Certainly our pioneers have been too much romanticized. The neurotic legacy which they bequeathed to us can plainly be seen in many characteristics of our uncouth Westerners with their alternate coldness towards visitors and their undignified warmth towards the casual stranger who really cannot mean anything to them. There is something wrong about man as a social animal when he cannot live happily in a valley where he sees more than the distant smoke of his neighbour’s chimney. When at last the pressure of population forces him to live socially his suspicion and distrust are likely to turn him into a zealot and reformer and make possible the domination in American life of such a sub-cultural type as Bryan or the beatitudes of a State like Kansas. The favourite Western exhortation to be able to look a man in the eye and tell him to go to Hell is worthy of an anti-social community of ex-convicts, and the maxim about minding your own business can only be understood as a defence against the prevalent tendency of everybody to mind his neighbour’s business. Thus the self-isolating neurotic ends by revenging himself upon society by making it intolerable.
But this is to anticipate. It must be said that until after the Civil War America remained singularly free from “nerves.” This is perhaps largely due to the fact, as I have tried to show, that they were not known as such. The only serious epidemic was the witchcraft hunting of the 17th century. It is certainly most charitable towards a religion which had so many other repellent features to characterize this as an hysterical epidemic and let it go at that, though it also freshly illustrates the time-worn truth that intolerance does not seem to make its victims any more tolerant in their turn. The passing of this epidemic also marked the last irruption of State intolerance towards religion, with the exception of later incidents in connection with the Mormon Church, though it has rarely been understood that especially in this country State tolerance of religion was compensated for by individual and social intolerance in matters that quite transcended the religious sphere. The vast importance of this phenomenon in relation to our modern nervous tension will be referred to again later on.
The first typical manifestation of American nerves on an imposing scale began to develop in the sixties and seventies of the last century in the form of neurasthenia. Until then the typical American, despite his religious obsessions and his social deficiencies, had, to a large extent, remained externally minded, a fact which is sufficiently attested by his contempt for the arts and his glorification of his purely material achievements. He had been on the make, an absorbing process while it lasts, though rather dangerous in the long run because it never comes to an end. Neurasthenia developed rapidly as soon as it had been properly labelled, and claimed a notable number of victims among our captains of industry and high-pressure men: indeed, the number might easily lead to the perhaps rather unkindly conclusion that business dishonesty, even though successful, is likely to result in nervous breakdown in a generation piously reared on the unimpeachable maxims of a Benjamin Franklin or a Herbert Smiley. More fundamentally it was, of course, the logical penalty for cultivating the purely energetic side of man at the expense of his contemplative nature. The philosophy of hurry and hustle had begun to totter.
The discoverer, expounder, and popularizer of neurasthenia was Doctor George M. Beard, under whose ægis neurasthenia came to be known as “the American disease.” Dr. Beard was a sound neurologist within the limits of his generation of medicine, but with a dangerous gift of imagination. His conception of neurasthenia was truly grandiose. According to him this fascinating disease was endemic in the United States and was the result of our peculiar social conditions. Its cause, he claimed, was “modern civilization, which has these five characteristics—steam power, the periodical press, the telegraph, the sciences, the mental activity of women.” Among the secondary and tertiary causes of neurasthenia or nervousness he threw in such things as climate, the dryness of our air and the extremes of heat and cold, civil and religious liberty, our institutions as a whole, inebriety, and the general indulgence of our appetites and passions. In a remarkable chapter he also assigned as one of the causes of our nervousness the remarkable beauty of American women, though he does not clearly state whether this made only the men nervous or the women as well. Such a diagnosis was to turn sociologist with a vengeance and Doctor Beard lived up to his implications by saying that the cure of neurasthenia would mean “to solve the problem of sociology itself.”
The inevitable result of such a broad and confident diagnosis was to make of neurasthenia a kind of omnium gatherum of all the ills of mankind less obvious than a broken leg. To explain the affliction in terms of America rather than in terms of the patient and his symptoms had about the value of a foreigner’s book about America written on his home-bound steamer after a six-weeks’ sojourn in this country. In fact, the wildest diagnoses were made, and such perfectly well-defined medical entities as tabes, arteriosclerosis, parathyroidism, myasthenia, and incipient tumours of the brain were frequently given the neurasthenic label. Various theories of exhaustion and nervous strain were also advanced and the attempt was made to feed and strengthen the nervous system directly on the analogy of Professor Agassiz’s famous assumption that the phosphates in fish could be directly absorbed as material for brain-cells, a theory which did not account for the fact that comparatively few intellectual giants have sprung from fisher-folk. This naturally opened up a wide field for quackery and ushered in the era of “nerve tonics” which are still with us to-day. The craze for sanitariums also started at about this time, and with every doctor having a little sanitarium of his own the public was pretty well fleeced both by its “medicine men” and its men of medicine.
