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Authors: Edward Shorter
Tags: History
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thereby increase in pressure; it can bind itself to particular objects, and transfer itself from one object to another.” 9 Thus tiredness sits at the middle of the whole diagnostic basin of nerves.
A Brief History of Fatigue
Let us attempt first a brief history of fatigue before looking at the psychiatry of it. The exercise is somewhat academic because today, of course, fatigue has vanished from psychiatry.
The first point is separating the history of subjective sensations of fatigue and weariness from the history of medical interest in the subject. Before 1900, real levels of fatigue would be expected to be very high, for several reasons.
One is the exhaustingly long work day in farm and craft shop, where most people labored before the great expansion of urban life began around mid-nineteenth century. For most urban dwellers at the beginning of the twenty-first century, it is simply unimaginable how long and hard people used to work—and how exhausted they were from their labor. Just before World War I, a young German doctoral student named Maria Bidlingmaier, who died during the war, did a work–time study of women’s days in a rural community in Württemberg. This was an era when women were fully engaged in farm work in addition to running the household and raising the children. Bidlingmaier interviewed 77 married women obligated to work in the family fields: Their average work day lasted 14 hours, leaving home for the fields around 6 am and returning evenings around 8 or 8:30 pm. The women’s entire work day, household chores included, was 17–18 hours. Bidlingmaier commented: “In these numbers lies much secret grief for the peasant women, much courageous determination to get it done, much weary dragging home on dusty country roads, torrents of sweat in the heat of the summer, much staunch persistence in the work that is their duty, much resentment against the harshness of fate, and much exhaustion … ” 10 The work of these Württemberg farm wives was unusually well documented. Yet their world was typical of an entire way of life that once prevailed in Europe and the United States when, in a premechanized era, work was done by hand, hour after endless hard hour, in the fields and the carpentry shops. This is now all vanished in the West, and our conception of hard work, though hard for us, has nothing in common with this former reality for millions of people.
Yet few of the physicians of the day saw “fatigue” as a medical complaint. In the older medical literature, there are almost no references to fatigue or any of its synonyms as medical complaints. At the end of the eighteenth century, a literary genre called the “medical topography” arose, in which local physicians described the hygienic and medical conditions of their district. There are hundreds of these. In almost none of them is fatigue ever mentioned, despite the local population having conditions of work as exhausting, or even more so, than those described by Bidlingmaier. 11 Medical historian Peter Voswinckel notes the appearance of “fatigue” in German medical writing only toward the end of the nineteenth century. 12
After the last third of the nineteenth century, these brutal working conditions started to come to an end. Objectively, we would expect real levels of fatigue in the population to decline. Time becomes available for recreation. Field and shop become mechanized with the advent of the electric motor. Work times in establishments become regulated. Unions demand the 10-hour day, then the 8-hour day. People begin to eat more protein and fat as they can afford to add meat to diets that previously consisted heavily of starchy porridge. 13 Iron-deficiency anemia was once a major cause of women’s fatigue in particular, owing to chronic blood loss from the menses and repeated childbearing. Low iron in your hemoglobin means fatigue, and it is interesting that in Britain the percentage of women admitted to hospital with
A Brief History of Fatigue
Let us attempt first a brief history of fatigue before looking at the psychiatry of it. The exercise is somewhat academic because today, of course, fatigue has vanished from psychiatry.
The first point is separating the history of subjective sensations of fatigue and weariness from the history of medical interest in the subject. Before 1900, real levels of fatigue would be expected to be very high, for several reasons.
One is the exhaustingly long work day in farm and craft shop, where most people labored before the great expansion of urban life began around mid-nineteenth century. For most urban dwellers at the beginning of the twenty-first century, it is simply unimaginable how long and hard people used to work—and how exhausted they were from their labor. Just before World War I, a young German doctoral student named Maria Bidlingmaier, who died during the war, did a work–time study of women’s days in a rural community in Württemberg. This was an era when women were fully engaged in farm work in addition to running the household and raising the children. Bidlingmaier interviewed 77 married women obligated to work in the family fields: Their average work day lasted 14 hours, leaving home for the fields around 6 am and returning evenings around 8 or 8:30 pm. The women’s entire work day, household chores included, was 17–18 hours. Bidlingmaier commented: “In these numbers lies much secret grief for the peasant women, much courageous determination to get it done, much weary dragging home on dusty country roads, torrents of sweat in the heat of the summer, much staunch persistence in the work that is their duty, much resentment against the harshness of fate, and much exhaustion … ” 10 The work of these Württemberg farm wives was unusually well documented. Yet their world was typical of an entire way of life that once prevailed in Europe and the United States when, in a premechanized era, work was done by hand, hour after endless hard hour, in the fields and the carpentry shops. This is now all vanished in the West, and our conception of hard work, though hard for us, has nothing in common with this former reality for millions of people.
Yet few of the physicians of the day saw “fatigue” as a medical complaint. In the older medical literature, there are almost no references to fatigue or any of its synonyms as medical complaints. At the end of the eighteenth century, a literary genre called the “medical topography” arose, in which local physicians described the hygienic and medical conditions of their district. There are hundreds of these. In almost none of them is fatigue ever mentioned, despite the local population having conditions of work as exhausting, or even more so, than those described by Bidlingmaier. 11 Medical historian Peter Voswinckel notes the appearance of “fatigue” in German medical writing only toward the end of the nineteenth century. 12
After the last third of the nineteenth century, these brutal working conditions started to come to an end. Objectively, we would expect real levels of fatigue in the population to decline. Time becomes available for recreation. Field and shop become mechanized with the advent of the electric motor. Work times in establishments become regulated. Unions demand the 10-hour day, then the 8-hour day. People begin to eat more protein and fat as they can afford to add meat to diets that previously consisted heavily of starchy porridge. 13 Iron-deficiency anemia was once a major cause of women’s fatigue in particular, owing to chronic blood loss from the menses and repeated childbearing. Low iron in your hemoglobin means fatigue, and it is interesting that in Britain the percentage of women admitted to hospital with
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