Heather Beatty's lucid and useful book is a new study of the subject of the supposed glamour of nervous disease in Georgian Britain, well known from the research of historians such as Roy Porter and George Rousseau. It seeks to counter the impression sometimes given that nervous illness was a fashionable pose, an upper-class imaginary condition designed to demonstrate superior sensibility, by focusing on records of actual patient experience. By showing the real suffering reflected in patients’ letters, often including decidedly unglamorous flatulence, she gives readers a salutary reminder not to mistake the hyperbolic sensibility found in novels and in a few prominent literary figures for the whole truth about these symptoms.
The first chapter gives an account of the familiar story of the development of the idea of nervous illness from Hippocrates to George Cheyne's famous book of 1733, The English Malady, which set the scene for future debates on the topic by simultaneously giving a somatic aetiology to the condition and linking it to the lifestyle of the rich. The second chapter gives a very thorough overview of the medical men responsible for creating the late eighteenth-century discourse of nerves, distinguishing ‘first-tier’ figures such as the Edinburgh doctors Robert Whytt and William Cullen (well-connected gentlemen–physicians writing original academic works on the subject), ‘second-tier’ physicians such as Thomas Beddoes and James Makittrick Adair (mainstream, but less original), and quacks. In some ways this is a useful angle, but some might regard the approach as giving the gentlemen something of an easy ride, and being a little too harsh on the second tier and the quacks. Despite their protestations, elite doctors also had clear financial interests, and, as Beatty herself makes clear, ‘quack’ nostrums were often very similar, and by no means necessarily less effective, than those prescribed by socially better-connected physicians.
Chapter 3, which considers patient experience, is the heart of the book. Its declared aim to look at patient experience beyond that of the elite, to question the prejudices of both Georgians and some contemporary historians about the class character of nervous disease, is entirely admirable. However, the nature of the sources that are easily available makes this a challenging goal, one that is only partially realized. Comparing the percentage of diagnoses of nervousness at hospitals (with an essentially lower-class population) with those from elite private practice is an excellent start. It clearly demonstrates that nerves were by no means a problem only for the rich, although more could be made of the apparently significantly higher numbers that were recorded in the elite sources. As far as actual patient experience outside the elite is concerned, though, the principal source, William Cullen's notes, provides rather thin pickings. To a certain extent, Beatty has set up a challenge for future writers on the subject to find more material so historians can really get a grip on the role of nerves in society as a whole.
Chapter 4 outlines some of the main treatments suggested to patients. While much of this is familiar territory, Beatty rightly emphasizes the power of patients to influence doctors’ decisions, with a marked reluctance to comply with strict regimen and an enthusiasm for pills and potions. She is also surely right to argue that the fact that so many patients were prepared to put up with the often unpleasant effects of many of these treatments is reason to take their reported suffering seriously. Chapter 5 examines the dramatic decline in the glamour associated with nervousness, as its connotations slid down the social scale and towards national decline and individual effeminacy. This reaction against ‘excessive’ sensibility is illustrated with well-chosen quotations, nicely complementing Sean Quinlan's work on France. When it comes to the discussion of the role of willpower in the debate, there is an apparent lack of interest in broader theoretical issues. The increasing importance of the idea of self-control in medicine, and the parallel medicalization of moral problems in this period, marks it out as a key moment in the development of modern conceptions of subjectivity. The meticulous examination of the sources found in this book would perhaps have more resonance if consideration were also given to the more philosophical approach of the likes of Michel Foucault, Philipp Sarasin and Volker Roelcke.
Indeed, although the book is very strong in its grasp of the primary sources, it is generally a little shy of theoretical issues. Having effectively shown that patients experienced genuine suffering, Beatty does not then spend much time exploring what notions of a ‘real’ diagnosis and a ‘fashionable’ disease might mean. A consideration of these questions, especially in the context of the work of the likes of Ian Hacking, would have given more depth to the book. Nevertheless, this is an admirable piece of work that sets out the debate on nervousness in a helpful and thorough way. By taking us back to the sources, Beatty gives us a balanced view of the real medical context of a topic that has often been examined with very different agendas. For example, it is good to be reminded of just how much of the discussion of nervousness in the period related not just to fainting fits and fashionable melancholy, but to digestion and its unappealing complaints. For these reasons, and for its readable prose and clear arguments, Beatty's Nervous Disease would be a good place to start research and teaching on the subject.
