In the late 19th and early 20th century the term neurasthenia was coined to describe nervous, emotionally disturbed men and women.  George Beard was the first to include the disease in medical literature, but the term neurasthenia existed in medical dictionaries long before Beard used it in 1869 (Abbey, Garfinkel, 1644).  Other symptoms that went along with the disease were tenderness of the scalp, emotional franticness, and Myelasthenia (which includes back pain and spasms, sexual difficulties, and sensitivity to cold and changes in the weather).  The rather broad disease was typically found in women, who were believed to be emotionally worn out from their evolving social role of at the time.  Men also suffered from the disease, but it was less common, and could be attributed to overworking.  It was also believed that men with neurasthenia could be superior to other men in society with the right treatment (Abbey, Garfinkel, 1644).  The most well-known remedy for neurasthenia, named “the rest cure,” was created by Weir Mitchell in 1872.  The extremely controversial treatment was highlighted by using overfeeding, isolation, massage, and electrical impulse to treat nervous women.  I believe the treatment was developed to continue to hold back women from being equal citizens and human beings in the world, and teach them they were inferior to men in all ways except for managing a house.  Charlotte Perkins Gilman’s The Yellow Wallpaper and the four scholarly journals (The Weir Mitchell rest cure: doctor and patients, The rest cure: Repetition or Resolution of Victorian Women's Conflicts?,The Weir Mitchell rest cure Forty Years Ago and Today, Neurasthenia and chronic fatigue syndrome.)  all give insight into the social construction of women in society and psychiatric care at the time, and show the absurdity of the treatment developed by Weir Mitchell.

In more detail, Mitchell developed the rest cure originally to treat PTSD in men returning from war, but later found it most effective in treating women with neurasthenia (Bassuk, 247) .  The treatment was used for about 50 years after it was first introduced and was used almost exclusively on women (Bassuk, 247).  Men with neurasthenia were traditionally treated with the West cure. The West cure - a completely separate therapy from the rest cure - treated Men by reaffirming their manhood with stereotypical “manly” activities such as cattle ranching (Stilles, 32).  The rest cure in its most basic form had three parts.  The first was rest, which was considered the most essential part of the treatment.  Patients were to rest all day for up to two months or even longer if they required (Poirier,v20).  Women under Mitchell’s treatment were to do nothing and nurses performed tasks that would only make sense if they were treating someone who was paralyzed such as vaginal douches and sponge cleaning of other body parts.  The patients were not even allowed to stand up when the sheets were changed.  Women also weren’t allowed to write, as it caused the mind to work too hard.  As Bassuk describes women weren’t allowed to do anything for themselves in an effort to make sure their rest was preserved.  Their lives for months were being put in the hands of men who said they weren’t to move.  Mitchell and his followers such as T.H. Weisenburg make claims that the rest is essential to almost all medical treatment, but the rest applied by Mitchell was more than that.  Mitchell was belittling women by telling them their minds and bodies couldn’t handle making their own beds and washing their own hands.  Women like the narrator of Charlotte Perkins Gilman’s The Yellow Wallpaper were driven mad from the constant rest. The narrator was treated with the rest cure and was confined to her bedroom for months like Mitchell's treatment called for.  Gilman, a former patient of Weir Mitchell, is saying that women as much as men can be driven insane if their primary action of the day is to stare at the wall or sleep.  Suzanne Poirier describes Gilman’s personal treatment saying once she returned home, dressing her baby was too emotionally stressful for her and it eventually led to the divorce of her husband (Poirier, 26).  How was it that Mitchell thought rest for days upon months would prepare women to return to their lives of running families?

