The making of 'American': race and nation in neurasthenic discourse

"Our one great national malady": Neurasthenia and American Imperial and Masculine Anxiety at the Turn of the Twentieth Century

White upper middle-class Americans at the turn of the twentieth century were entrenched in a battle with a newly discovered, or invented, mental illness called neurasthenia. This essay examines the ways in which the medical discourse of neurasthenia reflected late nineteenth- and early twentieth-century white Anglo-Saxon men's belief in, as well as anxiety over, American values bolstered by their idea of cultural, racial, and sexual superiority and consolidated through a conjunction of medicine and politics. The idea of neurasthenia as white American men's malady functioned as a mark both of whites' racial superiority to the "new" immigrants and African Americans as well as of women's intellectual inferiority to the opposite sex of their own race. Imposing a subtle distortion on the etiology and diagnosis of neurasthenia and associating it with specific groups of people, the "American disease" constituted the era's representative pathological symptoms which addressed Anglo-Saxon American men's anxieties about overcivilized effeminacy and racial and national decadence which was originated as a response to the racial and sexual heterogeneity. This essay also argues that neurasthenia was an imagined disease which addressed late nineteenth-century American men's spatial anxiety about the decline of the American pastoral ideal caused by the closure of the frontier. Given that the treatment for neurasthenic men was an escape to the frontier in the West in which they could rejuvenate withered American masculinity, their uneasiness about barbarous, unhygienic, and prolific immigrants and unruly white women, in fact, was tied to their spatial anxiety which symptomatically signifies the crisis of American masculinity. Channeled through the medical knowledge of neurology, it made American men's racial, sexual, and spatial anxieties function to act out their racist, misogynist, nativist, and imperialist impulses which legitimized exclusionary political techniques toward the racial and sexual others such as the U.S. imperial expansion in the 1890s and 1900s and a eugenic-influenced immigration policy from the 1900s through the1920s. In this sense, the decline of neurasthenia around 1920 should not be attributed solely to the continued efforts to professionalize American medicine accompanied by recent discoveries of chemical factors such as hormones and vitamins and the rise of psychiatry and psychology which offered physicians with a more specific theory of health built on clinical laboratory science. Like its rise, the decision to move away from the neurasthenic diagnosis was rather a cultural phenomenon, which reflected the American ascendancy to global power in the early twentieth century, particularly after the First World War. Sustaining a political order rested on racial and sexual hierarchies both within and outside the American continent, American men felt that they were no longer liable to specific, time-tested anxiety and somatic symptoms of neurasthenia, which was more an ideological and cultural construct than a clinical entity that dramatizes the racial, sexual, and imperial politics of the-turn-of-the-twentieth-century America.

"Insanity Is the Price of Modern Civilization": The Discourse of Civilization and the Asian Insane in Modern America

Examining debates on the link between civilization and insanity in the late nineteenth and early twentieth-century United States, this essay engages the discourse of civilization to discuss the ways in which insanity among Asian immigrants, in particular Chinese and Japanese, was understood, defined and debated. During the period, insanity was regarded as a disease of civilization, which had been increasing due to the struggles of modern life. While Americans witnessed insanity among the "colored" and Asians, they argued that these groups had lower rates of insanity than white Americans and European immigrants because they belonged to lower positions on the civilization scale. Though not explicitly racialist or even racist, the discourse of civilization ordered the international world and drew a clear color line between white westerners and non-white others. At the same time, American missionaries and medical professionals stationed in China and Japan, who were there to see and learn about insanity in Asia, reaffirmed the existing medical understandings of insanity and offered a knowledge base for American psychiatrists who would encounter the Asian insane at their mental institutions. The alleged rarity of mental troubles for Chinese and Japanese was not considered an asset; the insanity debates confirmed the non-white, non-American status of Asian immigrants, rendering them forever foreign. Moreover, their very distance from western civilization explained why Asians in America seemed to have suffered less from mental disturbances and how they could resist the debilitating effects of civilization and migration.

