November 30, 2022

Neurasthenia, and the strange beliefs of George Miller Beard

Instead of being at the mercy of wild beasts, earthquakes, landslides, and inundations, modern man is battered by the elemental forces of his own psyche.

How this started

This post began as a response to Scott’s execrable “Contra Resident Contrarian On Unfalsifiable Internal States”. Looking for ammunition, I reread Scott’s review of Crazy Like Us. Here is the important part:

Around the Meiji Restoration, when everyone was obsessed with how great foreign stuff was, Japanese medical students went to Germany, learned psychiatry, came back to Japan, and told everyone they were neurasthenic. Being neurasthenic became first a fashion, then a class marker. The idea was that neurasthenics were people who were working too hard (good, admirable), and who were so smart and doing so much furious intellectual activity that it was straining their nerves (impressive). Also, they were probably sensitive souls too pure for this world. The most embarrassing extreme of this happened in 1903, when some photogenic Japanese youth carved a poem in a tree, went to a beautiful waterfall, and leapt to his death. Everyone praised him for how sensitive and artistic and neurasthenic this was, and turned him into a posthumous national hero.


Finally everyone struck a compromise and agreed that most of the lower-class patients weren’t real neurasthenics (hard-working, intelligent, sensitive, admirable), but had a similar condition, imitating the symptoms of neurasthenia, based on being too weak and pathetic to cope. This seemed to do the trick, and people stopped coming to the hospital with neurasthenia symptoms.

Our protagonist

Wanting to learn more, I found some writings by George Miller Beard, the guy who invented neurasthenia. But then he turned out to be interesting enough for an article all by himself. And then the FTX stuff happened, and it’s just been a bad month for Scott in general. So this is now a George Miller Beard article.

What was neurasthenia?

Straight from the horse’s mouth:

The character of this malady, if I be allowed to call it such, may best be understood by comparing and contrasting it with anœmia, a condition which has been more thoroughly discussed, and is therefore more vividly appreciated by the profession at large.

Anœmia is to the vascular system what neurasthenia is to the nervous. The one means want of blood, the other, want of nervous force.


My own view is that the central nervous system becomes dephosphorized, or, perhaps, loses somewhat of its solid constituents; probably also undergoes slight, undetectable, morbid changes in its chemical structure, and, as a consequence, becomes more or less impoverished in the quantity and quality of its nervous force.


If a patient complains of general malaise, debility of all the functions, poor appetite, abiding weakness in the back and spine, fugitive neuralgic pains, hysteria, insomnia, hypochondriases, disinclination for consecutive mental labor, severe and weakening attacks of sick headache, and other analogous symptoms, and at the same time gives no evidence of anœmia or of any organic disease, we have reason to suspect that the central nervous system is mainly at fault, and that we are dealing with a typical case of neurasthenia.

Immediately we can see that the signs of neurasthenia are so broad that most people can be diagnosed with it at any given time. When they diagnosed someone with neurasthenia, Japanese shrinks usually prescribed rest and relaxation; no surprise that neurasthenia became so popular there. But Beard preferred a different treatment—electric shocks. This makes sense actually, based on his theory that neurasthenia is caused by some sort of depletion of the nervous system. Despite all the batshit things Beard believed—more on that soon—I have to give him credit for one thing: He was adamant that neurasthenia had a physical cause, which would eventually be understood through autopsy.

Beard believed that neurasthenia was “more frequently than any other, in our time at least, the cause and effect of disease.” He also believed it was a uniquely American disease. A couple of years before his death, he published a book, American Nervousness, Its Causes and Consequences, which contains his thoughts on neurasthenia, America, and many other things. These thoughts will form the subject of the remainder of this article.

What’s wrong with Americans?

The unifying theme of Beard’s book is that neurasthenia is a disease of civilization. Naturally, neurasthenia mostly affects members of the upper class, so Beard’s book is full of observations about the American upper class. For instance, this was about 40 years before Prohibition, and many upper class Americans had become teetotalers. Beard explains:

A European coming to America sees a sight that no other civilized nation can show him—greater than Niagara—an immense body of intelligent people voluntarily and habitually abstaining from alcoholic liquors, females almost universally so, and males abstinent, if not totally abstinent.

Contrast this with the English:

To see how an Englishman can drink is alone worthy the ocean voyage. On the steamer with me a prominent clergyman of the Established Church sat down beside me, poured out half a tumblerful of whiskey, added some water, and drank it almost at one swallow. He was an old gentleman, sturdy, vigorous, energetic, whose health was an object of comment and envy. I said to him: “How can you stand that? In America, we of your class cannot drink that way.” He replied, “I have done it all my life, and I am not aware that I was ever injured by it.”

As Beard would later put it, “the English are men of more bottle-power than the Americans.” Of course, this must have something to do with the Americans’ lack of nervous force:

The progress of total abstinence in both countries, is due, in part, no doubt, to the special efforts of reformers, but mainly to the general progress of culture, and perhaps, most of all, to that heightened nervous sensitiveness that makes it impossible for many to partake, even moderately, of wine without showing, instantaneously or speedily, the evil effects therefrom.

