Adventures in Neurasthenia, continued

Men and women were both subject to nervous diseases from different  pressures. Beard thought that men in the professions, especially his own, medicine, were most inclined to neurasthenia (he diagnosed and treated himself as a neurasthenic) because of the pressures of overwork and guilt for not living up to the standards of their professions

Adventures in Neurasthenia, continued

In Nervous Exhaustion (1880) and American Nervousness (1881) George Beard argued that while similar disorders appeared in other countries, neurasthenia was an illness peculiar to America and was brought on by changes in the conditions of the United States in his own time. Elsewhere, Men were expected to follow in their father's footsteps. In America, they were expected to work their way up the economic ladder, to make something of themselves!

But how were they to accomplish this mission if they were plagued all the time by severe fatigue?

"Let be be the finale of seem."

The Emperor of Ice-Cream

Wallace Stevens


Call the roller of big cigars,
The muscular one, and bid him whip
In kitchen cups concupiscent curds.
Let the wenches dawdle in such dress
As they are used to wear, and let the boys
Bring flowers in last month's newspapers.
Let be be the finale of seem.


The only emperor is the emperor of ice-cream.

Take from the dresser of deal,
Lacking the three glass knobs, that sheet
On which she embroidered fantails once
And spread it so as to cover her face.
If her horny feet protrude, they come
To show how cold she is, and dumb.


Let the lamp affix its beam.


The only emperor is the emperor of ice-cream.


1922




Wallace Stevens


Wallace Stevens (1879-1955) was born in Reading, Pennsylvania, and educated in the classics at Reading Boys' High School, and at Harvard during the years 1897-1900, acting as president of the Harvard Advocate and publishing some verse. After several years as a reporter in New York, Stevens entered New York Law School in 1901 and was admitted to the bar in 1904. In New York he worked for several law firms and then joined an insurance firm, the American Bonding Company of Baltimore, which became the Equitable Surety Company of St. Louis. Stevens married in 1909 and lived in New York until moving to Hartford, Connecticut, in 1916. Until his retirement, he worked for the Hartford Accident and Indemnity Company, moving up to Vice President in 1934, akin to composer Charles Ives, who also worked in insurance while pursuing his craft. Steven's poem "Pecksniffiana" won the Helen Haire Levinson Prize offered by Poetry in 1920.

Stevens wrote, "A poem need not have a meaning and, like most things in nature, often does not have." In Opus Posthumous, "Adagia" (1959). Stevens knew well Key West in Florida, which is probably where this poem takes place, since ice-cream was commonly served at funerals during the hot weather. It is said the poem speaks of the duality of eros and thanatos, of life and death.

Are Marathons Dangerous?

Special Report: Are Marathons Dangerous?



If running is so good for you, why do people drop dead during marathons every year? A lifelong runner, with help from the experts, finds the encouraging truth behind the scary headlines.


By Amby Burfoot


Image by Matt Mahurin


Grave Concerns


Special Report: Are Marathons Dangerous?


If running is so good for you, why do people drop dead during marathons every year? A lifelong runner, with help from the experts, finds the encouraging truth behind the scary headlines.


By Amby Burfoot


Image by Matt Mahurin


From the December 2008 issue of Runner's World


The Running Effect


"I feel a little awkward about meeting John Fixx," says heart specialist Paul Thompson, M.D. "His father made me famous." It's a gray, drizzly afternoon three days after my run with Steve Blair. Thompson and I are jogging from Hartford Hospital, where he's chief of cardiology, toward nearby Colt Park. I've arranged for Fixx, an old friend, to meet us there for a five-mile run.


A month earlier, Thompson, 61, had finished the Boston Marathon in 3:24:01. He's slight-5'7" and 144 pounds-with a boyish face, a forehead that goes on forever, and a respectful manner. Thompson completed his first Boston 40 years earlier, in 1968 (34th place, 2:49:22), while still a Tufts University undergrad. Several years later, he improved his Boston best to 2:28:25, his PR. He ran 14 straight Bostons, but a move to Pittsburgh, four kids, and increasing hospital responsibilities will put a dent in anyone's schedule. More recently, with the kids grown and a move to Hartford, he's run the last nine Bostons.


