Sunday, August 10, 2014

Madness, Melancholy and Medicine, Pt 1

by Maria Grace

Symptoms, types and  causes of nervous conditions diagnosed in the Georgian Era

The fine sensibility prized by women in the 18th century gave rise to an epidemic of nervous disorders in the early 19th century. Maladies of affluence and sophistication, nervous disorders paraded one's wealth, refinement and sensibility. Women were particularly susceptible to nervous disorders because of their ‘more delicate physiological network’. In fact, 'Nerves' were a woman’s claim to superior social status, the mark of being a lady.

The wealthy and indolent were not the only suffers though. Given that during the early 19th century people lived in a world where a small ache or upset stomach could be the harbinger of something far worse, or even fatal, it is not really surprising that hysterical diseases, hypochondria and melancholy—what we would call depression—were prevalent, especially when legitimized as disorders by respected doctors.  

General Causes of Nervous Disorders

While doctors agreed that they existed, "there's no Disease puzzled Physicians more than the Vapours, and Hysterick Fits. These complaints are produced by so many Causes, and appear in so many various Shares, that 'tis no easy Matter to describe them.” (Tennet) ‘The Annual Review’ said that after doctors started taking nervous disorders seriously, everyone was taking medication for them, outdoing each other with exaggerated symptoms and buying an array of medical equipment to deal with them. How strangely 21st century it all sounds.

Many factors contributed to the occurrence of nervous disorders. So many that very little did not contribute to these problems. Anything which resulted in too much relaxation or indolence might result in problems, just as did too much application or thought. Too much tea, too much fasting, unwholesome food or awkward posture all might result in the vapours.

Women were particularly susceptible to these disorders due not only to “peculiar organization of their frame…but to their very mode of living.” (Perkins) In specific, he felt an excess of “the passions of the mind”, which women were apt to experience, made them more prone to nervous conditions. Love, especially disappointed love, and anger were considered dangerous. Grief had the potential to be fatal, and fear might produce violent fits and convulsions.

Environmental factors might also weaken or disable one’s constitution, leaving the individual prone to nervous disorders. Intemperate air, excessive luxury and effeminacy had the power to degrade the constitution. Eating the wrong things (rich and fancy foods), or at the wrong times (late in the evenings), sleeping too long in the morning and indulging in too much recreation all contributed to a dangerous indolence that threatened ones vigor.

Symptoms and Types of Nervous conditions

According to William Buchan in his book Domestic Medicine (1790), “Of all diseases incident to mankind, those of the nervous kind are the most complicated and difficult to cure. A volume would not be sufficient to point out their various appearances. They imitate almost every disease; and are seldom alike in two different persons, or even in the same person at different times. Proteus-like, they are continually changing shape; and upon every fresh attack, the patient thinks he feels symptoms which he never experienced before. Nor do they only affect the body; the mind likewise suffers, and is often thereby rendered extremely weak and peevish.”

Like practitioners today, he recognized a number of different nervous conditions discernibly different from one another and which occasioned different courses of treatment. “These however are not to be considered as different diseases, but as various modifications of the same disease.”(Buchan) These disorders included: melancholy, low spirits, hysterical afflictions, hypochondriac affections, and nightmares.


Melancholy was considered a state of insanity that rendered an individual incapable of enjoying the pleasures or performing normal duties of life and might terminate in absolute madness.

It might be the result of inherited disposition, but more commonly intense thinking and violent passions of the mind, including those mentioned above and overreaching pride. Intense anger or cold that forced blood away from the brain could push melancholy into madness. Equally dangerous to the constitution were gloom and mistaken religious notions.

Acute fevers, suppression of ‘customary evacuations’, hard digestion or dryness of the brain constituted physical factors that contributed to a case of melancholy.

Both physical and emotional/behavioral symptoms could be detected in such cases. Physically the body would become ‘bound’, with thin urine, paleness and slow, weak pulse. Behaviorally, the individual might be seen fretful, fickle, attending to trifles and fond of solitude. The patient might be prone to imaginations—we could call them hallucinations—of being dead, an animal, too brittle to move, and the like. In its most extreme forms, melancholy might lead to suicidal behavior.

Today, this disorder would likely be considered an extreme form of depression, possibly with psychotic overtones.



Physicians of the era believed that those with weak nerves were likely to experience some degree of low spirits, a disturbance much like melancholy, but less severe. Symptoms could include sleeplessness, headaches, indigestion and loss of appetite. These would be exacerbated by solitude and gloomy thoughts, while cheery company and amusements might ameliorate them.

