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)

Next: Themes in the Pathogenesis of "Neurosis"

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