If we had to describe the characteristic features of a “nervous” type, we might think of an easily excitable, an anxious, or a very sensitive person—someone like the ailing lord of the manor in Edgar Allan Poe’s famous tale “The Fall of the House of Usher” (1839), for example. Roderick Usher—a product of cross-generational inbreeding and a thinly veiled parody of the high-strung Romantic artist—constantly vacillates between states of feverish agitation and melancholic listlessness. We learn that he “suffered much from a morbid acuteness of the senses; the most insipid food was alone endurable; he could wear only garments of certain texture; the odors of all flowers were oppressive; his eyes were tortured by even a faint light; and there were but peculiar sounds, and these from stringed instruments, which did not inspire him with horror.”
1Usher’s nerves are exceptionally responsive to external stimuli, but he is also tortured by anxieties generated by his overactive, morbid imagination (and Poe leaves open the question whether the cause of these anxieties is real or imagined). We might also think of Woody Allen as another example of a typically nervous character—a neurotic intellectualizer plagued by a catastrophic imagination, who cannot stop articulating his endless stream of worries about his body, his relationships, and his state of mind. Or we might think of an extremely shy and timid person, who feels uncomfortable in social situations and blushes and stutters when addressed, or someone who jumps every time a door closes or a phone rings. The word “nervous,” in brief, still essentially makes us think of character qualities.
Yet this connection between personality traits and bodily fibers is a residue from a bygone age in which the concept of “nerves” was embedded in a framework of beliefs that assumed a direct link between human energy, behavior, and the constitution of the nervous system. In the eighteenth and the nineteenth centuries, nerves resided at the heart of all medical theories of exhaustion: exhaustion during that period was essentially conceived as “nervous exhaustion,” as a condition triggered by a lack of “nerve force.” Nowadays, we no longer believe that nerves influence character, nor do we believe that they regulate our energy supply. We think of nerves as fibrous, cord-like structures whose main task is the transmission of impulses from the central nervous system to peripheral organs and vice versa. We divide them into sensory nerves, motor nerves, and autonomic nerves, which control the involuntary or partially voluntary activities of our bodies, such as the rhythm of our breath and the beating of our hearts. We know that electrochemical impulses can travel through the nerves at a speed of up to 200 miles per hour and that nervous damage is difficult to repair. Generally, most medical practitioners tend to differentiate rigorously between neurological (that is, physical) and psychological ailments.
Yet nerves have attracted much speculation about their shape, structure, and functions in the past. Galen considered nerves to be hollow tubes through which life energy (the “animal spirits”) was distributed in the body. The animal spirits, Galen conjectured, were invisible and weightless, transmitting sensory impressions to the brain and motor impulses to the muscles. In the seventeenth century, the French philosopher René Descartes proposed that the animal spirits were of a liquid nature. It was only in the eighteenth century that Galen’s basic assumptions were questioned and the modern conception of nerves as fibrous rather than hollow emerged.
Eighteenth-century medical thinking on nerves revolved primarily around new insights into the reflex functions of the nervous system and speculations about the role of electricity in the activities of nerves. Luigi Galvani’s experiments, for example, showed that animals such as frogs and sheep possessed intrinsic “animal electricity,” which controlled their motor activities. In the wake of these new theories, however, nerves were increasingly associated with irritability, fragility, and hypersensitivity. This was also reflected in a change of the meaning of the word “nervous”: “nervous” originally meant “tough,” “sinewy,” and “vigorous” but gradually came to denote a heightened receptiveness. Nerves were imagined as quivering and vulnerable bodily filaments, comparable to taut violin strings perpetually in danger of snapping and in need of constant safeguarding from being overstrained. Moreover, “nerve force” (a form of life energy and essentially a slightly modernized version of the animal spirits) was imagined as strictly limited in supply and vulnerable to harmful depletion.
Among the first studies of specifically “nervous” diseases is George Cheyne’s
The English Malady: or, A Treatise of Nervous Diseases of All Kinds, as Spleen, Vapours, Lowness of Spirits, Hypochondriacal, and Hysterical Distempers, etc. (1733). Cheyne (1671–1743), a Scottish physician, proposed nervous weakness as the primary cause of various ailments we would now describe as psychosomatic, which hamper the body’s and the mind’s vivacity. These ailments include “Lowness of Spirits, lethargick Dullness, Melancholy and Moping,” as well as hypochondria and hysteria. Cheyne, who still subscribed to many of the principles of ancient humoral theory, imagines the body as a machine made of “an infinite Number and Variety of different Channels and Pipes, filled with various and different Liquors and Fluids, perpetually running, glideing, or creeping forward, or returning backward, in a constant
Circle, and fending out little Branches and Outlets, to moisten, nourish, and repair the Expense of Living.”
2Nerves, in Cheyne’s view, are solid and fibrous and help to circulate and break down the vital juices that are necessary to keep the body alive. Nervous weakness and various mood disorders can occur when the fluids are unable to circulate freely in the body, which causes “Laxity or want of due Tone, Elasticity and Force in the
Fibres in general, or the
Nerves in particular.” Weak nerves, then, create a vicious circle: a “due Degree of Strength, Power and Springyness” is required in the nerve fibers to make the juices circulate smoothly to begin with, but when the juices do not flow freely the fibers are further weakened owing to lack of nourishment and lubrication. The body then falls prey to “vicious and morbid Juices.” “All Nervous Distempers whatsoever,” Cheyne concludes, “seems to me to be but one continued Disorder…arising from a Relaxation or Weakness, and the Want of a sufficient Force and Elasticity in the Solids in general, and the
Nerves in particular.” When the nervous system is weakened, an “Interruption of their Vibration or proper Action” occurs, “whereby the Soul is disabled to communicate its
Energy or Principle of Motion to the Muscular Fibres,” which leads to various states of mental and physical exhaustion.
