Book: Treatment of Neurasthenia, 1914, Hartenberg

It's interesting to read this.

I haven't made it to the end, but it looks like a muddle of medical hubris, accurate observations, inaccurate observations, wild speculation founded in prejudice, and a lack of attention to separating out subgroups.

That's not surprising given that this was written in 1914. Probably what is surprising and rather sad is that, despite some great advances in medical tools, the descriptions of CFS we see from a lot of self-described experts look so similar to this.

 

So many amazing quotes. I've chosen one that talks about what is required of a man who will be a doctor of neurasthenics, because I think, in the end, between the lines, this book tells us a lot more about that than about "neurasthenia".

"He who devotes himself to such cures must be robust, in sound health, of equable temperament, sure judgment, firm will, in no way neuropathic. He must possess the necessary patience to listen without fatigue to the interminable complaints of his patients, all the confidence in himself which inspires that feeling in others, all the energy necessary to make up for their deficiencies, and not himself give way to their dejection.

He must also possess the psychological sense i.e. that innate aptitude at divining what is passing the brains of others, at assimilating their individual impressions, that intuition which enables the most subtle alterations in the mental processes to be appreciated. Only under these conditions will he understand his patient, and the latter only gives his confidence when he feels himself understood.

Finally, he should possess a serene resignation, a lofty indulgence, a compassion devoid of bitterness. He who elects the care of neuropath his task must from the first accustom himself to every form of abnegation. Amongst our egotistical patients, neuropaths, and especially neurasthenics, easily hold the first place. Whilst expecting everything from their physician, holding everything to be their due, attention, patience, devotion, friendship, they give nothing in return. Their gratitude is nothing but a word which passes as they open their lips. How many patients have I had under my care who have said with emotion, "Doctor, if you cure me, I shall be eternally grateful". I have cured them, they have disappeared, and I have never heard from them again.

Their ingratitude, however, must be forgiven them. Let us remember that, even cured, many of these potential neurasthenics remain anxious, weak-willed. Let us console ourselves with the thought that we work for art, for beauty. Let us find in our inner satisfaction the greatest of our recompenses, and count neither on the gratitude nor the generosity of our patients to repay us for our efforts."

(I expect the physician was well paid for his work, so it is not quite clear exactly what more he is expecting from his patients. Perhaps the patients disappear without feeling the same certainty of cure that the doctor himself felt?)

 

DD, you might need to re-evaluate your friendship with the person who told you that.

To be fair, there is recommendation of rest. But after the doses of arsenic and strychnine, I doubt the patient was up to much else.

Just for the record:
https://emergency.cdc.gov/agent/arsenic/casedef.asp

https://emergency.cdc.gov/agent/strychnine/basics/facts.asp#:~:text=What strychnine is,produce severe effects in people.

 

With a stylistic tweak here and there for modern sensibilities, that could have been written yesterday by a certain sect in medicine. Their basic attitude to patients has not changed one jot in over a century. It remains dripping with narcissistic contempt and disgust at our failure to heal upon their command. Just very slightly better disguised.

 

For example: Prof Lynn Turner-Stokes in 2018 (with some quotes from her shown in the subsequent comment by Trish).