The approach to mental distress in the 19th century was fundamentally different from modern understandings of anxiety. Before the advent of neuroscience and psychology as distinct fields, emotional and mental suffering was primarily interpreted through a physical or moral lens. The medical establishment lacked the diagnostic framework we use today, viewing symptoms of worry, fatigue, and unease as manifestations of nervous system failure. Consequently, treatments were often primitive, sometimes harsh, and based on theories linking the mind’s health directly to the body’s physical state.
Defining Nervous Conditions in the 1800s
Physicians in the 1800s categorized symptoms we now associate with generalized anxiety disorder, panic attacks, and depression under broad labels like “nervous temperament” or “nervous collapse.” The dominant diagnostic term was neurasthenia, or “nervous exhaustion,” coined in 1869 by American neurologist George Miller Beard. This condition was believed to be caused by the depletion of the body’s limited “nervous force,” resulting from the increased intellectual demands and rapid pace of modern industrialized life. Neurasthenia became known colloquially as “Americanitis,” suggesting a uniquely modern, high-stress origin for the ailment.
The symptoms attributed to neurasthenia were vast, including chronic fatigue, irritability, insomnia, headaches, and general malaise. A related, and older, diagnosis was Hysteria, which was almost exclusively assigned to women and linked to the reproductive system. Physicians viewed women as inherently more susceptible to nervous conditions due to their perceived delicacy and emotional sensitivity. Hysteria presented with a wide array of physical symptoms, such as muscular spasms, fainting, and paralysis, which often lacked any discernible organic cause. These diagnoses framed mental anguish not as a psychological issue, but as a physiological failure requiring material repair.
Physical and Environmental Cures
The prevailing belief that nervous conditions stemmed from physical depletion led to body-focused treatments that often involved strict environmental control. The most famous and widely applied of these therapies was the Rest Cure, popularized by physician S. Weir Mitchell, primarily for neurasthenic and hysterical women. This method mandated complete, forced bed rest for four to eight weeks, isolating the patient from family, friends, and all intellectual activity, including reading and writing. The goal was to remove all sources of nervous strain to allow the body to replenish its vital energy.
The Rest Cure combined this isolation and inactivity with systematic, forced overfeeding, often starting with a diet consisting almost exclusively of milk and gradually introducing large quantities of rich food. Passive exercise was enforced through daily sessions of massage and the application of early electrotherapy, using induction batteries to stimulate muscles and prevent atrophy. The entire regimen was intended to reduce the patient to a state of “childlike acquiescence” and submission to the doctor’s authority. This approach was frequently criticized for its punitive nature, especially by patients like writer Charlotte Perkins Gilman, who detailed her traumatic experience.
Other physical treatments were also common, with hydrotherapy being a popular choice for its perceived calming effects on the nerves. This involved the systematic application of water at different temperatures and pressures, ranging from cold douches to hot baths and wet sheet wraps. Sanatoriums and specialized institutions became popular as environmental cures, providing a structured, controlled atmosphere away from the perceived stresses of home life. Patients were often sent away for extended stays, where routine, physical exercise, and a change of scenery were considered therapeutic elements.
Pharmaceutical Reliance and Sedatives
The desire for immediate relief from nervous symptoms fueled a massive pharmaceutical market built on sedating the agitated nervous system. The most common chemical agent used by physicians for its calming properties was potassium bromide. Bromides acted as a depressant on the central nervous system and were routinely prescribed for symptoms like insomnia, irritability, and general nervousness. This compound was so widely used that it was a standard component in countless patent medicines marketed directly to the public as “nerve tonics” or “sedatives.”
Opiates, particularly laudanum—a mixture of opium and alcohol—and its derivative morphine, were also heavily relied upon to manage mental distress and pain. These powerful narcotics were easily obtainable and affordable, often prescribed by doctors for a wide range of female complaints, including hysteria and menstrual pain. The introduction of the hypodermic syringe in the 1850s made it easier to administer morphine, leading to a rapid increase in use. By the late 19th century, this widespread and unregulated use of opiates and bromides resulted in a significant addiction epidemic, with women constituting the majority of those who became dependent.
Other potent substances were also incorporated into medicinal products intended to soothe the nerves, including chloral hydrate and sometimes elixirs containing cocaine or cannabis. The lack of understanding regarding addiction and the absence of regulatory oversight meant that these substances were frequently prescribed and consumed over long periods. This chemical reliance offered temporary symptomatic relief but fostered dangerous dependencies and masked underlying causes.
The Rise of Psychological Approaches
Toward the close of the 19th century, a subtle but significant shift began to occur, moving treatment away from solely physical and chemical remedies to include the mind itself. This transition was initially rooted in the “Moral Treatment” movement, which emphasized humane care, beneficial routines, and a supportive environment in asylums and sanatoriums. The focus was on engaging the patient’s intellect and emotions through occupation and kindness, rather than just restraining or medicating the body.
Early psychological theories began to emerge, challenging the purely physical explanations for nervous ailments. Hypnosis, which evolved from the earlier practice of mesmerism, gained traction as a tool to address hysterical and nervous symptoms. Figures like French neurologist Jean-Martin Charcot used hypnosis to demonstrate the psychological nature of these physical manifestations. This work paved the way for the development of new therapeutic models.
The most profound shift came with the pioneering work of physicians like Sigmund Freud, who studied Charcot’s methods and developed the cathartic method with Josef Breuer. This was the nascent form of talk therapy, or psychoanalysis, which proposed that nervous symptoms were rooted in unconscious emotional conflicts rather than nervous exhaustion. While psychoanalysis was still in its earliest stages by the end of the 1800s, this focus on the patient’s personal history, thoughts, and emotional life marked the beginning of the modern psychogenic understanding of anxiety.