The next stage in the treatment was overfeeding.  The goal of overfeeding was to provide women with all the necessary nutrients for their body to gain healthiness.  Despite neurasthenia being a mental disease, Mitchell placed an extreme focus on the diet.  Milk was prescribed heavily at first to gain weight as fast as possible.  It is also interesting to note, Mitchell admitted he didn’t understand the relationship between adipose tissue (fat) and general state of health (Bassuk, 248).  In taking a look at the overfeeding the social violations are clear.  Mitchell claims the weight was helping women mentally by fixing some of their physical issues.  Weisenburg notes that Mitchell's treatment aimed to solve women’s physical problems, since he believed the mental problems would gradually go away as the body is restored (Weisenburg, 388).  By doing this, Mitchell is failing to recognize that women could have mental problems which stems from thinking women aren’t smart enough to have psychological problems.  He thought that once they get some more fat on their bones, all their issues will go away.  Another major aspect of overfeeding was making women more dependent on their nurses and doctors.  With over rest, overfeeding, and complete lack of exercise, these women were capable of adding lots of fat, making it harder to try and get out of bed and do activities that Mitchell warned against. 

Another aspect of the rest cure was isolation.  Isolation was used to remove women from the environment that caused them to reach this state of mental weakness.  Children, husbands, parents, and friends were all typically removed from the patient’s life for months at a time to help them recover.  Often the patient would see only the nurse and doctor over the duration of their treatment (Bassuk, 252).  Also, patients weren’t allowed to write, and were encouraged not to think.  Both were believed to be too much for women's minds to handle.  Mitchell tried so hard to remove women from their everyday environments, that he placed them in an unrealistic setting.  I think the primary use of this was taking away women's support systems and people around them that might encourage growth, instead of reduction into what Mitchell wanted women to be.  And teaching them that their meals, their medicine, their using of the bathroom would come at the hands of men.  Part of the moral reeducation described by Bassuk was coming in ways that Suzanne Poirier also describes.  Once women were done with treatment they could return home and have their husbands, fathers, and other important men in their life to continue to direct their lives.  The other aspect of the isolation was the isolation of thinking.  Mitchell tried to force his patients not to read, not to write, and not to think to themselves.  All of these could prevent the treatment from being effective.  This to me is the most blatant suppression of women of all of the aspects of the treatment.  The main reason Mitchell did this is he didn’t want women to think about what was happening within the treatment.  As Poirier describes, three patients that the rest cure fail on were Charlotte Perkins Gilman, Virginia Woolf, and Jane Addams, all of which are writers.  As writers and feminists they were able to recognize how Mitchell's treatment was suppressing women as human beings.  And this is why Mitchell wanted to control women’s thinking.  The narrator in The Yellow Wallpaper is faced with this same problem saying she is encouraged not to think about her situation because it will only make things worse.  Instead she goes on describing the wallpaper, and this is exactly the aim of the lack of thinking (Gilman, 300). 

The final aspect was the rest cure was massage and use of electrical impulse.  Massage was extremely important as patients needed to prevent muscle atrophy, without truly exercising (Bassuk,247).  Normal exercising opposes both rest and the goal of overfeeding and thus went against the core theory of the rest cure.  Massage stimulates the muscles, but not nearly to the extent of typically exercise.  It was used to prevent the body from deteriorating when spending so much time laying down not using muscle, and consuming mostly fat.  Electrotherapy and hydrotherapy were also used for similar effects.  The final aspect of the treatment also tells us more of the underlying problems with the treatment.  The massage and electricity are used to replace the need for exercise and keep women healthy as they stay in bed.  There is no doubt that massage does have useful medical applications, as Weisenburg points out it can improve red cell blood count, and a study showed patients had higher carbon dioxide levels, higher oxygen levels and higher oxygen capacity (Weisenburg,387).  My problem is the role of massage to completely replace all exercise.  Once again this is to promote weight gain and get women fat as was talked about before.  Also included in the pseudo-exercise was the electrotherapy.  I believe this was used for intimidation.  The other aspects of Mitchell's treatment revolved around typical treatment, however, Mitchell was generally just taking these treatments to extreme extents.  Patients generally knew eating and sleep could be extremely important, but almost none of the patients would know the effects of electrotherapy.  So including this would add an aspect that the patient would know nothing about and distract patients from the fact that all it was doing was helping prevent muscle atrophy.

