Neurosis and Modernity: The Age of Nervousness in Sweden (review)

Petteri Pietikainen begins his account of how neurosis became a "national malady" in twentieth-century Sweden by citing one turn-of-the-century observer who described Swedes as completely "uninterested in psychology." By mid-century, however, they had become consumed by their own psychology and by the questions—those of sexuality, health, and work—surrounding it. By the 1980s, Sweden ranked second in the world in the number of psychologists per capita. How did this come about?

For those readers familiar with the broad outlines of this story as it has been told in other national contexts—those of England, Germany, and the United States—the main interest here will lie in the distinctively Swedish features of this modern "triumph of the therapeutic." Pietikainen emphasizes the emergence of the Swedish welfare state and specifically, the ascension of the Social-Democratic party to power in the 1930s. With Lutheranism in decline as a force of social integration, social democracy, he argues, embraced a new ideology of health. As part of this, psychological adjustment became a central objective of state policy. Leading social scientists like Gunnar and Alma Myrdal helped articulate a vision of enlightened social policy that, despite fears of national degeneration, remained relatively optimistic about the possibility of using the state's resources to manage the problem of modern neurosis and its feared effects on demography and economic vitality.

Yet while Pietikainen claims that Sweden's experience of neurosis "reflects its history of welfare capitalism and social-democratic social engineering" (p. 9), his efforts to substantiate this very promising claim are not entirely convincing. Despite paying some attention to the role of agencies such as the Royal Board of Pensions in helping establish a system of clinics and treatments for nervous invalids, we learn relatively little about the interactions among Pension Board officials, doctors, and patients. Nor do we hear much about the debates surrounding diagnoses, entitlements, and treatments. Though Pietikainen cites some doctors' warnings that welfare would breed a nation of sickly neurotics and thus promote the problem it sought to address, the establishment of what would become the world's model welfare state seems in his telling to have been remarkably free of the sort of bitter conflicts that occurred elsewhere and that made the "malingerer" and the "male hysteric," for instance, intensely stigmatized figures in England and Germany. Was the Swedish path to modernity, and its embrace of this new psychomedical idiom, really so unmarked by contestation?

"Modernity" as such remains similarly under-examined in this account. Though he is able to use patient records from a number of clinics and hospitals in Stockholm to document important themes in the lives of nervous invalids—overwork, sexual anxieties, and alcoholism—the author never succeeds in really getting inside the experience of neurosis or examining the way this experience became articulated around some of the key topoi that other scholars have made central to their own analyses of this topic. How exactly did new forms of work, technology, culture, or for that matter, medical advice become woven into the discourse about neurosis? Modernity, Pietikainen suggests, meant among other things a flood of psychological literature that spread the idiom of nerves and neurosis to an increasingly wider public. He notes that: "It would be fascinating to know who actually bought all these psychological books and read them, and what they thought of them" (p. 224). Precisely so. The interaction between doctors and patients, and the active role played by patients in casting the modern era as an "age of nervousness," remain for the most part hidden from view in this otherwise suggestive account.