His and hers: male and female anatomy in anatomy texts for medical students 1890-1990, part 1, February 13, 1992

Tom Lute: So far, as a little introduction about the two Mitchell's, Mitchell father and son, and then this talk about medical literature, and then the third part of this ... talks about several novels from the 20s and how some of these develops on the medical side of things, played and talks about some of the cultural preoccupations that may have something to do with the medical literature as well. And it starts with the quote from F Scott Fitzgerald, and the article he wrote in the early 30s about life in the 20s. Says, "By 1927," this is Fitzgerald, "a widespread neurosis began to be evident, faintly signaled like the nervous beating of the feet, by the popularity of crossword puzzles. I remember a fellow ex patriot opening a letter from a mutual friend of ours urging him to come home and be revitalized by the hearty bracing qualities of the native soil. It was a strong letter and it affected us both deeply until we noticed that it was headed from a nerve sanatorium in Pennsylvania." Now, Fitzgerald's joke here reaches in a number of directions for its targets in a society in which everyone is defining the nature of neurosis and the nature of health, one can never be sure which advice to follow. And in a society beset by nearly universal neurosis chances were that any advice was tainted. The theoretical discussions about the necessity for individualizing notions of nervous problems, the democratization of neurasthenia until it lost its ability to garner distinction, that kind of summing up sentence shows that I've left out part of the earlier talk, right? And the carving up of the domain, especially between the physical and the psychological, all tended to diminish the relation between the current epidemic and the diagnosis of social problems. Where Mitchell had helped warn his fellow citizens about race suicide, the end of civilization as they knew it, Fitzgerald here trivializes his announced epidemic by claiming the most profound symptom to be an attraction to crossword puzzles. Fitzgerald's masterpiece, The Great Gatsby, from 1925, represents any number of neurotic feet beaters. Gatsby nervously drums his fingers, as I've been doing throughout this talk, Nick Carraway, the narrator describes himself as restless, Daisy and Tom Buchanan nervously flit about the world, Tom's athleticism is no help, the athletic prowess which should have made him immune to mental or emotional problems, his cruel body has failed him, the narrator tells us. And not as where Mitchell would have assumed, because of his sexual improprieties. One of the main instigating activities for neurasthenia. The fact that he had a woman in New York was really less surprising, the narrator tells us, than that he'd been depressed about a book. Tom had been reading Henry L Goddard's latest work, a scientific book by a psychologist, about race suicide. A staple both of the older generation's medical theories of endangered civilization and of the new psychological science of mental testing. Something was making him nibble at the age of stale ideas, the narrator explains, as if his sturdy physical egotism no longer nourished his peremptory heart. That last phrase, his peremptory heart, is important, I think, because the problems that Fitzgerald's characters have in the 1920s, tend not to be with their nerves or even with their psyches, but with their hearts. There are still a number of books in the 20s in which the old version of the nervous economy is still very much apparent but they're dying out in the same way that the defenders of neurasthenia are dying out in the medical journals. What Fitzgerald's characters lose is not their senses or their minds finally, but their loves. As romantic a view of neurosis as ever was, the recipe for good health offered by the pre-jazz age doctors of neurasthenia was the wise spending of nervous energy. But this, as we're shown, Gatsby does. He has a Franklinian work ethic and arranges his life and days so as that no energy is wasted. He nonetheless loses everything. In fact, the book announces there is no ideal economy of the inner self. Those who husband their energy most wisely, like the gangster Wolfsheim, I'm relying on a little bit of knowledge of Gatsby here, but what else can I do. And those that spend theirs most extravagantly, like Daisy and Tom are shown to be equally, however differently corrupt. The one image of a physician in the novel is a billboard portrait of a doctor T.J. Eckleburg, long unpainted and gradually fading into the waste dump behind it. As one character, towards the end of the book, stares at Dr. Eckleburg, another character mournfully comments, not apropos, Dr. Eckleburg, at all, looking in different directions says, "God sees everything." And the first character not quite understanding, says, "That's an advertisement." The medical man is no longer a God, not even a priest, just an