Running on Empty: The Problem of Fatigue at the Workplace

Chapter 4: Running on Empty
Jordan Richman
George Miller Beard and Sigmund Freud: The Id Versus Civilization

George Miller Beard coined the term neurasthenia in 1869 to describe a set of symptoms which revolved around the issue of fatigue. Freud studied the use of Beard's term, accepted it and then described himself as a neurasthenic. He later modified the meaning of the word to limit it to a description of a nervous disorder caused by sexual frustration.

Id, ego, superego, and libido were key terms in Freud's psychoanalytical theories.

The Id is the primitive, unconscious store of energy from which come the instincts for food, love, sex, and other basic needs. It is constantly in search of pleasure and seeks to avoid pain.

The libido represents the energy forces behind sexuality. Freud believed sexual energy could be sublimated or channeled to serve the demands of society.

Conflicts between the individual's sexual needs and the work ethic sap sexual energy and lead to fatigue as well as other neurotic symptoms.

The ego or "I" maintains a balance between the demands of the Id and the superego which represents one's sense of right and wrong--the conscience--and the knower of the outside world (external reality).

Freud then developed an elaborate explanation of neurosis, basing it on unresolved sexual conflicts from early childhood and the various stages of infantile and child sexuality. In Western culture, Freud believed neurosis developed by the continued existence of an attachment of the child to the parent of the opposite sex into adulthood, the Oedipus and Electra complexes. There are a number of other concepts which are identified as Freudian theories concerning personality and neuroses, such as penis envy, psychomatic disorders from unresolved childhood conflicts, the importance of dream symbols, and the need for therapeutic catharsis to resolve neurotic guilt feelings.

The neurotic personility might develop different combinations of symptoms, pains, ailmments, or dysfunctions similar to the neurasthenic patient. Freud's neurotic image, like the neurasthenic one, would always include the presence of fatigue, exhaustion, and incapacity at various levels. The only treatment for Freud's neurosis would be psychotherapy, preferably Freudian.

Beard died at the age of forty-four and Freud at seventy-six. In his longer life, Freud was able to develop and modify his ideas more thoroughly than Beard.

Beard and his fellow neurologists postulated the existence of a mystery substance that provided enegy for the nervous system. He believed that some people had a limited amount of that energy. They were easily distressed by "the forces of civilization," a phrase Beard used to describe the technological advances of society and the complex urban relationships that were beginning to take place in America after the Civil War. This stress "bankrupts" the nerve cell enegy of those who are by temperament inclined toward neurasthenia, while stronger constitutions are able to withstand the stress of the new tech tecnologies and forms of social organization.

In Civilization and its Discontents (1939)), Freud viewed the wars and revolutions of the twentieth century and concluded that there were two forces at work in the western psyche, Thanatos, the death wish, and Eros, the urge for life. Thanatos leads to hate and war, Eros to love and the energy sublimations (transformations) necessary for the development of civilization. Since sublimation is easy for some and difficult for others, the fate of civilization always hangs in the balance as the two forces struggle against one another for dominance.

Adventures in Neurasthenia, continued

The popularity of treating symptoms like mental and emotional fatigue as neurasthenia ran from 1870 to 1910.

A large number of celebrities in literature, the arts, politics, and business were labeled as being neurasthenic, a diagnosis they accepted for themselves.

Theodore Roosevelt went out West to deal with his neurasthenia, while Charlotte Perkins Gilman wrote The Yellow Wallpaper, to challenge the male physicians' ways of dealing with neurasthenia as she experienced it.

By 1920, the Freudian approach, which was much more complex in explaining symptoms of fatigue, began to supplant the simple one-disease theory of neurasthenia. Satires against quack doctors who treated patients suffering from persistent fatique and other nervous disorders were written during the heyday of neurasthenic rest cures. S. Weir Mitchell's The Autobiography of a Quack, (1900) is one such example. In 1910, O'Henry wrote a satire called Let Me Take Your Pulse: Adventures in Neurasthenia.

More recently, a historical novel on the subject was written by T.C. Boyle called The Road to Wellville (1994).

The appearance of a condition labeled Chronic Fatigue Syndrome (CFS)  in the mid-1980s through to the mid-1990s has brought a renewed interest in the the term neurasthenia. In JAMA, April 27, 1994 appeared an article, "Was Neurasthenia a Legitimate Morbid entity":

During its heyday, which lasted from the 1870s to the turn of the century, the diagnosis of neurasthenia provided patients with a scientifically legitimate explanation of their inability to perform their expected roles. Furthermore, the patients, who tended to be in their 20s and 30s and from the urban middle classes, recovered.

Today, many people feel, like Beard's patients that they are living on a plane lower than normal. Symptom clusters that include fatigue and a general lack of vitality continue to command considerable medical attention. One has only to consult current medical journal articles on chronic fatique syndrome to see that symptom puzzles that engaged our recent ancestors continue to intrigue us. 

Neurasthenia does live on, however, as a popular diagnostic entity in China, where its discourse of nerves and energy flows is believed to be more compatible with traditional Chinese explanations of fatigue and malaise than with the more purely psychological explanation[s] from the post-Freudian West.