By the time of Jim Fixx's death at age 52 in 1984, Thompson had graduated from medical school, done some advanced studies at Stanford, and published two papers on heart-attack deaths in runners. That made him the go-to expert for hundreds of TV, radio, and newspaper reporters chasing down the Fixx story. Over the years, Thompson has remained everyone's favorite expert for insights on exercise and heart disease. He has also worked as a TV commentator at the Seoul Olympics and the New York City Marathon, and his name turns up frequently in publications like The New England Journal of Medicine.


Thompson has had a lifelong fascination with the workings of the heart, in particular its response to exercise. "Sometimes I wish I could read heart studies all day long instead of attending to administration details," he says. "Think about the overweight guy who's totally out of shape until he begins exercising. A couple of months later, he's a different person. The heart is so amazing, and so damned good at what it does."


Thompson runs with the quick, light stride of the veteran marathoner, and has already covered eight miles in the early morning. "It's the one time of day I get to focus on myself," he says. "This makes me a much better person when I get to work and have to focus on staff and patients."


I ask Thompson why some runners keel over and die from heart attacks. He explains, first, that the young ones, mostly under 30 or 35, generally have structural defects in their hearts, such as the heart scarring that apparently led to Ryan Shay's death. These include a bewildering variety of rare conditions, and one-hypertrophic cardiomyopathy-that gets mentioned much more than the others for two reasons. First, it's the most common cause of sudden heart death in young athletes. Second, it results from an enlarged heart. This leads to widespread confusion, because endurance athletes like marathoners also have enlarged hearts. But the two are completely different. The marathoner's heart is large, healthy, and efficient; it's like a car that gets 40 miles per gallon. The hypertrophic cardiomyopathy heart is misshapen, malfunctioning, and dangerous; it results from a physical defect, not from hard endurance training.


When an over-35 exerciser dies on the run, Thompson continues, the cause is almost always artery disease-that is, cholesterol deposits that rupture and provoke a heart attack. He describes it like this: Imagine a garden hose with a modest flow of water moving through it. That's your arteries when you're resting. When you begin to run faster, the flow of blood increases dramatically. The hose begins to twist and flail. You've felt this with your own hose, or noticed how firemen must brace themselves to control a high-pressure hose. "So your arteries are flexing and bending," says Thompson. "Now if you've got a cholesterol deposit in the artery, the movement can crack the deposit open. Your blood mixes with the cholesterol to form a clot that blocks the artery. A few minutes later, you've bought the farm."


In Thompson's classic 1982 study of runners' heart-attack deaths in the state of Rhode Island, he found that a runner's relative risk of dying during a workout was about seven times that of dying in front of the TV. It amounted to one death for every 396,000 hours of running, almost exactly the same rate found decades later in several marathon studies (see "Risk of Death While Marathoning," page 98). This doesn't mean that running caused the deaths. It would be more accurate to say that artery disease caused the deaths, and running was merely the trigger. Here's why: Another Rhode Island study showed that the blizzard of February 1978 touched off a mini-epidemic of snow-shoveling deaths. A week later, however, heart-attack deaths dropped below normal levels. In other words, after all the people with advanced artery disease had died, there were few diseased hearts left.


Like other heart experts, Thompson notes that regular exercise offers no sure protection from heart disease. Three hundred and twenty-five thousand Americans suffer an outside-a-hospital heart attack every year, often without warning, and 40 percent of these events end in sudden death. "Exercise is not a savior," Thompson says. "The risks are very low, the benefits are real, and the benefits outweigh the risks. But there are no guarantees. Regular exercise is like investing in the stock market. You hope that your stock will improve over time, but every once in a while you catch a Bear Stearns."


This can happen even to fit runners with low cholesterol who've passed a stress test in the last 48 hours. Still, the occasional exercise death doesn't change the advice for healthy living. "If you want to live a long, vigorous life, you should do an hour of moderate exercise a day," says Thompson. "If your only goal is to survive the next hour of your life, you should get into bed-alone."

Time on Newt

Sunday, November 20, 2011

November 9, 2011, 12:04 am

Gingrich Rises in Polls But Has Major Obstacles to Nomination

By NATE SILVER

I forget whether I posted something on Twitter to this effect or simply kept the thought to myself, but there was a point in time at which I would have given Newt Gingrich not more than a 1-in-1,000 chance of winning the Republican nomination.