advertisement for services and one fading into the waste he once promised to help his patients avoid. I go on and talk a bit about some other Fitzgerald novels here, but I'm going to skip all that. In a series of articles in Esquire in the 30s, Fitzgerald described his own crackup as a thorough disintegration of personality. There was not an I anymore, he writes. He found himself stripped of all values, beliefs and convictions, save the belief that he had once "had a heart". This was, he writes, the beginning of the end of his morass because he realized, as he put it, I felt therefore I was. His modification of the Cartesian formula was similar to the movement of understanding mental illness as a result of faulty cognitive faculties, to understanding illness as emotional disturbance. The doctors, of where Mitchell's generation considered emotional testimony of their patients as wrong headedness, as necessarily faulty data. Data that patients mistakenly believed to be more important than it actually was. The doctors in the 20s argued that neurasthenia "ebbs and flows" exactly in accordance with the consciously appreciated emotional needs of the patients and that doctors should therefore inculcate inpatients "regularity and habits, deliberation and regulation of all their physical activities and the exercise of control over their emotional life." And I give a series of other examples here from the medical literature on emotion. Emotion for these writers was the problem waiting to be solved, Fitzgerald's tale of the pathological Gatsby's emotional mania and the very normal Buchanan's petulant boredom accepts the logic of this medical conception. Gatsby can control everything except in his obsessional aspect of his emotional life. The Buchanan's are irregular and emotional but only in ways that they can literally afford to be, they suffer from no disintegration. Gatsby is our modern everyman, in control of modern civilization, working the angles, but an emotional basket case. Ellen Glasgow's Barren Ground, another novel from 1925 depicts the career of one Dorinda Oakley from 1890 through 1920 and provides a view of the way these medical developments played in the provinces. It's a southern novel, a very determinedly southern novel. Dorinda is impregnated while in her teens, circa 1890, by a neighbor who has gone to the city and come back as an MD. This young general practitioner, a man without a backbone, as we're told, is pushed into marriage with Dorinda's rival for his affections. And Dorinda goes into the city to live in disgrace. Once in the city, she collapses, has a miscarriage on the street, is picked up by a philanthropic neurologist, who uh ... could happen ... finds her an interesting case, and sends her home after a therapeutic period. Not clear what exactly the therapy is while she's there. But sends her home with enough investment capital to take the old dilapidated family farm and apply scientific farming methods to it. Dorinda renounces love and dives into her work day and night, for the next 30 years, which is perhaps why the novel isn't read that much, that takes 300 pages, becoming the most successful farmer in the country. A woman of substance. The neurologist in this tale is the GP's opposite number, he has wisdom, he saves lives, he rewards pluck and luck in the manner of Horatio Alger's providential gentleman. The GP on the other hand, ruins lives, including his wife's, she goes mad and commits suicide and his own through alcoholism. The true wisdom of the neurologist lies in knowing that what Dorinda needs is work, which is why his first therapy for her is that he hires her as an assistant after she's out of the hospital, and then sets her up in business on her own. Work, as the wise nerve Doctor knows, will take her mind off her troubles and thus help her avoid "morbid introspection". At the same time, work will substitute for the missing husband, financially and emotionally. And one last one, Lewis's Arrowsmith is also a celebration of work. This time through a celebration of pure science, of the search for scientific truth completely detached from commercialism, human desire, practicality or culture. As such, it pans most of what went on in the medical world of the 1920's, from the unscrupulous pharmaceutical firms and huckster medical equipment salesmen to the fashionable surgeons specializing in unnecessary voluntary surgery, to the new research institutes scrappling over questionable laurels for their robber baron patrons. If where Mitchell had signaled his position on the high ground by adopting the role of the lay preacher, Lewis signals Dr. Arrowsmith's by having him adopt that of the hermit monk, devoted to the truth and eschewing the world. Arrowsmith grows up in a small town where he hangs out in the office of the local GP, who is also a drunk, and has a filthy office, goes to medical school and becomes a pure researcher instead of a practitioner. What's wrong with the world for a true man of science, Lewis