3Cheyne argues that weak nerves can be inherited or acquired, the latter primarily through bad lifestyle choices. His greatest preoccupation is diet, and his tone verges on the messianic when he warns about the dangers of excessive consumption. Civilization and progress, in his view, are a mixed blessing: in their wake followed refinement, education, and enhanced sensitivity, on the one hand, but also the dangers of overindulgence and nervous weakness, on the other. Cheyne relates the epidemic rise of nervous weakness that he observed in the early decades of the eighteenth century to the fast-growing wealth of the seafaring English nation and the adverse consequences of immoderation, laziness, and luxury lifestyles. He urges his readers to follow a diet of milk, seeds, and vegetables; to avoid heavy wines, liqueurs, chocolate, spices, red meat, and snuff; and to take regular exercise. He also mentions city life, the moist climate and the rankness of England’s soil, as well as astral and aerial influences, as further generators of nervous weakness.
Cheyne claimed that the “atrocious and frightful Symptoms” of the nervous complaints he studied were “scarce known to our Ancestors, and never r[ose] to such fatal Heights, nor afflict[ed] such Numbers in any other known Nation.”
4 His assertion is characteristic of a more general tendency among theorists of exhaustion: as we have seen, many ages tend to present themselves as the most exhausted, as if exhaustion were a badge of honor and competing for the title of the most shattered were a kind of sport. A nostalgic vision of a quieter, more peaceful past and a romantic idealization of rural life often feature at the center of the many jeremiads that identify modern civilization as the major cause of exhaustion.
Cheyne, who was morbidly obese, includes his personal story in The English Malady, which functions both as a case study and as a cautionary tale. We learn that he gorged himself on the world’s most extravagant delicacies with an insatiable appetite, growing ever fatter and ever more short of breath. Moreover, by thus destroying the “springyness” of his nervous system, he grew physically exhausted and weary of life:
Upon my coming to
London, I all of a sudden changed my whole Manner of Living…being naturally of a large
Size, a cheerful Temper, and tolerable lively
Imagination…I soon…grew daily in
Bulk…constantly Dineing and Supping…my Health was in a few Years brought into great Distress, by so sudden and violent a Change. I grew excessively
fat,
short-breath’
d,
Lethargic and
Listless.
5The epicurean Cheyne’s mood and weight were to yo-yo dramatically for years to come, until he finally banished “animal foods” and “fermented liqueurs” from his menu for good; settled for a moderate diet of milk, seeds, and vegetables; and undertook regular daily outings on horseback. Like Galen’s and Marsilio Ficino’s before him, Cheyne’s therapeutic regime centers above all on the connection between diet, lifestyle, and exhaustion, and surprisingly many of his suggested cures still sound convincing.
A few decades after the publication of
The English Malady, another Scottish physician, John Brown (1735–1788), introduced the distinction between “sthenic” nervous diseases (defined by an excess level of energy) and “asthenic” nervous diseases (defined by a lack of energy). So great was his influence that an entire system of medical thinking was named “Brunonian” in his honor. Recommended cures for nervous patients treated by Brown depended on whether they were thought to lack nerve force owing to too much stimulation, in which case they were urged to rest, or to too little stimulation, in which case they were prescribed tonics and stimulants (Brown recommended mainly alcohol).
The repercussions of Brown’s theory were felt for a long time, and, among many other popular therapies such as hydrotherapy and electrotherapy, shaped Silas Weir Mitchell’s conception of the infamous “rest cure.”
6 Brunonian thinking was also responsible for the precursors of what we would now call occupational therapies: some nineteenth-century doctors in America, for example, sent listless male patients thought to suffer from understimulation to the Dakotas for rough-riding exercise cures.
7 It was assumed that their sluggish life energies could be reawakened if only they were exposed to stimulating sights, sounds, tastes, and experiences. It was, however, predominantly the asthenic diseases caused by a surplus of stimulation that captured the imagination of the nineteenth century and most worried its medical men.
In the 1840s, it was discovered that electricity was the true agent of nerve action—a finding that revolutionized the field of neurology. In the 1850s, it became common to think of the brain as a kind of battery, and nerve fibers as resembling electrical wires that conducted power though the body.
8 The idea that nerve force, just like the power of a battery, was limited in quantity and could be depleted if not managed wisely also chimed with the perturbing principles of the second law of thermodynamics. This law, proposed in the middle of the nineteenth century, suggested that the amount of energy in the universe was not only limited but also steadily decreasing.
The period between 1880 and the beginning of the First World War has often been described as the “nervous age.” The German historian Joachim Radkau, for example, claims that “nervousness” was not only a very common individual diagnosis but a state of affairs, a way of collectively experiencing and thinking about various cultural processes, including social, biological, and aesthetic developments.
9 Nervousness, he argues, was in the air, colored all debates, and even influenced the jittery political decisions that culminated in the war. Nerves had turned into civilization’s greatest weakness and threatened the stability of both the individual body and the body politic.
It was in the context of this ongoing preoccupation with nervousness and nervous weakness that the neurasthenia diagnosis was born. Neurasthenia was a baggy and infinitely expandable diagnostic concept, an umbrella term for a range of other symptoms that were clustered around its core symptom: nervous exhaustion. As in Cheyne’s theory, weak nerves were thought to be the main agents causing both mental and physical fatigue.
The term “neurasthenia” and its diagnosis were first proposed in the United States in 1869 and popularized in the early 1880s by the physician and electrotherapist George M. Beard.
