Tag Archives: history

Health Panics in Historical Perspective

Lesley A Hall is an archivist at the Wellcome Library, London and a historian who has published extensively on issues on gender, sexuality and bodies in the nineteenth and twentieth century UK. Her most recent publication is Sex, Gender and Social Change in Britain since 1880, 2nd edition (Palgrave, 2012). Check out her website and her blog.

Lesley A Hall says:

Reading the recent report that ‘Slightly Overweight is Healthy’ my first thought was that possibly the relevant authorities need to start redefining what a ‘healthy weight’ is, if it’s actually higher than they have been recommending. My second thought, as a historian of medicine/the body/sexuality and related areas, was to place this, and the general panic around weight in modern first-world cultures, in the longer history of how concerns over certain bodily phenomena, presented as health issues, have resonated profoundly with a range of other social and cultural questions.

I was deeply amused to see yet another of those ads promising some nifty simple trick to deal with ‘belly-fat’ in the side-bar when I clicked on one of the links from that report. These always seem to be targetted at women, whereas in the UK in the Victorian/Edwardian/Georgian period ‘belly-fat’ was pejoratively associated at least as much with defective masculinity. At a time of rising concerns about Imperial competitiveness and literal and metaphorical virility in the face of rival Western powers and rumblings of dissent among the subjects of colonial rule, the flabby middle-class male, who dined too well and too often, and never exercised, was one instance of what was wrong with modern manhood.

Thinking about the Victorian period, a number of historians, including myself, have drawn attention to the enormous and widespread social anxiety from that period well into the early twentieth over male masturbation. Condemned as sinful, it was also believed to have deleterious health consequences, including consumption, insanity, and even death. Beyond its impact on the individual, it was described as a potentially contagious ‘plague’: schoolmasters claimed that ‘one or two filthy boys will corrupt a whole school’.

It was practically impossible for men to avoid the chorus of voices warning them of the dangers of the solitary vice and of seminal losses. The upper and middle classes encountered sermons at school – there is a classic example in Dean Farrar’s melodramatic school story, Eric, or Little by Little. An enormous industry touted spurious remedies via fly-posters in public places, handbills distributed in the streets, and coded advertisements in newspapers. In larger cities ‘anatomical museums’ displayed luridly hyper-realist waxworks of the horrific consequences of self-abuse and then offered quack remedies. Not just deliberate self-abuse was dangerous: involuntary seminal emissions, for example in ‘wet dreams’, were defined as the disease of ‘spermatorrhoea’, with equally horrendous outcomes.

This widespread climate of fear about masturbation and nocturnal emissions did not just apply to children or young boys but also afflicted men in early adulthood, given the increasingly late age of marriage in the middle and upper classes. Many men feared to take their anxieties to their medical practitioners, given the caustics and cauterisation advocated in the leading British medical journal, The Lancet, in 1870. J. Laws Milton’s much-reprinted medical work On Spermatorrhoea incorporates leg-crossing illustrations of toothed and spiked penis rings. Quacks usually offered less painful and drastic treatments, such as herbal compounds and ‘galvanic belts’, to restore those debilitated by these ailments.

These anxieties also led to circumcision becoming recommended as a prophylactic against masturbation. The foreskin was described as a dangerous and polluting excrescence of redundant flesh. Its removal in infancy or childhood was recommended both as a preventive of, and a cure for, masturbation. The operation was usually performed without anaesthetic by the family doctors in the surgery or during home visits. This could result in excessive haemorrhaging or subsequent sepsis, pain, scarring and sometimes death.

These fears were about keeping inside the body the precious fluids that might leak away. An overlapping concern that sprang up in the Edwardian era was the reverse: about the retention within the body of matter that ought to come out. While historians have not discussed this as much as the masturbation panic, one or two have looked at the early twentieth concerns over keeping the bowels regular and the construction of constipation as a major hazard to health. This led to the prescription of potentially dangerous purgative substances and even to operations to shorten the colon and thus speed faecal matter along it at greater speed.

Historians have speculated on the reasons why such anxieties arise at specific historical moments and what they say about wider cultural anxieties. For example, the Victorian anxiety over masturbation and spermatorrhoea was not just about sexual anxieties but ideas of the importance of male self-control and the dangers of reckless ‘spending’ of precious limited resources. Though, after a point, something like the masturbation panic took on its own momentum and proved very hard to halt, as it entered into the realm of popular wisdom that ‘everybody knows’. Elite psychiatrists retreated from belief in ‘masturbatory insanity’ as an actual disease category well before the end of the Victorian era, instead positing that the anxieties about it were the problem. However, the idea remained in circulation and was possibly even given a new lease of life via Lord Baden-Powell’s manuals for boy scouts, with their warnings against ‘beastliness’. The diagnostic classification schedule produced by the UK Board of Control (formerly the Commissioners in Lunacy) still included a heading for ‘masturbatory insanity’ as late as the 1930s.

Looking back at these phenomena, we can see that conditions or practices which are pretty much part of the normal human condition and within the realm of healthy individual variation can become pathologized as threats to the health of the individual and of the entire society. This is a perspective that I wish could be brought to bear on contemporary health panics.

Some useful further reading
Alex Comfort, The Anxiety Makers: some curious preoccupations of the medical profession (London: Nelson, 1967). A very entertaining read about both the masturbation panic, and the concerns about evacuation; Comfort concludes by wondering what common medical wisdom of the mid-twentieth century would be similarly open to criticism and mockery.

