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Education: Higher Education

The Troubled Mind in Medicine and Society

Class 2: Was Neurasthenia real?


This second class, designed to evoke controversy and challenge conventional thinking, addresses the question of the “reality” of mental illnesses from an earlier time, such as neurasthenia and hysteria, from two different perspectives. The two reading selections should be read for information and for the author’s point of view. Edward Shorter is a historian, known for his many works on the history of medicine. Ian Hacking is a philosopher who has taken on the task of trying to understand mental illness today, especially the diagnosis of multiple personality disorder.

Class Resources
  • Shorter, Edward. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York: John Wiley & Sons Inc., 1997, Chap. 4, Notes for Chap. 4.
  • Hacking, Ian. Mad Travelers: Reflections on the Reality of Transient Mental Illnesses. Charlottesville: University of Virginia Press, 1998, Introduction, Chaps. 1, 2, and 4.
Discussion Questions for A History of Psychiatry
  1. What did “nervousness” mean in the nineteenth century?
  2. Why was it important to physicians and their patients?
  3. What kind of treatments were available?
  4. How does Shorter portray the role that Dr. S. Weir Mitchell played in the creation of the rest cure in the U.S.?
  5. What is Shorter’s judgment about physicians’ increasing use of the diagnosis of nervousness and neurasthenia? Why did doctors select these words, rather than mental illness or insanity?
Discussion Questions for Mad Travelers
  1. Central to Hacking’s discussion of fugue and fugueurs at the turn of the twentieth century, is a complex scheme that he has called transient mental illness’s “ecological niche.” What are the four elements or “vectors” that compose this? Does this approach provide a useful way of understanding such mental illnesses?
  2. What was the fugueurs’ syndrome? Can one substitute neurasthenia or hysteria for fugues?
  3. What does Hacking mean when he accepts the diagnosis of hysteria as being “warranted” but not “real?” Is this a helpful distinction?
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