Neurosis as incipient lunacy

This deplorable state of affairs was gradually modified when a few leading figures like Henry Maudsley began to build private practices. The affluent insane were directed toward small private asylums; but an increasing proportion of patients seeking advice from alienists did not require certification or confinement, but were described as suffering from 'neurasthenia' or 'incipient lunacy' rather than full-blown insanity. These patients, whom we should now deem neurotic, were thought to be carriers of some form of hereditary taint, or suffering from 'latent brain disease'. (l) Because the assumption was that neurosis, as well as insanity, was constitutional, it followed that not much could be expected from treatment other than minimal alleviation. Neurology became established as a medical speciality in the 1870s and 1880s, and many neurotic patients preferred to seek the advice of neurologists who were recognized as 'nerve-specialists', but who lacked any stigma of association with asylums. Because of the comparative rarity of organic neurological disease, many neurologists continued to make their living by treating neurotics with sedatives until the 1940s or later.

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