This book presents us with a study of the changing concepts of nervous illness (neurosis) in Sweden in the “Nervous Century”, that is 1880–1980, and, equally important, of the social and cultural reception and diffusion of what the author refers to as a “contagious diagnosis”. The 1880s witnessed an intensified attention towards nervousness. George Beard launched his diagnosis of “neurasthenia”, Charcot started his lectures/demonstrations of hysteria and, more locally, a neurological clinic was opened in Stockholm. For Pietikainen this attention heralded the Nervous Century, which lasted until the American Psychiatric Association in 1980 eliminated “neurosis” from the diagnostic list of the influential DSM-III (Pietikainen's study only goes up to 1950, thereby leaving out the last three decades of the Nervous Century). In this century, Pietikainen argues, Sweden saw a veritable epidemic of nervous diseases, due to an affinity between “nervousness” and “modernity”, and to the very contagious nature of the concept of neurosis. During this epidemic, the category of nervous illness went through a profound conceptual transformation that is variously, and at times confusingly, presented in the book as a “paradigm change”, a change of “cultures”, a shift between two “languages” and as a transition between two “ages” or “eras”. When nervous diseases occurred as a mass phenomenon in the 1880s they were linked with the physical reality of the nerves, and described in a language where energy was a central metaphor. Nervousness was understood as “overtaxing of the nervous system or the constitutional weakness of nerves” (p. 10). This physicalist (or naturalist) paradigm for thinking around and talking about nervous disease reigned from the fin-de-siecle until the 1930s. But from the early twentieth century this paradigm was challenged by a discourse of the psyche, most emblematically represented by psychoanalysis. By the end of the Second World War, as the “era of psychoculture” began, the physicalist language was fully replaced by the psychodynamic frame of reference in which neuroses were understood as the result of psychic conflicts and traumas. This shift also implied a change in the inter-professional relationship between neurologists and psychiatrists as neurosis moved from the domain of the former to that of the latter. Nervousness was now predominately located in the mind of the patient, and the mind was embedded in the social body, rather than in the brain. Hence mental problems to a large degree came to be perceived as problems in the social environment of the patient or in the larger social body. This new conceptualization of many mental problems fitted well with the ideological horizon of social democracy, based on reformism and interventionism, and hence came to have bearings also on the politics of health promotion. Pietikainen draws on a broad spectrum of historical sources, including psychological, psychiatric and medical journals, minutes of the meetings of medical associations, case records both from private practice and a neurological clinic, medical manuals, textbooks, popular books on neuroses and nerve illnesses, and more. One of the merits of the book is this diversity of sources, and especially the use of clinical records, which are rarely used in this kind of broad historical narrative. The book presents itself as a history of nervous illness in Sweden, taking as its departure point that “the Swedish experience of neurosis differed from that of most western nations” (p. 9), and therefore, since this experience is different, also the “history of neurosis in Sweden” is different from that of “other Western countries”. These initial statements are hardly substantiated in the book, and this reader was therefore left unsatisfied with the comparative aspects of the book. It may be unfair to demand an even broader analysis, but the introduction invites a reading that is bound to disappoint. An investigation of the possible specificities of Swedish neurosis, which would also have to confront the mobility of medical discourses, would probably demand a more systematic comparative approach. This book might, however, be a fruitful starting point for an analysis of national variations in the interpretation of neurosis.
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Jun 1, 2009
David Lee 
Open Access