How Late 19th-Century Psychiatry Influenced the Birth of the American Western Genre

Surprisingly, the birth of the American western genre can be traced directly to early psychiatric treatment. In the late 19th century, before the mental health community had named or differentiated the psychiatric illnesses identified today, there was neurasthenia, which referred to ailments that included what we would now call anxiety, depression, postpartum depression, and bipolar disorder (1). Popularized by Silas Weir Mitchell, a neurologist, neurasthenia was seen as a product of a modern society that could be managed and was in some ways an opportunity for growth (2). Mitchell practiced neurology in a time when the purview of psychiatrists was considered neurology.

Mitchell lived among the American elite, who respected him for his medical work as well as for his contributions to literature (2). Over the course of his life, Mitchell published more than 170 scientific articles, four exceedingly popular books on neurasthenia, and 17 novels (2). He socialized with and treated America's most privileged, but perhaps the most long-lasting way that Mitchell influenced American society was through his role in the birth of the American western genre. After Mitchell prescribed his "camp cure" to his neurasthenic patient and cousin, Owen Wister, Wister went West and wrote about his experiences. Wister's writings eventually became The Virginian: A Horseman of the Plains, the first American Western novel (3, 4).

Mitchell's career and place in American history began when he served as a surgeon in the Civil War and saw the impact of the trauma of war on the psyche (5). He wrote about how he saw American soldiers—men who to him exemplified American manhood—suffer from neurasthenia. In his 1904 publication, "The Evolution of the Rest Treatment," Mitchell recalled how soldiers "tired by much marching, gave out suddenly at the end of some unusual exertion, and remained for weeks, perhaps months, in a pitiable state of what we should call today, Neurasthenia" (6). Treating neurasthenic soldiers informed Mitchell's postwar prescriptions for civilians.

Today, Mitchell is best known for his development of the "rest cure," with which he infamously treated now acclaimed author Charlotte Perkins Gilman. Both Gilman and Mitchell are most remembered today because of Gilman's iconic feminist short story "The Yellow Wallpaper," which details a woman's devolution into insanity under treatment akin to Mitchell's rest cure (7). Mitchell's rest cure generally consisted of up to 8 weeks of isolation, massage, and rest. Patients were forced or encouraged to drink large quantities of milk and often gained up to 25 pounds (8). Mitchell treated many neurasthenic upper-class women and some men of the late 19th and early 20th centuries with the rest cure.

Far less discussed in the academic literature than the rest cure is Mitchell's camp cure, which scholars have described as a treatment he used exclusively with neurasthenic men, although an examination of Mitchell's work reveals that he recognized a less rigorous version of the treatment as worthwhile for women (9, 10). According to the theory that "Civilization has hurt—barbarism shall heal," as written in his popular work Nurse and Patient and the Camp Cure, published in 1877, Mitchell called on anxious, wealthy Easterners to restore themselves in the West (11). He saw neurasthenia as an outgrowth of American exceptionalism and the outdoors as the antidote to "the modern American marketplace, with its demands and depletions" (3). An important component of the camp cure was journaling about one's experiences in the wilderness, which Mitchell called "word sketching" (9).

Despite Mitchell's vision of "camp" as a stark departure from civilization, camp cure participants strayed only a comfortable distance from city life. Although they lived in the wilderness for a few weeks, they went with guides and companions, ate heartily, and returned to "civilization" as they saw fit. Mitchell's personal journals illuminate the camp cure experience as he chronicled his own treatment for neurasthenia (9). Mitchell often travelled to the Great Lakes and the backcountry of New York State for "fishing expeditions and the company of 'rough men' " (9). Barbara Will noted that "his journals reveal that these adventures were far less 'confrontational' than one might have imagined: on a trip to Yellowstone in 1879, Mitchell reports that twenty-two soldiers, four packers, one chief packer, one hunter, two cooks, fifty-five horses, twenty-one mules and one dog" accompanied him and another "gentleman" (9).

Mitchell's prescription of the camp cure to his cousin and patient, Owen Wister, led to Wister's penning the first American western (4). Wister became Mitchell's patient after suffering a nervous breakdown that likely emerged in part from his rejection of his natural proclivity for the arts in order to adhere to his father's traditional conception of success (12). Heeding Mitchell's advice, Wister went West to Wyoming in 1885 at the age of 25. Wister's prescribed writings about his experiences ultimately changed American culture forever when he published his resoundingly successful novel, The Virginian: A Horseman of the Plains, in 1902 (4, 13). Many scholars consider it to be the first modern western novel (14). Largely based on Wister's own experiences as a participant in the camp cure, The Virginian details a neurasthenic Easterner's ascent to red-blooded Western manhood under the guidance of a genuine frontier hero. To this day, The Virginian is often regarded as "the most popular Western that has ever been written (14)." Within the first 3 months, more than 100,000 copies were printed (13). The Virginian went on to be made into a movie and later served as the inspiration for a very popular American TV series.

To the extent that Wister's neurasthenic hero led to The Virginian's unique introduction of the western and the novel's resultant popularity, Mitchell and his treatment deserve credit for a portion of Wister's literary success. Wister's novel charmed Americans as a tale of ultimate self-construction. To this day, The Virginian, closely based on Wister's experience as Mitchell's patient, remains an outstanding example of Mitchell's camp cure. Wister, Mitchell's most loyal patient, cured himself and his narrator according to his doctor's vision.

Although it is impossible to know with absolute certainty the extent to which The Virginian spoke to Wister's actual experiences in the West, an analysis of his journals indicated that Wister grounded his novel in his life (14). Some scholars have gone so far as to assert that Wister essentially conflated reality and fiction. Sanford E. Marovitz wrote, "The Virginian … was also a personal diary for the author" (14). As Marovitz pointed out, The Virginian consistently mirrors Wister's journals about his trip West. For example, the narrator's first description of Medicine Bow, a frontier town, seems nearly identical to Wister's journal entry on July 19th, 1885 (14). Similarly, just as the Westerners in The Virginian called the neurasthenic character the "Prince of Wales," so too did locals mistakenly identify Wister as British when he originally arrived in the West (14). The correlations between Wister's actual experiences and what he presents as fiction in The Virginian highlight the way that psychiatric treatment provided the scaffolding for Wister's work. Not only did Wister write The Virginian in the West, he also wrote it about his own neurasthenic and ultimately curative experiences in the West based on Mitchell's prescription.

Without The Virginian, the modern western would look different than it does today. The relationship between Mitchell and Wister and the production of American mythology via medical prescription illustrate the linkages between medicine and culture. Psychiatric history, as evidenced by the treatment of neurasthenia in the late 19th and early 20th centuries, had enormous influence on cultural ideals at that time, and it continues to do so. The stories and treatments that physicians share with their patients have great power, both within and outside the clinical setting.