Apparently some Americans even went so far as to abstain from liquids altogether!

Thirstlessness—a lack of desire for water, and the difficulty of assimilating it—is as common among the upper classes of Americans as lack of desire for solid food, and is a most serious symptom, expressive of a lower grade of nerve exhaustion.

Beard also thinks the increase in nearsightedness is due to nervousness. But weirdly, he also thinks nervousness has a protective effect. Here is what he says:

The Germans, being less nervous than the Americans, excess in the use of any organ is more likely to induce in them local than constitutional disease, in accordance with the general law that in strong persons abuse of any function produces local disease and in the weak constitutional disease. An American breaks down all over—becomes neurasthenic before his eyes give out.

He seems to be trying to have it both ways. And he makes similar claims about tooth decay. To be fair, Beard also suggests that eye problems might be caused by staying indoors and only looking at close-up things—a theory that remains popular to this day. And he at least acknowledges that bad diet may cause tooth decay. But he gives little weight to this because, as he sees it, everybody eats sweets, and the Americans don’t have an especially sweet diet.

Neurasthenia in women

GMB would like you to know that American women are the most beautiful in the world.

Handsome women are found here and there in Great Britain, and rarely in Germany; more frequently in France and in Austria, in Italy and Spain; and in all these countries one may find individuals that approximate the highest type of American beauty; but in America, it is the extent—the commonness of this beauty, which is so remarkably, unprecedentedly, and scientifically interesting.

Incredible. To what do we owe this scientific miracle?

In no other country are the daughters pushed forward so rapidly, so early sent to school, so quickly admitted into society; the yoke of social observance (if it may be called such), must be borne by them much sooner than by their transatlantic sisters—long before marriage they have had much experience in conversation and in entertainment, and have served as queens in social life, and assumed many of the responsibilities and activities connected therewith.

Basically, Beard thinks that recent changes in women’s lives (e.g. early school) promote neurasthenia, which is bad. On the other hand, the same forces that cause neurasthenia also make women more attractive, which is good. It’s tenuous, and I think Beard just wanted to talk about how great American women are.

Beard even takes the opportunity to call out his least favorite painter:

One can scarcely believe that Rubens, had he lived in America, or even in England, at the present time, would have given us such imposing and terrible types of female countenances.

This goes on for many pages. Beard goes to great pains to argue that American women are objectively the most beautiful since they are the most desired by foreigners, and because the most beautiful foreign women are those who most resemble Americans. He assures us that while English women might look beautiful at a distance, their beauty does not bear close inspection. And this is all related to neurasthenia somehow.

He follows this up with his opinions on fashion. American women dress very tastefully, he tells us, because they, like all civilized people, find bright colors irritating. Beard apparently was in a poetical mood while writing this part:

If we could clothe ourselves in sunsets; if all this resplendency of crimson and scarlet and gold, and all these variations in hue and form could descend upon the delicate maiden, and fall about her in palpitating folds like a rich garment, the eye of that maiden and of those who gaze upon her would soon weary; the irritation of such splendor would become a pang, and only be worn as a badge and sign of a nature in the lower stages of evolution.

Big if true.


GMB had a great deal of respect for physicians, both past and contemporary. This was a mistake; the physicians of his time were absolutely awful, and those of the past were even worse. For example, at the time Beard wrote this book, bloodletting was still a common treatment for all kinds of disease, although its popularity was starting to wane. So, in an attempt to reconcile centuries-old medicine with modern science, Beard came up with this galaxy-brained idea: Bloodletting used to work, but doesn’t anymore.

We do not bear blood-letting now as our fathers did, for the same reasons that we do not bear alcohol, tobacco, coffee, opium, as they could. The change in the treatment of disease is a necessary result of the change in the modern constitution.

In other words, Beard endorses bloodletting, but only for uncivilized people, including peasants and “muscle-workers.” In fact, he thinks they might be getting undertreated!

These people frequently need more violent and severe purging, more blood-letting, more frequent blistering than the higher orders would endure.

It’s incredible to see the debate over bloodletting play out like this—going from one falsehood to an even worse falsehood before finally realizing the truth. This is what you get from reading primary sources.

But what do you mean by “civilization”?

At this point you are surely wondering, “If neurasthenia is a disease of civilization, then how come the Greeks didn’t suffer from it? The Greeks were super civilized!”

What? You weren’t wondering that? Well, GMB has an answer anyway:

The Greeks were certainly civilized, but they were not nervous, and in the Greek language there is no word for that term. The ancient Romans were civilized, as judged by any standard. Civilization is therefore a relative term, and as such is employed throughout this treatise. The modern differ from the ancient civilizations in these five elements—steam power, the periodical press, the telegraph, the sciences, and the mental activity of women. When civilization, plus these five factors, invades any nation, it must carry nervousness and nervous diseases along with it.

