How Did They Treat Anxiety in the Past?

For most of recorded history, the experience we now call anxiety was recognized under different names and treated with an enormous range of methods, from herbal concoctions and music to rest cures, sedative drugs, and even brain surgery. The treatments reflect whatever theory of the mind dominated at the time: imbalanced bodily fluids, spiritual corruption, exhausted nerves, or disordered brain chemistry. What ties them together is the persistent human impulse to find relief from a state of dread that, as evolutionary researchers have pointed out, appears to be hardwired into our biology.

Ancient Remedies and the Humoral Body

The oldest surviving medical texts already grapple with anxiety-like symptoms. Egyptian papyri from roughly 1550 BCE describe states of fearfulness and recommend herbal preparations and incantations. But it was the Greek physician Hippocrates, writing around the fifth century BCE, who gave the Western tradition its first medical framework for these conditions. Hippocrates grouped fear and sadness under “melancholia,” which he attributed to an excess of black bile, one of the body’s four humors. Treatment followed logically from the theory: if the problem was too much of a particular fluid, the solution was to restore balance through diet, exercise, purgatives, and bloodletting. That affective understanding of melancholia, centered on fear and sorrow rather than delusion, shaped medical thinking for centuries afterward.¹

Herbal remedies were central to ancient practice everywhere, not just in Greece. Valerian root, passionflower, and various preparations of opium appear across cultures as calming agents. Modern pharmacological research has started to catch up with some of these traditions, finding that bioactive compounds in certain medicinal plants can affect the same neurotransmitter systems targeted by today’s anti-anxiety drugs.² That does not mean ancient herbalists understood the chemistry, but the plants they chose were not random guesses. Many had genuine pharmacological activity, and their continued use across millennia was a kind of slow empirical test.

Medieval Approaches in the Islamic World and Europe

The Islamic medical tradition preserved and extended Greek humoral theory while adding innovations of its own. One of the most striking was the formal use of music as therapy for mental distress. Hospitals across the Islamic world incorporated music, pleasant gardens, and running water into their treatment of patients with psychological conditions. The Bimaristan Fez in Morocco, built in 1286, treated patients suffering from depression with music therapy, herbs, and spices, and also served as a shelter for those with severe mental illness.³ The idea that a healing environment itself could be therapeutic was remarkably progressive and would not become a mainstream Western concept for several more centuries.

In medieval and Renaissance Europe, the dominant framework remained humoral, but it mixed freely with religious interpretation. Anxiety-like states could be attributed to demonic influence, sinful thoughts, or divine punishment, and treatments ranged from prayer and pilgrimage to exorcism. The most ambitious attempt to systematize this messy tradition was Robert Burton’s 1621 book The Anatomy of Melancholy, a sprawling encyclopedia of causes and cures. Burton straddled two worlds: he accepted the old humoral physiology inherited from Galen but also observed that personal loss frequently preceded melancholy, an insight that would not find scientific backing for centuries.⁴ His recommended treatments were an eclectic mix: music, exercise, travel, conversation, moderate diet, and occasionally purgatives. Some of those suggestions sound surprisingly modern; others belong firmly to the seventeenth century.

Hysteria and the Gendered History of Nervous Illness

Any honest look at the history of anxiety treatment has to reckon with gender, because for much of that history, women’s anxiety was categorized and treated differently from men’s. The diagnosis of hysteria, often applied to women presenting with anxiety, panic, fainting, and a long list of other symptoms, is considered the first mental disorder attributed specifically to women. Descriptions appear as early as the second millennium BCE, and for most of the intervening centuries hysteria was regarded as an exclusively female disease.⁵

The ancient Egyptians and Greeks blamed hysteria on a “wandering uterus” that supposedly traveled around the body causing distress. Treatments included fumigation of the vagina with pleasant smells to lure the uterus back into place, or applying foul odors to the nose to drive it downward. These ideas persisted in various forms for an astonishingly long time. By the Victorian era, hysteria had become a catch-all diagnosis for anxious women, and treatments ranged from bed rest to pelvic massage to institutionalization. The effect was to pathologize women’s distress in ways that men’s distress was not, channeling genuine anxiety into a diagnosis that implied reproductive malfunction rather than a legitimate psychological condition. It was not until Freud and his contemporaries began reconceptualizing hysteria as a psychological phenomenon, rather than a uterine one, that the framework started to shift.

