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Medicine, Modernity, and Masculinity: a History of Neurasthenia in Spain, C.1890-1920 Violeta Ruiz Cuenca

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Medicine, Modernity, and Masculinity: a History of Neurasthenia in Spain, C.1890-1920 Violeta Ruiz Cuenca ADVERTIMENT. Lʼaccés als continguts dʼaquesta tesi queda condicionat a lʼacceptació de les condicions dʼús establertes per la següent llicència Creative Commons: http://cat.creativecommons.org/?page_id=184 ADVERTENCIA. El acceso a los contenidos de esta tesis queda condicionado a la aceptación de las condiciones de uso establecidas por la siguiente licencia Creative Commons: http://es.creativecommons.org/blog/licencias/ WARNING. The access to the contents of this doctoral thesis it is limited to the acceptance of the use conditions set by the following Creative Commons license: https://creativecommons.org/licenses/?lang=en Medicine, modernity, and masculinity: A history of neurasthenia in Spain, c.1890-1920 Violeta Ruiz Cuenca Supervisor: Annette Mülberger Programa de doctorado de historia de la ciencia Institut d’Història de la Ciència, Universitat Autònoma de Barcelona November 2020 A mis padres, Manuel y Ana; y a mi hermano, Pablo. 1 Contents Abstract (English) 4 Abstract (Castellano) 6 Acknowledgements 8 List of figures 10 Introduction 11 Neurasthenia in historical perspective 13 Progress, pathology, and modern selfhood 22 From women’s subjugation to a crisis of masculinity 25 Scope and sources 30 Chapter outline 34 Chapter one. The medical construction of neurasthenia 38 The emergence of neurasthenia in Spain, 1890s-1900s 40 From neuroses to psychoneuroses 47 A plurality of treatments 59 Invigorating the body and nourishing the blood 59 Asylums, sanatoria, and spas 62 Psychotherapy 70 Conclusions 72 Chapter two. The crisis of civilisation and Spanish manhood 74 Neurasthenia and the burden of responsibility 78 A respectable diagnosis? The thin line between virtue and vice 85 Aboulia and psychic passivity 91 Conclusions 96 2 Chapter three. Tonics, belts, and books: The market for neurasthenia 99 Advertising virility 104 Educating the will 118 Joan Bardina, Energy in ten lessons, and the modern subject 126 Conclusions 135 Chapter four. Honour, neurasthenia, and composure in Justo María Zavala’s memoirs (1899) 138 Honour in the identity of medical directors of baths 141 Justo María Zavala (1815-1900), a man of honour 148 Neurasthenia and composure in Zavala’s memoirs 153 Conclusions 161 Conclusions 163 Bibliography 172 3 Abstract In the late nineteenth century, a new disease category emerged and proliferated around the USA, Europe, and Asia. “Neurasthenia”, or nervous exhaustion, referred to a condition that affected both the body and the mind, and was the product of modern civilisation. Historians have pointed out the usefulness of neurasthenia as a lens through which to understand developments in medical and psychiatric ideas as well as the construction of national identities. This thesis analyses how neurasthenia was conceptualised in Spain in relation to these issues between the 1890s and early 1920s. It takes a cultural history of medicine approach to analyse the way in which neurasthenia was constructed according to contemporary Spanish ideas about medicine, modernity, and masculinity. The thesis offers two levels of analysis. The first deals with traditional questions in the history of medicine; namely, the appropriation of the concept, its clinical definition and pathological conceptualisation, and the different treatments that were presented for it. Spanish physicians critically appropriated the disease from the French context and debated different ways in which to understand the condition. They defined neurasthenia as a condition that primarily affected bourgeois men. The plurality of treatments they offered also contributed to defining it as a condition rather than a local or specific disease. However, although physicians played an important part in defining the disease, neurasthenia was also conceptualised in other spaces: namely, the market for medicines and devices; manuals for training the will; spas and sanatoria; and by patients themselves. These other sites broadened the boundaries of the disease, so that it ended up losing its specificity and becoming more generally construed as “weakness” in a broad sense of the word. A second level of analysis deals with the cultural meanings ascribed to the disease and how these shaped ideas of modernity and masculinity. The thesis shows that neurasthenia was tightly linked to the discourse of regenerationism, a discourse of crisis and change that characterised the Spanish fin de siècle and that was articulated in terms of a problem of vilirity and a crisis of masculinity. Spanish elites questioned Spain’s status on the hierarchy of civilisation and claimed that the regeneration of the country depended on the moral regeneration