A HISTORY OF THE DEVELOPMENT OF THE CONCEPT OF FUNCTIONAL NERVOUS DISEASE DURING THE PAST TWENTY-FIVE HUNDRED YEARS

In perspective it is obvious that a relationship between psyche and soma has been observed during the whole history of medicine. Until well within the last one hundred years no one conceived of nervousness in terms other than visceral disease. During the past hundred years there has been increasing emphasis upon the importance of psychological manifestations of illness until, at the high point of this interest the soma was almost forgotten. The tide has receded until now the interest is in the interrelations of physical and mental factors. The difference is that early physicians thought in terms of visceral disease as causing nervous manifestation, while today we have reversed the trend and think of visceral disorder in terms of nervous disease.

Reflection upon the history of medical thought may be profitable. The best minds of medicine have struggled with these disorders and contemporary fashion has been accepted as ultimate truth. The excellent descriptions show powers of observation of the highest quality, but the interpretation and the treatment are entirely matters of contemporary philosophy. To quote Lecky:

The doctrine, that the opinions of a given period are mainly determined by the intellectual condition of society, and that every great change of opinion is the consequence of general causes, simply implies that there exists a strong bias which acts upon all large masses of men, and eventually triumphs over every obstacle. The inequalities of civilisation, the distorting influences arising out of special circumstances, the force of conservatism, and the efforts of individual genius, produce innumerable diversities; but a careful examination shows that these are but the eddies of an advancing stream, that the various systems are being all gradually modified in a given direction, and that a certain class of tendencies appears with more and more prominence in all departments of intellect.

Nervous exhaustion, anemia, cerebral hyperemia, auto-intoxication, focal infection, glandular dysfunction, and psychogenesis have their day and then disappear except as matters of medical curiosity. This should lead us to a cautious, temperate and critical evaluation of present-day thought, in order that we may avoid, through excessive confidence, belief that the last hypothesis represents the ultimate truth.