by Marissa Hamm, IMHM Intern
In Charlotte Perkins Gilman's The Yellow Wallpaper, readers follow the downward spiral of the female protagonist as she suffers from “temporary nervous depression.” To cure her issues of fatigue and irritability, her physician husband, John, whisks her away to a house in the country where she is confined to an attic room and ordered to stay in bed. John provides his wife with “cod liver oil, tonics, ale, wine, and rare meat” and prevents her from having any “excitement” that would further drain her nervous energy. By the end of the story, the protagonist’s condition has worsened and she imagines that she is now part of the yellow wallpaper that lines the attic room.
This short story often lives on in the minds of those who read it in their high school literature classes. However, many do not know about the real condition underlying the protagonist’s troubles: Neurasthenia. In 1869, George Beard coined the term neurasthenia. Beard posited that the human body was a machine powered by nervous energy -- a compelling metaphor for Americans embroiled in the industrial revolution. When people expended too much nervous energy, they became fatigued and sick with neurasthenia.
Symptoms of neurasthenia included depression, irritability, insomnia, lethargy, indigestion, a lack of ambition, an inability to concentrate, anxiety, headaches, muscle and joint pain, weight loss, impotence, amenorrhea, and mental and physical collapse. As this laundry list of symptoms shows, neurasthenia was a catch-all diagnosis for many issues. So what exactly caused this illness?
Physicians like Beard believed that modernity and society’s progress took a toll on one’s nervous energy and led to neurasthenia. It was thought that modern conventions such as steam power, the periodical press, telegraphs, overpopulated cities, and “the mental activity of women” placed demands on citizens that were sometimes too much to handle. Neurasthenia quickly became known by a secondary name, “Americanitis,” and those with the condition were said to be an “active mind, a competitive character, a lover of liberty -- in short, the quintessential American.”[2,3] Some patients begged their physicians to diagnosis them with neurasthenia because of the condition’s positive perception, and many doctors were eager to make the diagnosis.
An important distinction to keep in mind is that neurasthenia was an illness of the privileged, particularly white, Northern, and Protestant Americans. In order to get the diagnosis, one had to be able to afford to see a physician and then pay for the recommended treatments. Further, the illness became a tool of oppression used against Catholics, Southern whites, Native Americans, immigrants, and African Americans. Beard theorized that these groups of people were immune to neurasthenia because they lived in various states of “ignorance” therefore their brains were not at risk of being overworked.
The primary treatments for neurasthenia were total rest for women, as seen in “The Yellow Wallpaper”, or an “escape” to the Western U.S. for men so that they could participate in “manly” work – an actual treatment prescribed to Theodore Roosevelt before his presidency. In Indianapolis, wealthy citizens could check into a facility such as “Norways”, Dr. Albert E. Sterne’s sanatorium for nervous diseases. In 1912, Norways cost patients $35 to $90 a week and promised a luxurious experience (as one would expect for that price tag!). Yet Central State Hospital also cared for neurasthenic patients, although on a much smaller scale. Between 1889 to 1916, Central State admitted four cases of neurasthenia, 75% of which were female.
The Hospital also admitted patients for “nervous prostration” and “overwork.” There were only two cases of nervous prostration (a type of nervous exhaustion), one male and one female, between 1889 and 1896. Significantly more popular was the diagnosis overwork. Between 1889 and 1916, 36 males and 25 females were admitted to the Hospital for overwork.[5,6] Overwork was very similar to neurasthenia. As Horatio C. Wood explained it in his 1885 book Brain-Work and Overwork, when people are engaged in “emotional excitement” for extended periods of time, such as stockbrokers, they forget to check in with their body and rest, which leads to nervous exhaustion known as overwork.
Despite its earlier popularity, neurasthenia eventually fell out of favor as the psychology field grew. By 1920, neurasthenia was largely out of use and in 1980, the DSM III officially removed the diagnosis. However the legacy of neurasthenia lingers. Not only do scholars agree that conditions such as chronic fatigue syndrome, fibromyalgia, anxiety, and depression are modern day equivalents of neurasthenia, the illness also transformed the way that Western nations view health. There is a societal belief that happiness, comfort, and emotional wellbeing lead to good physical health.
In many ways, people around the world still struggle with neurasthenia today, but instead we call it things like “stress” or “burnout.” We long to take relaxing vacations, spend time in nature, and discover our “inner peace” as ways to manage the daily stressors of modern life. We may have more ways to discuss and understand how our mental and physical health are connected, but at the end of the day, we are still trying to achieve the ideal “happiness” that promises long-term health, just like the neurasthenics did over a century prior.
 Gilman, Charlotte Perkins. The Yellow Wallpaper. Auckland: The Floating Press, 2009.
 Schuster, David G. Neurasthenic Nation: America’s Search for Health, Happiness, and Comfort, 1869-1920. New Brunswick: Rutgers University Press, 2011.
 Beck, Julie. “‘Americanitis’: The Disease of Living Too Fast.” The Atlantic. March 11, 2016. https://www.theatlantic.com/health/archive/2016/03/the-history-of-neurasthenia-or-americanitis-health-happiness-and-culture/473253/
 Hostetler, Joan. “Then and Now: Clifford Place and Norways Sanatorium.” Historic Indianapolis. May 12, 2011. https://historicindianapolis.com/then-and-now-clifford-place-and-norways-sanatorium/.
 Annual Report of the Central Indiana Hospital for the Insane, Volumes 40-49. http://hdl.handle.net/2027/nyp.33433004139758.
 Annual Report of the Board of Trustees and Superintendent of the Central Indiana Hospital for Insane, Issues 54-67. http://hdl.handle.net/2027/mdp.39015069712100.
 Wood, H.C., M.D. Brain-Work and Overwork. Philadelphia: P. Blakiston, Son & Co., 1885. https://hdl.handle.net/2027/umn.31951000955961b.
[a] “Dr. Miles Nervine Advertisement.” Indianapolis Times (Indianapolis, IN), April 15, 1927. https://newspapers.library.in.gov/?a=d&d=IPT19270415.1.9&srpos=92&e=-------en-20--81--txt-txIN-------
[b] “Americanitis Elixir Advertisement.” Greencastle Harold (Greencastle, IN), May 11, 1911. https://newspapers.library.in.gov/?a=d&d=GH19110511-01.1.4&srpos=2&e=-------en-20--1--txt-txIN-------
[c] “‘Norways’ Sanatorium Inc. – for Nervous Diseases Advertisement.” Indianapolis Medical Journal 15, no. 1 (1912): 18a.