The rise of medically unexplained conditions like fibromyalgia and chronic fatigue syndrome in the United States looks remarkably similar to the explosion of neurasthenia diagnoses in the late nineteenth century. In this paper, I argue the historical connection between neurasthenia and today’s medically unexplained conditions hinges largely on the uncritical acceptance of naturalism in medicine. I show how this cultural acceptance shapes the way in which we interpret and make sense of nervous distress while, at the same time, (...) neglecting the unique social and historical forces that continue to produce it. I draw on the methods of hermeneutic philosophy to expose the limits of naturalism and forward an account of health and illness that acknowledges the extent to which we are always embedded in contexts of meaning that determine how we experience and understand our suffering. (shrink)

After the introduction of the fifth Diagnostic and Statistical Manual of Mental Disorders, familiar voices were raised in protest. The voices stem from ideas of which, among others, and in different ways, Michel Foucault and Thomas Szasz were influential proponents: The movement was referred to as 'antipsychiatry.' This movement reacted, among other things, to the system of categorization of mental disorders. Diagnoses, in a system of classification, were thought to be vague, arbitrary, labelling, stigmatizing, and scientifically and clinically poorly validated. (...) In contemporary debates on DSM-5, similar critiques can be heard, expressed by a movement now referred to as 'critical psychiatry'... (shrink)

The present contribution analyses the nervousness and neurasthenia discourse in the early Soviet Union. Its focus is on psycho‐hygienic plays staged by the Moscow Theatre for Sanitary Culture. It asks in which images, figures and actions a knowledge about the nervous disorder was presented on stage, which genre traditions and communicative instruments were used and on which changing political implications those performances were based. To obtain this the archive sources, selected texts of neurasthenic dramas, reports and reviews in daily (...) press have been evaluated. (shrink)

A collection of before and after photographs of female patients treated using Weir Mitchell’s Rest Cure for neurasthenia shows how important the anorectic body was to the promotion of this specific method of treatment. The photographs document the inevitable weight gain that resulted from the Rest Cure’s prescription of absolute bed rest and the consumption of a high caloric diet requiring the ingestion of several quarts of milk daily. In doing this, the photos served a powerful semiotic function, since (...) the plump individual at the end of the treatment presented a dramatic contrast to the emaciated long-term invalid who had begun it. The after treatment photographs also implied that these women were now capable of discharging their roles as wives and mothers, since an additional benefit of the Rest Cure was that severely underweight patients resumed normal menstrual cycles. However, although the Rest Cure undeniably alleviated some physical symptoms, it did not address underlying issues of what had caused so many of these patients to take to their beds in the first place, often for years at a time. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 10.1 (2003) 57-62 [Access article in PDF] Listening to People Or Listening to Prozac?Another Consideration of Causal Classifications Jennifer Hansen Keywords causal classification, descriptivism, melancholia, neurasthenia, depression, cultural relativism. The shape and detail of depression have gone through a thousand cartwheels, and the treatment of depression has alternated between the ridiculous and the sublime, but the excessive sleeping, inadequate eating, suicidiality, withdrawal from social (...) interaction, and relentless despair are all as old as the hill tribes, if not as old as the hills. In the years since man achieved the capacity for self-reference, shame has come and gone; treatments for bodily complaints have alternated and crossed with treatments for spiritual ones; pleas to external gods have echoed pleas to internal demons. To understand the history of depression is to understand the invention of human being as we now know and are him. Our Prozac-popping, cognitively focused, semi-alienated postmodernity is only a stage in the ongoing understanding and control of mood and character. (Solomon 2001, 286) ALTHOUGH ANDREW SOLOMON clearly believes that "the shape and detail of depression have gone through a thousand cartwheels," Jennifer Radden gives us pause before assuming that depression is just another name for Dame Melancholy. Solomon's claim depends on a deeper metaphysical claim about the nature of depression and its causes. The current method of psychiatric nosology, descriptivism, does not necessarily support equating melancholia and depression. Furthermore, it appears that adopting descriptivism as the sole method of classifying mental disorders commits us to cultural relativist psychiatry. Below I reconsider whether we want to rule out causal classifications and suggest that embracing both descriptivism and causal classifications offer us greater possibilities in understanding human illness and culture.Although the occasion for Jennifer Radden's essay is to investigate whether or not melancholia and depression refer to the same thing, her essay detours into a consideration of extra-descriptivist models of psychiatric illness versus the descriptivism of current psychiatric nosology. This detour turns out to be warranted; her purely academic question yields to a timelier question concerning the proper methodology for classifying mental disorders. Whereas debates about psychiatric nosology are perennial, the recent success of the new generation of antidepressants [End Page 57] is reviving biological psychiatry and its search for the neurochemical origins of depression. Hence, embedded in Radden's question concerning whether or not melancholia is the same thing as clinical depression, is another important question concerning the causes of mental illness, particularly depression.Currently, with its descriptivist approach, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not classify mental illness, such as clinical depression, based on underlying causes. The cluster of symptoms and behavioral signs that lead a clinician to diagnose one as depressed that are contained in either the DSM or the International Classification of Diseases (ICD) may be too fuzzy or elusive to give any clear distinction between major depression, mild depression, and the blues. For example, one group of epidemiologists points out that [t]he DSM-III, DSM-III-R, and DSM-IV acknowledge that depression, like many mental disorders, has no currently obvious natural classes... If natural classes of depression exist, then their nosology awaits the discovery of distinct and reliable genetic, biological, clinical, or other predictors of risk, severity, or clinical course. Clinicians have a tradition of separating depressions into subtypes; however, this subtyping has not yet led to clear-cut delineations of syndromes in populations. (Kaelber 1995, 4) The evidence is still insufficient to establish the biological or psychological origins of depression. Although many theories exist that explain why people become depressed, scientifically we are not yet in a position to determine which is the right theory. From a pragmatic perspective, however, whether or not we know what causes depression, we can nonetheless attempt to alleviate suffering from depression. And it is with this goal in mind that the DSM-IV and ICD-10 classify mental disorders.Now, given that our current methodology for psychiatric nosology does not establish causes, it is also insufficient for determining what... (shrink)

