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Psychological conditions often mirror the societal fears of their time. An examination of the Diagnostic and Statistical Manual of Mental Disorders (DSM) highlights an ever-changing perspective, where once widely recognized mental health issues are now considered outdated. If history is any guide, our current understanding of mental health will also become obsolete in the future.
10. Hysteria in Men
Hysteria encompasses a range of nervous symptoms without a clear physical origin. Although men were equally susceptible to emotional breakdowns as women, societal and political barriers often prevented their diagnosis. During the 18th and 19th centuries in Britain, it became trendy for men to exhibit “nervous” conditions. This was tied to class distinctions, where emotional sensitivity was viewed as a mark of refinement, distinguishing the upper class from the working class.
By the early 20th century, male hysteria evolved into “shell shock,” reflecting a shift in how the condition was perceived, shedding its feminine associations. This new iteration of male hysteria was seen as honorable. By the 1980s, “shell shock” was replaced by PTSD—post-traumatic stress disorder. This progression marked a gradual move away from the stigma traditionally linked to the condition.
9. Dysaesthesia Aethiopica
During the mid-19th century, mental health experts invented disorders to rationalize the institution of slavery. Dysaesthesia aethiopica was characterized by behaviors attributed to “mental dullness and nerve insensitivity.” Those diagnosed were said to roam at night, sleep excessively during the day, cause disturbances, and “damage or destroy anything they touched.” Physicians also asserted that this “condition unique to African Americans” included physical signs like lesions, which were supposedly always present in affected individuals.
Sociologists and psychologists concocted this condition to provide a scientific basis for the claim that black individuals were unfit for freedom. The prescribed remedy for dysaesthesia aethiopica was enslavement. These practitioners argued that the disorder was more prevalent among free African Americans than those enslaved. They claimed that only enslaved individuals who mimicked the lifestyles of free people—through diet, drink, and exercise—or lacked white supervision were affected.
8. The Vapors
During the Victorian period, psychologists asserted that a quarter of women were afflicted by “the vapors.” This term originated from ancient Greek medical concepts centered on the body’s four humors. The condition was believed to stem from a humoral imbalance, where substances from the spleen traveled through the body to impact the mind. Women were considered more susceptible due to perceived anatomical irregularities. Symptoms included anxiety, depression, fainting, tremors, and bloating.
Women with independent thoughts were frequently labeled as having the vapors. Suffragettes were especially prone to this diagnosis. Given the broad spectrum of symptoms, the vapors often masked more severe conditions like depression, infections, and cancer. Today, the term is used humorously, with figures like Colin Powell and journalists Peggy Noonan and Claire Berlinski employing it to mock their opponents.
7. Homosexuality
Until the mid-1980s, homosexuality was classified as a mental illness. By the late 19th century, it transitioned from being viewed as a sin or crime to falling under the purview of mental health professionals. However, experts disagreed on its classification. Some saw it as a degenerative condition, while others believed it was innate and not a disease. Freud even suggested that bisexuality was humanity’s natural state. These conclusions were based on observations rather than empirical evidence.
Starting in the 1970s, mental health professionals began revising their stance on homosexuality, influenced by growing evidence and changing societal attitudes. In 1974, a vote was conducted to revise homosexuality’s classification in the DSM. By 1980, the only remaining entry was “ego-dystonic homosexuality,” referring to cases where homosexual feelings conflicted with an individual’s self-identity. This decision faced significant criticism. By 1986, homosexuality was entirely removed from the DSM.
6. Dementia Praecox
In 1893, Emil Kraepelin pioneered the first systematic classification of mental illnesses, dividing them into two main categories: circular insanity and dementia praecox. Circular insanity involved various mood disturbances but was treatable, while dementia praecox was an irreversible mental decline starting in youth. Symptoms included emotional numbness and a lack of willpower. The outlook was deemed hopeless.