Of course no treatment could possibly be successful in curing such a wide variety of diseases the very existence of many of which was hidden from the physician under the blanket term of neurasthenia; and in those cases where an actual neurasthenia was present the treatment as developed by Beard and his followers made only superficial progress. The S. Weir Mitchell formula, for instance, with its emphasis upon quiet, diet, and rest, remained, in the majority of cases, essentially a treatment of symptoms rather than of causes. The tired and over-wrought business man was given a pacifying vacation from his dubious labours and was then promptly sent back to them, like a dog to his vomit. The American woman, grown nervous from being insufficiently occupied, was initiated into a different form of doing nothing, whereat she felt much relieved for a time. Neurasthenia was soon moving in a vicious and ever-widening circle; the more it spread the more it had to include and thus became less and less digested medically; it played havoc especially among American women who exploited their “nervousness” much as their European sisters had exploited their “migraine” or their “vapours” in previous generations. By the nineties, however, neurasthenia had run its course as a fashionable affliction, other countries had succeeded in surviving without erecting a quarantine against it, and medical circles had begun to debate whether there was such a thing as neurasthenia at all.
But, despite the breakdown of neurasthenia and the sins that were committed in its name, it would be a mistake to be merely amused at Doctor Beard for the pretentiousness of his concept or to criticize him too severely for being too much of a medical popularizer. His insight was, after all, of considerable value. For he realized, however imperfectly, that the neuroses as a class are cultural diseases and that they cannot be properly understood without taking into account the background of modern civilization. This is a rare virtue in American medicine where the specialist is constantly in danger of isolating himself, a tendency which is particularly harmful in the study of the mental sciences. Unfortunately Doctor Beard did not follow through. He seems to have become frightened at his own diagnosis. For no sooner had he drawn the worst possible picture of American civilization as a breeder of neurasthenia than he turned around and assured the public that things were not so bad after all. He accomplished this by enriching his sociology with a philosophy which is a prodigy in itself. This philosophy of his he called the “omnistic philosophy” and claimed for it the peculiar virtue of being able to include “optimism on the one hand and pessimism on the other and make the best of both,” which is undoubtedly as uplifting a piece of American metaphysics as one is likely to find on the whole Chautauqua circuit. In criticizing the slow advance of American medicine as a whole it is always well to remember the atmosphere of intellectual quackery in which our physicians no less than our early metaphysicians so confidently moved.
By the end of the 19th century the study of functional nervous disorders in America was, as I have said, pretty well strewn with the disjecta membra of neurasthenia which still breathed slightly under the stimulus of electro- and hydrotherapeutics and of the “health foods” industry. Meanwhile hypnotism also had come to do its turn upon the American medical stage, where it ran through a swift cycle of use and abuse. Neurology as a special department, like the rest of American medicine, had been greatly enriched by contact with continental medicine, and the works of Kraepelin had come into honour among the psychiatrists. Dr. Morton Prince had begun to publish some interesting studies of double personalities, and a number of tentative systems of psycho-therapy based on a rather mixed procedure had been set up only to be knocked down again as a beneficial exercise for the critical faculty.
But now the stage was set for the appearance of the two modern theories of the neuroses as presented in Europe by Janet and Freud. In the rivalry that immediately ensued between these two opposing theories that of Janet was soon outdistanced. His fundamental conception of hysteria as a form of degeneration was in a way quite as repugnant to American optimism as the sexual interpretation of Freud was to American prudery. Janet had indeed been of invaluable help to the hysteric by taking him seriously, but his presentation of the subject was so narrow and his theory in the end proved so static that his views have made little headway. Janet was also under the disadvantage of working as an isolated figure in a prescribed field and did not come into any revolutionary relation to psychology as a whole or find those immensely suggestive analogies in the field of psychiatry, especially in dementia præcox and paranoia, which have given the work of Freud such a wide range. He had, besides, the defects common to so much of French medicine which is often so peculiarly insular and, so to speak, not made for export. His contribution more or less began and ended with the theory of the dissociation of the personality which is not characteristic of hysteria alone and could not successfully be grafted upon the old psychology to which Janet clung.
On the other hand, Freud after an initial resistance rapidly became epidemic in America. As was the case in Europe, he enjoyed considerable vogue among the lay public while still violently opposed in medical circles. His visit to America, however, in 1909, on the occasion of the twentieth anniversary of Clark University, created a very favourable impression and brought him to the attention of such American psychologists as William James, Edwin B. Holt, Adolf Meyer, and others. His works appeared in this country in translations by Doctor A. A. Brill, and in a short while Freud was “taken up” with a vengeance.