CHAPTER VIII - NEURASTHENIA
BY: GEORGE LINCOLN WALTON, M.D.
CONSULTING NEUROLOGIST TO THE MASSACHUSETTS GENERAL HOSPITAL
It was a common saying of Myson* that men ought not to investigate things
from words, but words from things; for that things are not made for the
sake of words, but words for things.
This term was introduced by [George Miller] Beard to designate a rather large class of the over-worked and worried who crowded his practice.
The word itself is derived from the Greek neuron "nerve", and astheneia "weakness".
Among the symptoms of this disorder are generally included disorders of digestion and circulation, muscular weakness, pains, flushes and chills, and anomalous sensations of every variety. It has been specially applied to cases showing such mental peculiarities as morbid self-study, fear of insanity and many various other phobias, scruples, and doubts with which we have become familiar.
The term, "American Disease", has been adopted abroad, in many cases, and volumes have been devoted to it.
Related: THE HISTORY OF NEURASTHENIA OR AMERICANITIS: HEALTH, HAPPINESS, AND CULTURE
Neurasthenia has been divided into cerebral, spinal, and otherwise, depending on how the fears and sensations of the patient are referenced to one or another part of his body. While the term neurasthenia became many years ago somewhat familiar to the general public, it was, on the whole, used, except as a convenient handle, rather less among neurologists.
[Footnote: In substantiation of this statement I need only cite the recent contribution of my friend, Dr. [Charles L.] Dana, on the "Partial Passing of Neurasthenia."]
The question has been asked, whether the symptoms of neurasthenia are always due to simple exhaustion. Advice regarding method, as well as amount, of work, came into vogue. Peterson, in a letter published in Collier's Weekly (November 9, 1907) spoke of a patient who has told him he is a practical business man, and that his mind has been so occupied with serious matters that he has been unable to attend to his health.
"You, practical! you, a business man! Why, you never had a serious
thought in your life until now--at least not since you were a lad in the
country.... Since boyhood you have never given a serious thought to health,
home, wife, children, education, art, science, racial progress, or to the
high destiny of man. You are simply a collector of money for its own sake,
with no appreciation of what it might represent if you were really serious
and really a business man or man of affairs. There are many like you in
our asylum wards, where they are known as chronic maniacs. Here is one who
collects bits of glass, old corks, and pieces of string. There sits another with a lap full of pebbles, twigs and straws."
Courtney (in [Walter Lytle] Pyle's "[A Manual of] Personal Hygiene") says, "The brain is an organ which, under proper training, is capable of performing an immense amount of work, provided only that the work is of a varied character and does not produce a corresponding amount of mental disquietude. The importance of the emotions, especially the depressing emotions such as grief, anxiety, and worry, as factors in the brain exhaustion, cannot easily be overestimated."
The obvious corollary to this proposition is that the constitutional
worrier is likely to break down under an amount of work which produces no
such effect upon the average normal individual.
The only quarrel I have with the name neurasthenia is that it diverts
attention from the real condition oftenest to be treated, namely, the
faulty mental tendency, and directs attention to an assumed debility which
may or may not exist. Misdirected energy, rather than weakness, is the
difficulty with one who is ready and anxious to walk miles to satisfy a
doubt, or to avoid crossing an open square, and who will climb a dozen
flights of stairs rather than be shut up in an elevator. Even the
exhaustion that follows long attention to business is quite as often due to
worry and allied faulty mental habits as to the work itself. In most cases
the phobias, the doubts, and the scruples, instead of being the result of
breakdown, must be counted among its principal causes.
This is why simple rest and abstinence from work so often fail to
accomplish the cure that should follow if the exhaustion were due simply to
overwork. In the "neurasthenic" rest from work only redoubles the worries,
the doubts and the scruples, and the obsession to improve his time only
adds to his nervous exhaustion. If a European trip is undertaken, the
temperament responsible for the original breakdown causes him to rush from
gallery to gallery, from cathedral to cathedral, so that no moment may be
lost. Not infrequently it so happens that the patient returns more jaded
The neurasthenic is not infrequently a confirmed obsessive, with all the
faulty mental habits of this temperament. If he cannot make up his mind it
is not because he is tired, but because this is his natural mental trend.
If he drums, twitches, and walks the floor, these movements are not always
due to exhaustion, but are habits peculiar to the temperament, habits well
worth an effort to eliminate while in health, since they doubtless, through
precluding bodily repose, contribute their mite toward the very exhaustion
of which they are supposed to be the result. If he cannot sleep it is not
simply because he is tired, but because he is so constituted that he cannot
bring himself to let go his hold on consciousness until he has straightened
out his tangles. If, in addition, one has the hypochondriacal tendency,
he may worry himself into complete wakefulness by the thought that he has
already irreparably injured himself by missing something of the mystic
number, eight or nine, or whatever he may deem the number of hours' sleep
essential to health.