Neurasthenia: tracing the journey of a protean malady

Neuresthenia has had its popularity waxing and waning over the years. This review article traces the path and trajectory of the concept of this disorder, how it changed and varied over time, to the current times, when it has been almost forgotten and the concept is heading towards oblivion. Although its place in the diagnostic systems is currently in question, neurasthenia is still part of professional conversations and practice. The concept of neurasthenia emerged at the intersections of clinical, cultural and sociological dimensions of society. A deeper examination of how neurasthenia was situated at the intersections of race, class and gender exemplifies how psychiatric diagnoses may reflect and shape societal biases. The neurasthenia label has all but disappeared from contemporary nosological frameworks, however, there is a proliferation of other disorders, e.g. chronic fatigue syndrome, fibromyalgia, that try to capture the experience of fatigue, pain, weakness, and distress even in the absence of clear-cut medical aetiologies. Only time will tell, if this concept has indeed been buried, or will rise as a phoenix in the years to come. Newer nervous fatigue syndromes are expected to emerge from the use of technology, screen time and the virtual world.

'Neurasthenia gastrica' revisited: perceptions of nerve-gut interactions in nervous exhaustion, 1880-1920

In this paper, some of the medical literature on the historical disease-concept of ‘neurasthenia gastrica’ is reviewed. Neurasthenia gastrica was defined as a sub-unit of the wider category of neurasthenia, also referred to as nervous exhaustion or nervous weakness. Neurasthenia was a commonly used diagnostic label at the end of the nineteenth century and a few decades onwards, and was used to describe a wide variety of symptoms for which no ‘organic’ basis could be found. In neurasthenia gastrica, however, the gastrointestinal symptoms predominated, and there was considerable debate as to how the gut interacted with the central nervous system in the development of these ailments. Some of these discussions may be seen as historical precedents for the current debates on the brain–gut–microbiota axis, particularly in relation to the so-called functional gastrointestinal disorders.

Neurasthenia at Mengo Hospital, Uganda: A case study in psychiatry and a diagnosis, 1906-50

This article uses a case-study approach to examine the complex and contradictory nature of diagnoses like neurasthenia in colonial Africa. Drawing on the case notes of European and African patients diagnosed with neurasthenia at the Church Missionary Society's Mengo Hospital, Uganda, it argues that in practice, and outside the colonial asylum in particular, ideas about race and mental illness were more nuanced than histories of psychiatry and empire might imply. At Mengo, the tales of pain and suffering recorded by the doctors remind us that there is more to the history of neurasthenia than colonial anxieties and socio-political control. This was a diagnosis that was negotiated in hospital examination rooms as much as in medical journals. Significantly, it was also a diagnosis that was not always reserved exclusively for white colonisers-at Mengo Hospital from the early 1900s neurasthenia was diagnosed in African patients too. It became part of a wider discussion about detribalisation, in which a person's social environment was as important as race.

'These strangers within our gates': race, psychiatry and mental illness among black Americans at St Elizabeths Hospital in Washington, DC, 1900-40

During the early decades of the twentieth century, William Alanson White and the medical staff at St Elizabeths Hospital in Washington, DC, developed an ambitious programme for US psychiatry wherein the profession would dedicate itself to the reconstitution of mentally-fit and socially-productive American citizens. The racist assumptions beneath this programme led most physicians at the institution to expect little more than deference, dependence and common labour from their black patients, preventing them from comprehending the impact of substandard and racially-segregated care. Black men and women were acutely aware of the injustices they faced. When they rejected elements of the hospital's medical regimen, these patients were also rejecting a social vision that consigned them to the margins of US civic life.

Cultural and social history of psychiatry

PURPOSE OF REVIEW

The purpose of this review is to highlight recent English language literature in the cultural and social history of psychiatry. It considers publications from 2007 and early 2008, as well as a few important older works that have not yet been reviewed in this journal.

RECENT FINDINGS

Cultural and social historians of psychiatry are incorporating a growing number of historical objects into their narratives and developing new methodological techniques that can accommodate the full diversity of psychiatry's hybrid past. Increasingly, these histories are coming to be written in terms of multilateral and multivalent interactions with various other disciplines and organizations. In crafting these new narratives, historians face a confusing panoply of historical agents and events, reminding them that like the discipline of psychiatry itself, theirs too is a heterologic undertaking, grappling to understand and explain the otherness of psychiatry's past.

SUMMARY

This review surveys the scholarly literature in several specific areas that have attracted the attention of historians of psychiatry in recent years. In particular, it considers work in the history of psychiatric institutions, borderline disorders, 20th-century somatic therapies, military psychiatry, and colonial psychiatry.