The Nineteenth Century and the Nervous Breakdown

The 1800s brought a new vocabulary for anxiety. In the first half of the century, the “moral treatment” movement transformed how people with mental illness were handled in institutional settings. Moral treatment emphasized kindness, structured routine, and the cultivation of character, moving away from the chains and squalor of earlier asylums. It flourished in American mental hospitals during the first half of the nineteenth century, and while it was designed for all forms of mental illness rather than anxiety specifically, the principle that humane surroundings and supportive relationships could heal the mind was a genuine advance.⁶

By the later decades of the century, a new diagnosis had taken hold: neurasthenia, or “nervous exhaustion.” It was one of the most commonly diagnosed disorders of the era, attributed to the supposed stresses of modern industrial life, and its symptoms overlapped heavily with what we would now call generalized anxiety and depression.⁷ The most famous treatment for neurasthenia was the “rest cure,” developed by the Philadelphia neurologist S. Weir Mitchell. Patients, most of them women, were put to bed for weeks or months, fed a fattening diet, given massage and electrical stimulation, and forbidden from reading, writing, or socializing. The idea was to rebuild depleted nervous energy through enforced passivity.

The rest cure was enormously influential and enormously controversial. Charlotte Perkins Gilman’s short story “The Yellow Wallpaper,” published in 1892, was a thinly veiled account of her own rest cure experience, depicting a woman driven toward madness by the enforced isolation. For many patients, the treatment likely worsened the very anxiety it was meant to address, an early example of a well-intentioned therapy that did real harm.

The Age of Sedatives

Before the twentieth century’s drug revolution, the chemical options for calming anxiety were limited but not nonexistent. Potassium bromide (KBr) was introduced as a sedative in the mid-1800s, followed by chloral hydrate, both of which dampened nervous activity but carried serious risks of toxicity and dependence.⁸ Opium and alcohol were also widely used as self-prescribed anxiolytics, though physicians rarely framed it that way.

The real pharmacological turning point came with barbiturates. The synthesis of barbital in 1903 and phenobarbital in 1911 opened a new chapter in sedative medicine. Over the following decades, a growing family of barbiturate compounds became the standard treatment for anxiety, insomnia, and agitation. They worked, in the sense that they reliably sedated patients, but the margin between a therapeutic dose and a lethal one was dangerously narrow. Dependence developed quickly, and overdose deaths were common.⁹ Despite these problems, barbiturates dominated anxiety treatment for half a century, until safer alternatives arrived in the 1950s and 1960s.

The Tranquilizer Boom

The mid-twentieth century ushered in what has been called the psychopharmacological revolution, and anxiety was at the center of it. In 1955, Carter Products launched meprobamate under the brand name Miltown, marketing it as a “tranquilizer” rather than a sedative. The rebranding was important: a tranquilizer sounded modern and sophisticated, something a busy executive might take, not a knockout pill for asylum patients. Miltown became a cultural phenomenon, one of America’s first blockbuster psychiatric drugs, openly discussed by celebrities and consumed in staggering quantities.

But Miltown’s reign was brief. In 1955, the same year Miltown hit the market, the chemist Leo Sternbach at Hoffmann-La Roche stumbled onto a new class of compounds that would reshape anxiety treatment for decades. The first benzodiazepine, chlordiazepoxide, was marketed as Librium in 1960. Diazepam, sold as Valium, followed in 1963.¹⁰ Benzodiazepines were dramatically safer than barbiturates in overdose, faster-acting, and effective across a wide range of anxiety conditions. Valium in particular set the standard for anxiety pharmacotherapy in terms of how quickly it worked and how reliably it calmed patients.¹¹

Valium became the most prescribed drug in America by the early 1970s, a fact that says as much about the era’s relationship with anxiety as it does about the drug itself. Physicians handed out prescriptions freely, and patients took them for years on end. It took roughly fifteen years after their introduction for researchers to fully understand how benzodiazepines worked in the brain, and only gradually did the medical community acknowledge that these drugs, too, carried significant risks of dependence.¹⁰ The pattern is striking across the centuries: a new treatment arrives, is embraced enthusiastically, and only later reveals its downsides.

Surgical and Somatic Interventions

Not all historical anxiety treatments were gentle. The twentieth century saw several invasive somatic interventions used on patients whose anxiety and agitation did not respond to available treatments. Insulin coma therapy, in which patients were deliberately overdosed with insulin to induce a comatose state, was used from the 1930s through the 1950s. Cardiazol shock therapy, which triggered seizures chemically, was another approach. Electroconvulsive therapy (ECT) replaced chemical convulsive methods and, unlike the others, survives in modified form today, though it is primarily used for severe depression rather than anxiety.

The most notorious somatic intervention was lobotomy, or psychosurgery. Invented by the Portuguese neurologist Egas Moniz in 1935, the procedure involved severing connections in the brain’s frontal lobes. It was used on patients with a range of conditions, including severe anxiety and agitation. Lobotomy spread rapidly through many countries; in Denmark, evidence suggests more lobotomies per capita were performed than anywhere else.¹² The procedure often left patients docile but cognitively impaired, and it fell sharply out of favor as drug treatments improved in the 1950s and 1960s. Moniz received the Nobel Prize for his work in 1949, a decision that remains controversial.

