Evolution of the Construct of Nervous Disease
In the 19th century those conditions which were broadly termed "nervous" diseases comprised all organic diseases of the nervous system, the major psychiatric disorders, and lesser psychiatric disorders which would today be regarded as "psychoneuroses" (Drinka, 1984). It is important to understand that these lesser psychiatric disorders (which included hysteria, hypochondria and mild depression) were regarded by many physicians as "functional" in the sense that there was no demonstrable organic disorder of the nervous system. Although it was recognised that to some extent they were culturally determined, they were defined as organic brain disorders, thereby "legitimising" them in the eyes of the sufferers.
"Nervousness" ("the English malady") as a
distinct and common condition was first described in the 18th century
by Cheyne, an English physician. In his opinion those affected either
had the misfortune to have inherited delicate nerves or had
over-indulged themselves with spicy foods and strong drinks which had
rendered the bodily juices caustic and bitter (Drinka, 1984). In 1764,
Whytt noted that "nervous" disorders could be induced by emotional
factors, which he referred to as "passions of the mind" (Shorter,
1991). Whytt divided these disorders into hysteria, hypochondria and
nervous exhaustion. He proposed that the symptoms of "nervous"
disorders could be reflexly induced: a sensation in one part of the
body is carried inward through the nerves, back into the spinal cord
and even up to the brain, then outward through another nerve to another
part of the body, thereby causing a symptom (Drinka, 1984). This
concept of reflex action had great explanatory power for many
functional medical conditions as it provided a dynamic link between the
mental and the organic.
The term "neurosis" was first used by
Cullen in 1769, defined as "sense and motion injured, without
idiopathic pyrexia and without local disease". Cullen postulated four
categories of "neurosis": comata (conditions like apoplexy and stroke),
adynamiae (alterations of the involuntary, or what we would call today
the autonomic, nervous system), spasmi (disturbances of voluntary
muscle, such as convulsions and tetanus), vesaniae (by which he meant
intellectual impairment). Cullen's aim was to direct medical thought
away from the ancient humoral theory of disease towards the tonus
theory, an equally ancient concept which meant literally a tightening
or loosening of the nerves (Knoff, 1970).
These three concepts focus unequivocally on the nervous system where it was believed that a physical lesion existed even if not yet discovered. Although this idea penetrated the 20th century, the term "neurosis" came to denote a clinical condition where not only had no lesion been found but also such a lesion was believed not to exist (Ross, 1937; Culpin, 1945)
