Free How Everyone Became Depressed by Edward Shorter

due time to be rested, or as a bottomless pit of exhaustion, demanding sighs and groans.” 27 It was this that “neurasthenia” accomplished.
Neurasthenia
    Wh at fixed the attention of everybody—doctor and patient alike—upon the phenomenon of tiredness, to the exclusion of everything else in the nerves package, was the coining of the diagnosis “neurasthenia” by New York electrotherapist George M. Beard in 1869. To be sure, the term neurasthenia had been used before and Beard did not literally coin it. But his 1869 article in a prominent American medical journal, and following book in 1880, gave the diagnosis a kind of viral spread.
    Beard’s neurasthenia bombshell burst into the medical world with an article in 1869 in The Boston Medical and Surgical Journal, which was the forerunner of the New England Journal of Medicine. In a talk in 1868 to the New York Medical Journal Association, Beard said, “I am to speak to-night of a condition of the system that is, perhaps, more frequently than any other, in our time at least, the cause and effect of disease. I refer to neurasthenia, or exhaustion of the nervous system.” Thus at the beginning, Beard appeared to be referring not to a whole syndrome but to the specific symptom of tiredness, the result of the central nervous system becoming “dephosphorized … and as a consequence becomes more or less impoverished in the quantity of its nervous force.” But attentive listeners on that evening would have learned that Beard was in fact speaking more of a nervous syndrome than an isolated symptom: “If a patient complains of general malaise, debility of all the functions, poor appetite, abiding weakness in the back and spine, fugitive neuralgic pains, hysteria, insomnia, hypochondriasis, disinclination for consecutive mental labor, severe and weakening attacks of sick headache, and other analogous symptoms … we have reason to suspect that … we are dealing with a typical case of neurasthenia.” 28 So, from the outset, neurasthenia was really just a synonym for nerves, but one that focused in particular upon the component of fatigue.
    Beard’s 1880 book, A Practical Treatise of Nervous Exhaustion (Neurasthenia), reached a wide medical audience and was at once translated into the most important medical language of the day: German. Indeed, it was dedicated to the Heidelberg neurologist Wilhelm (“William”) Erb, one of the major international authorities, with whom Beard was by now bosom buddies. Here Beard made it clear that he included in neurasthenia a variety of anxiety disorders, including phobias and obsessive-compulsive traits (one of his patients was unable to “go more than half a mile in a straight line”); others displayed what would later be hived off as “social anxiety disorder”: “This aversion of the eyes is so constant a symptom in neurasthenic patients that I often make the diagnosis as soon as they enter the office, before a word has been spoken by either party, and even before the patient has had time to be seated.”
    And insomnia! “One man finds no difficulty in getting to sleep on retiring, but soon wakes, and must remain awake for the rest of the night.” Beard’s patients had disorderly intestinal tracts. “Flatulence with annoying rumbling in the bowels these patients complain of very frequently; also nausea and diarrhoea.”
    Some of the symptoms of neurasthenia were almost certainly the result of medical suggestion, such as “crawling, creeping, and burning sensations” along the spine, a holdover from the days of “spinal irritation” (which Beard considered part of neurasthenia).
    Beard believed “nervous exhaustion” to be synonymous with neurasthenia, and in the 1880 book he dilated upon, “This feeling of exhaustion, though not exactly pain in the usual sense of the word, is yet, in many cases, far worse than pain.” Exhaustion might come on in what would later be called “panic attacks”: a kind of