Worn Out

"Owing to the excessive increase in traffic and the wire-networks of our telegraphs and telephones, which now span the entire globe, our trading patterns and circumstances of life have been transformed completely: All affairs are conducted in haste and excitement... [overheating] people's heads and [forcing] their spirits to undertake ever new exertions while robbing them of the time for rest, sleep, and stillness."

As German neurologist Wilhelm Erb breathlessly argued, 1884 was an exhausting time, part of perhaps the fastest-paced, most taxing era in history. Was he right? And is today's environment, with its own wire-networks and haste, even more demanding?

These are among the questions examined in two new books on our eternal struggle to keep up. In Exhaustion: A History, Anna Katharina Schaffner, a reader in comparative literature at the University of Kent, places Erb on a timeline of thinkers dating back to antiquity who became convinced that their era was the highest pressured. British political commentator Robert Colvile would see Erb as prescient: In The Great Acceleration: How the World Is Getting Faster, Faster, he outlines how those trends have reached their apotheosis today.

Schaffner's book, the more thoughtful and wide-ranging of the pair, is a study of the exhaustive historic literature on the causes of fatigue, including an imbalance of the four humors, the influence of the planets (specifically, Saturn), spiritual failing, and a reaction to loss. She draws on sources ranging from Jason and the Argonauts to the treatises of the great medieval physician Ibn Sina, who notably railed against masturbation because it drained an individual of precious energy. His formulation that the loss of one part of semen was equivalent to the loss of 40 parts of blood remained in the medical literature until well into the 1800s. And the belief that excessive or "deviant" sexual activity, like masturbation, homosexuality, and oral and anal sex, led directly to exhaustion provided powerful justification for legal and doctrinal rules against these practices.

Schaffner highlights not just what we've known about exhaustion at various points in history but why we've feared it, epitomized in her discussion of Bram Stoker's symbolism-laden Dracula of 1897 and other Victorian vampire narratives. The villainous protagonists of these stories, she reminds us, were aligned with necrophilia, homosexuality, polygamy, fetishism, gynophobia, and oral sex, but their aristocratic mien and ability to suck the precious life energy from their victims led many observers, including Marx, to link them to capitalist exploiters.

Exhaustion astutely focuses on one particular wrinkle of energy depletion that modern readers will immediately recognize—the pride certain people have long taken in their alleged burnout symptoms. We all know people who insist on telling us every time we meet how worn out they are, how much they have to do—and, implicitly, how important and in demand they are. As it happens, contemporary humblebraggers have nothing on 19th-century sufferers of "neurasthenia."

Schaffner places this "baggy and infinitely expandable diagnostic concept" in the context of centuries of thought on the role of nerves as conduits for life energy, dating back at least as far as the Roman Empire. Neurasthenia encompassed a range of symptoms, with "nervous exhaustion" at its core, but also included irritability, restlessness, digestive upset, dry hair, and cold feet. First identified in 1869, it was widely promoted by American physician George Beard a decade later. His formulation of the condition, which would remain prevalent for a half-century—the diagnosis was largely abandoned after World War I but remained in the Diagnostic and Statistical Manual of Mental Disorders until 1980—was strikingly elitist. He noted that patients were almost exclusively of the "brain work" classes, those with "superior intellect, and with a strong and active emotional nature." In other words, "the civilized, refined, and educated, rather than ... the barbarous and low-born."

As one might imagine, a diagnosis of neurasthenia quickly became a badge of honor, one mocked by Oscar Wilde, himself a patient, who wrote in 1900: "I am now neurasthenic. My doctor says I have all the symptoms. It is comforting to have them all; it makes one a perfect type." Kafka, Proust, Henry James, and Virginia Woolf all shared the diagnosis.

Woolf was one of many female neurasthenics treated with American physician Silas Mitchell's notorious "rest cure," which entailed being confined to bed for six to eight weeks and consuming at least four pints of milk a day, along with mutton chops and beef tea. ("To gain in fat is nearly always to gain in blood," Mitchell claimed.) In a 1910 letter to her sister during her treatment, Woolf wrote, "I shall soon have to jump out of a window." She endured the "cure," but later wrote bitterly of the doctors who prescribed it and instead praised the "sick" and their unique sensibilities and imaginations, which for her were far preferable to the outlook of the "army of the upright."

