In the decades after the Civil War, a lot of things were changing in the (re-)United States. The late 19th century and early 20th saw a huge increase in the country’s population (nearly 200 percent between 1860 and 1910) mostly due to immigration, and that population was becoming ever more urban as people moved to cities to seek their fortunes—including women, more of whom were getting college educations and jobs outside the home. Cars and planes were introduced to the public; telephones and telegraphs proliferated. Modern society was full of new wonders—or, seen differently, new things to be anxious about.

In his 1871 book Wear and Tear, or Hints for the Overworked, the physician S. Weir Mitchell fretted: “Have we lived too fast?”

As you may have guessed from the book’s title, he answered that with a capital-Y Yes. He glorified earlier settlers who “lived sturdily by their own hands,” and who didn’t have “the thousand intricate problems … which perplex those who struggle to-day in our teeming city hives.”

A prominent medical theory at the time was that the human body was like an electrical machine, powered by energy distributed through the nervous system. An unfortunate byproduct of the teeming cities and their attendant problems was that people spent too much of this “nervous energy” and when it was depleted, they got sick with a condition called neurasthenia. Both Mitchell and George Beard, a neurologist who coined the term in 1869, saw the disease as a direct consequence of modern life.

The nature of this sickness was vague and all-encompassing. In his book Neurasthenic Nation, David Schuster, an associate professor of history at Indiana University-Purdue University Fort Wayne, outlines some of the possible symptoms of neurasthenia: headaches, muscle pain, weight loss, irritability, anxiety, impotence, depression, “a lack of ambition,” and both insomnia and lethargy. It was a bit of a grab bag of a diagnosis, a catch-all for nearly any kind of discomfort or unhappiness.

This vagueness meant that the diagnosis was likely given to people suffering from a variety of mental and physical illnesses, as well as some people with no clinical conditions by modern standards, who were just dissatisfied or full of ennui. “It was really largely a quality-of-life issue,” Schuster says. “If you were feeling good and healthy, you were not neurasthenic, but if for some reason you were feeling run down, then you were neurasthenic.”

Neurasthenia then, took these age-old problems of happiness and comfort and medicalized them. Though older conditions like melancholia similarly treated happiness as a health issue, neurasthenia did it at the same time that modern medicine was emerging, giving it more scientific weight.  Plus, Schuster writes, “neurasthenia commanded an intuitive legitimacy because it incorporated the anxieties that arose from [modern] changes into the way people thought of their health.”

And it could only have happened in America. The condition had “a certain American flavor,” Schuster writes, so much so that the early psychologist William James (a neurasthenic himself) called it “Americanitis.” (The suffix “-itis” in medical parlance connotes inflammation; the inflamed things here, I suppose, were people’s relationships to society.)

“Remember pursuit of happiness?” Schuster asks. “When Americans are not happy, we try to blame it on something.”

In this case, the accepted reason for Americans’ suffering was just how awesome they were. This widespread depletion of nervous energy was thought to be a side effect of progress: The U.S. had evolved beyond the rest of the world, and the demands on its citizens just proved to be too much sometimes.

“Their intellectual superiority could be both a strength and a weakness,” says Anne Stiles, an associate professor of English at Saint Louis University. “Such a complex system was prone to breakdowns.”

Neurasthenia, in other words, was a disease of culture as much as of the mind and body. Beard thought that people in earlier societies could not have been neurasthenic because they weren’t exposed to the modern things that depleted nervous energy, particularly “steam power, the periodical press, the telegraph, the sciences, and the mental activity of women.” Beard didn’t think they were bad; they just used up people’s time and energy and didn’t give them room to relax.

But in the land of the Protestant work ethic, relaxing’s for chumps, anyway. “Neurasthenia did not simply denote the presence of sickness,” Schuster writes, “Beard argued it indicated the presence of an active mind, a competitive character, a lover of liberty—in short, the quintessential American.” Many characters in fiction of the day were neurasthenic, and portrayed positively.

This attitude made the diagnosis desirable and some patients sought it out. Because American medicine was still trying to establish itself as a respected profession, doctors were motivated to give the patients what they wanted. Medicine manufacturers also did a booming business selling bottled treatments of dubious composition directly to patients through newspapers and other periodicals, giving people the opportunity to self-diagnose—and, in the process, to assign themselves a label that said more about them than just their health. Tom Lutz, the author of American Nervousness: 1903, and a professor of creative writing at the University of California, Riverside, writes that people sometimes used “claims to sickness as claims to privilege.”

And this was an illness of the privileged—the white, Protestant, Northern privileged, mostly. Mental activity was thought to use more energy than physical activity, a belief that allowed Beard to offer racist explanations for why blacks and Native Americans didn’t get neurasthenia—because they didn’t overuse their minds, he thought, or didn’t have the mental capacities to overuse in the first place. Catholics just did whatever the church told them, in Beard’s view, so that relieved some of their mental burden, and the South wasn’t as modernized as the North.

It was thought that “if you were lower class, and you weren't educated and you weren’t Anglo Saxon, you wouldn’t get neurasthenic because you just didn't have what it took to be damaged by modernity,” Lutz says.

In reality, members of the upper and middle classes were the ones who could afford to see a neurologist and get the diagnosis in the first place. They could afford tonics from advertisements, and afford the expensive, time-consuming treatments. But even within this more well-off population, there was a sharp divide between how the disease was conceptualized and treated for men and for women.

