Manufacturing depression (14 page)

The cure for mental illness was not to breed insanity out of the human race. Rather, psychic suffering should be seen as a sign that a person was having difficulty doing what we all have to do: adapt to a demanding environment. It wasn’t long before Meyer concluded that people, even psychologically troubled people, could reinvent themselves, and psychiatrists, in Meyer’s view, could and should help them to do it.

It took Meyer only a few years from the time he arrived in America to figure out something important about his adopted country. “
The public here
believe in drugs,” he wrote to the governor of Illinois in 1895, “and consider prescription as the aim and end of medical
skill.” Americans, that is, wanted their doctors to
do something
for them. That was the last thing that psychiatrists, with their life-sentence diagnoses, could offer.

Just before he made his report to the governor, Meyer visited the Battle Creek Sanitarium in Michigan. Battle Creek was one of the biggest spas that sprang up in the last half of the nineteenth century in the United States and Europe, where doctors, but not psychiatrists, offered multifarious treatment for nervous disorders. There Meyer saw doctors doing all kinds of something for (and to) their patients: enforced bed rest, cold baths, tonics, enemas, electric therapy, pelvic massage, and, of course, lots and lots of corn flakes, which the Kellogg brothers, who ran Battle Creek, invented.

Convinced by all that prescribing, Meyer formed an Association of Assistant Physicians of Hospitals for the Insane, which he envisioned as a forum to “
give us a clue for progress
” toward actually helping patients. (This was in some ways
a rearguard action
; there was already an Association of Superintendents of Hospitals for the Insane—which would eventually become the American Psychiatric Association—but Meyer thought it was too much concerned with administrative rather than clinical matters.) But with his nascent ideas about mental illness as a maladaptive reaction to the world, he couldn’t have failed to notice that this was exactly how Battle Creek’s doctors thought of their patients’ problems—as the result not of constitutional weaknesses or infections like syphilis, but of the difficulties of everyday life. And he must also have noticed that these doctors, who were more than willing to minister to their patients’ psychic suffering, were not psychiatrists but members of other specialties, especially neurology.

In Europe,
neurologists had already cornered
the market for treating life’s problems. Even as Kraepelin was tweaking his categories and Ehrlich was concocting his potions, neurologists like Sigmund Freud and his French mentor Jean Charcot were treating respectable, educated, and well-heeled people whose suffering stopped well short of the kinds of madness that landed patients in
the asylum. These neurologists were glad to reassure their patients that they were not insane, but merely
nervenkranken
(“nervous patients”), as the Germans called them, and suffering from illnesses like
l’erithisme nerveux
(“nervous weakness”)—a malady characterized by irritability, avoidance, and depression—and to treat them in
Nervenkliniks,
or in private offices, rather than asylums.

Successful as they were, however, the Europeans paled in comparison to the Kelloggs and their colleagues in the United States, who by the turn of the century had built a thriving industry on treating nerves, and especially a single nervous disorder: neurasthenia, or, as George M. Beard, neurologist and inventor of the diagnosis called it, “American nervousness.” Beard’s book by that title came out in 1881. It was the
Listening to Prozac
of its day, a runaway bestseller in which a doctor gave voice to common, if not yet articulated, worries about emotional life and what doctors proposed to do about it.

The ranks of the afflicted were legion. William James, his brother Henry, and their sister Alice, Theodore Roosevelt, Edith Wharton, W. E. B. DuBois, Frederic Remington, Mary Baker Eddy, Jacob Riis, Emma Goldman, Samuel Clemens—“
the list
,” says one scholar, “could go on until it included the majority of well-known cultural producers of the time”—not to mention the regular people, most of them affluent, whose doctors told them they had neurasthenia. And no wonder so many of them received the diagnosis! Beard’s list of symptoms takes up two pages of
American Nervousness,
from “
Insomnia, flushing, drowsiness
, bad dreams” through “ticklishness, vague pains and flying neuralgias” to “exhaustion after defecation and urination,” and, finally, just in case he missed something, “etc.”

