Putting the Rest Cure to Rest Again
Is mental illness the result of a physical malfunction of the body or is it purely in the mind? This is the question that doctors asked themselves after they discovered the nervous system.
Mental illness can affect the mind, torso and behaviour, and the symptoms tin be difficult to pin down. Sometimes there are no obvious concrete signs of a condition and sometimes physical signs are very apparent.
No wonder that people take looked to the stars, the supernatural, heredity and social and environmental factors for ways to explicate and treat mental affliction.
In the 1600s, a growing interest in anatomy and dissection led to new discoveries nigh the nervous system and the pathways betwixt the nerves, spinal cortex and the encephalon.
Among mental health doctors a new debate emerged virtually whether the causes of some mental disease might lie in the physical malfunction of the fretfulness rather than something less tangible.
Neurology—a new medical specialism
Neurology is a branch of medicine dealing with disorders of the nervous arrangement. Neurological do relies heavily on the field of neuroscience, the scientific study of the nervous system.
A neurologist is a md specializing in neurology. Since neurologists entered the field of mental illness, psychiatry and neurology have tended to overlap. Early pioneers of neurology included Guillaume Duchenne de Boulogne (1806–1875) and Jean-Martin Charcot (1825–1893).
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Neurology was readily accepted as a mental health discipline, because a concrete basis for their status gave people hopes of treatment and even cure, whereas disorders of the mind raised the prospect of indefinite incarceration in an asylum.
Neurological treatments for mental illness included hypnosis, electrotherapy and the 'rest cure'. These could be carried out in doctors' offices, wellness spas or patients' homes. But expensive neurological therapies were only available to the wealthy. For ordinary people with nervous illnesses, there were nerve tonics.
Nerve tonics
Medical entrepreneurs responded to the growing market in nervous disease treatments with an enormous variety of nerve tonics made from their own secret recipes. The term 'tonic' came from the outdated idea that organs needed firmness or tone to function properly. In this case, the organ in question was the nervous organisation.
Many of these tonics used powerful, poorly understood and oft addictive ingredients such as strychnine, morphine, lithium salts and cocaine. Many nervus tonics were banned in the early 1900s when new laws required them to specify their ingredients.
The nervous breakup
In the 1700s, the term 'nervous breakup' referred to a specific medical disorder that was emphatically a illness of the fretfulness, non a illness of the mind. The difference was subtle simply crucial, as information technology kept patients out of asylums.
The nervous breakdown was also known every bit 'nervous exhaustion' and 'nervous collapse'. It was characterised by pain, weakness, migraine headaches and fatigue. The condition besides included symptoms that we at present acquaintance with low, such every bit despair, feelings of inadequacy and a lack of joy in whatever attribute of life.
Popular and medical opinion linked nervous sensitivity to delicacy and refined sensibilities. It allowed people with nervous symptoms to avoid the stigma and prejudice associated with mental illness. The diagnosis of nerves became fashionable amidst the upper classes: 'I'm non ill, but I'grand nervous,' Rex George Iii bodacious his courtroom.
Hysteria
Hysteria was a status long associated with women. Symptoms differed from patient to patient and from one historical flow to another, but they always involved both the body and the mind. Some feature symptoms were: shortness of breath, heaviness in the abdomen, muscular spasms and fainting. Anxiety, irritability and embarrassing or unusual behaviours were also noted.
The Aboriginal Greek philosopher Plato gave an explanation for hysteria in which the uterus was an creature. He said it roamed inside women's bodies, causing symptoms as it moved. Every bit anatomical knowledge improved, the idea of the roaming uterus was rejected, but medical explanations for hysterical symptoms remained vague for centuries.
In the 1800s, hysteria was recast as a nervous illness. Nearly all Victorian physicians considered women more sensitive and mentally and emotionally frail than men. They believed women were more susceptible to nervous breakdowns and 'weak nerves', then hysteria, as the archetype 'female malady' had to be a nervous disease.
However, in the late 1800s the French neurologist Jean-Martin Charcot proposed that hysteria was a more general inherited nerve illness, like to multiple sclerosis, and not a 'sexual trouble' unique to women.
Sigmund Freud, who had studied under Charcot in 1885, later developed the theory that hysteria was rooted in unconscious emotional disharmonize rather than weak nerves. But the characteristics of the condition remained elusive.
Some early treatments for hysteria:
Neurasthenia
Neurasthenia emerged as a new nervous affliction in the late 1800s. The term was coined by American asylum doctor Edwin Holmes Van Deusen, who noted a detail status among rural, isolated communities of farmers and peculiarly farmer's wives. People with neurasthenia were solitary, bored, depressed and oft over-burdened with childcare and housework. Typical symptoms were irritability, indisposition, indigestion and a general malaise, which could develop into mental breakdown if ignored.