That may have been foolish. This year’s Republican nomination process, if nothing else, has reminded us how often things don’t go to plan and how unpredictable the primaries can be. Lately, Mr. Gingrich has been showing some signs of life.


He has averaged 13 percent of the vote in polls conducted of Republican voters so far in November, his third straight month of improvement after he bottomed out at 5 percent in July and August. There’s also some evidence that Mr. Gingrich tends to be competing for the same types of voters as Herman Cain, so if Mr. Cain’s campaign begins to erode support, Mr. Gingrich could be the beneficiary of that.

Perhaps more surprising is the rebound in Mr. Gingrich’s favorability ratings among Republican voters. According to Gallup’s tracking poll, Mr. Gingrich is now viewed favorably by 55 percent of Republican voters and unfavorably by 23 percent, a big improvement from June when those numbers were 42 and 31 percent, respectively.


But there is much to consider in a primary campaign beyond the national polls. I would group these “fundamental” factors into five broad categories, each of which we will consider in the context of Mr. Gingrich:

Early State Polls and Positioning Somewhat contrary to the perception that Mr. Gingrich is running a national book tour rather than a serious campaign for the White House, he has spent most of his time in the key early-voting states. Based on Politico’s candidate tracker, I show Mr. Gingrich as having held 11 events in Iowa between Sept. 1 and Oct. 31, along with seven in Florida and five in South Carolina. He has spent very little time in New Hampshire, but overall he made 25 appearances between the four states during this period, about the same number as Mitt Romney

Polls suggest that Mr. Gingrich is right to concentrate on the other three states at the expense of New Hampshire: his numbers lag his national support by several points in the there, while running roughly in line with it in the others. It’s conceivable that Florida and South Carolina could turn into strengths for Mr. Gingrich. He is from Georgia, which neighbors both of them, and polls find that Mr. Gingrich runs relatively strongly among older voters, which will be helpful to him in Florida. But he will probably have to perform strongly in Iowa to get to those states in decent shape, and although recent polls show his numbers improving there, he lacks infrastructure in Iowa and fared very poorly in the Ames Straw Poll.

Endorsements and Party Support. Mr. Gingrich has a half-dozen endorsements from Republicans in the U.S. House, but almost all of them came toward the start of his campaign in May and all but two of them are from his home state of Georgia. (He also has the endorsement of Georgia’s governor, Nathan Deal.) Mr. Gingrich has very few endorsements in key early-voting states.


Some endorsements are better than none, and Mr. Gingrich has more from members of the Congress than candidates like Herman Cain (who has just one), Representative Michele Bachmann (zero) and Jon M. Huntsman Jr. (also zero). It’s important to remember that relatively few Republican party leaders have made endorsements of any kind so far, and it’s certainly not impossible to imagine the former speaker of the House finding support within the Republican establishment. For the time being, however, the low endorsement total qualifies as a weakness for Mr. Gingrich.


Fundraising and Campaign Infrastructure. Mr. Gingrich’s fundraising has been simply abysmal — just $2.9 million brought in through Sept. 30. Not only that, but as of Sept. 30, Mr. Gingrich had only $353,000 in cash on hand but $1.2 million in debt. There’s some question about whether fundraising is more of a lagging or a leading indicator; the money sometimes follows the polls. But it is hard to see how numbers like these are anything other than a huge problem for Mr. Gingrich.


What they may really point toward is his lack of a robust campaign infrastructure, caused in part by numerous staff defections early in this campaign. He may even be in something of a Catch-22: it’s hard to hire staff if you don’t have money, but it’s hard to raise money if you don’t have any staff. Whether Mr. Gingrich makes a credible effort to address these issues over the next several weeks will be a good sign of how seriously his surge should be taken.


Ideological Positioning. Mr. Gingrich got himself into trouble early on with his apostasies over Rep. Paul Ryan’s budget plan. But most every Republican candidate has one or two positions that they now find inconvenient, and Mr. Gingrich’s overall ideological positioning isn’t bad given the mood of the Republican electorate. We did not include Mr. Gingrich in our recent magazine feature on Republican candidates that rated their ideology from center to right on a 100-point scale, but his score would be fairly close to that of Gov. Rick Perry, which in my view represents something of a sweet spot for the Republican primary electorate: solidly conservative but not in Michele Bachmann territory. Mr. Gingrich is also fairly well positioned on what I call the establishment-insurgent axis; he can claim to know how Washington works while also seeming like an outsider since he has been out of it for some time.