10 His version of neurasthenia would remain by far the most influential until the diagnosis gradually disappeared from Western medical handbooks after the First World War. In
American Nervousness: Its Causes and Consequences, Beard defines neurasthenia as a “deficiency or lack of nerve-force.” “
Nervousness,” he writes, “
is nervelessness.” The long list of symptoms explored in his sprawling study includes, above all, physical and mental exhaustion, but also irritability, indigestion, insomnia, inebriety, drowsiness, hopelessness, phobias of all kinds (including “fear of everything” and “fear of fears”), hay fever, bad teeth, ticklishness, cold feet, dry hair and skin, and premature ejaculation.
11 Oscar Wilde mocks the sweeping inclusiveness of the diagnosis in a letter dating from 1900 (the year of his death, following his imprisonment for homosexuality): “I am now
neurasthenic. My doctor says I have all the symptoms. It is comforting to have them
all, it makes one a perfect type.”
12Yet Beard clearly hit a nerve with his diagnosis: soon it was highly fashionable to be neurasthenic in America and western Europe. The popularity of Beard’s diagnosis has partly been explained by the fact that he drew together into a single medical condition a whole range of more or less trivial symptoms.
13 Moreover, Beard clearly signposts neurasthenia as a physical rather than a psychological disorder, thereby freeing its sufferers from any stigma that might be attached to mental illness. Those who adopted the diagnosis could derive solace from the fact that there was a “real,” organic dimension to their sufferings, as opposed to “just” a mental one, as, for example, in the case of hysteria.
Like Cheyne before him, Beard explicitly declares neurasthenia a disease of civilization, triggered by various characteristics of the modern age, including “steam-power, the periodical press, the telegraph, the sciences, and the mental activity of women.”
14 The causes of neurasthenia were firmly attributed to the outside 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. Interestingly, similar arguments about the dangers of permanent overstimulation caused by new communication technologies, and other adverse psychological effects of neoliberal techno-capitalism and globalization, also feature prominently in current theories regarding the origins of stress and burnout.
Furthermore, Beard associates neurasthenia with the middle and upper classes, arguing that its symptoms are the result of too much “brain work,” particularly common among businessmen and captains of industry.
15 The “brain-working, indoor-living classes” are repeatedly contrasted in his study with the “lower orders”—muscle workers, day laborers, and peasants, as well as with “savages and barbarians of all times and ages.” Beard defines “a fine organization” as the key characteristic of a person with a nervous disposition:
The fine organization is distinguished from the coarse by fine, soft hair, delicate skin, nicely chiselled features, small bones, tapering extremities, and frequently by a muscular system comparatively small and feeble. It is frequently associated with superior intellect, and with a strong and active emotional nature…. It is the organization of the civilized, refined and educated, rather than of the barbarous and low-born and untrained—of women more than of men. It is developed, fostered, and perpetuated with the progress of civilization, with the advance of culture and refinement, and the corresponding preponderance of labor of the brain over that of the muscles. As would logically be expected, it is oftener met with in cities than in the country, is more marked and more frequent at the desk, the pulpit, and the counting room than in the shop or on the farm.
16As is clear from this extract, Beard associates so many positive and flattering qualities with the neurasthenic disposition that in effect he turns it into a distinction rather than a disease. In his account, neurasthenia is construed as a marker of evolutionary refinement and social and intellectual status, a condition signaling sensitivity, industriousness, and sophistication. It is not surprising, then, that neurasthenia became so fashionable and that so many embraced the diagnosis with enthusiasm. Moreover, Beard also furnishes his diagnostic invention with a patriotic dimension, as neurasthenia is to be found not simply among the “highest social orders” but only among the most highly developed and civilized nations, and in particular, of course, in America, which he frequently compares favorably with England, Germany, and France.
To render his diagnosis even more palatable to the general readership at which his study was aimed, Beard repeatedly uses metaphors from the fields of economics, engineering, and physics to illustrate the workings of neurasthenia. For example, in the chapter “Nervous Bankruptcy,” he uses an extended “wise management of limited funds” simile. We learn that there are those among us who are
very poor in nerve force; their inheritance is small, and they have been able to increase it but slightly, if at all; and if from overtoil, or sorrow, or injury, they overdraw their little surplus, they may find that it will require months or perhaps years to make up the deficiency, if, indeed, they ever accomplish the task. The man with a small income is really rich, as long as there is no overdraft on the account; so the nervous man may be really well and in fair working order as long as he does not draw on his limited store of nerve-force. But a slight mental disturbance, unwonted toil or exposure, anything out of and beyond his usual routine, even a sleepless night, may sweep away that narrow margin, and leave him in nervous bankruptcy, from which he finds it as hard to rise as from financial bankruptcy.
17These similes are telling—they not only connect the diagnosis with distinctly modern social and technological developments but also frame it in popular imagery that reflects the dominant economic values of the time. Like capital, nerve force can be squandered and wasted by ill-judged expenditure and overinvestment in potentially ruinous activities. One’s limited energy supply needs to be managed as prudently as one’s financial assets: bodily economies, Beard suggests, adhere to the same rules as apply to household or national budgets. Yet, as Janet Oppenheim points out, there is one crucial limitation to the explanatory potency of Beard’s financial metaphors: bodily economies, in contrast to national ones, cannot accommodate profits. Unlike wealth and capital, nerve force is not suited to include aspirations of expansion and growth.