The cause of all this trouble, Beard said, was a failure of the nervous system to keep up with the demands of “
modern civilization
,” which he listed as: “steam power, the periodical press, the telegraph, the sciences, [and] the mental activity of women. When civilization, plus these five factors, invades any nation,” he wrote,
“it must carry nervousness and nervous diseases along with it.” The main disease vector, apparently, was one young man, Thomas Edison, whose “experiments, inventions, and discoveries…are making constant and exhausting draughts on the nervous forces of America…[and keeping] millions in capital and thousands of capitalists in suspense and distress.” But even without Edison, rapid innovation and industry had become a whirlwind that was leaving Americans dizzy. Put Edison together with democracy and the rise of “
agnostic philosophy
” inspired by the rise of Darwinism—which, Beard said, had led to an expectation that everyone would become “an expert in politics and theology”—throw in “the liberty allowed…to Americans to rise out of the position in which they were born,” and cap it off with the possibility of knowing instantaneously what is going on everywhere and anywhere in the world, and the next thing you know, you have an epidemic of severely overworked nervous systems on your hands.

Not that Beard thought there was anything wrong with modernity. His catalog of stresses was not a jeremiad, but a celebration of progress. He prophesied not social and moral collapse but exhaustion, which was, with the help of doctors, eminently treatable. Neurasthenia was not a sign of degeneracy but the mark of the elect—the “brain workers” whose refined nature both qualified them to manage the new world and made them susceptible to its difficulties. It was the new white man’s burden, the stigma of the elite. “
Of our fifty millions
,” Beard estimated, “but a few millions have reached that elevation where they are likely to be nervous.” Our natural allotment of nervous energy may have been sufficient for “the lower orders,” but for “the very highest classes” these demands were like a new set of lamps interposed in an electrical circuit:

Sooner or later
…the amount of force is insufficient to keep all the lamps actively burning; those that are weakest go out entirely, or, as more frequently happens, burn faint
and feebly—they do not expire, but give an insufficient and unstable light.

It was up to the doctors to “bulk up the blood,” as Beard put it, in order to increase the output of our dynamos.

Charlotte Perkins Gilman made the nerve doctors infamous with her chilling story “The Yellow Wallpaper,” in which she chronicled the descent of a neurasthenic woman through her regime of “tonics, and journeys, and air, and exercise”—and an absolute prohibition of work—into a psychotic obsession with her sickroom’s wallpaper. But her doctors had help.

If a physician
of high standing, and one’s own husband, assures friends and relatives that there is really nothing the matter with one but temporary nervous depression—a slight hysterical tendency—what is one to do?

The entire society had heard Beard’s gospel—that there was a form of psychological suffering, of
nervous depression
, that had nothing to do with insanity. The patients weren’t the Tom O’Bedlams of the world but the leaders of society, who declared their neurasthenia much as celebrities today confess their depressions. Neurasthenia was as well known and accepted as Teddy Roosevelt, with his rough-riding military career, exaltation of open spaces, and his energy-conserving soft speaking/big stick philosophy. And the illness was simply to be accepted and dealt with, no different from the electric light bulb and the automobile. Even William James, in the midst of writing his
Principles of Psychology,
couldn’t resist the diagnosis. He took not only the rest cure at various spas but also injections of the extracts of goat’s lymph and bull testicles—all this despite the fact that “
I have no confidence
in three-quarters of what the doctors tell me,” as James wrote to a friend. But, he added, “I have so little independent hold on the situation that I am hypnotized by the remaining quarter, and by the prestige of their authority.”