Ann Dally, Fantasy Surgery, 1880-1930: with special reference to Sir William Arbuthnot Lane (Amsterdam: Rodopi, 1996), which is particularly about Lane’s influential contributions to constipation paranoia and his development of ‘Lane’s operation’. Dally, a qualified medical doctor, also wrote The trouble with doctors: fashions, motives and mistakes (London: Robson, 2001), Women under the knife: a history of surgery (London: Hutchinson, 1991), and Inventing motherhood: the consequences of an ideal (London: Burnett Books, 1982), which similarly look at the impact of changing fashions and beliefs on medical practice and what people think of as ‘healthy’.

Ina Zweininger-Bargielowksa, Managing the Body: Beauty, Health, and Fitness in Britain 1880-1939 (Oxford University Press, 2011). A deeply-researched scholarly study on ideas about fitness in the UK from the late Victorian era to the outbreak of the Second World War, and changing ideas of what the healthy and aesthetic body should be like, dealing with a wide range of interventions, from fringe health reform movements to government initiatives.

Do You Have “Irritable Heart”? The History of PTSD

Debbie says:

Post-traumatic stress disorder as a publicly recognizable syndrome was first formally named when I was almost 30. I can remember the first time a friend told me she had it, and how it sounded kind of clunky and unreliable in my ears; I can trace the progression from there to now, when I am aware of it everywhere, understand it just about as well as a lay person can from the outside. I don’t have PTSD: I had the amazing luck to fall into a mostly protected childhood, and I’ve been lucky enough to miss most of the things that bring on shorter-term PTSD in adulthood.

That didn’t make me any less fascinated to read Charlie Jane Anders’ “secret history” of PTSD on io9. Anders starts with some ancient historical and literary instances of PTSD-like symptoms, including mentions from Herotodus to Shakespeare and Dickens. She then gives a list of earlier names for the condition, including:

Nostalgia This is the diagnosis given to Swiss soldiers in 1678 by Dr. Johannes Hofer. In 1761, Austrian physician Josef Leopold Auenbrugger wrote about the widely diagnosed condition of nostalgia in his book Inventum Novum, writing that soldiers “become sad, taciturn, listless, solitary, musing, full of sighs and moans. Finally, these cease to pay attention and become indifferent to everything which the maintenance of life requires of them. … French physicians in the Napoleonic wars believed soldiers were more likely to suffer nostalgia if they had come from a rural, rather than urban, background. They prescribed such cures as listening to music, regular exercise, and “useful instruction.”

Estar Roto Spanish physicians came up with this term for PTSD, which means “to be broken.”

Soldier’s Heart Internal medicine doctor Jacob Mendez da Costa studied Civil War veterans in the United States, and discovered that many of them suffered from chest-thumping (tachycardia), anxiety, and shortness of breath. He called this syndrome “Soldier’s Heart” or “Irritable Heart.” But it also came to be called “Da Costa Syndrome.”

I especially appreciate how “nostalgia” has moved in the last 350 years from something so serious to something rather wistful and sweet.

Some of the later ones, like “shell shock” are less surprising, but I didn’t know this one:

Compensation Sickness or Railway Spine As railroad travel became much more common in the late 19th century, so did railroad accidents — and psychologists started noticing a lot of cases of trauma among survivors of those accidents. … Psychologist CTJ Rigler coined the term “compensation neurosis” to describe these cases — with the “compensation” part referring to a new law that allowed people to sue for compensation for emotional suffering. Rigler believed people were more likely to report their traumatic symptoms — or possibly exaggerate them — if they were going to get paid. Victims of railway accidents were also referred to as having “Railway Spine,” as if their spinal cords had suffered a concussion that caused them to be more nervous or tramautized afterwards.

Note how economics and suspicion of any condition that could be compensated are already starting to creep into the story of human health.

Finally, Anders gives us a diagnostic history of how the syndrome has been viewed by doctors:

Starting after World War II, psychologists started classifying all of these cases of trauma, based on loads of notes that the Armed Forces had been collecting since 1933. There was just one trouble: the military shrinks were working on the assumption that all of these cases were “transitory” or “acute.” Meaning that otherwise normal people would have a short-term problem, after they got back from combat, but that by its nature this wouldn’t last long.

Because the psychological studies were based on the military data, which all made this assumption, psychologists also assumed that cases of PTSD would be short-term or temporary in nature.

After the Vietnam War, countless veterans were diagnosed with “stress response syndrome” — but the VA declared that if the problem lasted more than six months after the soldiers returned home, then it obviously was a pre-existing condition and had nothing to do with their wartime service. And thus, it was no longer covered.

So: let’s define it a particular way, and then exclude everything that looks almost like it but doesn’t do what we expect. To some extent, that’s how diagnosis is done, but it’s also how marginalization is done. Fortunately, the DSM-IV definition of PTSD goes in the other direction, having a defining criterion of “lasting more than one month.”

Knowing this history won’t change anyone’s PTSD; at the same time, the historical context and the clear improvement in acknowledging both the reality and the importance of PTSD in people’s lives has its own value.

I read io9 pretty regularly, but I missed this one; I’m very glad that wordweaverlynn pointed it out to me.