18 In other words, one can neither reinvest nerve force nor stockpile it for the future.
After the publication of Charles Darwin’s
On the Origin of Species in 1859, medical and cultural debates began to draw on evolutionary biological models and became increasingly preoccupied with the idea of “degeneration.” Particularly in France and Germany, fears about degeneration as a form of perverse, backward evolution, and as a process that entails the gradual exhaustion and weakening of a nation’s genetic capital, created a climate of cultural pessimism. Works such as Richard von Krafft-Ebing’s famous sexological compendium
Psychopathia Sexualis (1886) and Max Nordau’s
Degeneration (1892), a polemical attack on various aspects of modern culture, warned of the grave dangers of deficiencies that could be passed on to, and intensified in, the next generation. Nervous weakness, “perverse” sexual desires, alcoholism, criminal inclinations, effeminacy, and feeble-mindedness, for example, were all thought of as qualities that could be inherited. Many Continental theorists who embraced the idea of hereditary diseases painted gloomy pictures of the future, fearing an ever-increasing contamination of their nations’ gene pool and workforce. In Beard’s account, however, the figure of the neurasthenic is not a representative of decadence, decline, and degeneration but instead is cast as its opposite: his neurasthenic is the very pinnacle of evolutionary refinement. Beard thus turns the idea that nervous weakness is a bad thing on its head—his account is essentially optimistic and affirmative.
Beard’s writings on neurasthenia show once again the ways in which ideological and cultural factors shape the theorization of medical symptoms more generally, and of theories of exhaustion more specifically. In an age dominated by the values of productivity, activity, and efficiency, the exhausted were considered a major problem. However, Beard gives these anxieties a positive spin: since he believed that exhaustion was caused by the very processes that characterized the modern age—recent technological inventions, the faster pace of life, a shift from physical to intellectual labor—being exhausted could be seen as a positive quality. As a wound inflicted by modernity, exhaustion could be borne as proudly as a battle scar. In our age, too, burnout is not as stigmatized a condition as depression, for example, but almost viewed as a distinction, as it implies that one has simply worked too hard and invested everything, and more, in one’s job. It is thought to affect, above all, hard-working, ambitious, successful, caring, and conscientious types. Furthermore, it is the twenty-first-century workscape itself (with its unique set of sociopsychological stressors) that is held responsible for the spread of the condition, and not so much the individual who experiences it.
Given that a range of positive characteristics manifest in dubious claims about the social, intellectual, and racial superiority of the neurasthenic individual were integral to Beard’s diagnosis, it is not surprising that neurasthenia quickly became not just a disease of civilization but a
maladie à la mode (melancholia, too, was a similarly fashionable disease at certain points in history, such as in the age of Romanticism).
19 Neurasthenia traversed the Atlantic and soon passed from medical into popular and literary debates. In addition to Oscar Wilde, Franz Kafka, Marcel Proust, Henry James, and Virginia Woolf, to name just a few, were among the many modernist authors diagnosed with neurasthenia. In 1913, when Kafka was torn apart by his inability to decide whether to marry his fiancée, Felice Bauer, he named neurasthenia as one of his many ailments. In his diary entry from May 4, he arranges his complaints into the following hierarchy: “1. Digestion. 2. Neurasthenia. 3. Rash. 4. Inner insecurity.”
20 Just like John Cassian in the case of acedia, he hoped that he could cure his neurasthenia with work.
The German writer Heinrich Mann (brother of the better-known Thomas Mann), too, frequently describes himself as neurasthenic and as nervous in his correspondence and in other nonfictional works. Neurasthenic characters feature repeatedly in his oeuvre. In his satirical novella Dr. Bieber’s Temptation (1898), for example, a character called Herr Sägemüller, who is in a sanatorium for nervous patients and has embraced his neurasthenia diagnosis with an eagerness that borders on religious fervor, explains his condition in the following terms:
As you probably know very well, my dear Fräulein, in the past intellectual activities took place in monasteries. While intellectuals have never been on good terms with the brutality and coarseness of reality, we can no longer escape it today—it assaults us both at home and outdoors. The electrical tram…intervenes as insolently into my life as the phone wires that are whirring outside my bedroom window at night. Advertisements on the street corners and the howling of the trade people and the press, bells ringing everywhere, bikes and motorcars—all of these phenomena rape my senses; I am entirely defenseless. Another aggravating factor is that while the conditions of material life have become ever more complicated, our intellectual organization has become infinitely finer. Yet unlike in the case of the cruder scholar of the past, there is no safe haven for the much more sensitive intellectual worker of today. This is why you find me here. The clinic is a sanctuary where I can find relief from the preoccupation with my physical existence. As far as possible, I have surrendered my will to that of the doctor, and you can barely believe how good a so-called modern person feels when they are finally allowed to cease desiring and wanting things.
21In this speech, Sägemüller concisely lists the then-prevalent anxieties about the vulnerability of the self in the modern world and the impact on that self of new technologies. This vulnerability is particularly manifest in the porous boundary between inside and outside (Sägemüller feels “raped” by the noise from the streets), the recurrent penetration of technology into all spheres of life, and the sense of being unable to find shelter from the vicissitudes of modernity. Sägemüller blames external forces for his condition and does not fail to emphasize his superior “fine organization”—a detail that is clearly derived from Beard’s account of neurasthenia. It is also interesting to compare Sägemüller’s lament with the breathless jeremiad of the psychiatrist Wilhelm Erb, who, together with Krafft-Ebing, was the most important theorist of neurasthenia in Germany:
Owing to the excessive increase in traffic and the wire-networks of our telegraphs and telephones, which now span the entire globe, our trading patterns and circumstances of life have been transformed completely: all affairs are conducted in haste and excitement, nights are used for travelling, days for doing business, and even “recreational journeys” have turned into strains on the nervous system; the worrying repercussions of serious political, industrial, and financial crises permeate into much wider circles of the population than in the past; the general public now participates in public life; political, religious, and social battles, party politics, election campaigns, and the excessive dominance of clubs and societies overheat people’s heads and force their spirits to undertake ever new exertions while robbing them of the time for rest, sleep, and stillness; life in big cities has become ever more refined and restless.