To this list we should also add: clocks, noise pollution, railroads, usury, “increased capacity for sorrow,” repressed emotions, finance, politics, religion, liberty, and Protestantism. Indeed, rather than a disease of civilization, neurasthenia is apparently a disease of GMB’s many fixations. He even thinks bad weather may be to blame.


After complaining about the weather at some length, Beard decides to compare America with Japan, since Japan has “the best analogue to the American climate.” This section is very ironic, since we know that neurasthenia eventually became common in Japan, but Beard didn’t live long enough to see that happen. Here is what he says:

In the Japanese, however, we see suggestions of a fineness of type which is peculiarly American; and had the Japanese obtained civilization which, in institutions and in intensity had even approximated that of America and Europe, it is not improbable that they might have developed a nervous susceptibility which, in their present condition, does not exist.

Most of what Beard knew about Japan came from a travelogue written by the Englishwoman Isabella Bird in the early years of the Meiji Restoration. So he could hardly tell what was to come.

He concludes this section by telling us that the Japanese are much better than the Chinese, and that high class Japanese women, “according to Miss Bird and all authorities,” are “of a sensitiveness of organization and a grace and delicacy of manner that suggest the highest types.”


There’s a long chapter on longevity and whether “brain-work” is healthy, and it’s kind of boring. I’ll only pick out this interesting part:

Thomas Hughes, in his life of “Alfred the Great,” makes a statement that “the world’s hardest workers and noblest benefactors have rarely been long-lived.”


The remark is based on the belief which—against the clearest evidence of general observation—has been held for centuries, that the mind can be used only at the injurious expense of the body. This belief has been something more than a mere popular prejudice; it has been a professional dogma, and has inspired nearly all the writers on hygiene since medicine has been a science; and intellectual and promising youth have thereby been dissuaded from entering brain-working professions.

Beard then spends about a hundred pages arguing that so-called brain-work is actually health-promoting. This is a bit surprising, since it sounds like brain-work would be a risk factor for neurasthenia. How can it be healthy? Beard has several answers:

Beard still gets a lot wrong here, but this is probably the most reasonable chapter of the whole book. A shame it’s so dull.

A possible future

After the longevity chapter, Beard gives us some predictions for the twentieth century and beyond. He foresees the rise of a sort of benefactor class:

In the centuries to come there will probably be found in America, not only in our large cities, but in every town and village, orders of financial nobility, above the need but not above the capacity or the disposition to work: strong at once in inherited wealth and inherited character. … The moral influence of such a class scattered through our society must be, on the whole, with various and obvious exceptions and qualifications, salutary and beneficent.

This class will be small in number but won’t be a hereditary aristocracy:

The America of the future, as the America of the present, must be a nation where riches and culture are restricted to the few—to a body, however, the personnel of which is constantly changing.

At this point, Beard slips into purple prose again, and it’s kind of hard to tell what he’s imagining here. He talks a lot about “evolution,” and it sounds like he’s thinking the competition to be part of the benefactor class will lead to natural selection. But actually, I think he just doesn’t understand evolution. Whatever the case, it’s clear that Beard thinks Americans will eventually become less nervous, and become better people in general, but things will get worse before they get better.


In this final section of the book, Beard gives us his thoughts on education. Beard thinks education is stultifying and inefficient. He absolutely detests lectures. He thinks most education just consists of learning a bunch of useless facts that are immediately forgotten. And of course, like everything else, this must be somehow related to neurasthenia.

The systems of education in colleges and universities, and at home, are, in almost all respects, adapted to exhaust the nervous system.

Beard proposes sweeping changes, and chief among them is preaching the “gospel of rest.”

Our children must be driven from study and all toil, and in many instances coaxed, petted, and hired to be idle; we must drive them away from schools as our fathers drove them towards the schools; one must be each moment awake and alive and active, to keep a child from stealthily learning to read.

Most of the curriculum should be forgotten, leaving room only for the most essential facts. Nothing is to be retained longer than it is useful.

Ignorance is power as well as joy … to know one thing, we must needs be ignorant of many other things.

First on the chopping block: geography.

I applaud the English because they boast of their ignorance of American geography.

In summary, according to Beard, the most notable English traits are:

This is why you read primary sources.

Closing thoughts

I would’ve liked to write about neurasthenia in Japan, but this article has already taken too long to write. Maybe some other time. For now I just want to add a brief timeline of neurasthenia after Beard’s death.

Even though Beard said neurasthenia was an American disease, it turned out to be very popular in other countries. It spread to Germany, and from there to Japan. According to this article from the French Journal of Japanese Studies, neurasthenia exploded in popularity following the Russo–Japanese War, and remained popular until WWII. The story presented in Crazy Like Us—of psychiatrists choosing to stigmatize neurasthenia to stop the mass hysteria—is probably an oversimplification.

Over time, neurasthenia transformed into something very different from Beard’s original concept. But there were two key features that remained the same in America, Germany, and Japan: neurasthenia was a “disease of civilization,” and it had a physical cause. This second part was to be its undoing, since no physical cause was ever found. So neurasthenia was abandoned in favor of less falsifiable ideas.