The underlying notion of neurasthenia—that nervous energy gets depleted because people’s bodies weren’t built for modern life—provided an easy way to reinforce traditional gender roles. When men spent too much time indoors, when they couldn’t keep up with the pace of their work, or had money problems, they were susceptible to neurasthenia. Women were susceptible when they were too socially active, or spent too much time outside the home.

For men, the frontier held the cure. Doctors would often send male neurasthenics westward to ride horses, rope cattle, do pushups, and slap each others’ butts until the sheer manliness of it all restored their nervous energy. None other than the 26th president of the United States, Teddy Roosevelt, received such a “West cure” for his neurasthenia. Before his cure, when he was a New York state legislator, Roosevelt had a reputation as a dandy, and people called him names like “Young Squirt” and “Punkin-Lily,” Lutz writes. Some called him an American Oscar Wilde. His neurasthenia was seen as an “effeminizing sickness” that the West cure got rid of, making him buff and tough enough to be elected president. Such were the times.

For women, the go-to was Mitchell’s “rest cure” which consisted of being confined to bed for four to six weeks, with every aspect of their lives controlled by physicians for that period. (Some men did the rest cure as well, just fewer.) They were spoon fed milk and soup, and not even allowed to read or move themselves—massages kept their muscles from atrophying. This treatment was made famous in Charlotte Perkins Gilman’s story “The Yellow Wallpaper,” in which a woman confined to an “atrocious nursery” slowly loses her mind. The story was inspired by Gilman’s own experience with the rest cure.

There were also some women, Gilman included, who used neurasthenia  to challenge the status quo, rather than enforce it. They argued that traditional gender roles were causing women’s neurasthenia, and that housework was wasting their nervous energy. If they were allowed to do more useful work,they said, they’d be reinvesting and replenishing their energies, much as men were thought to do out in the wilderness.

Given the flexibility of neurasthenia, it makes sense that it could be used to argue two opposing points. The disease was both deeply cultural and deeply personal, and so provided a metaphorical framework for people to discuss how culture affected their lives and their health. “The appeal of neurasthenia as a disease was in part the way in which it allowed patients to reexplain the world to themselves,” Lutz writes.

And neurasthenia, in turn, did a lot to reorder the world. The national parks were pretty much created to give neurasthenics places to retreat into nature and heal. Recess time was established in schools because of the fear that sitting in a classroom all day was bad for children’s nervous systems. Christian Science as a religion grew up alongside neurasthenia, and its “think yourself well” doctrine, dubious as it was, did provide relief for some people suffering from the condition. The growing popularity of activities like bike-riding, traveling for vacations, and sports leagues was buoyed by the fact that these things were thought to help stave off neurasthenia.

Neurasthenia shaped so many things, but its true legacy is in how people talk about health and happiness and lifestyles. The more I’ve learned about neurasthenia, the more I’ve felt like I can hear its echoes in all the self-help books that promise to tell you how to be happy, in the Westernized yoga classes offering inner peace, in everyone fretting over whether the Internet is alienating or if babies should look at screens or if Americans are working too much and burning out. People haven’t stopped worrying about what the trappings of modern life are doing to us.

“How can Americans stay healthy while struggling with the demands of modern life?” This is the central question of Schuster’s book, and though he’s asking it about neurasthenia in the late 1800s, he could just as easily be asking it about stress today. (What is stress, anyway? Like, what is it? I went to the doctor recently with an ear problem and they told me it was probably stress. It was not illuminating.) Both neurasthenia and stress are vague concepts that make for easy scapegoats because they are so flexible. Both are grounded in reality but invoked in ways that exceed what is truly known about them.

“These are real things and metaphorical things,” Lutz says.

When health is tied to happiness, it takes on an almost spiritual, moral quality: This is the way you should live, to be happy. And you should value happiness, not only for its own sake, but because it is equivalent to healthiness. Mitchell, for one, characterized his writings about neurasthenia as “lay sermons.”

Health has long been tied to morality, from Christians who thought illness was a punishment for sin, to “debates about whether the use of drugs or alcoholism are moral failings or medical failings,” Lutz says. “We still confuse these things as a culture.” And for advice on how to live right, you can turn to any number of scientific experts with tips for how to relax, be more mindful, or be kinder.

As for neurasthenia itself, it declined as a diagnosis in the 1920s. The nervous-energy theory never really panned out, and the rise of psychology meant medicine began to consider mind and body separately for a while. Truth in advertising laws meant companies couldn’t just bottle whatever and market it as a neurasthenia cure anymore. Neurasthenia is still included in the World Health Organization’s International Classification of Diseases and is still sometimes diagnosed in Japan and China, but in America, American-itis is now a relic.

“We’ve basically divided neurasthenia up into a lot of different diagnoses—anxiety disorders, depression, OCD, eating disorders, or even something like chronic fatigue syndrome,” Stiles says. “Because the diagnosis is so broad, you can really see it in numerous aspects of American life now. What’s different is we seem to have made the diagnoses more specialized.”

Regardless, the idea of happiness as a predictor of health persists today—and is, as the case of neurasthenia shows, deeply entangled with cultural norms and developments. Technology can give happiness and comfort in some ways, and take it away in others. With wonders come anxieties. Have we lived too fast? No matter when the question is asked, the answer always seems to be yes.

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