“THERE are fads in illness, as in most things,” writes Dr Richard Shepherd in a recent memoir of his long career as a forensic pathologist in the UK. “Their popularity waxes and wanes according to our perceptions.”
Dr Shepherd is particularly referring to the shifting diagnoses around sudden infant death from the 1970s on, but the same could be said of many illnesses.
You don’t have to look far back in history to find a host of conditions that once held disease status but wouldn’t be found in clinical guidelines today.
In Unwell: what makes a disease a disease? Australian science writer Mike McRae charts the fascinating story of some of those vanished illnesses.
There’s neurasthenia, a debilitating condition that swept across late 19th century America, causing headaches, palpitations, high blood pressure, indigestion, neuralgia and depression.
Sometimes referred to as “Americanitis”, neurasthenia was one of the most common diagnoses given to patients at the time.
Its principal cause was considered to be the ever-accelerating pace of modern life: one neurologist described it as “a disorder of capitalist modernity”, while other observers blamed it on the new-fangled electric lights invading American homes.
Neurasthenia only finally disappeared from clinical guidelines in the 1980s.
“There are numerous sicknesses long abandoned like pathological ghost towns,” McRae writes, “leaving unanswered the question of whether they were illnesses that met a cure, or medical mirages.”
His catalogue of diseases once considered to require treatment includes left-handedness, nostalgia and homosexuality, officially classified as a mental illness until the 1970s.
Defining a particular kind of behaviour or identity as illness can be a means of exercising social control, as McRae makes clear.
In the 1850s, American physician Samuel Adolphus Cartwright described a condition, “particular to negroes”, which he named drapetomania. The disease caused African-American slaves to seek freedom against God’s will.
Another of Cartwright’s clinical discoveries was an illness called dysaesthesia aethiopica that led to laziness in slaves.
Caused by an insensitivity of the skin, the disease could be treated by having “the patient well washed with warm water and soap” then rubbed with oil. Next, Cartwright recommended, “slap the oil in with a broad leather strap … [and] put the patient to some kind of hard work in the sunshine”.
Definitions of disease have been used to prop up gender hierarchies too.
From ancient Greece to the 19th century, misbehaving female reproductive organs were deemed to cause psychological symptoms including unruly behaviour and overt sexuality.
In some unfortunate women, the uterus would take off from its appointed position to go for a wander around the body. Hippocrates believed an errant uterus could enter the chest cavity and suffocate its owner.
As late as the 19th century, medical men recommended various techniques to jolt the wandering organ back into place, including clinical stimulation of the genitals to induce “paroxysm”.
“Hysteria was a disease only when women did not act as society expected them to,” McRae writes. “Errant female behaviour became a condition, one that could be managed by medical authority, always male.
“And that authority’s ideas about what a woman’s body should do, not how it operated in reality, turned functions now considered quite normal into diseases.”
Unlike hysteria or drapetomania, modern definitions of disease generally have a strong underpinning in biological reality, but McRae reminds us that the whole idea of disease only makes sense in opposition to our definition of the healthy or normal.
Such definitions determine “who is broken and who is a pariah, who is forgiven and who is damned, which conditions deserve to be studied and which aren’t worth our attention”, he writes.
With new scientific discoveries, with shifts in social attitudes, our definitions of disease will continue to change.
It’s interesting to wonder what conditions in 21st century clinical guidelines might one day look ill-founded, even ridiculous.
Jane McCredie is a Sydney-based science and health writer. She can be found on Twitter @janemccredie
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless that is so stated.