9 The Culture of Neurasthenia


The Culture of Neurasthenia

Gilman struggled with “nervous troubles,” as her narrator called it, for much of her life. When she gave birth to a daughter, Katherine, in 1885, she fell into a depression. She recalls saying to herself, “You were called to serve humanity, and you cannot serve yourself. No good as a wife, no good as mother, no good at anything” (quoted in Bederman 130). In 1887, she checked herself into Silas Weir Mitchell’s clinic in Philadelphia. Mitchell diagnosed her with neurasthenia, a condition characterized by a depressed or anxious mood, fainting, or pains with no apparent physical cause.

Mitchell’s famous “rest cure” for neurasthenia was designed to reduce the patient to the state of an infant. The patient would be forbidden to leave her bed, isolated from almost everyone, and force-fed large quantities of milk and iron supplements. Gilman found her stay in the clinic “agreeable.” Mitchell pronounced her cured. He instructed her to “Live as domestic a life as possible” upon her return home, to “have your child with you at all time” (even though dressing Katherine had been a source of distress), and to “never touch pen, brush, or pencil as long as you live” (quoted in Bederman 131). It was in attempting to follow Mitchell’s advice at home that Gilman “came so near the borderline of utter mental ruin that [she] could see over” (Gilman, “Why I Wrote ‘The Yellow Wallpaper’”).

Was Gilman suffering from postpartum depression? Yes and no. A medical diagnosis is a set of meanings, not just a set of symptoms. Studying literature can help us see how changes in language can change the way patients feel and the way doctors treat their patients. Postpartum depression is by definition a woman’s condition, and by implication, a condition whose cause is assumed to be primarily hormonal. Neurasthenia was not exclusively a woman’s disease, although it was infused with gendered attitudes (as you will see in the online exhibition below).

Neurasthenia was also thought to be a uniquely modern condition. In a book called American Nervousness: Its Causes and Consequences (1881), the neurologist George M. Beard held that “The chief and primary cause of this development and 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” (quoted in Lutz 4). In other words, neurasthenia was said to be the body’s shocked response to a world that was faster and more connected than ever before: the world of In the Cage and, to a lesser extent, McTeague. And, of course, the last item on the list tells us that Beard considered intellectual women something new and unnatural.

Representations of “nerve weakness” reinforced dominant ideas about gender and class. Historians Barbara Ehrenreich and Deirdre English write:

It was acceptable, even stylish, to retire to bed with ‘sick headaches,’ ‘nerves,’ and various unmentionable ‘female troubles,’ and that indefinable nervous disorder ‘neurasthenia’ was considered, in some circles, to be a mark of intellect and sensitivity….

From the domestic perspective, the sick woman was not that far off from the ideal woman anyway. A morbid aesthetic developed, in which sickness was seen as a source of female beauty, and beauty—in the high-fashion sense—was in fact a source of sickness. Over and over, nineteenth-century romantic paintings feature the beautiful invalid, sensuously drooping on her cushions, eyes fixed tremulously at her husband or physician, or already gazing into the Beyond. Literature aimed at female readers lingered on the romantic pathos of illness and death…. Society ladies cultivated a sickly countenance by drinking vinegar in quantity or, more effectively, arsenic. The loveliest heroines were those who died young, like Beth in Little Women [1868], too good and too pure for this world. (Ehrenreich and English 119)

Ehrenreich and English are not saying that women who suffered from these symptoms were “faking it,” but that real illnesses and disabilities were overshadowed by fictional representations thereof. A middle-class woman might occupy a position of privilege (romantic beauty, pampering, an association with “modernity” or “civilization”) and still have her concerns ignored.

In the nineteenth century, the word neurasthenia was used interchangeably with the word hysteria (from the Greek word meaning ‘womb’). Around the turn of the twentieth century, with the rise of Freudian psychoanalysis, there was a shift from the economic model of hysteria (a depletion of nervous energy) to a psychological model, whereby unspoken feelings or desires were thought to be unconsciously converted into physical symptoms. Another significant difference between the nervous-exhaustion paradigm and the Freudian one is that Freudian psychoanalysis starts with listening and interpretation, both of what the patient says and how she says it; Weir Mitchell, by contrast, made it clear that he did not care what Gilman wrote. That’s part of the reason Freud has influenced many literary critics and Weir Mitchell has influenced very few. You are not expected to know any Freudian theory for this course, but it is likely you will encounter some when you read scholarship on Gilman. Gilman’s objection to Freud? Too much sex (Moynihan).

As a review, browse the online exhibition “Neurasthenia and the Culture of Nervous Exhaustion,” created by the Health Sciences Library of the University of Virginia. Pay particular attention to the pages called “Neurasthenia Cures for Women” and “The Neurasthenia Rest Cure and Dr. Silas Weir Mitchell.”


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