The rest cure was most famously tarred in Charlotte Perkins Gilman's 1892 short story, "The Yellow Wallpaper." Gilman herself had been treated by Mitchell, but when she returned home after nine weeks in his clinic with orders to continue following the cure and to "never touch pen, brush, or pencil as long as you live," her condition worsened until, Schaffner relates, she "finally abandoned his advice, divorced her husband, dedicated herself fully to her intellectual projects, and swiftly recovered."

Neurasthenia fell out of diagnostic favor as doctors began to focus more on its component symptoms than on its umbrella label and treatments. This shift coincided with the ascent of Freud and his dismissal of the physical and cultural causes previously tied to exhaustion. Instead, Schaffner writes, he insisted that neurasthenia, "like all neuroses, could be explained with recourse to one phenomenon only: sexuality." By the 1930s, depression had become the primary diagnosis for exhausted patients.

Besides resting on a foundation of elitist and sexist presumptions, the neurasthenia fervor, in blaming modern technology for exhaustion, ignored another important disconnect between ancient and modern times—a radically altered approach to sleep. Before the Industrial Revolution and the advent of artificial lighting, most people had two or more periods of sleep during the night, punctuated by a period of productive wakefulness. We've left these habits so far behind today that we fail to consider that those who can't "sleep through the night" may just be more in sync with a primitive body clock. Instead, we diagnose and treat them for sleep disturbance.

In The Great Acceleration, Colvile draws on stacks of similar research to detail just how fast the world has become. He notes, for example, that while our bodies are designed for brief periods of stress and sudden bursts of activity, the modern workplace, with its demands for nonstop attention and decisions, pushes our fight-or-flight response to the limit, leading to burnout. When researchers asked a group of medical residents to wear brain monitors during their shifts, they found this sleep-deprived group to experience near-constant "microsleep events," in which groups of neurons simply shut down. The young doctors routinely experienced full or partial sleep in the middle of operations and when talking to patients.

Channeling Beard, Colvile points out that many in the white-collar class are at risk for burnout because of cognitive load, but he is quick to add that the poor face even greater challenges—as the relentless pressures of poverty reduce mental bandwidth and sap executive attention and cognitive control, people become less able to muster the focus to begin to map a way out.

Despite the stress that pace and technology put on health, Colvile is fairly confident that we can handle it. "We are not mere passive victims of some vast, impersonal force," he writes. "We have, collectively, chosen to bring the great acceleration on ourselves. We are, as humans, hard-wired to crave novelty, speed, and convenience." We know that the use of multiple screens, for example, negatively affects sleep, but Colvile anticipates a solution: Phones lit at different frequencies that will be less likely to keep us up, and apps that can induce slow-wave sleep when we need it will, he imagines, help us avoid insomnia.

Schaffner is not entirely resistant to this hope. "There is something soothing," she writes, "about the knowledge that ours is not the only age to have wrestled with the demon of exhaustion." She quotes literary critic Frank Kermode, who wrote, "[I]t seems doubtful that our crisis... is one of the important differences between us and our predecessors. Many of them felt as we do. If the evidence looks good to us, so it did to them."

This consistency is most clear in Schaffner's discussion of burnout—the modern descendant of neurasthenia. Diagnoses of burnout may not blame an imbalance of the four humors, but they do cite the theory of "conservation of resources," which postulates that exhaustion is primarily a result of "resource loss, gain, and protection" caused by an imbalance of vital energy in the body—as stress raises cortisol levels, it depletes the circulating steroids in the blood needed to maintain energy levels. Another conception of burnout portrays the forces that cause it, such as work demands, Internet alerts, and needy friends and family, as, yes, "energy vampires." And other popularizers of the condition stick to Beard's playbook by reassuring sufferers that they tend to be "conscientious, hard-working, and highly motivated with drive and commitment," as well as having high levels of compassion and high ideals.

Schaffner opens her book with Pope Benedict XVI's decision to step away from the papacy in 2013, a virtually unprecedented act in the modern church, which he pegged in part to physical and spiritual exhaustion—"the weakness of my entire person." The author finds something "decidedly unsettling" in the fact that a figure who is "traditionally a beacon of ... indefatigable service unto death should have decided to hang up his papal mantle and to play the piano instead."

It's not as easy for the rest of us to throw off our mantles, and probably never will be. Exhaustion is likely to remain endemic to humanity, no matter how advanced our technology, because of our instinctive resistance to slowing down, stepping back, and giving ourselves a break.

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