Towards a Cultural History of Exhaustion

Anna Katharina Schaffner writes: In the age of burn-out, in which even the pope – traditionally a beacon of unwavering faith and indefatigable service until death – has cited both physical and spiritual exhaustion as one of his official reasons for resigning, it is illuminating to investigate more closely the phenomenon of exhaustion and its historical vicissitudes. In conjunction with the periodic rise and fall of empires and eras, the spectre of exhaustion – understood as both an individual and a wider cultural experience – tends to haunt medico-psychological, philosophical and literary discourses. Yet the arguments that shape the scholarly and the popular image of exhaustion, and the narratives that medical and other writers produce to explain both interior processes and the relation between the individual’s energy reserves and society, fluctuate historically and often overlap with other diagnostic categories.

Exhaustion is a metaphorically potent concept that can be understood as a subjective physical, psychological and spiritual experience, but also as a broader cultural occurrence, which may involve political apathy, philosophical and aesthetic nihilism, anxieties about the sustainability of the environment and limited natural reserves, and various other forms of cultural and economic pessimism. Physically, exhaustion manifests itself as chronic fatigue, tiredness, weakness and a general lack of energy. On a psychological and spiritual level, we could describe it as weariness, disillusionment, disenchantment, apathy, hopelessness, lassitude, and lack of motivation. Exhaustion is also connected with ‘lateness’, as a preoccupation with it tends to emerge in the context of the final stages of epochs and empires, for example at the nineteenth-century fin-de-siècle, and is in these cases related to ennui, decadence and decline.

Advertisement for Horsford’s Acid Phosphate, late nineteenth century. Courtesy the National Library of Medicine.

Advertisement for Horsford’s Acid Phosphate, late nineteenth century. Courtesy the National Library of Medicine.

Exhaustion is commonly understood as a specifically modern affliction, as both an individual and a broader cultural reaction to various features of modernity, including urbanization, industrialization, and bureaucratization, the faster, technologically enhanced pace of modern life, the specific stresses of sedentary ‘brain work’, secularization, the dissolution of stable social hierarchies and the theoretical possibility of social mobility, and, of course, the psychological repercussions of ‘late’ capitalism.

Physical (and, in some accounts, also mental) exhaustion features at the heart of the neurasthenia diagnosis, first proposed in the United States in 1869 and popularized in the early 1880s by the physician and electrotherapist George M. Beard.[1] Beard clearly hit a nerve with his diagnostic venture; the rapid spread of the diagnosis is legendary, comparable to the popular success of Charcot’s influential hysteria symptomatology. In American Nervousness: Its Causes and Consequences, specifically written for a more popular audience and published in 1881 as a supplement to his previous study A Practical Treatise on Nervous Exhaustion (Neurasthenia) (1880), Beard defines neurasthenia as a ‘deficiency or lack of nerve-force’.[2]Nervousness’, he writes, ‘is nervelessness’.[3]

The popularity of his category has partly been explained by the fact that he drew together a plethora of more or less trivial symptoms to form one nosological entity.[4] Moreover, Beard clearly signposts neurasthenia as a ‘functional disease’ of the nervous system, that is, a somatic rather than a psychological disorder, thus freeing its sufferers from the stigma attached to mental illness. He explicitly declares it a disease of civilization, triggered by various characteristics of the modern age. Amongst these he famously lists ‘steam-power, the periodical press, the telegraph, the sciences, and the mental activity of women’.[5] Furthermore, he associates neurasthenia with the middle and upper classes, arguing that its symptoms are the result of too much ‘brain work’, particularly common amongst businessmen and captains of industry.