22Unlike Erb, however, Mann does not subscribe to the conception of neurasthenia that his character embraces. In the course of the novella, he mercilessly exposes Herr Sägemüller as a highly dubious and self-pitying malingerer, completely lacking in self-knowledge, who has adopted the fashionable identity of a neurasthenic to excuse his own shortcomings, to abdicate responsibility for his actions, and to be able to look down on others. Ultimately, Mann suggests that what is really sick is not the modern age as such but the very people who argue that this is the case—people like Herr Sägemüller.
Mann was not the only one to ridicule the neurasthenia fashion—many other writers and caricaturists, too, produced scathing satirical portraits of malingerers, shirkers, and hypochondriacs who readily embraced the diagnosis. Thomas Mann, for example, criticizes an entire industry based on a morbid preoccupation with illnesses—minor, major, and imagined—in
The Magic Mountain (1924) and created a character much like Herr Sägemüller in his novella
Tristan (1903). Other novels that present negative portraits of neurasthenics include Marcel Proust’s
In Search of Lost Time (1913–1927) and Italo Svevo’s
Zeno’
s Conscience (1923). An aphorism penned by the Viennese cultural commentator Karl Kraus neatly encapsulates the gist of the less sympathetic attitudes toward neurasthenics at the turn of the twentieth century: “Anesthesia: wounds without pain. Neurasthenia: pain without wounds.”
23Beard’s theories were received particularly positively by the medical establishment in Germany. The most important German theorists to spread the neurasthenic gospel were Wilhelm Erb and Richard von Krafft-Ebing, the forensic psychiatrist and author of
Psychopathia Sexualis, who also wrote the influential study
On Healthy and Sick Nerves (1885). Krafft-Ebing repeatedly refers to Beard and reproduces many of his arguments. His version of neurasthenia differs from Beard’s in various important respects, however, and is ultimately much more pessimistic in outlook. Krafft-Ebing argues that given the large number of developments that have taken place in the name of progress, one might reasonably be inclined to assume “that modern civilized man would advance ever more towards happiness and satisfaction, as Enlightenment, education, the comforts and luxuries of the refined cultural life suggest.” Yet nothing could be further from the truth: a murky shadow looms over modern culture:
People appear pale, glum, excited and unsteady in our modern civilization, particularly in the centers, in the big cities, and that they are not happy is evident among other things in the fact that the sorry philosophical Weltanschauungen of Schopenhauer and E. v. Hartmann have been met with so much praise.
The worm that gnaws at the fruit of cultural life and that poisons the love of life and life energy of so many people is the so-called nervousness…. It is the sickly reaction of nerves that is to a large extent responsible for the epidemic of
Weltschmerz and pessimism that has penetrated large strata of modern society and that is, among other highly worrying symptoms, statistically manifest and expressed in the ever growing number of suicides and mental illnesses.
24
Krafft-Ebing fears that “modern society is heading toward inevitable moral and physical ruin.” Like Beard, he uses economic metaphors to illustrate his theories and refers to “nerve capital” and “nerve labor.” The idea of overspending or wasting precious and limited resources features prominently in his account, too: “The various symptoms of nervous weakness…are nothing but the permanent symptoms of a nerve-life that is unable to strike a balance between production and consumption of nerve-power.”
25 Yet Krafft-Ebing, unlike Beard, does not celebrate nervous weakness as a sign of refinement. Rather, he views nervous exhaustion both as a symptom of moral decline and as what we would now call a biopolitical problem, as it threatens the nerve capital of the entire body politic.
Krafft-Ebing, again unlike Beard, does not believe that the increase in external sensory stimuli in cities is the reason for the loss of the population’s nervous capital. Instead, he shifts the blame to those who seek out the hustle and bustle of the big cities, those “poor wretches” who are addicted to diversion and distraction.
26 He believes that the more irritable, weak, and unhealthy the nervous system becomes, the more it requires diverse and ever stronger stimuli.
27 In other words, Krafft-Ebing assumes that nervous weakness blunts the senses, rather than rendering them more refined. Like debauched libertines who have seen and done it all, restless nervous people incessantly have to search for new, ever more elaborate excitements.
Krafft-Ebing is a declinist thinker, a culturally conservative pessimist focusing on the night side of modern civilization. His study is, above all, a nostalgic, Rousseauian lament that contrasts a more inward, learned, and harmonious past with the modern, fast-paced rat race, in which idealism has been replaced by crude materialism, rampant egotism, hedonism, and degenerate forms of entertainment. Among the urban phenomena that vex him most are “shocking dramas, adultery comedies, trapeze artists, nerve-wrecking and agitating music, images that generate sensual responses and irritate the eyes, expositions, strong wines, cigars, liqueurs, clubs, gambling dens, amorous adventures, and news stories about crimes and people’s misfortunes in the daily press, etc.”
28Finally, while Beard blames the rise in neurasthenic symptoms on technological advances, overwork, and an increase in sensitivity, Krafft-Ebing believes that the key factor behind the growing nervousness of the modern age is a “neuropathic constitution”—that is, inherited qualities. These hereditary qualities, combined with the various lamentable social developments listed earlier, among which Krafft-Ebing also counts the emancipation of women, would lead, if unchecked, to the decline of the entire Western world.
29 Most late-nineteenth-century explanations of nervous exhaustion ultimately vacillate between the two poles represented by Beard and Krafft-Ebing: the spread of nervous diseases is blamed either on external environmental factors or on heredity and the somber laws of degeneration.
