By Vera H-C Chan and Claudine Zap
In 1952, the Diagnostic and Statistical Manual of Mental Disorders weighed in at a wispy 50 pages. In 1994, DSM-IV numbered 943 pages. The DSM-5 will actually be less than that — still, when comparing the versions, "one thing you're struck with right away is the increase of diagnostic categories," says David Baker, director of the Archives of the History of American Psychology at the University of Akron. "It's largely a kind of a mirror on the culture... It's not purely objective."
Not surprisingly, well before the DSM came into existence, respected intellectuals were espousing psychological theories on why females went into hysterics, the sickness that made slaves want to run from their masters, and the upper-class ailment triggered by hard work and social upheaval. Here’s a look at disorders, past and present, that fell out of fashion, got caught up in other illnesses, or changed its name.
Well before the DSM came into existence, a whole host of slave-related diagnoses justified the institution of slavery. In 1854, Samuel Cartwright, a surgeon and psychologist from Louisiana, took the Greek words for "runaway slave" and "crazy" and expounded on drapetomania in The Georgia Blister and Critic (above). His essay in the monthly Southern periodical, which focused specifically on "diseases and physical peculiarities of the Negro race," did blame this "disease of the mind" on white masters who either treated slaves as equals or "treated them cruelly." One prescribed treatment was amputating toes.
Other slave-related diagnoses centered on brain size and work aptitude—all musings that Baker says were "totally irrelevant to the practice of psychiatry and were never considered mental disorders per se—certainly not in the North." The theories didn't stand up too much in the South either following the Civil War.
You can of course thank Sigmund Freud for illuminating or stigmatizing the better half in a condition called female hysteria. "The pejorative [definition] would be emotional excess,” Baker explains, “women who could not manage their emotions and exhibited conversion disorders." Symptoms included fainting, nervousness, muscle spasms, loss of physical control.
The diagnosis lingered through the second-half of the 50th century, and testified to how so much of American psychology was tied to Freudian theory. One of the most popular treatments for hysteria was hypnosis, as demonstrated by French neurologist Jean-Martin Charcot (above), although he would later question his own theories. Freud studied under Charcot and would even name his firstborn, but the student would later depart from the master and dispute the neurological, aka physical, origins of female hysteria.
A diagnosis can be a badge of honor—and a sign of your class. Take neurasthenia. First coined in 1869 by George Miller Beard, the middle to upper class manifested the symptoms of neurasthenia first, explains Lisa Held, a Ph.D. candidate in the history and theory of psychology at Canada's York University. The condition had upward of 75 symptoms, which included malaise, poor appetite, weakness in the back and spine, hysteria, insomnia, headache, even uterine displacement or excessive masturbation. Treatment was just as varied, from electricity (supposedly provided by the illustrated brush) to castration.
"It was really considered a disease of modernity," Held explains to Yahoo News, as people had trouble coping with the changing role of women, the move from a rural to an urban culture, and general social upheaval. People as famous as Charles Darwin and Sigmund Freud were considered neurasthenic. "This wasn't seen as something to be ashamed of," Held says. "It was a mark of your class. If you had neurasthenia, it was because you were working so hard."
The condition lasted 30 years and was even exported to Europe, before waning around 1910, partly heaving under its own symptomatic load, partly because when the lower classes started getting it, it really wasn't worth having anymore. It never entirely disappeared but branched out or was subsumed into other illnesses. Some see some elements of neurasthenia in the current condition chronic fatigue syndrome.