This week, Nursing Clio is featuring posts written by undergraduate students. The following post was written by a student in Carolyn Herbst Lewis’ course on the history of medicine. Lewis’ students spent the semester writing a longer research paper, and then had the added challenge of sharing the contents of that paper with a broader audience through a blog post. The Nursing Clio editors selected two to share, but you can read the rest of Lewis’ students’ posts here.
by Jeanette Miller
Consider two diseases: Disease A and Disease B. Children with Disease A are described as being “excitable” and “precocious,” at risk of being “overstimulated.” Thus, they are unable to balance “academic, intellectual, and physical growth.” [Schuster, 116] Children suffering from Disease B, on the other hand, are “active, restless, and fidgety” and have difficulty “sustaining attention to tasks, persistence of effort, or vigilance.” [Barkley, 57] At first glance, the symptoms of the two diseases in children seem oddly similar. Yet these are two wildly unique diseases that have never overlapped in time. The former, Neurasthenia, was popularized in the nineteenth century, diagnosed primarily in adults but often in children. The latter, Attention-Deficit/Hyperactivity Disorder, or ADHD, did not enter the mass consciousness until the latter part of the twentieth century and is diagnosed primarily in children but often in adults. If a child with ADHD were to travel backwards in time seeking psychiatric help, my money is on a Neurasthenia diagnosis.
Neurasthenia was the “popular disease” of the nineteenth-century. Characterized by a lack of nerve energy, Neurasthenia’s symptoms vary wildly from depression to hyperactivity to indigestion. Since anything abnormal could be attributed to Neurasthenia, the disease became an umbrella term. ADHD gained momentum more than a century later. Generally understood today as a lack of inhibition in the cerebral cortex, the symptoms of ADHD include hyperactivity, inattentiveness, distraction, and failure to complete tasks effectively. Thus, both definitions attempt to characterize abnormal or unproductive behaviors as treatable diseases.
I am not suggesting that the symptoms of ADHD are fabricated; the symptoms and their effects on people’s lives are very real. Yet, many of these same symptoms were ascribed to an entirely different disease in the previous century. The fact that physicians in different eras have pathologized this set of symptoms speaks to the arbitrariness of the diagnosis and the significance of the broader social context. Or, as historian David Schuster puts it in his book on Neurasthenia, “Depression, irritability, insomnia, lethargy, indigestion, and pain—these have long been part of what it means to be human.” It wasn’t until the 19th century that these “unfortunate but entirely normal aspects of life…had begun to represent something: the intolerable symptoms of disease.”
The instability of diagnostic categories doesn’t make the lived experience of these ailments any less real. Try telling a depressed person that their disease isn’t real because it wasn’t a diagnostic category until 1980—actually, please don’t try. Instead, ask the question: why have these diseases been constructed in divergent ways over the past couple centuries? Neurasthenia was considered the American Disease, conceived of as a side effect of the rapidly industrializing world and schedule-oriented society. While proponents of Neurasthenia looked to the outside world to explain physical and emotional abnormality, ADHD does the opposite.
So, where do we put the blame? Neurasthenia over-emphasized external causes for abnormality, while ADHD emphasizes internal causes to explain deviant behavior. Perhaps, as Peter Conrad argues in his groundbreaking piece, “The Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior,” this reflects a broader shift in society’s “individualization of social problems.” By casting Hyperkinesis, or ADHD, as an illness, we ignore the possibility that the behaviors in question are means of adaptation rather than an illness, diverting attention from “the family and school and from seriously entertaining the idea that the ‘problem’ could be in the structure of the social system.” [Conrad, 19] And isn’t it easier to blame ADHD on “a glitch in the brain that could be tweaked with stimulant drugs” [Smith, 98] rather than on problems in the school or family?
Somewhere between Neurasthenia and ADHD, society shifted in its understanding of abnormal behaviors. The blame shifted from the society to the individual, or more specifically, from society to an isolated brain dysfunction—a dysfunction that can only be treated with medication. We treat the symptoms without fully understanding their origin. Reducing complicated behavior patterns to neurological abnormalities may prevent us from seeing how these “problems” fit into the broader experience of the individual.
And the irony behind all of this? By placing the blame on the individual, the individual is removed from the equation. Disease, as we understand it, has become individual yet impersonal—and thus is approached with a limited perspective.
- Jeanette Miller is completing her undergraduate studies in English at Grinnell College in Grinnell, IA. She enjoys writing poetry, listening to folk music, and drinking an occasional cup of tea.
Russell A. Barkley, “Attention-deficit/hyperactivity Disorder,” in Treatment of Childhood Disorders, 2nd edition, edited by E. J. Marsh and R. A. Barkley, 55-110. New York: Guilford Press, 1998.
Peter Conrad, “The Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior.” Social Problems 23, no. 1 (October 1975): 12–21.
David G. Schuster. Neurasthenic Nation: America’s Search for Health, Happiness, and Comfort, 1869-1920. New Brunswick, NJ: Rutgers University Press, 2011.
Matthew Smith. Hyperactive: The Controversial History of ADHD. Reaktion Books, 2013.
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excellent work! It would also be interesting to consider the “gendering” of these diagnoses in their historical/cultural contexts, and what that implies regarding the categorization of “deviant” or “abnormal” behavior and its potential causes… Neurasthenia was more commonly diagnosed not only in adults, but in females (like hysteria); ADHD is now more commonly diagnosed in (young) males, if I’m not mistaken.
another excellent set of observations! I’ve long considered ADHD to be a “made-up” disease, though recently I’ve wondered if shortened attention spans are a real effect of increasingly multifaceted inputs? I.e., is the constant push to read more, pay attention to more, watch more, and do more creating a group of people who find it difficult to concentrate on anything? Then again, it may just be the American tendency to pathologize anything that doesn’t fit into our increasingly-narrow definition of “normal.”