James doesn’t even mention neurasthenia—his own or anyone else’s—in his
Principles.
That’s because no one thought that the affliction that had Americans submitting en masse to the nerve doctors was psychological in nature. It was a
physical
problem, a reaction of the body to an environment that demanded more than it could supply. If the mind was involved, it was only as a by product of these economics. There was nothing wrong with the inner selves of neurasthenics; they were merely victims of their put-upon nervous systems. All they had to do was to let themselves be hypnotized (sometimes literally) by the neurologists and all would be well.

It’s not hard to see why neurasthenia was such a hit and the neurologists who purveyed the cures so successful. The diagnosis gave a name to anxiety about the dizzying pace of change even as it reassured patients that as soon as their nervous system caught up, the disease would remit and all would be well—not to mention that their illness was a sign of their superior refinement. But no psychiatrist, least of all an ambitious psychiatrist like Adolf Meyer, could fail to see that the disease benefited one group of healers at the expense of his own. While neurologists, despite all their quackery, had become the go-to guys for otherwise reasonable people like William James, psychiatry was languishing. By World War I, according to historian Edward Shorter,
it had “become marginal
to the mainstream of medicine.” It was left to Adolf Meyer to reclaim the everyday psychological suffering of Americans for his profession, and he did it in part by making depression less like insanity—and more like neurasthenia.

In 1932, nearly four decades after he returned from Europe, Meyer recounted to the membership of the American Psychiatric Association (of which he was then president) about the time when he first came to America—“
days when real science
in medicine was identified with the deadhouse and the use of microscopes” and psychiatrists
wanted nothing more than to adopt that identity. Meyer told his audience that he was proud that psychiatry had made the shift from the deadhouse to the study of “plain facts.”

But, he went on, something still troubled him. When he was a country doctor in Switzerland, he said, he had gone on rounds with his uncle at a “small cotton mill in which about a hundred…demented women were employed and cared for.” He ministered to their coughs and complaints, discussed their diseases with their keepers, but “nobody asked or told me anything about their personalities.” Meyer was incredulous at his own former cluelessness. “How was it that a practical vision of psychiatry took shape with me so slowly?” He answered his own question:

Psychiatry became real
to me only when I had to handle patients whom I also had known without the mental disorder and who were viewed not as mere derelicts but as persons to be readjusted…giving me many an opportunity to incorporate well-known human facts in my more strictly medical thought of the time.

Psychiatry had been led astray by Kraepelin. In his effort to hitch his profession to science’s star, he had lost sight of humanity. “
The great mistake
of an over-ambitious science has been the desire to study man altogether as a mere sum of parts…as a machine, detached, by itself.” This, Meyer told his assembled colleagues, was the error that had led him to ignore the personalities of his Swiss patients when he was a callow youth. It was also the error that had pushed psychiatry to the margins.

In place of “strictly medical thought,” Meyer proposed what he called “
commonsense psychiatry
.” It was an approach that fit in well with his adopted home by placing people on an equal footing with their environment, transforming external circumstance into a force to be met with the mind—aided, when necessary, by psychiatrists—just as the physical landscape had been transformed from
primeval forest to civilization over a couple of hundred years. Freed from Kraepelinian constraint, from its racialist agenda and its therapeutic nihilism, psychiatrists could help patients understand what was wrong with their reactions to the world and then help them to change. They didn’t have to wait for people to become insane, nor did they have to resort to outlandish theories about nervous weakness. Taking the optimistic view that the mind was up to the challenge of curing itself, psychiatry could become a force for self-improvement in everyday life.

The commonsense approach meant that a diagnosis of a mental illness could be as benign as the diagnosis of neurasthenia, requiring nothing more or less than a prescription. You could be sick without being ruined, Meyer said, but only if you weren’t tossed into Kraepelin’s bins. This was especially true of depression.

Kraepelin’s manic-depressive insanity
and dementia praecox…do not exhaust the material that presents itself to us…There, are, for instance, many
depressions
which command our attention…without their belonging to the above groups.

Many people, Meyer went on, suffer from
essential depressions
that have nothing to do with manic-depressive insanity.