of its men. 4 This thesis shows that neurasthenia was framed by this discourse. Physicians claimed that the disease was the consequence of the modern “struggle for survival”, characterised by competition between individuals and among nations in the quest for civilisation. It was primarily a disease of the bourgeoisie, who were responsible for guaranteeing the future of the nation through their intellectual labour. Physicians used the disease to define the boundaries of what constituted proper and improper forms of bourgeois masculinity: the selfless pursuit of progress and the common good, on the one hand; and egotism and passivity on the other. As such, physicians articulated an ambiguous narrative about neurasthenia that could be either validating or destructive to the patient’s masculinity. At the same time, neurasthenia served to articulate an ideal modern subject, one who was an active participant in the struggle for survival. Overall, the thesis argues that neurasthenia served to present individual and international competition as a natural condition of modernity, and to establish the normative boundaries of what constituted proper masculine bourgeois behaviour between 1890 and the early 1920s. In doing so, it demonstrates the value that diseases have as historical objects through which to explore the history of medicine, national identity, and gender in the past. It concludes that the historians should return to the history of diseases to explore how the self has been constructed in the past. 5 Abstract A finales del siglo XIX, surgió una nueva categoría de enfermedad que proliferó en Estados Unidos, Europa y Asia: la neurastenia. Esta se concibió como una condición que afectaba tanto al cuerpo como a la mente, y era producto de la civilización moderna. Los historiadores han señalado el valor que tiene esta enfermedad como objeto a través del cual comprender los desarrollos de las ideas médicas y psiquiátricas, así como la construcción de identidades nacionales. Esta tesis analiza cómo se conceptualizó la neurastenia en España en relación a estas cuestiones entre la década de 1890 y principios de la de 1920. Aplicando un enfoque de historia cultural, analiza la forma en que se construyó de acuerdo con las ideas españolas contemporáneas sobre la medicina, la modernidad y la masculinidad. La tesis ofrece dos niveles de análisis. El primero trata cuestiones tradicionales de la historia de la medicina; a saber, la apropiación del concepto, su definición clínica y conceptualización patológica, y los diferentes tratamientos que se le prescribieron. Los médicos españoles se apropiaron del concepto de la enfermedad procedente del contexto francés, y debatieron diferentes formas de entenderla. La pluralidad de los tratamientos que ofrecieron contribuyó a definirla como una condición general del sujeto, más que como una enfermedad local o específica. Sin embargo, la tesis muestra que la neurastenia también se conceptualizó desde otros espacios y por otros sujetos: el mercado de medicamentos y dispositivos; los balnearios y sanatorios; por los autores de los manuales para la formación de la voluntad; y por los propios pacientes. Estos actores ampliaron los límites de la enfermedad, de modo que terminó perdiendo su especificidad y se interpretó de manera más general como “debilidad” en el sentido amplio de la palabra. Un segundo nivel de análisis se ocupa de los significados culturales atribuidos a la enfermedad y cómo estos dieron forma a las ideas de modernidad y masculinidad durante el periodo que se analiza. La tesis muestra que la neurastenia estuvo estrechamente ligada al discurso del regeneracionismo que caracterizó al fin de siglo español y que se articuló en términos de una crisis de masculinidad. Las élites españolas cuestionaron el estatus de España en la jerarquía de la civilización y afirmaron que la regeneración del país dependía de la regeneración moral de sus hombres. Los médicos españoles afirmaron que la neurastenia era consecuencia de la moderna "lucha por la existencia", caracterizada por la competición entre individuos y 6 entre naciones en la búsqueda de la civilización. Fue principalmente una enfermedad de la burguesía, aquella clase social encargada de garantizar el futuro de la nación a través de su labor intelectual. Los médicos utilizaron la enfermedad para definir los límites de lo que constituía formas adecuadas e inadecuadas de masculinidad burguesa: la búsqueda desinteresada del progreso y el bien común, por un lado; y el egoísmo y la pasividad por el otro. Como tal, los médicos articularon una narrativa ambigua sobre la neurastenia que podría validar o destruir la masculinidad del paciente. Al mismo tiempo, la neurastenia sirvió para articular un sujeto moderno ideal, definido como un participante activo en la lucha por la existencia. En general, la tesis sostiene que la neurastenia sirvió para presentar la competición
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