Advertisement for Newbery & Sons  Effervescent Brain Salt, nineteenth century. Image courtesy Wee_Lisa

Advertisement for Newbery & Sons Effervescent Brain Salt, late nineteenth century. Courtesy of Wee_Lisa

In order to render his diagnosis palatable to the general readership at which his study was aimed, Beard repeatedly deploys metaphors from the spheres of economics, engineering and physics to illustrate the workings of neurasthenia. Neurasthenics are compared to chronically overdrawn or badly managed accounts, to leaking batteries and to tired steam engines. These similes are telling – they not only align the diagnosis with distinctly modern technological developments, but also frame it in popular imagery that reflects the dominant economic values of the time, most significantly, the importance of unhampered productivity and judicious management of one’s capital assets. Given that a whole range of positively connotated characterological features as well as dubious claims about the social and racial superiority of the neurasthenic individual and the neurasthenic nation as a whole were integral to Beard’s diagnosis, it is not surprising that neurasthenia quickly became not just a Zivilisationskrankheit, but a Modekrankheit, and rapidly spread to Europe, especially Germany, England and France.

Edward Shorter explains the rise of chronic fatigue-related diagnoses and symptoms through recourse to wider medical paradigm changes, arguing that patients unconsciously choose psychosomatic symptoms that are deemed ‘legitimate’ by doctors and are in tune with current medical thinking. When the spinal reflex theories and organicist hereditary models of the earlier decades of the nineteenth century were gradually replaced by the paradigms of central-nervous disease and psychogenesis, the convulsive fits, paralyses and other motor symptoms that had been produced by hysterics gave way to subtler sensory symptoms, above all fatigue.[6]

Neurasthenia experienced its heyday between 1880 and the beginning of the First World War. Thereafter, it gradually disappeared from the medical handbooks and lost its appeal as a diagnostic category. The reasons for its disappearance are manifold and complex. However, amongst the most important are a paradigm shift in the fields of psychiatry and psychology, namely, the advent of psychoanalysis. The safely somatic aetiology of the symptoms clustered together under the neurasthenia umbrella was increasingly questioned,[7] and psychoanalytic explanations began to replace purely biological models. Neurasthenia was also a large, unwieldy category, comprising a cluster of diverse symptoms, and as diagnostic tools became more refined, this nosological entity was broken up again into more sharply delineated sub-categories.[8] Gradually, depression began to be seen as a more powerful master category that could explain a host of other physical and mental symptoms that are structured around exhaustion.[9] Furthermore, later in the twentieth century, a concern with exhaustion began to reappear, once again under the banner of somatic diseases and new labels such as ME, CFS and burn-out.

Advertisement for Labarraque's Quinium, late nineteenth century. Courtesy of Bibliotheque Nationale, Paris, France.

Advertisement for Labarraque’s Quinium, late nineteenth century. Courtesy of Bibliotheque Nationale, Paris, France.

However, whilst the nineteenth and twentieth centuries are considered as the age in which the theorization of exhaustion reached its zenith, the phenomenon has also been a concern in other periods. The idea that exhaustion, technological progress and ‘late’ capitalist modernity are inextricably linked might itself be a modern myth, one that was ardently propagated by the erstwhile theorists of neurasthenia and is still perpetuated by many historians writing on the topic today. Exhaustion might well be a more ubiquitous, less specifically ‘modern’ phenomenon than is often assumed. The notion of volatile bodily economies and the limited supply of human energy capital, for example, was not at all Beard’s invention. The importance and the precarious nature of a balance between the four humors that could be threatened by a surplus or waste of particular fluids was a constitutive component of humor theory, first introduced to medicine by Hippocrates in the fifth century BC and arguably the dominant paradigm in medicine until the nineteenth century. Anxieties about the perilous wastage of non-renewable life energy were also the chief driving force in the anti-masturbation panic that swept across Europe in the eighteenth and early nineteenth centuries.[10] Even the art of aligning an ultimately flattering disease with a particular nationality is not a new strategy – George Cheyne, in his influential study The English Malady: or, A treatise of nervous diseases of all kinds, as spleen, vapours, lowness of spirits, hypochondriacal, and hysterical distempers, etc (1733), had already deployed the same device.[11]

As aetiologies of exhaustion vacillate historically between somatogenetic and psychogenetic models, they can function as illuminating case studies for an exploration of the ways in which the relation between mind and body, inside and outside, the individual, society and the cultural and natural environment, has been construed in medical and other works. Yet, given that exhaustion is a phenomenon that traverses the personal and the cultural, how can we disentangle the concept from related terms and identify its core characteristics.