How “Anxiety” Became a Formal Diagnosis

One of the less obvious aspects of this history is that “anxiety disorder” as a standalone diagnosis is remarkably recent. For most of the twentieth century, anxiety was folded into broader categories. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-I), published in 1952, treated anxiety as nearly synonymous with “psychoneurotic disorders,” a catch-all category heavily influenced by Freudian theory. Anxiety was described as a danger signal perceived by the conscious mind, and the various neurotic conditions were understood as different ways the psyche defended itself against that signal.¹³

The DSM-II, published in 1968, continued this framework under the heading “Neuroses.” It was not until 1980, with DSM-III, that the concept of anxiety disorders as distinct clinical entities took shape. The old category of “anxiety neurosis” was split into panic disorder and generalized anxiety disorder (GAD), a division driven partly by the observation that the antidepressant imipramine could block panic attacks but had no effect on other forms of anxious distress.¹⁴ In other words, a drug response helped define a diagnostic category, a pattern that has repeated throughout psychiatry’s history. Subsequent DSM editions further refined the anxiety disorders, eventually separating obsessive-compulsive disorder and post-traumatic stress disorder into their own groupings in DSM-5.¹³

This diagnostic evolution matters for the historical question because it means that before 1980, physicians were not really “treating anxiety disorders” in the modern sense. They were treating neurasthenia, nervous exhaustion, hysteria, neurosis, melancholia, or just “nerves.” The experience was continuous across the centuries, but the label kept changing, and with each new label came new assumptions about cause and cure.

Self-Medication Through the Ages

Alongside formal medical treatments, people have always self-medicated their anxiety, and alcohol has been the most consistent tool for doing so. Modern epidemiological data gives a sense of the scale: surveys of adults with anxiety disorders find that roughly one in five reports using alcohol to manage their symptoms, and when drugs are included alongside alcohol, the rate for some conditions climbs even higher.¹⁵ There is no reason to think this proportion was lower in earlier centuries, when formal treatments were scarcer and access to physicians was limited to the wealthy. Taverns, wine, and home-brewed spirits were far more available than any doctor’s prescription.

The nineteenth and early twentieth centuries added a layer of commercial self-medication. Patent medicines, sold without prescription and often containing opium, alcohol, cannabis, or bromides, were marketed directly to anxious consumers with extravagant promises. Laudanum, a tincture of opium in alcohol, was a widely available over-the-counter remedy for “nervous complaints” throughout the 1800s. It was cheap, effective in the short term, and profoundly addictive. The regulatory framework that eventually controlled these substances, including the Harrison Narcotics Tax Act of 1914 in the United States, was partly a response to the enormous public health damage caused by unregulated self-medication.

Anxiety as a Feature, Not a Bug

Running through this entire history is a tension that the evolutionary perspective helps illuminate. Anxiety is not simply a malfunction. Normal anxiety is an emotion that helps organisms defend against a wide range of threats, and the capacity for it appears to be an adaptation shaped by natural selection.¹⁶ From this viewpoint, anxiety disorders arise not because the system exists, but because it has become dysregulated, firing too often, too intensely, or in response to non-threats.¹⁷

Researchers have even raised the possibility of a “hypophobic” condition, the mirror image of an anxiety disorder, in which too little anxiety leaves a person dangerously unresponsive to real threats.¹⁶ Negative emotions like anxiety and low mood, as one researcher put it, are not disorders but evolved defenses, comparable to the capacity for physical pain.¹⁸ This framing would have been alien to Hippocrates or Burton or the Victorian neurologists, all of whom treated anxiety as something to be eliminated. It suggests that the goal of treatment should be recalibration rather than suppression, a principle that modern cognitive-behavioral approaches take seriously even if their historical predecessors did not.

What the Pattern Reveals

Looking across this sweep of history, one pattern stands out: each era’s treatment for anxiety was a direct product of its theory of what anxiety was. When the problem was bad humors, the solution was bloodletting and diet. When the problem was spiritual, the solution was prayer. When the problem was exhausted nerves, the solution was rest. When the problem was disordered brain chemistry, the solution was a pill. Each approach had genuine insights and genuine blind spots, and each was eventually supplanted not because it was entirely wrong but because the next framework fit the evidence a little better.

What also stands out is the recurrence of harm done in the name of help. The rest cure confined women to bed for months. Barbiturates killed tens of thousands through overdose and dependence. Lobotomy destroyed cognitive function in exchange for reduced agitation. Benzodiazepines were prescribed for decades before the medical profession fully acknowledged their addictive potential. The pattern is not one of steady progress from ignorance to enlightenment. It is one of partial solutions, each carrying costs that take years or decades to recognize, with the human experience of dread and worry persisting stubbornly underneath whatever treatment the era has to offer.