British psychiatrist Simon Wessely today referenced the nineteenth century physician George Beard to attribute
the disease chronic fatigue syndrome to neurasthenia in
At Fatigues Root, published by the Washington
Post on March 4, 2008.
It is an interesting choice of experts. Beard coined the term neurasthenia in his book American Nervousness,
published in 1869. His theories were popularized by Harvard physician Edward H. Clarke in his best-selling book
Sex in Education, or, A Fair Chance for Girls (1875). According to Beard:
The chief and primary cause of this development and very rapid increase of nervousness is modern civilization,
which is distinguished from the ancient by these five characteristics: steam-power, the periodical press, the
telegraph, the sciences, and the mental activity of women. [From Beard, American Nervousness, vi].
The mental activity of women? How does that fit in with the other items in that paragraph?
Beard and Clarke wrote that the American race was in danger of losing out to foreign races because middle class
Americans were allowing their daughters to attend high school and study science. Young women needed to devote
this period in their lives to the development of their reproductive organs; young men did not require so much
physical effort for their own. Consequently, an earnest young woman who studied science risked either a malformed
reproductive system (hysteria, which they defined as the shrunken womb), or a malformed nervous system (leading
to neurasthenia, a perpetual nervous condition).
Beard pointed to the squaw in her wigwam, who happily and healthily bred numerous children because she had been
permitted to develop naturally; Clarke referenced Celtic womens reproductive capabilities. Either way, if
middle class women continued to pursue this dangerous path, the American race would die out. Already, they
pointed out, American women limited their family sizes to two or three children.
A malformed nervous system from over-use of the brain led to neurasthenia in later life; a malformed
reproductive system created, by definition, hysteria. But this was not the classic definition of hysteria
the wandering womb. In Beard and Clarks vision of hysteria, the womb did not wander it shriveled up.
Beard even referenced a fellow physician who claimed to have measured the wombs of intellectual women and
found them half-sized.
Why would anyone want to resurrect a hoary old theory about the physical damage that would be visited upon
young women permitted to study science? Because Dr. Wessely, along with the late Stephen Straus of NIH
(who also referenced Beard), wished to re-diagnose patients with chronic fatigue syndrome as victims of
a nervous disorder quite specifically, as victims of either hysteria or neurasthenia.
May I suggest the editors of the Post visit the website of the HHV-6 Foundation, to see peer-reviewed
published research connecting CFS to Epstein-Barr, HHV-6 (Variant A), other viruses, and numerous immune
defects? One wonders why Wessely cites a nineteenth century neurologist (who clearly had issues with gender,
ethnicity, and race) instead of Harvard physician Anthony Komaroffs survey of the literature in the
Journal of American Medicine in 2000:
There is now considerable evidence of an underlying biological process in most patients who meet the CDC [Fukuda]
case definition of chronic fatigue syndrome. [This evidence] is inconsistent with the hypothesis that chronic
fatigue syndrome involves symptoms that are only imagined or amplified because of underlying psychiatric
distress symptoms that have no biological basis. It is time to put that hypothesis to rest and to pursue
biological clues. in our quest to find answers for patients suffering from this syndrome.
Using the prevalence estimates from the Jason et al study of chronic fatigue syndrome [Archives of Internal
Medicine, 1999] and population estimates of the U.S. today, leads to the conclusion that roughly one
million patients in the U.S. suffer from CFS. The CDC estimates that households with a CFS patient lose
$20,000 in income per year. The nation as a whole thus loses at least $20 billion a year in national product,
and nearly $7 billion a year in income tax revenues, because these patients have been ignored.
This is a serious disease, deserving of serious analysis. How quaint for the Post to have included a picture
of a woman lying on what used to be called a fainting couch. Perhaps we will next read about the resurrection
of the theory of the four humors and the value of bleeding patients suffering from pneumonia. Or how to use
phrenology to discern an individuals true character.