In order to insure women would stay healthy after leaving Mitchell's care he prepared guidelines.  Two major components were setting a very detailed schedule for every day, and also fighting every urge to revert back to the way you were.  It was believed that in order for the rest cure to work it was important that patients modeled their post-treatment around the underlying themes of not overworking or over thinking (Bassuk,249).  This included scheduling the whole day - including free time.  Patients were to set specific time to wake up and were warned not going out without a concise list of how the day is planned.  By advocating for this, Mitchell could simulate care once it the treatment period was over.  And through every moment of these women’s lives they would be reminded of the rest cure and its ideologies.  This also provided insurance for Mitchell that women would remain satisfied with their treatment.  If they got the feeling of nervousness, or if any of the other symptoms recurred it was due to them breaking rules of the treatment.  They were told that they could become healthy once again by fighting these urges and returning for life the way Mitchell scripted.

Reviewing Mitchell's success can be tricky.  Journals such as Bassuk's don’t ever seem to include numbers, but generally like to look at personal testimonies.  There are multiple reasons for this: one being the sheer number of doctors practicing the treatment and patients being treated, and two, the difficulty the defining success within treatment.  To look at the first point Mitchell had published this cure and it was being practiced by many other physicians than himself.  So calculating what percent of all the women treated were successes would be tough, not to mention that not all the women were receiving the same treatment.  The second aspect, definition of success, is critical when looking at Mitchell's results.  A woman who returns home after four to six months of treatment, lives a life that is completely regimented by some man in her life, takes care of babies, and doesn’t dream of any other role in society would be labeled a success by Mitchell.  What Mitchell and other male doctors at the time were considering success at the time was essentially turning women into what they wanted them to be.  They were removing women’s desire to grow larger than their previous roles and while they may have seemed happier, they essential oppressed any feelings of growth and progression.  They attributed the emergence of these feelings to be simply put by Poirier, as women being emotional creatures (Poirier,16).  When looking at failures it is interesting to see why these cases are determined to have failed.  Women who recognize any weakness in the treatment would probably be labeled as failures by Mitchell.  Women who would not stand for the isolation from their loved ones, the gallons upon gallons of milk consumed, the adamancy not to leave the bed to so much as use the bathroom, would all be considered failures.  Charlotte Perkins Gilman, Virginia Woolf, and Jane Addams, all highly educated women who were able to reflect on the suppressive nature of their treatment and became worse under Mitchell's treatment, would also be failures despite levels of success they reached in their careers after the treatment. However, Mitchell wouldn’t be able to take responsibility for these failures because as Suzanne Poirier notes.  Mitchell warned about pursuing activities outside their physician's prescription, such as thinking, and even more critically, writing.  In reality, as pointed out by Poirier, these women seem to be the actual success stories of the treatment as they were able to prove women are able to live outside of the constrictions that Mitchell tried to apply.

One thing in common with all journals however is they recognize some aspect of Mitchell's success - whatever it may be. Weisenburg praises Mitchell for being a pioneer in psychology and argues had it not been for his death, the rest cure would still be practiced.  To people who agree with this, I would have to say this definition of success doesn’t include social demoralization women were facing, whether they recognized it at the time or not.

In review, Mitchell's rest cure was as much a treatment for stopping the progressive or evolution of women's independence as it was for neurasthenia. The treatment violated the rights of patients and because of the views of women at the time the rest of the medical community saw no problem with the methods.  In fact, he was praised and his methods spread to practices all over.  Had it not been for women like Charlotte Perkins Gilman, Virginia Woolf, and Jane Addams, Mitchell's general ideologies and treatments could have spread more and had an even greater effect on women’s psychiatric care to this day.