Nerves, nervous exhaustion, and degeneration also feature at the very center of Joris-Karl Huysmans’s decadent masterpiece
Against Nature (1884)—the model for the infamous “yellow book” so cherished by Oscar Wilde’s Dorian Gray. The novel’s protagonist, Duc Jean Des Esseintes, is the last scion of an ancient noble line whose male members have grown progressively more effeminate, sickly, and weak owing to two centuries of inbreeding. Des Esseintes, “a frail young man of thirty, nervous and anaemic,” is the very embodiment of the degenerate fin-de-siècle aesthete, permanently plagued by ennui and spleen. His nervous system is so extraordinarily hypersensitive that every smell, taste, sound, or sight that jars with his refined tastes is experienced as excruciatingly distressing. Exhausted, world-weary, and disgusted with what he perceives as the vulgarity and stupidity of contemporary society, which he associates primarily with the rise of the moneyed middle classes, Des Esseintes decides to retreat to the outskirts of Paris. Having escaped the hustle and bustle of metropolitan life, he attempts to create a refuge “from the incessant deluge of human folly,” in which good taste and eternal quietude reign.
30Des Esseintes has tried everything to alleviate his weariness, including studying Latin theology, socializing with the Faubourg Saint-Germain set, indulging in debauched sexual practices, and seeking solace in the arts. Yet eventually, all his passions burn themselves out. “Having lost faith in everything” and “ravaged by spleen,” “he had reached such a pitch of nervous sensibility [
sensibilité de nerfs] that the sight of a disagreeable object or person would etch itself into his brain so deeply as to require several days for its imprint to be even slightly dulled; during that period, the touch of a human form, brushed against in the street, had been one of his most excruciating torments.”
31 His weak nerves propel him on a quest to abolish unpredictable “natural” stimulation from his life and to seek out controllable, artificial sources of stimulation instead. Having moved to his suburban refuge, he dedicates much energy to the interior design of his retreat. The furnishings are to correspond precisely to his mood—providing or weakening stimulation as necessary. Even the color scheme he chooses is designed to match his nervous tastes: like all “weak and nervous people” (
affaiblis et nerveux), Des Esseintes is inevitably drawn to “that irritating, morbid colour, with its deceptive splendours, its febrile sourness: orange.”
32 He decides to have his walls bound like books, in heavy, smooth Moroccan leather; wild animal skins lie scattered across the parquet; bluish panes in the casement windows filter the unbearably shrill daylight; and heavy draperies made out of the darkened, smoky gold thread work of antique stoles help to shield him further from the vicissitudes of nature.
Des Esseintes also gilds the shell of a giant lethargic tortoise and has it encrusted with rubies, which he hopes will offset the intricate pattern of his Oriental carpets when the creature crawls across them. However, the animal proves resistant to becoming a part in his ambitious interior design project and dies, just like a host of rare and exotic orchids, with which Des Esseintes is temporarily enchanted. Even his cutlery is designed to satisfy his morbid obsessions: it is silver-gilded, “so that the silver, barely visible through the faintly eroded layer of the gold, gives it a suggestion of something sweetly old-fashioned, a vague hint of something utterly weary and close to death [
tout épuisée, toute moribonde].”
33Having sold his ancestral chateaux, Des Esseintes keeps only two old servants, whom he forces to wear thick felt slippers, so as not to be disturbed by the sound of their footsteps. Everything in his new house is hermetically sealed and padded; double-doors are installed, with well-oiled hinges; thick carpets muffle any sound of life; an aquarium positioned in front of a window breaks the light in such a way that it is not too tiring for his strained sensory apparatus. Des Esseintes, in short, turns “against nature” and embraces artistry, as the artificial can be both controlled and shaped according to one’s tastes. He lives in a house filled with imitations: he possesses, for example, an array of scents that evoke natural ones and occasionally infuses the air with these synthetic perfumes to conjure up memories of past experiences or faraway places. Artifice, he believes, is “the distinguishing characteristic of human genius. As he was wont to remark, Nature has had her day; she has finally exhausted [
lassé], through the nauseating uniformity of her landscapes and her skies, the sedulous patience of men of refined taste.”
34The majority of the novel’s chapters are dedicated to detailed descriptions of Des Esseintes’s decadent tastes. Above all else, Des Esseintes cherishes his library, as he deems the pleasures of the imagination preferable to genuine experiences. Unsurprisingly, he is most drawn to the works of late Latin authors, the chroniclers of the fall of Rome detailing “a decayed civilization, a splintering empire.”
35 He appreciates, above all, literary styles that mirror decline in their syntax, that enact decadence in the very texture of their verbal material. He also holds some contemporary prophets of ennui in high esteem, especially Charles Baudelaire, Edgar Allan Poe, and Stéphane Mallarmé. According to Des Esseintes, Baudelaire expertly exposes the morbid psychology of the soul “which has reached the autumn of its capacity to feel” and shows the moment “when the enthusiasms and convictions of youth are exhausted [
sont taris], when nothing remains but the arid recollection of hardships endured.”
36 Baudelaire probes the wounds inflicted by satiation, disillusionment, and contempt, chronicling the “morbid conditions that afflict exhausted minds and despairing souls.”
37 In Poe, in contrast, Des Esseintes admires the writer’s astute dissections of the torpor of the will: “Violently agitated by hereditary neuroses, maddened by convulsive moral disturbances, [Poe’s] creatures lived solely on their nerves.”
38 Yet it is a collection of Mallarmé’s prose poems that is the most treasured item in his library. Mallarmé’s is a literature that is
enervated by old ideas and exhausted by a surfeit of syntax [
affaiblie par l’
âge des idées, épuisée par les excès de la syntaxe], which responds solely to the peculiar interests that exacerbate the sick and yet, in its decline, feels impelled to give expression to everything, and on its deathbed desperately longs to compensate for all the pleasures it has missed and to leave behind a legacy of the subtlest memories of pain.
39Huysmans, it is obvious, feels a deep kinship with the aesthetic projects of the writers his protagonist admires. Huysmans’s own highly embellished, complicated, and often feverishly obsessive literary style, too, powerfully communicates the demise of established classical ideals and literary models, and enacts the nervous exhaustion it depicts on the level of content.