It is important that the overwrought business or professional man realize
the importance of undertaking no more than he can accomplish without fret
and worry; the importance of taking proper vacations before he is tired
out; the importance of learning to divert his mind, while he can still do
so, into channels other than those connected with his business; above all,
the importance of cultivating the faculty of relaxing, and of dismissing
doubts, indecisions and fears. He must cultivate what my colleague Dr. Paul
succinctly terms "the art of living with yourself as you are." If he would
"last out" he must learn to proceed with single mind upon whatever work he
undertakes, and with equal singleness of mind apply himself, out of hours,
to other occupation or diversion, preferably in the open air. For the most
effective work, as well as for peace of mind, it is essential that every
thought of one's office be shut out by other interests when there is no
actual business requiring attention. Mental relaxation is materially
hampered by such persistent thoughts of one's place of business as those
cited by Dr. Knapp:
"A striking instance of the sort was related to me by a friend remarkably
free from any psychopathic taint. It often happens that he does scientific
work in the evening at the Agassiz Museum. When he leaves for the night he
puts out the gas and then stands and counts slowly up to a given number
until his eyes are used to the darkness, in order that he may detect any
spark of fire that may have started while he was at work. This is his
invariable custom, but it sometimes happens that when he goes back home so
strong a feeling of doubt comes over him lest he may that once have omitted
to do this, that he is uncomfortable until he returns to the museum to make
Among the predisposing causes for nervous breakdown none is more potent
than the inability of the obsessive to adapt himself to change of plan, and
to reconcile himself to criticism, opposition, and the various annoyances
incident to his occupation.
In dealing with others the following suggestion of Marcus Aurelius may come in play:
"When a man has done thee any wrong, immediately consider with what opinion
about good or evil he has done wrong. For when thou hast seen this, thou
wilt pity him, and neither wonder nor be angry." Again, in this connection
the lines of Cowper are pertinent:
"The modest, sensible and well-bred man
Will not affront me, and no other can."
Pope, also, who is said not always to have followed his own good counsel, contributes a verse which may serve a turn:
"At ev'ry trifle scorn to take offense,
That always shows great pride, or little sense."
The practice of such commonplace philosophy (which, to be effective, should
be ready for immediate use, not stored away for later reflection), together
with training against faulty mental states studied in these pages, will
go far toward relieving the mental perturbation that unfits for effective
work, and contributes to "neurasthenia."
During an hour's delay, caused by the failure of another to keep an appointment, I formulated the following maxim:
"These are the annoyances incident to my business; to fret when they occur means that I cannot manage my business without friction."
This may not appeal to the reader, but for me it has proved as good an
hour's work as I ever did. Since that time, on the occurrence of similar
sources of provocation, I have found it necessary to go no farther than
"These are the annoyances," to restore the needful balance. When we allow
our gorge to rise at ordinary sources of discomfort, it implies that we
are prepared only for our affairs to run with perfect smoothness. This
represents the insistent idea carried to an absurdity.
At the risk of losing caste with the critical I cannot forbear sharing with
the reader an inelegant maxim which has more than once prevented an access
of rage upon the blunder of a subordinate: "If he had our brains he'd have
Spinoza says: "The powerlessness of man to govern and restrain his emotions
I call servitude. For a man who is controlled by his emotions is not his own master but is mastered by fortune, under whose power he is often
compelled, though he sees the better, to follow the worse." The same philosopher in counselling self-restraint adds:
"The mind's power over the emotions consists, first, in the actual
knowledge of the emotions." Again: "An emotion which is a passion ceases
to be a passion as soon as we form a clear and distinct idea of it." The
meaning of this dictum I first realized on experiencing the magical effect
of the line of thought suggested by the delayed appointment.
Communion with Nature has a peculiarly soothing effect on tired and jangled
nerves. My friend, Dr. Harold Williams, tells me that among his main
reliances for tired and overwrought women are the reading of children's
books, and working in the garden. Peterson thus advises his busy
"A small farm in a simple community would be for you an asset of
immeasurable value from the standpoint of health and spiritual
rejuvenation. But true simplicity should be the rigorous order of that
country life. A chateau by the sea, with a corps of gardeners, a retinue of
servants, and yachts and automobiles, would prove a disastrous expedient.
"In that quiet retreat you should personally and tenderly learn to know
each rosebud, shrub, vine, creeper, tree, rock, glade, dell, of your
own estate. You should yourself design the planting, paths, roads, the
flower-garden, the water-garden, the wood-garden, the fernery, the
lily-pond, the wild-garden, and the kitchen garden."
Not everyone is so happily situated as to be able to follow this advice
in its entirety, but many can make a modest effort in this direction: the
kitchen-garden may appeal to some who have no appreciation for the wild
flowers, and who scorn to cultivate such tastes.
One warning is, however, here in order: The cultivation of the garden or
the field for utilitarian purposes is inevitably associated with the maxim,
"Hoe out your row"--an excellent maxim for the idle and disorderly, but not
to be taken too literally by the over-exacting and methodical business man
who is trying to make the radical change in his view of life necessary to
free his mind from the incubus of worry. Nor must the amateur husbandman
scan with too anxious eye the weather map and the clouds. If he mind these
warnings he may learn to say,--
"For me kind Nature wakes her genial pow'r,
Suckles each herb, and spreads out ev'ry flower,
Annual for me, the
grape, the rose renew,
The juice nectareous, and the balmy dew."
The over-conscientious individual may object that it is selfish to consider
his own comfort when he has work to do for others. But expending too freely
of our nervous energies, even in a good cause, is like giving to charity
so much of our substance that we in turn are obliged to lean on others for
In properly conserving our own energy we may be lightening the ultimate
burden of others. There is no place for selfishness in Haeckel's philosophy
regarding the proper balance between duty to one's self and duty to others.
Nor was selfishness a failing of the Quaker poet who idealized
*Myson of Chenae. One of the "seven sages" of Greece, according to Plato.
"The flawless symmetry of man,
The poise of heart and mind."
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