{"id":96,"date":"2013-12-15T15:09:59","date_gmt":"2013-12-15T21:09:59","guid":{"rendered":"http:\/\/history295.wordpress.com\/?p=96"},"modified":"2013-12-15T15:09:59","modified_gmt":"2013-12-15T21:09:59","slug":"a-tale-of-two-diseases-adhd-and-neurasthenia","status":"publish","type":"post","link":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/uncategorized\/a-tale-of-two-diseases-adhd-and-neurasthenia\/","title":{"rendered":"A Tale of Two Diseases: ADHD and Neurasthenia"},"content":{"rendered":"

Jeanette Miller is completing her undergraduate studies in English at Grinnell College in Grinnell, IA. She enjoys writing poetry, listening to folk music, and drinking an occasional cup of tea.<\/em><\/p><\/blockquote>\n

Consider two diseases: Disease A and Disease B. Children with Disease A are described as being \u201cexcitable\u201d and \u201cprecocious,\u201d at risk of being \u201coverstimulated.\u201d Thus, they are unable to balance \u201cacademic, intellectual, and physical growth\u201d (Schuster, 116). Children suffering from Disease B, on the other hand, are \u201cactive, restless, and fidgety\u201d and have difficulty \u201csustaining attention to tasks, persistence of effort, or vigilance\u201d (Barkley, 57).\u00a0 At first glance, the symptoms of the two diseases in children seem oddly similar. Yet these are two wildly unique diseases that have never overlapped in time. The former, Neurasthenia, was popularized in the nineteenth century, diagnosed primarily in adults but often in children. The latter, Attention-Deficit\/Hyperactivity Disorder, or ADHD, did not enter the mass consciousness until the latter part of the twentieth century and is diagnosed primarily in children but often in adults. If a child with ADHD were to travel backwards in time seeking psychiatric help, my money is on a Neurasthenia diagnosis.<\/p>\n

Neurasthenia was the \u201cpopular disease\u201d of the nineteenth-century. Characterized by a lack of nerve energy, Neurasthenia\u2019s symptoms vary wildly from depression to hyperactivity to indigestion. Since anything abnormal could be attributed to Neurasthenia, the disease became an umbrella term. ADHD gained momentum more than a century later. Generally understood today as a lack of inhibition in the cerebral cortex, the symptoms of ADHD include hyperactivity, inattentiveness, distraction, and failure to complete tasks effectively.\u00a0 Thus, both definitions attempt to characterize abnormal or unproductive behaviors as treatable diseases.<\/p>\n

I am not suggesting that the symptoms of ADHD are fabricated; the symptoms and their effects on people’s lives are very real. Yet, many of these same symptoms were ascribed to an entirely different disease in the previous century. The fact that physicians in different eras have pathologized this set of symptoms speaks to the arbitrariness of the diagnosis and the significance of the broader social context. Or, as David Schuster puts it in his book on Neurasthenia, \u201cDepression, irritability, insomnia, lethargy, indigestion, and pain\u2014these have long been part of what it means to be human.\u201d It wasn\u2019t until the 19th<\/sup> century that these \u201cunfortunate but entirely normal aspects of life\u2026had begun to represent something: the intolerable symptoms of disease.\u201d (1)<\/p>\n

The instability of diagnostic categories doesn\u2019t make the lived experience of these ailments any less real. Try telling a depressed person that their disease isn\u2019t real because it wasn\u2019t a diagnostic category until 1980\u2014actually, please don\u2019t try. Instead, ask the question: why have these diseases been constructed in divergent ways over the past couple centuries? Neurasthenia was considered the American Disease, conceived of as a side effect of the rapidly industrializing world and schedule-oriented society. While proponents of Neurasthenia looked to the outside world to explain physical and emotional abnormality, ADHD does the opposite.<\/p>\n

So, where do we put the blame? Neurasthenia over-emphasized external causes for abnormality, while ADHD emphasizes internal causes to explain deviant behavior. Perhaps, as Conrad argues in his groundbreaking piece \u201cThe Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior,\u201d this reflects a broader shift in society\u2019s \u201cindividualization of social problems\u201d (19). By casting Hyperkinesis, or ADHD, as an illness, we ignore the possibility that the behaviors in question are means of adaptation rather than an illness, diverting attention from \u201cthe family and school and from seriously entertaining the idea that the \u2018problem\u2019 could be in the structure of the social system\u201d (19). And isn\u2019t it easier to blame ADHD on \u201ca glitch in the brain that could be tweaked with stimulant drugs\u201d (Smith 98) rather than on problems in the school or family?<\/p>\n

Somewhere between Neurasthenia and ADHD, society shifted in its understanding of abnormal behaviors. The blame shifted from the society to the individual, or more specifically, from society to an isolated brain dysfunction\u2014a dysfunction that can only be treated with medication. We treat the symptoms without fully understanding their origin. Reducing complicated behavior patterns to neurological abnormalities may prevent us from seeing how these \u201cproblems\u201d fit into the broader experience of the individual.<\/p>\n

And the irony behind all of this? By placing the blame on the individual, the individual is removed from the equation. Disease, as we understand it, has become individual yet impersonal\u2014and thus is approached with a limited perspective.<\/p>\n

___________________________<\/p>\n

Peter, Conrad. \u201cThe Discovery of Hyperkinesis: Notes on the Medicalization of Deviant Behavior.\u201d Social Problems<\/i> 23, no. 1 (October 1975): 12\u201321.<\/p>\n

David G. Schuster. Neurasthenic Nation: America’s Search for Health, Happiness, and Comfort, 1869-1920. <\/i>New Brunswick, NJ: Rutgers University Press, 2011.<\/p>\n

Matthew Smith. Hyperactive: The Controversial History of ADHD<\/i>. Reaktion Books, 2013.<\/p>\n

\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Jeanette Miller is completing her undergraduate studies in English at Grinnell College in Grinnell, IA. She enjoys writing poetry, listening to folk music, and drinking an occasional cup of tea. Consider two diseases: Disease A and Disease B. Children with Disease A are described as being \u201cexcitable\u201d and \u201cprecocious,\u201d at risk of being \u201coverstimulated.\u201d Thus,… Read more A Tale of Two Diseases: ADHD and Neurasthenia<\/span><\/a><\/span><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-96","post","type-post","status-publish","format-standard","category-uncategorized","entry"],"_links":{"self":[{"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/posts\/96","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/comments?post=96"}],"version-history":[{"count":0,"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/posts\/96\/revisions"}],"wp:attachment":[{"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/media?parent=96"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/categories?post=96"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lewiscar.sites.grinnell.edu\/HistoryofMedicine\/wp-json\/wp\/v2\/tags?post=96"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}