# Madness in the Nineteenth Century
This week we discussed "madness" in the nineteenth century. In your
reading journal, please reflect on how mental health is understood
today. How is it similar and what ways is it different? How do you think
ideas about mental health relate to our on going discussion of "health?"

Like physiological health, mental health is an ideal, and its nonmedical
cultural environment shapes it deeply.
Victorian ideas about women's place in the Cult of Domesticity, for
example, structured mental wellbeing around how well they fit into that
mold.
The general cultural unfitness of a mental patient stigmatized mental
health, which has remained today.
There is gradual work to remove this stigma, but it nonetheless remains.
In fact, despite great medical change around the treatment of mental
illness, like the development of the "talking cure" in contrast to the
rest cure or opiates, popular treatment of mental illnesses remains
similar to 19th century beliefs.
They are seen as signs of weakness or essential deformity of the person.

[IMAGE: Don't Worry---Cheer Up. / Worry wears worse than work / Worry
wastes energy, work utilizes it. / Worry subtracts, work multiplies. /
Worry dwarfs, depresses, confuses, kills. / Worry stops digestion,
paralyzes the bowels, slows the heart. / Worry anticipates failure and
creates disaster. / Worry is a mind malady---a  mental unsoundness. /
Anxiety in the face of grave danger is natural and unavoidable. / Worry
about petty troubles, or even big ones, is useless and may become
calamitous. / Worry is often a habit and may be cured by an effort of
the will. / Ofttimes worry is due to loss of sleep, tea or coffe
indigestion or constipation. / Take a neutral bath at bedtime, eat
biologically, abjure tea and coffee, move the bowels three times a day
and---CHEER UP. CAPTION: A 1920 medical manual from J.H. Kellogg
recommends sufferers of neurasthenia to stop worrying and cheer up in
poetry, showing some of the "blame" being put on the patient. SRC:
https://upload.wikimedia.org/wikipedia/commons/9/9b/Why_the_%22blues%22
%2C_%22nerves%22%2C_neuralgias%2C_and_chronic_fatigue_or_neurasthenia_
%28IA_whybluesnervesne00kell%29.pdf (page 8)]

Mental health is not fundamentally different from physiological health,
and it often derives from physiological issues itself, like addiction.
And exaggerated in mental health diagnoses and attitudes toward ill
people is discrimination, especially racially.
Black people, paralleling their general medical undertreatment, remain
undiagnosed or misdiagnosed for mental illness more often than white
people, and American culture, at least, is much more likely to
sympathise with white mentally ill people than black mentally ill
people.
"The odds that white shooters will receive the mental illness frame are
roughly 19 times greater than the odds for black shooters," one study
reports.

Mental illness is often characterized differently by authors depending
on their intent.
In Doyle's *The Sign of Four*, for example, Holmes is treated as
ever-curious and having a very active mind because of his addiction to
cocaine.
Nineteenth century doctors treated male neurasthenics as hardy with
strong work ethic rather than stigmatizing their disease.
But nineteenth century doctors, in medical journals discussed in
Washington's *Medical Apartheid*, sought to discredit black people and
assigned them the moniker of madness.

Mental health also often has stronger behavioral interpretations than
physiological health.
In the scheme of physiological health, vice, infection, and grime are
perceived as causes or intrinsic symbols of unhealth.
However, more liberal ideas about mental health allow interpretation of
addiction, trauma, suppression, and even larger social trends as
unhealthy.
Sometimes this acts as a lens, with unhealth being a simple proxy for
what the author considers immoral or degenerate, but, like the general
idea of health, the social ideal of keeping people interacting
positively with society and behaving "normally" restricts certain
behaviors

[IMAGE: Sigmund Freud, founder of psychoanalysis, holding a cigar.
Photographed by his son-in-law, Max Halberstadt, c. 1921. CAPTION:
Freud's developments in psychology were, like other doctors, trying to
develop a sense of objectivity about mental diseases. They generated
new health-based interpretations of behavioral and moralistic behavior.
SRC: https://upload.wikimedia.org/wikipedia/
commons/1/12/Sigmund_Freud_LIFE.jpg (Public Domain)]

Sources:
- https://psmag.com/social-justice/white-mass-shooters-are-treated-more-sympathetically-by-the-media
- https://www.healthline.com/health/racism-mental-health-diagnoses
- "Medical Apartheid" by Harriet A Washington
- https://www.mhanational.org/issues/black-and-african-american-communities-and-mental-health
- Markley lectures: Freud and the development of the "talking cure"
- Doyle's "The Sign of Four"
- https://en.wikipedia.org/wiki/Neurasthenia
- https://en.wikipedia.org/wiki/Hysteria#Sigmund_Freud