Silenced by the Rest Cure

A history of the psychological treatment for nervous women

“I’m all right. Sure I am. I’m fine, I am. I’ve been a little nervous but I’m all right now. I’m having a rest-cure. That’s what they tell me. I’m having a rest-cure and I can’t see anybody.”

So begins a satirical short story from 1929 on the rest cure, a now-debunked medical treatment used widely around the turn of the twentieth century. While it’s true the cure wasn’t as severe as the invasive ovariectomies and hysterectomies sometimes used to treat nerve disorders, the isolation and depression some patients experienced warrants serious criticism, especially as traces of the treatment remain in our healthcare system today.

Developed in the late nineteenth century by Silas Weir Mitchell, a fashionable American neurologist, the rest cure was first used on Civil War veterans. The cure’s main tenets were: rest (usually 6–8 weeks), a high-calorie diet (as the doctor thought weight gain was a symbol of improved health), massage, and electrical stimulation of the muscles, which could mean an electrode placed along the spine or a weak current run through the body. The latter two ensured the muscles didn’t atrophy, since physical activity was strictly forbidden. Mitchell gained a fair amount of notoriety for this work at Philadelphia’s Turner Lane Hospital; he helped discover causalgia, a rare pain syndrome related to nerve injuries, as well as the phantom limb phenomenon. His work with veterans was largely considered a success, although he was treating men with nerve damage caused by bullet wounds, not mental illness.

Shortly thereafter, in the 1880s, Mitchell turned his attention to “nervous women,” those suffering from the suspiciously female maladies of hysteria and neurasthenia — more or less catchall psychological disorders whose symptoms included depression, insomnia, anxiety, and headaches. Patients traveled to the doctor’s Philadelphia clinic for treatment, which was in vogue until around the time of World War I. Rest cure patients tended to be young and thin (some were anorexic) and perfect subjects to receive Mitchell’s directive of a high-fat diet, which he believed went “hand in hand with a rise in all other essentials of health.” As noted in his 1891 book, Fat and Blood, patients ate bread and butter three times a day, drank three or four pints of milk, and ate breakfast, lunch, and dinner. He also had a recipe for raw beef soup, another high-calorie meal, made by mixing one pound of meat with water and chlorhydric acid, which is found in human digestive fluid. The soup was used as a peptone to aid in digestion. Patients who had troubling consuming this diet were force-fed if necessary.

Mitchell’s patients were primarily upper-class white women, who would have known about his work and had the means to access the treatment. Several notable and accomplished ladies, from Jane Addams, who founded Hull House, to the author Elizabeth Stuart Phelps, received the rest cure in its heyday. Mitchell’s colleague, the neurologist George Beard, believed the illness was a consequence of the evolved brain and nervous system. Using blatant bigotry, he believed nonwhite races didn’t suffer from the disorder, describing the neurasthenic type as having “fine, soft hair, delicate skin, nicely chiseled features” and “superior intellect.” Dr. Margaret Cleaves, a pioneer of electrotherapy and herself a neurasthenic, thought otherwise — she attributed the disorder to women’s intellectual and financial ambitions.

The feminist writer Charlotte Perkins Gilman was perhaps Mitchell’s best-known patient, as well as one of his harshest critics. She fictionalized her treatment in the now-infamous story “The Yellow Wallpaper,” wherein the protagonist, confined to the bedroom, slowly descends into madness. Gilman later wrote that the cure brought her “perilously near to losing my mind.” Especially disconcerting to Gilman was Mitchell’s prohibition of work, including writing.

“I don’t know why I should write this. I don’t want to. I don’t feel able,” Gilman’s protagonist writes. “But I MUST say what I feel and think in some way — it is such a relief!”

Virginia Woolf, who underwent several rest cures, similarly despised the experience. She wrote scathingly of it, and of the mental health profession in general, through the experience of Septimus Warren Smith, a veteran who commits suicide in Mrs. Dalloway. There were indeed male neurasthenics, such as The Virginian author Owen Wister, although their treatment was often the exact opposite of the rest cure. For them, Mitchell prescribed the West cure: a trip to the American West where they engaged in rigorous physical activity in an attempt to reinvigorate their mental capacities. In his 1891 publication, Wear and Tear: Or Hints for the Overworked, Mitchell writes that, “Some such return to the earth for the means of life is what gives vigor and developing power to the colonist of an older race cast on a land like ours.” Professor Anne Stiles, who teaches literature at Saint Louis University, notes, “both cures existed to reinforce ‘proper’ sexual behavior,” in turn emphasizing “the biological differences between men and women.”