In New York, neurologist George Beard popularised the term neurasthenia, but reframed the 'rising epidemic' of neurasthenia to the hectic pace of urban life. Neurasthenia became something of a catch-all diagnosis that could be the result of rural isolation and colorlessness, or urban over-stimulation and crowding.
Treatment was like to nervous breakdowns: a range of therapies if you could afford them and tonics if you could non. Some other popular and relatively safe handling, especially for neurasthenic men was vigorous outdoor practise.
The diagnosis of neurasthenia never caught on in Great britain, where doctors saw information technology every bit an American attempt to lend false scientific legitimacy to the old condition of fretfulness.
The balance cure
A new condition like neurasthenia required a new treatment. The remainder cure was a strictly enforced authorities of six to 8 weeks of bed residual and isolation, without any creative or intellectual activeness or stimulation. Information technology was often accompanied by massage and electrotherapy, as well as a fatty diet, rich in milk and meat.
The cure was devised by neurologist Silas Weir Mitchell as a treatment for neurasthenia. He attributed neurasthenia to a depletion of the nervus force. This depletion irritated the brain, digestive organs and reproductive arrangement. It was also used to treat hysteria and anorexia nervosa and prescribed more for women than men.
Weir saw the rest cure equally particularly suited to treating women, partly because he thought women tolerated a lack of stimulation and inactivity better than men. He also saw information technology as a corrective for women who were overly active, socially and physically. According to Mitchell, the high fatty diet boosted weight and claret supply, making a woman "as a mother more capable, as a married woman more helpful".
The residuum cure was really only suitable for educated, skilled and wealthy patients who had the fourth dimension and aid to undergo the treatment in their own homes or in a fashionable sanatorium. It may have kept some patients alive and others out of asylums, but some patients and doctors found the cure worse than the affliction. Charlotte Perkins Gilman'south chilling short story 'The Yellow Wallpaper' describes how a adult female isolated by her rest cure begins obsessing on the yellow wallpaper in her room and eventually goes mad.
Neuroses
In the early 1900s, German neurologists distinguished neurological diseases from neuroses. Neurological disorders such every bit epilepsy, dementia, multiple sclerosis and Parkinson's disease had a proven anatomical footing in the nervous organization or brain, whereas the ground of neuroses could non be definitively determined every bit either physical or mental.
Neurasthenia gradually became office of the broader diagnostic category of neurosis and the term disappeared from medical usage. But the 'nervous breakdown' remained pop as a less stigmatised manner to describe a debilitating but temporary episode of mental disease.
The distinction betwixt neuroses and neurological disease put conditions like 'fretfulness' and nervous breakup firmly in the domain of the mind and not the torso, and by the 1930s, treating neuroses was clearly the domain of psychoanalysis and psychiatry, rather than neurology.
Psychoanalysis—the talking cure
In the first half of the 1900s psychoanalysis was extensively used for treating neuroses. The therapy was developed by Sigmund Freud in Vienna at the very end of the 1800s. Freud was convinced that neuroses, foreign dreams and other difficult-to-explain aspects of mental life were rooted in alien and commonly unconscious desires rather than neurological malfunction.
Freud'south psychoanalytic practice was based on listening carefully to the patient. He recorded whatever they talked nigh, looking for clues to the origins of their condition. One of Freud'southward patients, Bertha Pappenheim, summed it up as the 'talking cure'.
After Freud, psychoanalysis went on to develop in many directions and became one of the well-nigh influential therapies of the 1900s.
Psychoanalysis became very influential in American mental health when many European practitioners fled Nazi Germany in the 1930s and fabricated their homes in the United States. Their efforts helped to establish psychoanalysis during and after the Second World War. Psychoanalytic theory became popular among American psychiatrists as well equally psychologists every bit a style to admit the role of both mind and body in mental illness.
The use of psychoanalysis inside psychiatry began to decline from the 1960s, largely because of the development of new psychiatric drugs, which offered a cheaper and less labour-intensive treatment. Simply psychoanalysis in its various forms is still at the middle of many rehabilitation therapies.
Suggestions for further enquiry
- Porter, Roy; 'Madness: a brief history', Oxford University Printing, 2002.
- Showalter, Elaine; The Female person Malady: women, madness and English civilization, 1830-1980', Penguin Books, 1985.
- Orbach, Susie; 'In therapy : how conversations with psychotherapists really work', Profile Books Ltd, 2016.
- Hallet, Christine; 'Containing trauma : nursing piece of work in the Commencement World War', Manchester Academy Press, 2009.
Notice out more than near mental health
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Source: https://www.sciencemuseum.org.uk/objects-and-stories/medicine/nerves-neuroses
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