argues, is that its most luxurious allurements, the leisure life of the wealthy, for instance, offer nothing but boredom, they have no real meaning. Arrowsmith marries a rich woman and she tries to pull him out of the laboratory to go to dinner parties and he gets thoroughly bored with that and leaves her and his child to go back to work. Unlike Fitzgerald, whose heart bled too much for boredom, Glascow and Lewis offered not emotion but a stoic gospel of work. A belief that work in and of itself is the stuff that makes meaning out of barren ground, the ash dump, the boring wasteland of modern life. Lewis may have written one of the most important obituaries of neurasthenia in Arrowsmith, at one point Arrowsmith breaks down, this is the picture ... As sharply and quite as impersonally as he would have watched the crawling illness of an infected pig, Martin watched himself and the madness of overwork drift towards neurasthenia, from an irritability which made him a thoroughly impossible person to live with, he passed into a sick nervousness in which he missed things for which he reached, dropped test tubes, gasped at sudden footsteps. Arrowsmith became neurasthenic because he was working day and night, driven by his desire for scientific results, but his neurasthenia however much it disabled him, finally did not require the attention of a doctor for diagnosis or treatment. This is not because of his own medical training, despite his medical training, all of the fears, he keeps a catalog, he gets agoraphobia, claustrophobia, pyrophobia, anthropophobia and the rest, what he asserted to be the most fool, pretentious, witchdoctor term of the whole bloomin' lot, namely siderodromophobia ... any doctors recognize that one? The fear of a railway journey. But despite his cynical self scrutiny and a tend to derision, his fears are real and powerful and including the fear of the railway journey, I won't even try to say it again. When his fears become unendurable he permitted himself to rest, the text says, that's all. There's no morality involved, No relation to modernity, no sexuality and most importantly, no medicine. Too much work eventually drove him to rest and so four days of resticity in Vermont and he finally comes back to his scene and entertaining routine. Their splenic overwork is represented as very real but very commonplace an almost commonsensical reaction of the body, which like hunger or a minor scratch can be dealt with easily and sensibly. Neurasthenia is no longer a sign of approaching insanity, it's the sanity of the body and the instinctual mind demanding their due. Arrowsmith exultant in his scientific overwork happily has only one human relation, his lab partner who displays no motion except scorn for bad science. Arrowsmith and his partner do not need to love anyone, for they love their work. They're not even sure that saving humanity from disease is a worthwhile project, as they hunt for antibacterial and antiviral serums, they are driven by notion of progress that's serialized beyond pragmatism. They are devoted to an ideal which has no human reference, but the manifestation of which is work. Work here like that in Barren Ground is self-sufficient pragmatism. It is effectively, for itself an insanity which is its own cure, a cure which is its own insanity. So finally these books agree, what cannot be disintegrated is one's love life and one's work life. Gatsby loses it because he's too thoroughly subordinated one to the other. Arrowsmith is constantly beset by the conflicting demands of work and home. Dorinda aches for love as she stoically renounces it and works ever harder. But Aerosmith finally achieves bliss when he accepts his work as his only love and Dorinda is heroic, her self-denial in the realm of love the secret of her success, not just as a worker but as, at the end of the novel we're told the spirit, as a permanent self in living communion with the earth under her feet, the earth that she works. In the last line of Barren Ground, Dorinda explains that love is forever a part of her past with an infinitely wise smile she says, "I am thankful to have finished with all that." Love and work, as Freud said, and for the 20s the greatest of these is work. Desire, success, failure, buying, selling, sex, leisure, saving, splurging this stuff where of Mitchell's world of his theories of his moral distinctions are not represented as thesis leading to a synthetic progress in these novels. Altogether, they are the structure of the problem, the antithesis of which is work. Neurasthenia was a disease that managed the dialectics of Victoriana, by the 20s, like Martin Arrowsmith people seemed to manage the disease as one would manage an aged parent, with a little respect but no longer any fear. These novels maintain then a somewhat different relation to high culture than did Langdon Mitchell, but Mitchell to then concluded that American culture was driven by men whose characters bear "the evidence of labor", if we're