In addition to weak nerves, low spirits might be brought on by continued mental distress or through more direct physical causes. A weak, relaxed state of the stomach or bowels, or an obstruction thereof might be the culprit. Similarly, “suppression of the menstrual or of the hemorrhoidal flux” (Buchan) could cause them.

Today, this disorder would likely be considered a mild mood disorder, possibly dysthymia.


Those of melancholy temperament were the most susceptible to hypochondriac attacks in which “the worst consequences imagined from any unusual feeling even of the slightest kind; and in respect to such apprehensions and feelings, there is always the most obstinate belief and persuasion.” (Perkins) Physical symptoms tended to cluster around digestive upsets, and vague physical discomforts.

The chief cause of the disorder was thought to lie in indolent, luxurious lifestyles or conversely overly unfortunate or studious ones. Congestion of one or more of the abdominal organs was thought to be the foremost cause of this problem.

This disorder sounds most like hypochondria, possibly with a mood disorder like depression or dysthymia as well. 


Women, who were considered particularly delicate, were thought to be most susceptible to hysterical complaints. These included fits of laughter or crying, fainting, convulsions, low spirits, anxiety, heart palpations, and cramps throughout the body.

These complaints were thought to be brought on by sudden irritations of the stomach or intestines or a sudden suppression of menses. Violent emotions like fear, grief, anger or intense disappointment might aggravate the condition.

Today this disorder might be considered a somatization disorder, or possibly an adjustment disorder depending on the specific symptoms involved.


Patients afflicted by nightmares experience, during sleep, a sensation of oppression or weight on their chest that they cannot shake off. They may cry out during sleep, often fancying themselves in some grave danger to life or limb which results in awakening.

Nightmares were thought to be the result of blood stagnating in the brain and lungs, arising more from indigestion than nervous affection, though those things which oppressed the mind, like deep thought or anxiety, could also contribute to the condition.

Today, this might be diagnosed as a nightmare disorder.

Avoiding Nervous Disorders 

Doctors offered specific advice on how these disorders might be avoided. “Excessive grief, intense study, improper diet, and neglect of exercise, are the great sources of this extensive class of diseases…Grief indulged destroys the appetite and digestion, depresses the spirits, and induces a universal relaxation and debility of the whole system… (While) misfortunes indeed are not to be avoided, but surely their effects, by a vigorous and proper exertion of the mind, might be rendered less hurtful…

Domenico Feti - Melancholy (Version 2) "The effects of intense study are pretty similar to those occasioned by grief. It preys upon the animal spirits, and destroys the appetite and digestion. To prevent these effects, studious persons ought… never study too long at a time; nor attend long to one particular subject, especially if it be of a serious nature. They ought likewise to be attentive to their posture, and should take care frequently to unbend their minds by music, diversions, or going into agreeable company.” (Buchan)

Attention should be paid with regard to proper diet, which avoided extremes of all forms. Regular exercise and fresh air should be a part of one’s routine. “But the most general cause of nervous disorders is indolence. The active and laborious are seldom troubled with them. They are reserved for the children of ease and affluence, who generally feel their keenest force. All we shall say to such persons is that the means of prevention and cure are both in their own power. If the constitution of human nature be such, that man must either labor or suffer diseases; surely no individual has any right to expect an exemption from the general rule.” (Buchan)

In part 2 of this article, we will explore the treatments recommended for these disorders.


Buchan, William. Domestic Medicine: Or, A Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, 11th ed., (1790)
Parissien, Steven. Regency Style. Phaidon Press Limited (2000)
Perkins, John. Every Woman Her Own House-keeper; Or, the Ladies’ Library. James Ridgeway: London (1790)
Sales, Roger. Jane Austen and Representations of Regency England. Routledge (1994)
Shoemaker, Robert B. Gender in English Society 1650-1850 Pearson Education Limited (1998)
Tennet, John . Every Man his own Doctor: or, The Poor Planter's Physician, Williamsburg, VA, (1736).
The Home Book of Health and Medicine. Philadelphia: Key and Biddle. (1834)
Wilson, Ben. The Making of Victorian Values, Decency & Dissent in Britain: 1789-1837 The Penguin Press (2007)
Wiltshire, John - Contrib. to Jane Austen in Context. Cambridge University Press (2005)


 Maria Grace is the author of Darcy's Decision,  The Future Mrs. Darcy, All the Appearance of Goodness, and Twelfth Night at Longbourn and Remember the PastClick here to find her books on Amazon. For more on her writing and other Random Bits of Fascination, visit her website. You can also like her on Facebook, follow on Twitter or email her.

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