Last Updated on May 6, 2015, by eNotes Editorial. Word Count: 1849
Victorians who suffered from severe depression received little help from the British medical profession. In “Shattered Nerves,” Janet Oppenheim traces the efforts of British physicians to understand depression and to develop appropriate therapies. Their attempts to do so were based on assumptions about the relationship between mind and body that often hampered understanding of mental illness. Their perception of the causes of mental illness was also shaped and often distorted by Victorian gender ideologies and class attitudes. Although the focus of Oppenheim’s book is on the emerging understanding of mental illness, she also shows how Victorian culture shaped the practice of medicine during the Victorian period.
To put this subject in context, Oppenheim provides an illuminating, if brief, account of the transformation of psychiatry during the nineteenth century from a low-status occupation to a profession. Until the 1840’s, those who worked with the mentally ill were known as “mad-doctors,” usually worked in insane asylums, and were not recognized as practitioners of a distinct field of medicine. To gain greater respectability, those working in the field began to call themselves “alienists” in the 1860’s and “psychiatrists” in the 1890’s; physicians, though, continued to be reluctant to accept psychiatry as a legitimate field of medicine. Its claim to standing as a science was hampered by the fact that its theories were based on clinical experience rather than on laboratory research. Perhaps even more important, psychiatrists were never able to explain adequately what caused depression or what therapy to prescribe for it.
In Folie et déraison: Histoire de la folie á l’âge classique (1961; Madness and Civilization: A History of Insanity in the Age of Reason, 1965), Michel Foucault claimed that nineteenth century psychiatrists were agents of the capitalist system who used their authority as practitioners of medicine to remove from society those persons whom the middle classes considered dangerous to social stability. Oppenheim rejects this view of psychiatry as a form of social control. While accepting that medical definitions of mental illness reflected class assumptions, she maintains that Foucault’s thesis exaggerates the power wielded by Victorian psychiatrists over their patients. During the nineteenth century, psychiatry was a weak, vulnerable branch of medicine forced to incorporate prevailing cultural moods into its practice. Furthermore, there is no evidence of a conscious attempt to impose middle-class or capitalist values on working- class patients as a means of maintaining class hegemony. Psychiatrists did often prescribe treatment that was rooted in middle-class values, but such practices stemmed from the doctors’ belief in the intrinsic merits of those values rather than from any cynical attempt to oppress patients who rejected such values.
Oppenheim notes that Victorian psychiatrists believed that the incidence of nervous illness was increasing during the nineteenth century, and they became concerned that this was an inevitable by-product of urbanization and industrial capitalism. It appeared to them that anxiety arose from the relentless competition and fast-paced life of modern society. In focusing on the stress arising from competition and overwork, Victorian psychiatrists presented middle-class employers and professionals, rather than members of the working class, as the chief victims of modern capitalism. The belief that modernization would cause nervous disorders to multiply was implicitly critical of capitalism, although psychiatrists shrank from drawing that conclusion.
Since there was no standard remedy for shattered nerves, psychiatrists resorted to a variety of treatments, some of which were decidedly unhelpful. Drugs were commonly prescribed. Iron, quinine, and strychnine were considered the most effective nerve tonics. Even though the use of arsenic was restricted by the 1851 Arsenic Act, the drug continued to be used as a nerve tonic. Opium, morphine, laudanum, and codeine were frequently prescribed by physicians for nervous disorders. According to Oppenheim, in the Victorian era opium was as widely used as tranquilizers are in the late twentieth century, and for much the same purpose. Psychiatrists recognized a connection between diet and shattered nerves but disagreed as to what type of diet was best. The use of electricity as shock therapy and, in lighter doses, as a nerve stimulant was also widespread in the Victorian period. Oppenheim suggests that this wide array of therapies reflected psychiatrists’ perplexity over why a certain remedy would work for one patient but not another. The practice of psychiatric medicine was far more a matter of trial and error than psychiatrists would ever have admitted to their patients.
Men were as likely as women to experience shattered nerves, a fact that caused Victorian psychiatrists considerable concern. According to Victorian gender stereotypes, men were active, purposeful, strong-willed beings, while women were passive, emotional, and weak-willed. The basic Victorian distinctions between masculinity and femininity were undermined by nervous breakdowns in men, however. Such incidents left men passive, indecisive, and weak-willed—traits identified as feminine. To avoid conflict with firmly entrenched gender stereotypes, Victorian psychiatrists became involved in the reconstruction of notions of masculinity.
Self-control was the central characteristic of the late Victorian concept of manliness. The man of action required strong nerves, and late nineteenth century psychiatrists encouraged this focus on nervous stability as crucial to masculinity. Social Darwinism reinforced the capitalist notion that life is a series of struggles and that only those with strong nerves were equipped to fight successfully. Medical writers during the late Victorian period attributed nervous breakdowns in men to a failure of will, with the implication that such episodes were the result of a moral weakness in the patient. Thus, “real” men, those with a strong will, did not suffer nervous breakdowns; the illness appeared only in those who were morally deficient. Oppenheim notes that this concept of masculinity contributed to the inability of men to discuss their emotions, especially feelings of inadequacy, for fear they would be thought effeminate.