During the course of the novel, Des Esseintes mainly languishes in his armchair, dwelling in memories. But even his ruminations about the past leave him “feeling drained, exhausted, half dead” (
anéanti, brisé, presque moribond), and his numerous physical ailments increase and become ever more worrisome.
40 They include dyspepsia, vomiting, nausea, migraines, irritable bowel syndrome, sweating, insomnia, nightmares, lack of appetite, weight loss, and auditory and olfactory hallucinations. In the end, seriously weakened and worried that he will perish, he calls in a specialist for nervous diseases, who prescribes pepsins, cod-liver oil, beef tea, burgundy, and egg yolk. Following the physician’s dietary regime, Des Esseintes manages to regain his physical strength. However, the doctor does not leave it at that: to tackle the underlying psychological causes that have generated the other ailments, he insists, Des Esseintes must abandon his solitary existence and morbid dwelling and return to society. Fearing death and the reappearance of his numerous debilitating ailments, Des Esseintes resentfully consents to the doctor’s orders, packs up the paraphernalia of his artificial paradise, and prepares to move back into the center of Paris. In the end, Des Esseintes collapses exhausted into a chair and succumbs to the “waters of human mediocrity” that are about to engulf him. He wishes that he were able to force himself to possess faith, to embrace Catholicism, and “to make it a protective crust, to fasten it with clamps to his soul, to place it beyond the reach of all those ideas that undermine and uproot it.”
41A nostalgic longing for the long-lost spiritual certainties of Catholicism runs like a red thread through the entire novel. It is certainly neither a coincidence nor a surprise that its creator, Huysmans, not long after the publication of
Against Nature, rediscovered his own faith. Yet Des Esseintes’s decadent tastes not merely are caused by a loss of faith but also constitute the direct result of his nervous exhaustion: “[A]s his constitution had become unbalanced and his nerves had gained the upper hand, his tastes had altered and the objects of his admiration had changed.”
42 In other words, decadence, aestheticism, and nervousness go hand in hand.
Huysmans’s representation of exhaustion powerfully illustrates the ways in which it is tied up with a certain zeitgeist and how a more general cultural atmosphere can affect the energy levels of an individual. It also reinforces the link proposed by Beard and many other theorists of neurasthenia between a highly refined disposition and a propensity to suffer from exhaustion, as well as the association of exhaustion with the upper classes, artists, and “brain workers.” The causes that Huysmans offers as explanations for Des Esseintes’s nostalgia for the past and his spiritual disenchantment with the present are many and include the decline of the aristocracy and the rise of the bourgeoisie; the advent of positivism, scientism, and materialism; and the cultural pessimism that reigned in France after it suffered military defeat in 1870/1871 at the hands of the Prussians.
It is evident that Huysmans was well informed about then-current medical and psychiatric debates about nervous exhaustion, and he directly weaves this knowledge into his fiction. He clearly supports the argument that many French and German psychiatrists in particular propagated: that the causes of nervous diseases are, above all, hereditary: Des Esseintes is the product of incest and degeneration—the final offspring of an “exhausted bloodline.” Huysmans also refers to then-common medical cures for exhaustion: Des Esseintes is prescribed pepsins, tonics, and a moderate diet and at some point tries to follow a hydrotherapy regime in his house. Like Krafft-Ebing, Huysmans suggests that the more strained and exhausted someone’s nerves are, the more “decadent” their tastes will be. As many others before him, he firmly aligns the nervous temperament with artistic inclinations. Finally, it is telling that it is a medical man who is granted the last word in this novel: it is the nerve specialist who terminates Des Esseintes’s aestheticist extravaganzas and his doomed experiment with solipsistic seclusion.
Although their accounts differ in many respects, both Beard and Krafft-Ebing, and the majority of their contemporaries, believed that nervous exhaustion could be explained primarily by organic factors—that is, a lack of nerve force, which was essentially a version of human energy. This lack of nerve force, they conjectured, could be brought on either by external factors that vampirically deplete limited supplies of nervous energy or by an inherited weak nervous constitution. To a certain extent, somatic narratives of this kind protected sufferers from being held responsible for their condition, an idea that the famous goodnight-kiss episode at the beginning of Proust’s
In Search of Lost Time neatly illustrates. In that scene, the narrator, Marcel, is subjected to a medical reassessment that encapsulates the way in which nervous weakness was theorized in the age of neurasthenia. The narrator’s mother previously considered her son’s anguished and obsessive longings for her evening embrace as morally bad but voluntary and thus curable behavior. Yet after the narrator’s despair culminates in a particularly dramatic nocturnal scene on a staircase following a dinner party, his mother begins to regard him as sick and nervous, as someone whose behavior is determined by a medical condition. “[I]t’s his nerves,” she apologetically explains to the family servant. “And thus for the first time,” the narrator writes, “my unhappiness was regarded no longer as a punishable offence but as an involuntary ailment which had been officially recognised, a nervous condition for which I was in no way responsible: I had the consolation of no longer having to mingle apprehensive scruples with the bitterness of my tears; I could weep henceforth without sin.”
43Yet the period in which patients were able to derive solace from the neurasthenia diagnosis was short-lived. Neurasthenia’s heyday occurred between 1880 and the beginning of the First World War. Thereafter, it gradually disappeared from the medical handbooks and was no longer widely used as a diagnostic category. That said, neurasthenia was dropped officially from the Diagnostic and Statistic Manual of Mental Disorders (DSM) only in 1980 and is still included in the tenth revision of the International Classification of Diseases (ICD-10). The ICD-10 identifies mental and/or physical fatigue as its core symptoms and currently differentiates between two types of neurasthenia:
In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. The mental fatiguability is typically described as an unpleasant intrusion of distracting associations or recollections, difficulty in concentrating, and generally inefficient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax.