The West cure wasn’t the only medical remedy that considered exposure to nature restorative. The popularity of mineral-rich water and spa towns had been soaring in Europe since 1700. In these towns, the material components of the water were isolated and distinctly marketed toward the specific ailments they were said to cure. Such a “watering-place” figures in Anna Karenina, published in 1877, when the scorned Kitty Shcherbatsky travels to a German spa seeking to restore her well-being. “In favour of a journey abroad I should like to mention the change of habits, and the removal from surroundings which awaken memories,” Kitty’s doctor explains. Mitchell also recommended patients be removed from home — he believed they enjoyed the attention of the sick bed. Jane Austen’s fondness for the restorative powers of the sea are well-documented. In her unfinished novel Sanditon, she extolls the ocean’s virtues, writing that “the sea-air and sea-bathing together were nearly infallible; one or other of them being a match for every disorder of the stomach, the lungs, or the blood.”

Ideas from these remedies abound in contemporary ideas of health and well-being. The popularity of day spas, vacations in the country, and other elements of self care are solid proof. We can thank one of Mitchell’s West cure patients, Theodore Roosevelt, for much of America’s protected green space. The future president, once considered effeminate, went out West several times to treat asthma and neurasthenia, in turn gaining a more masculine reputation. He eventually became a conservationist, created the United States Forest Service, and established well over 100 national forests, parks, and monuments.

But not all Victorian holdovers are as benign as public parks. Perhaps most controversial is bed rest, one of the most commonly prescribed treatments for pregnant women in the U.S. for a variety of issues. One study reports that up to 95 percent of obstetricians have prescribed bed rest to their patients, despite a plethora of evidence showing the practice yields no benefits for mom or fetus. A review of several studies found that bed rest is ineffective at treating hypertension or impaired fetal growth and fails to prevent miscarriage, preeclampsia, or preterm birth. Still more studies show that pregnant women put on bed rest identify negative side effects ranging from muscle atrophy, bone loss, weight loss, and decreased infant birthweight to psychosocial problems.

The French scholar Asti Hustvedt, who wrote a book on hysteria, thinks the Victorian view of the female body as strange and unknowable is alive and well. Although both the medical world and the mainstream media are less sexist than in Mitchell’s day, “when it comes to the idea that the female body is, say, more vulnerable to hormones than the male body — that absolutely continues,” she says. “As does the idea that anything connected to the entirely natural, biological female reproductive system — pregnancy, childbirth, menstruation, menopause ‑ is a medical issue.”

In theory, the rest cure was meant to relieve women of psychological ills and leave them fit to tend to their families and homes. In practice, though many patients were charmed by Mitchell and some found it helpful, the treatment prescribed women to the roles society laid out for them, leaving no room for other ambitions. Kate Zambreno’s 2012 book Heroines gives voice to the type of woman who might have been silenced by the rest cure: the talented wives of famous literary men. Zambreno says diagnoses were an easy way to label and dismiss these women, as with Zelda Fitzgerald, who was diagnosed with schizophrenia and later died when her asylum caught fire, and Vivienne Eliot, who also died while institutionalized. The same is true of Mitchell’s patients, who were isolated, unable to write, voiceless. “Never touch pen, brush, or pencil as long as you live,” he wrote in Gilman’s prescription, which she followed for several months before realizing such inactivity would never lead to recovery. She later wrote, “The mental agony grew so unbearable that I would sit blankly moving my head from side to side.”

“The thing about writing, if one can be empowered to write, one can actually succeed in writing against the culture, in challenging how you’ve been written,” Zambreno says. “And if you cannot write, if you are silenced, others are allowed to write your narrative for you.” We are lucky that women like Gilman and Woolf found their way back to writing. It is rumored that after reading “The Yellow Wallpaper,” Mitchell lessened the severity of his treatment. Amazing what can happen when women have a voice in their own health decisions, in their own lives.

Kerry Cardoza is a freelance journalist based in Chicago. She sings about Elena Ferrante and the weakness of men in Espejos and tweets @booksnotboys.