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.

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, 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.

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.

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[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.