After grimly hanging onto my privileged status as one of the 15% of British people in the UK who had never tested positive for Covid-19, I finally lost it last weekend. Now I’m through the initial sneezy and coughy period, and into the vaguely fatigued stage.
I’m very lucky in the sense that I was able to retire from teaching in 2019 to focus on the writing, training and research elements of my career, so I pretty much determine my own work timetable now. The summer holiday is always a slow period anyway, so this week I’ve had a lot of couch-time, developing a strange fascination with The Great Australian Bake-Off and the BBC3 series ‘Red Rose’. But I’m fully aware that this is a very untypical situation.
I’ve also been contemplating the Victorian attitude to acute infectious illness, arising from a society in which antibiotics were not available. Consequently, the impetus to avoid the secondary infections acute viral illnesses pre-dispose the human body to assumed huge importance for our ancestors. The overarching remedy applied was a period of post-illness convalescence, a period of rest to allow the body to fully recover.
‘Neurasthenia’ was a word commonly used in the 19th and early 20th century to describe post-viral fatigue, which was frequently extended to additionally encompass the impact of work-related stress. In 1871, American Weir Mitchell published a book: Wear and Tear, or hints for the overworked. He reflects on health issues arising from a society that he perceives as over-modernised:
“Have we lived too fast? The settlers here had ample room, and lived sturdily by their own hands, little troubled for the most part with those intense competitions which make it hard to live nowadays and embitter the daily bread of life. Neither had they the thousand intricate problems to solve which perplex those who struggle to-day in our teeming city hives. I should like, therefore … to see if it be true that the nervous system of certain classes of Americans is being sorely overtaxed–and to ascertain how much our habits, our modes of work … may have to do with this state of things.”
Weir also expresses fear for the pressure that assessment requirements put upon children in ‘modern’ (city school-based) education. Much of his analysis is, for today’s readers, quaint and horrifically racist/classist/ sexist, an issue taken up in detail by Julie Beck in The Atlantic.
But the fact that what we would think of as such a modern question was initially raised 150 years ago is definitely worth some reflection.
Neurasthenia and chronic fatigue syndrome
Neurasthenia is sometimes mentioned in modern research as an early recognition of chronic fatigue syndrome. Bennett proposed in 2020 “The proximate association of infections, especially influenza, with chronic fatigue (i.e., neurasthenia) was appreciated in the late 19th century”.
The 19th century ‘cure’ was a break from the daily city grindstone, either a spell engaging in outdoor physical exercise (principally for men) or a confinement to complete rest and bland diet, principally for women. The latter is vividly described by Charlotte Perkins Gilman in The Yellow Wallpaper as a ‘cure’ that was worse than the initial illness.
And, just as we have denial of chronic fatigue syndrome in today’s world, we find HG Wells making gentle fun of neurasthenia in his lesser-known novel Men Like Gods (1923). The story opens with the protagonist, journalist Mr Barnstaple, becoming heartily sick of his daily round between his wife and teenage sons and his demanding editor:
The first step towards resting from Mr. Peeve was evidently to see a doctor.
So, Mr. Barnstaple went to a doctor.
“My nerves are getting out of control,” said Mr. Barnstaple. “I feel horribly neurasthenic.”
“You are suffering from neurasthenia,” said the doctor.
“I dread my daily work.”
“You want a holiday.”
What this all adds up to is the finding that we share a lot more common concerns with our ancestors than we may initially think we might.
But is there also a lesson lurking in and among these texts that speak to us from so many years ago?
The lost art of convalescence
Lucy Enfield presents a series of pictures that give us a window onto the lost Victorian world of convalescence, in spa towns and other resorts, convalescence homes, nursing homes and sanitoriums, and the focus on nutrition for the recovery of health. Turning to the government’s current ‘guidance and support’ for those with Covid, a very different attitude is revealed:
“Try to stay at home and avoid contact with other people, until you no longer have a high temperature (if you had one) or until you no longer feel unwell … Try to work from home if you can. If you are unable to work from home, talk to your employer about options available to you.”
In other words, don’t expect any time off work whatsoever, if your employer doesn’t agree to give it to you. Not only is convalescence off the menu, no time off work at all might be the result, if your employer is uncaring and irresponsible.
The relevant webpage is headed ‘People with symptoms of a respiratory infection including COVID-19’. So, what this means is that not only are many people with Covid not going to be given any time to rest and recover, should their employer decline to let them do so; Covid and any other respiratory virus that might find its way into general circulation is going to be handed free reign to colonise itself within the population, and to continue to evolve into new variants.
Breeding sickness and destitution
By the nature of evolutionary fitness, viral variants most likely to prosper are those that are most highly infectious and have the most efficient vaccine escape. And there is no guarantee that a more deadly variant might not emerge from this process, either of Covid or a completely new illness.
People who are compelled to work through their illness will not recover as quickly, possibly resulting in a chronic fatigue syndrome-related condition called ‘post-exertional malaise’, which may in time lead on to the full blown syndrome. Like neurasthenia, post-viral fatigue diagnoses are fraught with a range of difficulties, most especially cultural beliefs about illness. We have the misfortune to live in an era in which our politicians perpetuate a belief that people who struggle financially do so through ‘lack of graft’ and that ‘illness is for wimps’.
We are now moving into a winter where we will also see many families lack the resources to keep their homes sufficiently warm, and enough food on the table. The pressure for adults to do their employers’ bidding, even when sick, in order to keep their jobs will be intense. This week, leading medics in the UK have advised that a deadly combination of cold homes, poor nourishment and rampant respiratory illness will cost children’s lives.
The situation, when considered from a range of perspectives, is very worrying indeed. It is time to learn lessons from our ancestors about the value of care and convalescence, and ensure, in a more modern frame, that this humane approach to illness is available to everyone, not just those who are in a fortunate enough position to arrange their lives to secure such spaces for themselves.