American Exceptionalism in a Perhaps Unexpected Arena

In 1869, two American physicians discovered in their patients “neurasthenia,” or exhaustion of the nervous system and consequent loss of energy. A historian, David G. Schuster, has written the story of the rise and fall of a medical diagnosis. It is not a standard internal history of a disease, such as medical historians often write. Rather it is the cultural history of an idea, the idea that many people suffered from a somatic disorder recognizable as “neurasthenia.” What is more, the syndrome was soon known worldwide as “the American disease.”

Neurasthenia produced “an array of chronic symptoms, including depression, irritability, insomnia, lethargy, indigestion, a lack of ambition, an inability to concentrate, anxiety, headaches, muscle and joint pain, weight loss, impotence, amenorrhea, and both mental and physical collapse”—or any combination of them (p. 1). Moreover, the chief publicist of the disease declared directly and bluntly: “The chief and primary cause of this . . . very rapid increase of nervousness is modern civilization, which is distinguished from the ancient by these five characteristics: steam-power, the periodical press, the telegraph, the sciences, and the mental activity of women.”¹ Beard goes on to say, in a passage quoted in Schuster (p. 21), “All of this is modern, and originally American; and no age, no country, and no form of civilization, not Greece, nor Rome, nor Spain, nor the Netherlands, in the days of their glory, possessed such maladies.”

Historians have been particularly attracted to this phenomenon because neurasthenia so strongly identified what “American” meant. As Schuster spells it out, “Catholics were relatively safe from neurasthenia because their church made important theological decisions” for them. Southern whites were fixated on the past, not the new that brought “nerve-wracking innovation.” American Indians lived in ignorance and lacked curiosity, and, besides, they also lived robust lives outdoors. “American blacks, especially in the south, supposedly lived primitive, hardy lives and possessed ‘immature minds.’” All that, of course, left northern WASP populations with nerves that could suffer from modernization (p. 22).

Both physicians and members of the “public” in the late nineteenth and early twentieth centuries appeared ready to think that modernization extracted a cost from the most civilized people in society, especially white-collar workers and professionals—“brain workers” as writers of that period referred to them. Past a certain point, many sensitive people became miserable or dysfunctional to the point that they would consult a physician, who would diagnose them as sufferers from an exhausted nervous system. Neurasthenia was therefore a diagnostic category. At the same time, it served as a gauge to measure how the fundamentals of a particular culture changed and did not change.

This disease based on a culture, and more specifically a culture undergoing modernization, has attracted a number of historians since 1950. As early as 1962, medical historian Charles Rosenberg noted that the writings of one founder-publicist of neurasthenia “record with unconscious fidelity the intellectual temper of post-bellum America.”² And, in fact, people of the late nineteenth century and after sensed that the stresses of the economic, social, and intellectual changes were making people ill.

Some historians who looked closely at neurasthenia saw the diagnosis as only a precursor to Freud, often misreading neurasthenia as an early version of psychological illness, which it was not (neurasthenia was somatic, literal physical exhaustion of the nerves). Other scholars placed the subject in the area of therapy, again leading to psychotherapy. The best known such work, by Eric Caplan (Mind Games: American Culture and the Birth of Psychotherapy, 1998), locates neurasthenia between “railroad spine” and American mind cures in the evolution of psychotherapy.

In 1987, Francis G. Gosling (Before Freud: Neurasthenia and the American Medical Community, 1870–1910) examined the ways in which American physicians absorbed and used the category of neurasthenia in their practices. He did, however, start out, as did so many others, by noting the striking connection that many Americans made...