Victorian women seemed particularly susceptible to depression, although for them it was more often a chronic condition than a distinct event. Psychiatrists viewed women’s illnesses through the lens of sexual stereotypes. Women’s lives were believed to be shaped by their biology, and medical advisers were prone to link women’s illnesses with their reproductive systems. Women were believed to have a more nervous temperament than men. A woman’s nervous system was thought to be tied to her ovaries and uterus, and as a result, the latter were implicated in disorders of the former. Also, since women were believed to have smaller brains than men, it was accepted that women were weak-willed and therefore lacked the degree of self- control that men possessed.
This view of women’s nature led medical advisers to oppose efforts to make higher education, professional employment, and other strenuous mental activities available to women. They held that activities involving great intellectual effort would, because of women’s small brain size, strain a woman’s nervous system and thereby threaten her reproductive ability. Antifeminists attempted to prevent changes in women’s roles and drew extensively upon medical authority to support their position. Oppenheim claims that even clergymen were not as important as doctors in shaping public opinion on these issues, because physicians had the authority of science behind them.
It is widely accepted that Victorian physicians, virtually all of them men, believed that normal women did not experience sexual desire or pleasure. This perception applied only to leisured ladies; middle-class men, including doctors, assumed that working-class women were potentially, if not actually, sexually depraved. Upper-class women who acknowledged enjoying sex ran the risk of being diagnosed as mentally ill; some physicians even performed clitoridectomies to cure women of excessive sexual desire. Oppenheim insists, however, that only a minority of Victorian physicians held such a misguided notion of female sexuality.
Anorexia nervosa was identified as a distinct illness in the 1870’s by a British physician, William Gull. It was viewed as a form of mental illness, in part because it was often accompanied by severe depression. Gull believed that the key to successful treatment lay in making the female patient submit to the doctor’s more powerful will; forced feeding was accepted as necessary in extreme situations. Oppenheim acknowledges that the goal of the medical profession was to restore female patients to women’s traditional domestic life. Independent-minded women who had become depressed and anorexic because they were restricted to domestic roles were unlikely to benefit from male doctors’ use of their medical authority to force them to accept traditional roles.
Oppenheim notes that feminist scholars today are prone to view the pattern of depression and recurring ill health among Victorian women as evidence of unresolved conflicts between personal aspirations and restrictions imposed by gender stereotypes. It is claimed that through sickness women could rebel against endless service to others and force others to serve them.
Oppenheim disagrees. She notes that it is not proven that the incidence of female nervous disorders during the second half of the nineteenth century was any greater than in earlier or later periods. She believes many women experienced depression for physiological reasons that were not understood by Victorian physicians. Oppenheim also suggests that severe depression in many instances stemmed not from rebellion against oppressive cultural norms but rather from disappointment over an inability to fulfill the expectations generated by those norms; she cites Sarah Austin and Jane Welsh Carlyle as examples. Furthermore, as Oppenheim points out, the feminist interpretation endorses the widespread belief among Victorian medical men that women were using illness to manipulate those around them. Finally, Oppenheim objects to the feminist explanation because it leads to the conclusion that the wives who did not rebel by feigning illness were dupes of Victorian gender ideology. She argues that many wives were content with their roles because they were able to shape their lives in ways that gave them personal significance.
In her concluding chapter, Oppenheim suggests that British psychiatry was experiencing a disabling crisis of confidence in the early twentieth century. Even the leading practitioners admitted to extreme pessimism about the ability of psychiatric medicine to understand mental illness and help patients. Oppenheim claims that psychiatric thought was based on a metaphysical notion that mind was distinct from brain. The nature of the link between the two, and the way in which the mind affected the brain, remained a puzzle to even the most advanced psychiatrists of the Victorian period.
“Shattered Nerves” is a well-informed, insightful account of an important branch of Victorian medicine. The author is especially skillful at demonstrating the ways in which gender and class assumptions shaped psychiatric thinking and therapy. Her analysis of the limitations of psychiatry has implications for current practice in that field of medicine. It is not clear why Oppenheim has chosen to end her book at the beginning of World War I; she admits that the war was not a major turning point in psychiatric medicine. That, however, is a minor criticism of a book that will be an eye-opening experience for many readers.
Sources for Further Study
The Guardian Weekly. CXLV, September 15, 1991, p. 20.
History Today. XLI, December, 1991, p. 57.
Journal of the History of Ideas. LII, July, 1991, p. 530.
Lancet. CCCXXXVIII, October 19, 1991, p. 1001.
The New Republic. CCV, August 12, 1991, p. 40.
The New Yorker. LXVII, July 1, 1991, p. 88.
The Village Voice. July 23, 1991, p. 65.