The Anger of Achilles, Robert Graves’ 1959 translation of Homer’s Iliad, has been variously dismissed by classical scholars as an ‘outrageous sortie into the field of translation’ and a work of ‘sheer egotism’, marred by its author’s ‘scattered yapping’. And yet, it can be read with greater understanding if we approach it not merely as a literary anomaly, but as a refraction of Graves’ experience of ‘Shell Shock,’ or PTSD, following his front line service during the First World War. This (...) paper proposes that the act of translation can itself be cathartic, creating a formalized textual space in which the translation of traumatic memory into narrative memory becomes viable, and that Graves used Homer’s epic as a tool to access his own occluded, traumatic past. By comparing The Anger of Achilles to R. Lattimore’s relatively literal translation of the Iliad, it will illuminate the ways in which the former is deeply rooted in Graves’s experience of combat, his ensuing neurasthenia, and the personal Myth by which he made sense of both – the matriarchal mythopoetics of The White Goddess. (shrink)

The Viennese obsession with sex at the fin-de-siècle was vividly expressed in the artworks of Gustav Klimt and Egon Schiele. Their depictions of women demonstrated their fascination with and fear of female sexual pleasure and desire, reflecting a wider societal anxiety and erotic fixation. This paper will analyse selected paintings and drawings by both Klimt and Schiele to explore this dynamic of 'erotic neurasthenia.'.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.4 (2005) 343-348 [Access article in PDF] Doomed by Nature: The Inevitable Failure of our Naturally Selected Functions Andreas De Block Keywords psychoanalysis, Darwinism, evolutionary psychiatry, pathogenic metaphysics In their very thoughtful and stimulating replies, the three commentators foreground several topics crucial for both psychoanalysis and philosophical psychiatry. In my short response, I focus primarily on what the commentators believe to be the paper's main (...) shortcomings. The first critique reads as follows: Freud never claimed that the Homo sapiens is a fundamentally sick animal, but in fact thought that normalcy is possible and that normal behavior need not be interpreted as neurotic, perverse or psychotic. The second is that current Darwinian psychiatry does not substantiate the view that Homo sapiens is essentially an ill animal, whatever Freud's position might be. Third and last, the proposal that all human beings are ill to the core seems to be more of a religious slogan than a scientifically useful description. What Freud Really Said A transhistorical approach to Freud's work is far from simple, considering that it spans a period of over forty years and that it underwent considerable changes during that time. Not only did Freud introduce some radically new concepts during that time, such as narcissism and the death drive. Also, he regularly changed his position on the aim of psychoanalytic therapy, the ontogenesis of anxiety, and the nature of human sexuality. That Freud sometimes saw homosexuality as an inborn drive did not keep him on other occasions from thinking that homosexual desire was a result of the repression or projection of an oedipal (heterosexual) drive. Examples like these show that any exegesis of Freud's writings inevitably has to deal with some tensions. Freud's work contains numerous apparent, as well as real, contradictions, so that it is no surprise at all that Katherine Morris can produce textual evidence "proving" that Freud never held the view I attribute to him. According to her, Freud thought that we are not all neurotics and that normalcy is possible.I do not deny that several passages in Freud's work underscore the possibility of non-neurotic normalcy. Indeed, Freudian theory even describes processes—sublimation, the transformation from Id to Ego, the resolution of the oedipal