In my work-in-progress Exhaustion: A History I am exploring the ways in which exhaustion (understood for this purpose simply as physical and/or mental fatigue) relates to other diagnostic criteria, both historical and current. Physical and/or mental fatigue lie at the centre of various other diagnostic categories, including melancholia, nervousness, hysteria, neurasthenia, depression, ME, CFS and burn-out. However, these phenomena also comprise other symptoms, and their aetiologies differ substantially. I wish to identify the ways in which exhaustion has been incorporated into these illnesses and the function that its core symptoms perform within them. Is there an historically and culturally ubiquitous set of experiences that we can include under the term ‘exhaustion’, or do the different labels under which it is categorized shape the experience? Exhaustion has been theorized as a product of humoral or biochemical imbalance, as a psychological or a somatic ailment, as an individual reaction to the loss of a love object or a broader cultural response to a faster pace of life and transformations in economic and social structures. What can these narratives tell us about the cultural mechanisms that drive the construction of specific diseases? And in what ways are the boundaries drawn between the individual and their environment, the somatic and the psychological, the local and the systemic in the respective diagnostic narratives? Finally, in addition to the medical narratives of exhaustion, I will also explore the metaphorical potential of the concept by investigating its uses in economic, political, philosophical and historical discourses, as well as aesthetic representations of exhaustion in literature, the fine arts and film.

Please do get in touch if you have any suggestions/comments/queries – I would be very grateful to hear from anyone with feedback and/or an interest in setting up an interdisciplinary research network.

[1] See George M. Beard, A Practical Treatise on Nervous Exhaustion (Neurasthenia): Its Symptoms, Nature, Sequences, Treatment (New York: W. Wood, 1880) and American Nervousness: Its Causes and Consequences. A Supplement to Nervous Exhaustion (Neurasthenia) (New York: G. P. Putnam Sons, 1881).
[2] Beard, American Nervousness, p. vi.
[3] Ibid., p. 5.
[4] For general discussions of neurasthenia, see, for example, Andreas Killen, Berlin Electropolis: Shock, Nerves, and German Modernity (Berkeley and London: University of California Press, 2006); Joachim Radkau, Das Zeitalter der Nervosität. Deutschland zwischen Bismarck und Hitler (Munich: Carl Hanser Verlag, 1998); Marijke Gijswijt-Hofstra and Roy Porter (eds), Cultures of Neurasthenia from Beard to the First World War (Amsterdam and New York: Rodopi, 2001); Volker Roelcke, Krankheit und Kulturkritik. Psychiatrische Gesellschaftsdeutungen im bürgerlichen Zeitalter 1790–1914 (Frankfurt a. M.: Campus, 1999); Simon Wessely, ‘Neurasthenia and Fatigue Syndromes’, clinical section, in A History of Clinical Psychiatry: The Origins and History of Psychiatric Disorders, ed. by German E. Berrios and Roy Porter (London: Athlone, 1995), pp. 509–32; Tom Lutz, ‘Neurasthenia and Fatigue Syndromes’, social section, in ibid., pp. 533–44; Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York: The Free Press, 1992); Tom Lutz, American Nervousness, 1903: An Anecdotal History (Ithaca, NY: Cornell University Press, 1991); Janet Oppenheim, ‘Shattered Nerves’: Doctors, Patients, and Depression in Victorian England (New York and Oxford: Oxford University Press, 1991); F. Gosling, Before Freud: Neurasthenia and the American Medical Community, 1870–1910 (Chicago: University of Illinois Press, 1987); and Elaine Showalter, The Female Malady: Women, Madness and English Culture, 1830–1980 (London: Virago Press, 1987). For reflections on neurasthenia and literature, see Maximilian Bergengruen, Klaus Müller-Wille, Caroline Pross (eds), Neurasthenie. Die Krankheit der Moderne und die moderne Literatur (Freiburg im Breisgau: Rombach, 2010).
[5] Beard, American Nervousness, p. vi.
[6] Shorter, From Paralysis to Fatigue, pp. 267–94.
[7] Cf. Wessely, ‘Neurasthenia and Fatigue Syndromes’, clinical section, in A History of Clinical Psychiatry, pp. 509–32; Lutz, ‘Neurasthenia and Fatigue Syndromes’, social section, in ibid., pp. 533–44.
[8] Cf. Radkau, Das Zeitalter der Nervosität, p. 440.
[9] Cf. Wessely and Lutz. See also Alain Ehrenberg, The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age (Montreal and London: McGill-Queen’s University Press, 2010), for his discussion of the rise of the depression diagnosis.
[10] See Samuel-Auguste Tissot, Onanism: Or, a Treatise upon the Disorders Produced by Masturbation: Or, the Dangerous Effects of Secret and Excessive Venery, trans. A Hume, based on the third, revised edition (London: Wilkinson, 1767); Thomas W. Lacqueur, Solitary Sex: A Cultural History of Masturbation (New York: Zone Books, 2003); and Anna Katharina Schaffner, Modernism and Perversion: Sexual Deviance in Sexology and Literature, 1850–1930 (Basingstoke: Palgrave, 2012).
[11] Cf. Andrew Scull, Hysteria: The Biography (Oxford: OUP, 2009), pp. 95–6.

