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Before Freud: Neurasthenia and the American Medical Community, 1870-1910
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From Library Journal
This historical account of 19th-century psychiatry in America suggests a greater sensitivity to psychological factors in medical practice than is often recognized. The book focuses on "neurasthenia," a catchall term that described a variety of "nervousness" short of insanity touching a sizable percentage of the population. Using quantitative as well as anecdotal material, the author convincingly portrays the ubiquitous nature of this complaint in all reaches of American life and the broad attempts to treat it. The book provides some interesting case vignettes and convincingly links this period with more contemporary psychiatric approaches, but much of the material has been more exhaustively covered elsewhere. Paul Hymowitz, Cornell Medical Ctr., New YorkCopyright 1988 Reed Business Information, Inc.
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Product details
Hardcover: 214 pages
Publisher: University of Illinois Press; First Edition edition (December 1, 1987)
Language: English
ISBN-10: 0252014065
ISBN-13: 978-0252014062
Product Dimensions:
6.5 x 1 x 9.5 inches
Shipping Weight: 1.2 pounds
Average Customer Review:
4.0 out of 5 stars
3 customer reviews
Amazon Best Sellers Rank:
#1,120,702 in Books (See Top 100 in Books)
This amazing little book summarizes the 19th and early 20th century Neurology journal articles describing cases of Neurasthenia, the forerunner to what we call today "Stress Disease". Of course, the vast numbers of medical practitioners practicing today still know little about these conditions, even though the majority of their patients suffer from them. Go figure.
The history of neurasthenia (hysteria) is a fascinating attempt to override a lack of empirical evidence in the 19th century. For the knowledgeable reader, it is also a cautionary tale of the distortion of social construct used by some modern psychiatrists. Fortunately, although hardly comprehensive, biomedical science is steadily revealing the fallacies of "historical" medical speculation.In the late 1800s doctors in "modern" hospitals sent post childbirth morbidity soaring to unprecedented heights. Why? The failure of physicians to wash their hands between autopsy and delivery room. The medical establishment of the day ignored the growing science of germs blaming rocketing death rates on bad mother's milk.Were medical historians to attempt to resurrect the "concepts" behind this historic medical nightmare now, the attempt would be ridiculed in biomedical circles and quite possibly the subject of intense litigation.The fashionable revival of the archaic concept of neurasthenia, declared clinically invalid and eliminated as a diagnostic category in the American Psychiatric Association's widely accepted Diagnostic and Statistical Manual of Mental Disorders IV should also be viewed through the lens of biomedical progress.The "political"reclassification attempts of biomedical disease including Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, formally and exclusively classified for decades as an organic neurological disorder (ICD10 G93.3), is an excellent example. Biomedical resarch tells us a great deal about the complex, but cohesive and distinct biomedical pattern of substantial autonomic dysfunction, objectively verified cognitive deficits, pathological post-exertional fatigue, CNS disordered sleep and endocrine function, and post viral immune dysfunction. Another biologically defined overlapping disorder, medically classified as a soft tissue disorder involving the muscles and pain, is fibromyalgia.Although the precise pathogenesis of biological, rarely pathogonomic, illness remains medically unclear in many organic disorders, including ME/CFS and fibromyalgia; seventy years of substantial, peer-reviewed biomedical research should be heeded and the scientifically and empirically unsubstantiated myths of previous centuries - left where they belong.As noted by British psychiatrist Eliot Slater, the resurrection of "hysteria" is a pseudo-diagnosis, which functions principally as 'a disguise for ignorance and a fertile source of clinical error'.
Before Freud is an enlightening and well written overview of neurasthenia. [The most simple present day equivalent term for `neurasthenia' is `stress'.] The myriad symptoms of neurasthenia are still widespread at the dawn of this new millennium, showing that some things change little in the course of human events. In the 21st century people speak of the symptoms of feeling `stressed out' in the same ways in which their great-great grandparents described neurasthenia. Instead of the diagnosis of neurasthenia, we now prefer to label the same symptoms by the names of `clinical depression', `chronic fatigue', `fibromyalgia', and `anxiety'.Gosling thoroughly explores one of the most common medical diagnoses of the latter 19th and early 20th century. This book presents information and data which help the reader understand the concept of neurasthenia, and reach opinions about its diagnosis and treatment more than a century ago. The book also helps the reader gain insight into changing medical and social attitudes toward some of the most common chronic symptoms that large numbers of the public still experience.Some of the commonly-held beliefs and practices of physicians more than 100 years ago persist today within `alternative medicine'. These include belief in the inseparability of the body and mind; emphasis on healthy diet and adequate rest; conservative physical medicine and the importance of exercise; and involving the patient in his/her process of healing. We also learn that the most effective `ingredients' in the health regimens employed in the effective treatment of these vague, non-life-threatening symptoms, included sympathy with the patient, and the general belief that most patients can recover from or learn to manage their symptoms.Before Freud also outlines for the reader the evolution of medical practice from holism to specialization. The reader will discover how psychiatry moved from the general practitioner's office, and gradually evolved into a medical specialty. [The same phenomena happened with most categories of illness.]One of the greatest contributions of Before Freud is that the information provides us with the realization that medical thought and public opinion does indeed shift from one generation to another. What is considered to be good medical science in one generation is commonly viewed as outdated by successive generations. Although the labels and methods of treatment have changed, the complex of symptoms once known as neurasthenia is very much a part of modern life.
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