44In both types of neurasthenia, a variety of other symptoms may be present, including dizziness, tension headaches, feelings of general instability, insomnia or hypersomnia, worries about decreasing mental and bodily well-being, irritability, anhedonia, and varying minor degrees of both depression and anxiety.
The reasons for the diagnosis’s gradual disappearance after the First World War are manifold. As is evident even from the
ICD-10 entry, neurasthenia is an imprecise category that overlaps with others that are now more commonly used, and it comprises too many disparate symptoms. When diagnostic tools became more refined at the beginning of the twentieth century, neurasthenia was broken down again into its constituent parts.
45 However, the most important reason for the disappearance of neurasthenia as a widely used diagnostic category was a major paradigm shift in the fields of psychiatry and psychology: the advent of psychoanalysis.
46 The somatic explanation of the many symptoms of neurasthenia was increasingly questioned, and in the early decades of the twentieth century, psychoanalytic explanations began to replace the biological models.
47 Freud sweepingly dismissed all the causes that Beard, Krafft-Ebing, and many other theorists had established as triggers for the condition and argued that neurasthenia, like all neuroses, could be explained with recourse to one phenomenon only: sexuality. In addition, from the 1930s onward, the concept of depression, which comprised some of the symptoms that were also present in neurasthenia, grew ever more popular. Depression was to become the most frequently diagnosed condition in the field of mental health in the second half of the twentieth century.
While neurasthenia is now diagnosed only very rarely in western Europe and the United States, it is still considered a valid diagnostic category in some Asian countries precisely because it does not carry the same social stigma as depression and other illnesses that are deemed to be mental rather than physical in nature. Many who experience chronic fatigue syndrome strongly argue for the purely organic origins of their illness for similar reasons.
48 In China, for example, neurasthenia (
shenjing shuairou) is considered to be caused by a decrease in vital energy (
qi). Neurasthenia functions essentially as a culturally sanctioned and stigma-free label for symptoms of distress that are very similar to those experienced by depressives in the West.
49 Yet in Japan, in contrast, the explanatory model for neurasthenia (
shinkeisuijaku) verges more toward psychological causes. Japanese neurasthenia is associated with a specific personality type characterized by hypersensitivity, introversion, self-consciousness, perfectionism, and hypochondriac tendencies and is frequently treated by the Morita therapy, which combines insights from modern psychology and Zen Buddhism.
50The rise and fall of the neurasthenia diagnosis, and the fact that it is defined differently in different cultural contexts, illustrate once again that there is nothing “natural” or inevitable about the ways in which specific sets of symptoms are clustered together into distinctive diagnostic entities. The history of medicine shows us that disease categories change, sometimes quite dramatically, and especially at the borders between physical and mental health. Nowadays, the long list of symptoms associated with neurasthenia appears rather random and peculiar, and it is difficult to see how conditions as distinct as physical and mental exhaustion, toothaches, hay fever, phobias, and dry hair could ever have been imagined as sharing a singular physical cause. It is also extremely rare to encounter the underlying value judgments and dominant cultural attitudes that often shape medical diagnoses in such an explicit, unapologetic form as in Cheyne’s, Beard’s, and Krafft-Ebing’s narratives; it is plainly visible that their personal attitudes to various cultural, political, and social developments substantially influenced their medical theories and their therapeutic recommendations. In Cheyne’s and Beard’s cases, national pride, classism, and a celebration of progress are particularly pronounced, while Krafft-Ebing’s account is that of a pessimistic declinist, who feels profoundly ill at ease with many of the developments of the modern world.
Even after the golden age of the neurasthenia diagnosis in the West, and the advent of neurology proper, the idea of nerves as determiners of moods, energy levels, and behaviors continues to haunt our language, as is evident in the meaning of the word “nervous” discussed at the beginning of the chapter, and in figurative expressions such as “to get on somebody’s nerves,” “nervous wreck,” “shattered nerves,” “nerves of steel,” and “bundle of nerves.” Nerve imagery also still features prominently in many literary works written after the heyday of neurasthenia. T. S. Eliot, for example, uses it in his poem The Waste Land (1922), in which one of the many distraught narrative voices declares:
“My nerves are bad to-night. Yes, bad. Stay with me.
Speak to me. Why do you never speak? Speak.
What are you thinking of? What thinking? What?
I never know what you are thinking. Think.”
The erratic anxious woman who is uttering these lines in the second part of the poem might be modeled on Eliot’s first wife, Vivienne, who was struggling with an array of physical and mental problems that included bouts of fatigue, feverish agitation, migraines, and insomnia. Eliot himself suffered a nervous breakdown in the early 1920s. Unlike nervous exhaustion, a nervous breakdown entails a sudden, severe, and usually temporary decline in mental health that is often brought on by stress or trauma. It is an acute rather than a chronic condition and affects people who ordinarily cope well with life’s vicissitudes.
When Eliot’s mental well-being abruptly deteriorated, his doctor recommended that he take the rest cure for three months. Eliot followed his advice and sought recovery first on the shores of Margate and then in a sanatorium in Lausanne. It was during this period that he completed his famously bleak, disjointed, and desolate poem (“On Margate Sands/I can connect/ Nothing with nothing”), which was to become one of the most iconic representations of the weary and apocalyptic mood of the postwar period. Even spring, traditionally associated with renewal and rebirth, is represented as a negative force in
The Waste Land:
April is the cruellest month, breeding
Lilacs out of the dead land, mixing
Memory and desire, stirring
Dull roots with spring rain.
Spring’s crime is that it perpetuates the cycle of life, which, in the poet’s view, entails nothing but suffering, sordidness, and slow decay. Everything in Eliot’s bleak vision has gone to waste: he deems it preferable that the exhausted soil and the weary, ghost-like inhabitants of the ruin-strewn present should be allowed to expire peacefully, rather than having to be forced to continue with their pointless plight.