Psychiatry of the Past: Abandoned Diagnoses

Unlike physical maladies, mental illnesses often lack clear-cut diagnostic criteria. Who, and on what grounds, decides which characteristics of the human mind to proclaim pathological? The once-valid psychiatric diagnoses that are obviously archaic from a modern-day perspective may be the best examples of the thin line between madness and social undesirability.



Neurasthenia was a rather common diagnosis in the latter half of the 19th century. At first, it referred to a literal “mechanical weakness of the nerves”, a condition that led to dramatic symptoms such as headache, fatigue, anxiety and irritability. It was epidemic among the female population, in those funny times when women suffered from oh-so-many illnesses – like “hysteria” that of course didn’t have anything to do with the fact that their lives were reduced to the role of an obedient housewife, none at all, but were rather the consequence of their frail nature. Doctors suggested an ingenious therapy called “the rest cure” and those who didn’t heed their professional advice, like the bold Virginia Woolf, had this therapy imposed upon them.

“Well, there’s nothing wrong with taking a little rest, is there? I want this therapy!” some wisecracker may quip. “Well that’s just dandy,” we’d reply. Then we would add how this “rest cure” confines one to about two whole months in bed, during which the person is forbidden from moving an inch, but is being fed, washed and changed by the assigned nurses – an adult is practically treated like an infant. All the while she is completely isolated from her family and friends, and is probably not allowed to talk, read, write, knit or… do anything, really. Occasionally the doctor would give her a nice massage, or else, an electric shock, as to stimulate the failing muscle.

Americanitis Elixir A1 F&D 1906

Guaranteed to soothe the nerves

Sometime later, neurasthenia became a staple diagnosis for people of higher class and profession among the city population. Americans were especially prone to this serious disorder, hence it was affectionately nicknamed “Americanitis” by the first American psychologist, William James. Some professionals tried to explain this phenomenon as a consequence of the suddenly increased pace of life and stress at work, both consequences of urbanization. Freud, however, in his good ol’ custom, had his own ideas: according to him, this disorder is caused by “unfinished sexual acts” or “insufficient libidinal discharges” which result in the body poisoning itself with excess hormones.

Bonus info: neurasthenia has just recently been dismissed from the American diagnostic manual DSM, whereas it holds its place to this day in the International Classification of Diseases, as well as in the Chinese Classification of Mental Disorders.


Another malady that’s haunted us since the beginning of time is – masturbation. In case you didn’t know, this heinous act causes insanity, imbecility, melancholia, epilepsy, blindness, stunted growth, kidney failure, and can lead a man to suicide. Long-term or excessive masturbation apparently causes catatonia and can even cause your spine “to go dry”. In the 19th century, doctors remorselessly castrated, shackled and put chastity belts on “children-libertines” and all other such “mental patients”. Cauterization (burning the skin by pressing red-hot iron on sex organs and spine) was strongly recommended, while the most efficient “treatment” was considered to be circumcision of both sexes.


Health comes first!

Politically-incorrect insanity

The American slavery system gave birth to its own “disorders”. These included Drapetomania (Greek: drapethes– “to run” and mania– “prosecution”) from 1850, which refers to “a pathological feature of slaves to seek freedom.” And let’s not forget Dyasthesia aethiopica, “a pathological tendency of slaves, coloured people and the poor not to respect private property.”

Ko je ovde lud

Some crazy folk, indeed.

In order to prevent their slaves from getting “sick” like this, slavers were advised a number of preventive measures by the good doctors: as soon they notice a slave “looking sullen and unhappy for no good reason” (a sure sign that something is wrong) give him a good flogging, preferably  until he passes out. If the owner still doubted his slave’s mental health, the doctor would sagely advise to cut off both his toes- just in case. After all, better safe than sorry.

The Soviet Union was especially fond of resolving political intrigues by transforming them into psychiatric cases. “Metaphysical intoxication” is a disorder pertaining to adolescents shamefully caught in the act of thinking about the meaning of life, politics, religion and their role in society. This, of course, should not be done. Who is this young person anyway to dare think with his own head and – the raw nerve of him – question the world?!

Adults could easily get pinned with the diagnosis of “social schizophrenia” because of course the man’s gone insane if he claims that he can imagine a better form of social organization than communism.

Očigledno, slučaj paranoidne šizofrenije

Obvious cases of paranoid schizophrenia

You were especially in trouble if you were, God forbid, a poet, going around making up some nebulous metaphors that could, incidentally, be interpreted as criticism of the government. There’s a pretty long list of writers who ended up in the psychiatric ward, but here we will only illustrate the interesting case of the Nobel-prize winner Joseph Brodsky. He was accused of “being a poet” (the horror!) and, therefore, of “being unproductive”; the initial diagnosis he got was “social parasite”. From that point on, Brodsky was thrown around courts and psychiatric institutions, and just when they thought on giving up on him, they turned to the famous Soviet psychiatrist Snezhnevsky, who immediately solved the mystery. Without even paying Brodsky a glance, Snezhnevsky gave him his all-time favorite diagnosis – sluggish schizophrenia – accompanied by his professional opinion that Brodsky is “an absolutely worthless human being and may be released.”

Lesson learned?

It’s fun to look at how quickly climate changes in psychiatry. What used to be described as a person “just snapping” under the pressure, is now called “intermittent explosive disorder”. Then again, homosexuality, that was once considered a psychiatric disorder, is now considered a sexual orientation.

Thankfully, in our progressive modern age psychiatrists are more cautious than ever: for something to be classified as a mental disorder, it must satisfy a number of objective criteria. So, for the latest edition of the classification manual DSM5, released in 2013, a new mental disorder was suggested that properly meets all the criteria: affective disorder, pleasant type – HAPPINESS.

Yes, you read that right: happiness. Think about it for a moment. Indeed, true happiness is:

1. statistically rare
2. manifested by acute episodes of irrational reactions
3. excites the nervous system into a state of extreme arousal
4. on cognitive level, it leads to distortions of thought, such as greater belief in your own competence and self-efficacy, overestimating your control over completely random events, and giving unrealistically positive image of personal achievements
5. on behavioural level, it is accompanied by a characteristic facial expression (smile) and reckless, impulsive, unpredictable behaviour
6. it leads to specific social reactions, such as frequent unnecessary initiation of interpersonal contact and an increased number of pro-social actions.

He sure knows it

It can be concluded that happiness, on all counts, could indicate a mental disorder – except, there are two more criteria, on the basis of which it was, thankgoodness, rejected: happiness doesn’t cause distress to the “sufferer”, and it is not socially undesirable. “But that is a meaningless criterion anyway,” argue the proponents of this “disorder”. Should we not look past societal values? We learned our lesson throughout the history of our profession: science should be value-neutral. Well, if that’s right, happiness is nothing but a subjective value. If depression is a disorder, why can’t extreme happiness be one, as well?

While we can see how often the criterion of social (un)desirability was misused in the past, it seems that today, paradoxically, we can only be grateful for its existence, and for the fact that “happiness” did not become one of the diagnoses in the psychiatric manual – as of yet.

This article was initially written in Serbian, and translated by the author; in case you fancy tiny Slavic languages, you can admire the original by clicking here. Alternatively, browse the rest of our English section – we may be mad, but we have cookies nonetheless. 

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