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10 Responses to Towards a Cultural History of Exhaustion

  1. Hey there, May I suggest a couple of books for your project. Firstly, Post-Viral Fatigue Syndrome by the late Dr Melvin Ramsay, who today remains highly respected in the field of ME, and secondly, you might be interested in reading my autobiographical novel ‘The State of Me’ (HarperCollins 2008), a fictionalisation of my own experience of the illness ME. I was diagnosed with myalgic encephalomyeltiis n early 1984 by a consultant neurologist, after becoming ill with Coxsackie B4 virus in late 1982 – there was a cluster of ME in the west of Scotland at this time. I had never hear of ME or Coxsackie, my undergraduate studies were severely disrupted when the illness punched into my life. I remain ill today. It is worth mentioning, I think, that ‘exhaustion’ is not strictly at the core of ME, rather PEM (post-exertional malaise) or PENE (post-exertional neuroimmune exhaustion) – ie. exhaustion and pain and brainfog after even *trivial* exertion, taking 24 hrs to a week to ‘recover’. PEM is the cardinal feature of ME, but not ‘chronic fatigue’. . In fact, recent studies have shown that people with ME produce 20 times more lactic acid than healthy people when they exercise. You may also be interested in reading the International Consensus Criteria for ME, published in 2011, which demonstrate the difference between ME and ‘chronic fatigue’. And as you may know, ME has been categorised as a disease of the central nervous system by WHO since 1969. Link to ICC here:
    Hope this is helpful!

    • AK Schaffner says:

      Dear Nasim,
      Many thanks for your suggestions – they are very helpful indeed. I will definitely explore these texts.
      Best wishes,

  2. says:

    Estimada Anna Katharina Schaffner: Gracias por enviarme la página, es muy interesante el tema que está abordando. Respecto a su propuesta: me encantaría formar parte de un grupo interdisciplinario de investigación sobre este tópico. Actualmente tengo un proyecto sobre esto mismo, pero para un trabajo empírico, con médicos residentes de psiquiatría. Trata de investigar sobre la importancia y alcances de crear un programa de humanidades médicas y su relevancia en la atención de desgraste emocional en los mismo médicos. No lo he iniciado aún por falta de recursos, desafortunadamente en el país no hay interés en financiar este tipo de estudios. ¡Estaré pendiente de qué manera podría yo participar en dicho grupo!. Atte.- Ana Silvia Figueroa-Duarte

  3. JB says:

    Gender will be a very interesting factor in your study!

