Victorians who suffered from severe depression received little help from the British medical profession. In “Shattered Nerves,” Janet Oppenheim traces the efforts of British physicians to understand depression and to develop appropriate therapies. Their attempts to do so were based on assumptions about the relationship between mind and body that often hampered understanding of mental illness. Their perception of the causes of mental illness was also shaped and often distorted by Victorian gender ideologies and class attitudes. Although the focus of Oppenheim’s book is on the emerging understanding of mental illness, she also shows how Victorian culture shaped the practice of medicine during the Victorian period.
To put this subject in context, Oppenheim provides an illuminating, if brief, account of the transformation of psychiatry during the nineteenth century from a low-status occupation to a profession. Until the 1840’s, those who worked with the mentally ill were known as “mad-doctors,” usually worked in insane asylums, and were not recognized as practitioners of a distinct field of medicine. To gain greater respectability, those working in the field began to call themselves “alienists” in the 1860’s and “psychiatrists” in the 1890’s; physicians, though, continued to be reluctant to accept psychiatry as a legitimate field of medicine. Its claim to standing as a science was hampered by the fact that its theories were based on clinical experience rather than on laboratory research. Perhaps even more important, psychiatrists were never able to explain adequately what caused depression or what therapy to prescribe for it.
In Folie et déraison: Histoire de la folie á l’âge classique (1961; Madness and Civilization: A History of Insanity in the Age of Reason, 1965), Michel Foucault claimed that nineteenth century psychiatrists were agents of the capitalist system who used their authority as practitioners of medicine to remove from society those persons whom the middle classes considered dangerous to social stability. Oppenheim rejects this view of psychiatry as a form of social control. While accepting that medical definitions of mental illness reflected class assumptions, she maintains that Foucault’s thesis exaggerates the power wielded by Victorian psychiatrists over their patients. During the nineteenth century, psychiatry was a weak, vulnerable branch of medicine forced to incorporate prevailing cultural moods into its practice. Furthermore, there is no evidence of a conscious attempt to impose middle-class or capitalist values on working- class patients as a means of maintaining class hegemony. Psychiatrists did often prescribe treatment that was rooted in middle-class values, but such practices stemmed from the doctors’ belief in the intrinsic merits of those values rather than from any cynical attempt to oppress patients who rejected such values.
Oppenheim notes that Victorian psychiatrists believed that the incidence of nervous illness was increasing during the nineteenth century, and they became concerned that this was an inevitable by-product of urbanization and industrial capitalism. It appeared to them that anxiety arose from the relentless competition and fast-paced life of modern society. In focusing on the stress arising from competition and overwork, Victorian psychiatrists presented middle-class employers and professionals, rather than members of the working class, as the chief victims of modern capitalism. The belief that modernization would cause nervous disorders to multiply was implicitly critical of capitalism, although psychiatrists shrank from drawing that conclusion.
Since there was no standard remedy for shattered nerves, psychiatrists resorted to a variety of treatments, some of which were decidedly unhelpful. Drugs were commonly prescribed. Iron, quinine, and strychnine were considered the most effective nerve tonics. Even though the use of arsenic was restricted by the 1851 Arsenic Act, the drug continued to be used as a nerve tonic. Opium, morphine, laudanum, and codeine were frequently prescribed by physicians for nervous disorders. According to Oppenheim, in the Victorian era opium was as widely used as tranquilizers are in the late twentieth century, and for much the same purpose. Psychiatrists recognized a connection between diet and shattered nerves but disagreed as to what type of diet was best. The use of electricity as shock therapy and, in lighter doses, as a nerve stimulant was also widespread in the...
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