upon reflection, this disease causes one to question the blind trust many of us instill in science and physicians by showing that medicine is no less influenced by societal norms and prejudices than any other occupation.


Bibliography
Beard, George M. A Practical Treatise on Nervous Exhaustion (Neurasthenia): Its Symptoms, Nature, Sequences, Treatment 2nd ed., rev. New York W. Wood & Company, 1880.
Bederman, Gail, Manliness & Civilization: A Cultural History of Gender and Race in the United States, 1880-1917. Chicago: The University of Chicago Press, 1995.
Ehrenreich, Barbara and Deirdre English, For Her Own Good: Two Centuries of the Experts Advice to women. New York: Random House, 1978.
Gilman, Charlotte Perkins. The Yellow Wallpaper. (The New England Magazine, 1892), accessed November 25, 2014, http://www.gutenberg.org/files/1952/1952-h/1952-h.htm
Markel, Howard, When Germs Travel: Six major Epidemics That Have Invaded America and the Fears They Have Unleashed. New York: Random House, 2004.
Oshinsky, David M. Polio: An American Story. Oxford: Oxford University Press, 2006.
Sicherman, Barbara, "The Uses of a Diagnosis: Doctors, Patients, and Neurasthenia." Journal of the History of Medicine 32 (1977): 33-54.
Skloot, Rebecca, The Immortal Life of Henrietta Lacks. New York: Random House, 2010.
Stiles, Anne, "Go rest, young man," American Psychological Association Time Capsule 43 (2012): 32.
"The Malady of the Age" The Sunday Inter Ocean January 28, 1894.15