This diagnosis was likely applied to all cases of severe, untreatable mental illness. By the late 1920s, dementia praecox lost favor, replaced by Eugene Bleuler’s concept of schizophrenia, which offered a more hopeful perspective. Bleuler considered symptoms like delusions, hallucinations, and emotional flatness as secondary. By 1952, dementia praecox was officially removed from psychological terminology with the publication of the first DSM.
5. Lunacy
For centuries, people believed that full moons could drive individuals to madness. Aristotle argued that the brain, being the “moistest” organ, was particularly vulnerable to lunar influences. This idea of the “lunar lunacy effect” persisted through the Middle Ages in Western culture. Even today, some believe full moons lead to spikes in hospital admissions, violent crimes, suicides, and traffic accidents. In 2007, UK police even established full moon units to handle the perceived rise in criminal activity during these periods.
There is little scientific evidence linking moon phases to mental instability. The Moon’s gravitational pull remains consistent across all phases and only impacts large bodies of water. However, there might have been a grain of truth to the idea in the past. Before modern lighting, moonlight could significantly disrupt sleep patterns. Full moons may have caused sleep deprivation, which is known to exacerbate erratic behavior in individuals with bipolar disorder.
4. Neurasthenia
In 1869, physician George Miller Beard identified a mental condition seemingly tailored for America’s elite. Neurasthenia, or nervous exhaustion, presented symptoms like migraines, fatigue, depression, and digestive issues. Beard attributed “American nervousness” to the pressures of urban life’s rapid pace. The prescribed remedy was escaping the city. Women were advised to rest, while men were encouraged to pursue vigorous outdoor activities.
By the early 20th century, neurasthenia became a mark of prestige, spreading from the upper class to all societal levels. It even gained traction in Europe, China, and Japan. The condition’s stigma was reduced by framing it as a physical ailment rather than a sign of mental frailty. By 1930, neurasthenia largely vanished from psychological discourse, though its symptoms persist in modern conditions like clinical depression and chronic fatigue syndrome.
3. Gender Identity Disorder
In 2012, the DSM eliminated “gender identity disorder,” a diagnosis that pathologized transgender individuals. Gender rights activists had long criticized this label as stigmatizing. Its removal affirmed that being transgender is not a mental illness.
Gender identity disorder was replaced with “gender dysphoria,” which specifically addresses individuals distressed by their gender identity. While some view this as a major step forward, others remain skeptical. Advocates argue that retaining gender dysphoria in the DSM ensures transgender individuals can access necessary healthcare. Critics, however, feel progress has been insufficient. Still, advancements are undeniable. In the 1990s, transgender individuals were lumped together with pedophiles under the Americans With Disabilities Act.
2. Inadequate Personality Disorder
Individuals with inadequate personality disorder display poor judgment, social instability, and low physical and emotional endurance. They struggle to adapt to their environment despite having no apparent physical or intellectual impairments. Many lack a clear sense of self and rely heavily on family for support. The disorder was removed from the DSM III in 1980.
Significant evidence connects inadequate personality disorder to frontal lobe syndrome. In 1848, Phineas Gage, a railroad foreman, suffered a spike injury to his frontal lobe, leading to drastic personality changes. He became impulsive, irresponsible, and childlike, eventually working as a circus attraction. Similarly, frontal lobotomies, once used to manage violent psychiatric patients, often resulted in diminished creativity, spontaneity, and social functioning.
1. Moral Insanity
First identified in 1835 by physician J.C. Prichard, moral insanity refers to a disorder of the conscience. It is characterized by a “morbid perversion” of emotions, habits, and impulses, despite intact intellectual and reasoning abilities.
Moral insanity remained a diagnosis until 1881, when it was cited during the trial of Charles Guiteau, the assassin of President James Garfield. One doctor argued Guiteau suffered from this outdated condition, while another dismissed him as an “imbecile.” By 1888, the term “psychopathic inferiority” replaced moral insanity. Many see moral insanity as the precursor to modern psychopathic and antisocial personality disorders, though experts remain divided on this connection.
