Free How Everyone Became Depressed by Edward Shorter Page A

“going-to-die feeling,” Beard said. Beard avoided describing symptoms of depressed mood, probably because he did not want to risk having his precious diagnosis conflated with melancholia or even with what people were already referring to as “depression.” Yet he could not avoid the subject. On variations in muscular strength, he said, “One may have great mental depression at times, or at all times may have neurasthenic asthenopia, the various forms of morbid fear, general debility in its various phases, and yet be capable of great muscular endurance.” One of his patients, a physician, “gave a perfect history of the disease [neurasthenia]; but when I asked him if he was subject to mental depression, he replied: ‘I passed through all that;’ and this I observe oftentimes of neurasthenics in middle life, that symptoms of the early stages of the disease, such as mental depression and dyspepsia, have ceased their annoyances.” 29 So mild depression was definitely part of the picture.
    The many advocates of neurasthenia in the decades ahead increasingly avoided the expression “nerves,” which now seemed too old-fashioned, and shunned as well phrases conveying mood disorders, because they wished to cling to the organicity of neurasthenia, rather than turfing their booty to the psychiatrist.
    But booty there was aplenty. Medical empires became founded on neurasthenia. Physicians set up profitable consulting practices as neurasthenia specialists, not psychiatrists to be sure, but not your ordinary run-of-the-mill doctor either. Paul Hartenberg in Paris saw mainly patients with hysteria and neurasthenia and profiled his high-end practice along those lines. Yet, trained by internist and hypnotherapist Hippolyte Bernheim at Nancy, he was not a psychiatrist. He was 41 years old when in 1912 he published his widely read Treatise on Neurasthenia, featuring patients such as “the forty-ish man who entered my office and said to me, ‘Docteur, I’ve come to consult you because I am always fatigued and incapable of working. When I get up in the morning, I am tireder than the night before. During the whole day, I feel my body, my limbs all stiff. The slightest effort exhausts me, and I can no longer go for walks or take any physical exercise. Even standing upright is painful.’”
    Thus far, a clear-cut fatigue case, right? But there is more. “But I’m tired, not just in the body but in the head. There is constantly a tension band about my scull. I feel that my head is empty. My mind refuses to work. My thoughts are confused and I can no longer fix my attention. My memory is shot. When I read, I no longer know by the bottom of the page what I’ve read at the top. I forget my appointments, my business affairs.” This certainly sounds like depression.
    And it is: “With all that, I’m sad. I am bored to death everywhere and always. Everything that other people find amusing leaves me flat. I take no pleasure at anything.” These are classic symptoms of depression. But Hartenberg’s patient was also anxious: “I am worried about everything. The slightest problem alarms me. The least upset exasperates me.” Moreover, this forty-ish man had “lost his appetite, slept poorly and had no sexual desire.” 30 Doctor, your diagnosis? Today we would say unhesitatingly “major depression,” with comorbid anxiety. But there is nothing that differentiates Hartenberg’s patient from the many other nervous patients of history, merely that the both the patient and Hartenberg chose to focus on the man’s fatigue, rather than on his anxiety or dysphoric mood. Fatigue is not a medical emergency. The complete absence of pleasure in life is, because these patients are inclined to suicide.
    Every big city had its Doctor Hartenberg, the neurasthenia specialists who sometimes were genuine scientific figures as well, such as Hermann Oppenheim in Berlin, or sometimes they were just medical businessmen. Oppenheim, a leading neurologist