This, overall, is one of Mr. Gingrich’s greater strengths: one can imagine him being acceptable in theory to a fairly broad array of conservative voters.


Electability and Personal Liabilities The downside to being acceptable to most conservative Republicans is that you may not be ideally positioned for the general election. I don’t place a lot of emphasis on horse-race polls this early out, but Mr. Gingrich trails President Obama by 11 points in recent surveys, about the same as Mr. Perry. Our forecasting model, which is based on ideology ratings rather than these polls, suggests that he might ultimately run a net of about 4 points worse than someone like Mitt Romney nationally.


Of course, in the context of a nomination race, the perception of electability may be more important than the reality of it. But those numbers are quite poor for Mr. Gingrich as well. In the recent ABC News/Washington Post poll, just 5 percent of G.O.P. voters identified him as the candidate with “the best chance to defeat Barack Obama in the general election,” well below the 11 percent support he had overall in the survey.


Meanwhile, although Mr. Gingrich’s personal favorability rating has rebounded a great deal among Republican voters, he has some image problems that could come back to harm him should he rise in the polls and receive more scrutiny from voters and the media. The most obvious problem is Mr. Gingrich’s two divorces, a subject that may receive more attention given the recent focus on the sexual harassment allegations against Mr. Cain. Mr. Gingrich may also not be as thoroughly vetted as candidates like Mr. Romney and Mr. Perry, who have run for office more recently.


Finally, there’s the fact that Mr. Gingrich is anything but a new face to voters and is associated with an exceptionally unpopular institution, the United States Congress.


Overall, I would read three of these factors, establishment support, personal liabilities, and (especially) fund-raising, as being clearly negative for Mr. Gingrich. This contrasts against one, ideological positioning, which is potentially favorable for him. He has both strengths and weakness in the key early-voting states, meanwhile.


That balance is unfavorable enough to suggest that his chances of winning the nomination are weaker than his polls alone would imply. That certainly does not mean that his chances are zero, or 1,000-to-1 against. If Republican voters decide that they really don’t want to nominate Mitt Romney, Mr. Gingrich could be the last man standing. But even if Mr. Gingrich continues to gain in the polls, he will have some major weaknesses to overcome.

George Miller Beard, M.D. (1837-1883)

George Beard, M.D. (1837-1883)


George Beard is credited with coining the word "neurasthenia," a term that came into great prominence in the late 19th and early 20th centuries.

Beard received his medical degree in 1866 at The College of Physicians and Surgeons in New York and then joined Dr. A. D. Rockwell, a New York neurologist who was using electricity in medical and surgical therapy and with whom Beard later published favorably received book on the subject. Beard became interested in psychology, and in 1876 he read a paper at a meeting of the American Neurological Association entitled, "On the influence of the mind on the cure and causation of disease" (Journal of Nervous & Mental Diseases, 1876, vol. 3, pp. 429-434). Beard credited emotions as influencing symptoms which could be dispelled by positive thinking, to which he applied the term "mental therapeutics." His paper met with derision from his colleagues, and The Superintendents’ Association lost no opportunity to disparage Beard’s writings. Beard’s book, A Practical Treatise on Nervous Exhaustion (Neurasthenia) (New York, 1880) received a scathing review in The AJI (April 1880, v. 36, pp. 522-526).

Historian Charles Rosenberg wrote, "Beard was neither a profound nor critical thinker. His popularization of the idea of neurasthenia won him an international reputation in the late 19th century… he was a forerunner of French and modern psychological medicine." ("The place of George M. Beard in 19th-century psychiatry," Bulletin of the History of Medicine, 1962, v. 36 (3), pp. 245-259).


Profile from: http://www.nim.nih.gov/hmd/diseases/note.html

From Wikipedia:
George Miller Beard (May 8, 1839 – January 23, 1883) was a U.S. neurologist who popularized the term neurasthenia, starting around 1869.