  4. Dave says:

    Hi there Great to see that you are taking an interest in ME CFS but maybe you might want to update your ideas here about ME being as being exhaustion , neurasthenia or some other mental health issue.
    There is plenty of evidence now coming from researchers in science done by respected scientists one of them being Julia Newton, Dean for Clinical Medicine at Newcastle University in the UK showing that ME has an underlying biological cause.
    You might not be aware of this new research comeing from Newcastle University not everyone is up to date with the latest research findings of abnormalities in ME.
    ‘Biological breakthrough offers fresh hope for ME sufferers’ | The Times | 23 April 2013
    by Tony Britton on April 23, 2013

    From The Times, 23 April 2013 (story by Hannah Devlin, Science Editor).

    Scientists have found compelling new evidence of an underlying biological cause for the constant fatigue suffered by ME patients.

    The study revealed abnormalities in the muscle cells of ME patients, which are likely to contribute to feelings of tiredness and the inability to cope with sustained physical activity that many experience.

    An analysis of muscle biopsies suggested that the cells had undergone substantial changes, making them less able to cope with exertion.

    The finding shows that, whatever the initial trigger for ME, which affects more than 600,000 in Britain, the condition leads to a cascade of physical changes right down to the cellular level.

    Some patients still report facing stigma due to popular misconceptions that the condition is “all in the mind”, despite growing evidence that ME has real physical symptoms.

    Julia Newton, Dean for Clinical Medicine at Newcastle University who led the study, said that the latest science was changing “people’s perception of this terrible symptom”.

    Professor Newton presented the findings at a meeting in London yesterday marking the launch of a collaboration aimed at generating more research into the disease.

    In the study, scientists took muscle biopsies from ten patients and ten healthy but sedentary volunteers.

    The muscle cells were grown into small pieces of muscle and then subjected to “exercise” in the form of electrical impulses.

    The cells from ME patients produced on average 20 times as much acid when exercised, suggesting an underlying cause for the aching muscles that patients often experience as soon a they begin to exercise.

    The cells also showed other abnormalities, such as reproducing more slowly.

    “We have found very real abnormalities”, said Professor Newton.
    University of Newcastle press release | 23 April 2013

  5. A wonderful post. Fascinating research. Good luck to you. The ends of centuries are also associated with epidemics of “hysteria” (broadly defined). You might find an interesting connection here. See Elaine Showalter’s ‘Hystories: Hysterical Epidemics and Modern Culture.’

  6. Hey again, Re. above comment, I have not read Showalter’s book, but she caused much anger with her arguments that ‘CFS’ and Gulf War Syndrome – like claims of alien abduction – were manifestations of hysteria, ‘psychogenic syndromes of the 1990s’. This review from The Independent, 1997:

  7. Dave says:

    Jan Henderson I’m not sure how you can chose to ignore Julia Newton, Dean for Clinical Medicine at Newcastle University and then say ME CFS is just hysteria when Women fought for the vote in the 1800s and also to be taken seriously as scientists .

    Dr. Anthony L Komaroff has treated hundreds of ME/CFS patients over the past 25 years
    Ten discoveries about the biology of CFS
    Anthony Komaroff, MD, is a professor of medicine at Harvard Medical School, senior physician at Brigham and Women’s Hospital in Boston, and the editor-in chief of Harvard Health Publications. Dr. Komaroff has an ongoing research program on chronic fatigue syndrome and has published more than 230 research articles and book chapters.

    Multiple sclerosis were also at one time said to be hysteria
    Multiple Sclerosis History
    1. It was Dr. Jean Martin Charcot (1825 – 1893) who first scientifically described, documented, and named the disease process, we still call Multiple Sclerosis.

    So named, from the many scars found widely dispersed throughout the Central Nervous System (CNS), but are usually found to be arrayed in a symetrical pattern near the Cerebrum’s Lateral Ventricles.
    2. The first patient Dr. Freud ever treated was his former Nanny, who had Multiple Sclerosis. *Creeping Paralysis* as it was called in those days, was considered a mental condition caused by *Female Hysteria*. As such, little or no extensive research was conducted into the mysteries of MS, until very recent times.

  8. Pingback: Sunday Morning Medicine | Nursing Clio

  9. Pingback: ‘Exhaustion’ (CfP – University of Kent, Friday, 25 October 2013) | Centre for Medical Humanities Blog

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