bored Mitchell writes, we need to re-civilize ourselves as will be accomplished in part by art, but art does its best work, he wrote through example, that's why he loved Whitman. And finally Mitchell agrees only work can bring real satisfaction, only plowing or reaping or milking cows or chopping wood. How the people that went to Langdon Mitchell's place on Broadway were going to find a cow to milk, he doesn't really get into but that's the argument. Neurasthenic discontent was the disease of a culture that elevated leisure to an ideal, as leisure was attacked by the keepers of culture the disease no longer had any real work to do and the class it was developed for. It's left over force in fact, was directed at workers, as the veterans hospitals continue to use the diagnosis they noted that there were no longer any professionals among the sufferers. A student now and then, or a teacher, but the rest were laborers, tradesmen, farmers. One final end of neurasthenia then can be found among those physicians most closely tied to industry. They argued among other things that labor unrest was psychopathological. That the problem of modern industry is that it caused fatigue neurosis because of monotony of occupation and most make arguments about work and nervousness that corresponds to those of the novelists. Whereas the Victorian doctors assumed that workers melancholy and inefficiency was due to alcohol and agitation, the new industrial hygienists argued that latent cravings and pent up emotions had found no outlet in work were responsible for both the alcohol and the agitation. By the end of the 20s massive surveys, like the Hawthorne studies at Western electric in Cicero attempted to make work for workers fit the model of work championed by the middle-class novelists by asking workers how they felt about their work. And then in this next section I talk about the arguments as they apply to the housewives of the time, both in medical literature again and in advertisements for appliances and other laborsaving products that highlight a woman's emotional work instead. There was less and less need for a doctor in the house, not because machines and other products created leisure, but because they allowed the real emotional work to go on. Neurasthenia in this case, in the case of housewives, renamed fatigue could now be cured by the happiness, self-sufficiency and dignity found in one's work. Professionals like Martin Arrowsmith had less need for physicians because they were not threatened, they were simply slow down by neurasthenic reactions to overwork. In the workers to whom neurasthenia had trickled down were busily being interviewed by efficiency experts armed with the latest psychologies in an attempt to find out how they might be happy with their work. The main benefit to be accrued from industrial psychology was the end of strikes and other agitation, the conclusion drawn from the Hawthorne studies that more important than wages, physical work conditions, the length of the work week or other considerations was the social environment of the worker. How the worker felt towards his or her coworkers and how the worker thus felt about his hard work. Again, love and work were the cure for ailed and the most important of these was work. So in conclusion, not until ... there's a little post script, I guess this is which, I still don't know what this paragraph means but I'm going to read it to you anyway ... Not until the heyday of stress in the 1980s, did we again have a national malady that threatened both the psychological and physical health and which seemed to legitimately call upon the full force of the expertise of the health professions. Neurasthenia was a disease fully imbued with economic metaphors. Nerve force could be spent or saved, invested wisely or poorly squandered improvidently. The national malady of boredom in the 20s made these metaphors real and the very processes of making and spending money became the means to health. Like neurasthenia, stress began as as an epidemic of the professional class and like it, albeit in much less time, it was democratized and lost much of its cachet. Economic panics, as they were called in the late 19th century and depressions like our predecessors knew are we're now told, clearly anachronistic. Perhaps, the current lack of faith in economics brought on by the excesses and doublespeak of the 1980s will provide the final blow to economic disease. Or perhaps, we're now ready to feel good and recessed, or at least sluggish, what experts should be turned to in that case? How might we work through this malady? Might it be that the question, where does it hurt, will find an answer in our day, outside the professional body. Already, the economists argue that our problem is we don't know how to work like the Japanese, which apparently is enough to make even our president sick. Perhaps, instead of more advice about selling, saving, work and industry what we need is a more charitable therapeutics.