Biography:


Dr. Beard was born in Montville, Connecticut on May 8, 1839, [1837, according to the NIH profile, J. Richman] to Rev. Spencer F. Beard, a Congregational minister, and Lucy A. Leonard. He graduated from Yale College in 1862, and received his medical degree from the College of Physicians and Surgeons of New York in 1866. While still in medical school during the American Civil War, he served as an assistant surgeon in the West Gulf squadron of the United States Navy. After the war and graduation from medical school, he married Elizabeth Ann Alden, of Westville, Connecticut, on December 25, 1866.[1]


He is remembered best for having defined neurasthenia as a medical condition with symptoms of fatigue, anxiety, headache, impotence, neuralgia and depression, as a result of exhaustion of the central nervous system's energy reserves, which Beard attributed to civilization. Physicians who agreed with Beard associated neurasthenia with the stresses of urbanization and the increasingly competitive business environment. Stated simply, people were attempting to achieve more than their constitution could cope with. Typically this followed a short illness from which the patient was thought to have recovered.[2]


One of the more unusual disorders he studied from 1878 onwards was the exaggerated startle reflex among French-Canadian lumbermen from the Moosehead Lake region of Maine, that came to be known as the 'Jumpers of Maine'. If they were startled by a short verbal command, they would carry out the instruction without hesitation, irrespective of the consequences. The studies stimulated further research by the military and Georges Gilles de la Tourette.[3]


Beard was also involved extensively with electricity as a medical treatment, and published extensively on the subject. He was a champion of many reforms of psychiatry, and was a founder of the National Association for the Protection of the Insane and the Prevention of Insanity. He also took an unpopular stance against the death penalty for persons with mental illness, going so far as to campaign for leniency for Charles J. Guiteau, the assassin of President James Garfield on the basis that the man was not guilty because of insanity.[1]


He died on January 23, 1883 in New York City.[4]


[Other accounts say he died of pneumonia in his mid-forties, along with his wife who also died from the disease in their downtown New York City home which was also his office. Living before the age of anti-biotics, Beard was supposed to have tried electricity cures to treat their disease. Electrical medical devices to treat a range of diseases from cancer to cold were common in the late 19th and early 20th century.
Contrary to commonly held views on his work from his own period on to the present, I do not believe he was a "shallow" thinker. Quite to the contrary, his early death may have aborted a much more brillant career as a humanistic doctor of the science of mental disorders.
Beard had a profound effect on the thinking and writings of Sigmund Freud whose essay Civilization and its Discontents owes its core thesis to Beard and his associates view of the stresses of the business world we inhabit. Freud also converted the term neurasthenia to apply to other manifestations of neurotic behavior which his theories adumbrated.
He deserves a much higher place in American medical history. In the Race for the Republican nominee for the presidency, Newt Gingrich has declared his interest in funding a vigorous research program for treating disorders from neurosis to Alzheimers! Such a revolutionary declaration should put him first in the hearts of all those who have lost their loved ones to Alzheimer's disease and other mental disorders.
Interestingly, Jonathan Swift, who in the last 10 years of his life as Dean Swift at St. Patricks in Dublin perished from a number of severe mental disorders, which led one of  his lesser admirers, Dr. Samuel Johnson, in his long poem, The Vanity of Human Wishes, to observe, "See Swift expire a drivel'r and dumb show," ('dumb show,') His caretakers would charge money to show off the Dean in his decrepit condition, thus marking the ultimate irony of the life of Swift after his earlier literary victories over his political enemies, in Johnson's poem. J. Richman]


References1.Dictionary of American Biography Base Set. American Council of Learned Societies, 1928-1936.


2. A Handbook of Practical Treatment, John H. Musser, M.D. and O. A. Kelly, M.D., 1912.


3. Beard, George (1878). "Remarks upon 'jumpers or jumping Frenchmen'". The Journal of Nervous and Mental Diseases 5: 526.


4. Almanac of Famous People, 8th ed. Gale Group, 2003.

Contact us: I am posting my book called "Running on Empty" on my Writers Anonymous blog. After I have posted the entire book, in about a year, I will be glad to review the scholarship on Dr. Beard and others included in my book for Wikipedia articles.
A follow up book could be, From George Miller Beard to President Newt Gingrich!
jordanp.richman@gmail.com