complex, among others—that explain how human beings can escape neurosis and other mental disorders. But Freud's illustrations of these mechanisms or processes make clear that he could not conceive [End Page 343] of a nonpathogenic psychodynamics. Consider, for instance, how Freud emphasizes throughout his study of Leonardo da Vinci that Leonardo's sublimations make him extremely vulnerable to psychic exhaustion or "neurasthenia" (1910). Freud never tires of repeating that there is only a gradual difference between a neurotic patient and Leonardo da Vinci, the sublimating ("healthy") artist and scientist.Morris (2005) is right, of course, in arguing that a gradual difference between normality and mental illness does not imply that there is no difference at all. Quantity should not be thought the opposite of quality, because small quantitative differences can transform an "articulation" into a "breach." To use Hegel's famous example, there is a continuum between 110° C and -10° C, but everybody knows that that water evaporates above 100° C and freezes below 0° C. Applied to mental disorders, quantitative differences in levels of testosterone and serotonin may lead to qualitative differences in behavior; in other words, categorical and dimensional approaches to mental illnesses are not mutually exclusive. Having established that, we now need to take a closer look at how Freud articulated the differences between seemingly normal individuals and the mentally ill.Freud held that neurosis, psychosis, and perversion are caused by the interplay between instincts and defense mechanisms. Further, he thought that the pathogenic instincts were almost exclusively sexual. Now, although it is true that he sometimes recognized that the fear of death and the death drive are important factors for psychic life (Deeley 2005) and for the etiology of psychosis, more often than not he interpreted the fear of death as a symbolization of... (shrink)

This paper focuses on the make-up of different cultures in experimental neurology, neuroanatomy, and clinical psychiatry. These cultures served as important research bases for early regenerative concepts and projects in the area of neurology and psychiatry at the beginning of the 20th century. Nevertheless, the developments in brain research and clinical neurology cannot be regarded to be isolated from broader societal developments, as the discourses on social de- and regeneration, neurasthenia, nerve-weakness and experiences of the brain-injured after WWI show. (...) Societal and cultural developments directly influenced researchers’ conceptualisation, scientific ideas, and even their experimental and clinical orientation. They directly reflect which scientific problems the neuroscientists felt inclined to address and what areas they began to leave aside. Using the concept of socio-technical experiments, it is demonstrated that research methodologies in neuronal de- and regeneration studies were not simply a product of recent advances in the scientific differentiation of somatic neurology or brain-psychiatry. Moreover, they resulted in important interdisciplinary attempts which emerged from great collaborative work including neuroscientists from various areas of investigation in both basic and clinical contexts. (shrink)

During the late nineteenth and early twentieth centuries, gas-pipes were among the most popular therapeutic devices available to an unhealthy public. Spurred on by the explosion of print advertising, mail-order gas-pipes were questionable remedies promoted for such diverse conditions as pneumonia and neurasthenia. Though they are an interesting part of the social history of questionable therapeutics, no historian has recently looked in depth at these devices. This paper examines the clinical, social, and economic environment that facilitated the success of (...) the most ubiquitous gas-pipe, the Oxydonor, and its proprietor, Hercules Sanche. (shrink)