Anna Katharina Schaffner, Exhaustion: A History (New York: Columbia University Press 2016) 304 pp. $24.00 Pb, $30.00 Hb. ISBN: 9780231172301
Anna Katharina Schaffner’s Exhaustion: A History offers a comprehensive overview of exhaustion-related conditions from antiquity until the present day. Tracing exhaustion as a medical diagnosis, a cultural phenomenon, and a vehicle of social critique, Schaffner’s approach is rooted firmly within the wider agenda of medical humanities, aiming to put the human back into the clinical. She emphasises how medical, social, and entrepreneurial concerns have been historically interrelated and continue to influence each other, arguing, for example, that the clinical diagnosis of depression only rose significantly in prevalence and importance when a 'big pharma' remedy was made available. (171) This elegantly-written work offers a clear and informative narrative, peppered with colourful anecdotes from historical literature and personal observations, creating a chronicle of fatigue that is far from fatiguing to read.
Schaffner, a Reader in Comparative Literature, masters a wide-reaching source selection, including literary, medical, and philosophical texts from within and beyond the Anglo-American world. These sources exemplify the ubiquitous and malleable nature of exhaustion narratives, and enable Schaffner to trace the changes in medical models (from melancholia due to black bile, to neurasthenia due to nervous exhaustion, to burnout due to endocrinological imbalances) against the shifts in cultural metaphors and literary tropes, such as vampiric parasites and the 'brain as a computer and the body as its hardware.' (218-19)
At times, the narrative could have benefited from a more critical analysis of the authorship, aim, and reception of different genres. While Schaffner offers a nuanced and thorough evaluation of the media attention around chronic fatigue syndrome in the 1980s and 1990s (195-199), the question of reception could have been more systematically incorporated into the preceding chapters. In terms of authorship, the fact that Max Weber was himself a sufferer from exhaustion (118-119) leaves the question as to whether it was common for writers on the topic to be sufferers themselves (as is the case with food allergy, similarly a historically contested affliction).1
Pivotal to the thematic structuring of Schaffner’s narrative is the assertion that we 'rarely find discussions of states of exhaustion in their pure form.' (6) Schaffner therefore opts to trace instead the complex models and syndromes in which the symptom of exhaustion has been historically embedded, divided across the following chapters: Humors; Sin; Saturn; Sexuality; Nerves; Capitalism; Rest; The Death Drive; Depression; Mystery Viruses; and Burnout.
In charting these theories across literature published predominantly by (and for) a white male elite, the sense of lived experience – especially of women and the working class – is often missing. While Schaffner convincingly argues how ideas of ‘natural’ gender behaviour influenced medical diagnoses (141-142), the chapter ‘Sexuality’ focuses predominantly on male sexuality and sexual behaviour in texts written by men, and would have benefited from an analysis of historical gender differences (or absences) in these discussions. Schaffner attempts to tackle the question of experience ('How does living with chronic fatigue actually feel?'), but subsequently draws only on printed literature, focusing largely on a single semiautobiographical account (187). Future research into these experiences would (where possible) benefit from oral history methods or from collaboration with organisations like the Health Experiences Research Group, who conduct detailed qualitative research into both acute and chronic conditions.2
Nevertheless, Schaffner incorporates themes of responsibility, agency, and willpower throughout the publication, and highlights the central role of these themes in experiencing and understanding exhaustion (11, 235). This is especially clear in medieval theological distinctions between vice and sin: while vice entails a moral or psychological predisposition or weakness which one is not responsible for, sin comprises a controllable behaviour which one can be held accountable for, thus rendering vice more socially acceptable than sin (39). Concepts of responsibility and willpower continue to play a central role in societal portrayals of ailments linked (at least in part) to ‘lifestyle choices’, including obesity and alcohol-related diseases,3 and are crucial in determining levels of social support and empathy.
Most exhaustion phenomena presented in this detailed publication comprise a prominent emotional component – often as mental despair or depression – which Schaffner tends to analyse within a framework of 'transhistorical psychological factors' including fears of illness, ageing and death (12-13). There are numerous mentions of these timeless fears and anxieties, which – from a history of emotion perspective – do not necessarily encourage a rich contextual reading of emotional language. At times (even though Schaffner emphasises that exhaustion is historically contingent) the narrative can slip into one of continuity, by emphasising the parallels between theories from different periods, especially with our present-day understandings of exhaustion. Furthermore, through these emotionally laden examples, it remains unclear as to whether exhaustion can occur without emotional distress (whether as cause, effect, or both).
Overall, Schaffner’s Exhaustion is an impressive and important contribution to the growing field of medical humanities. Her assertion that 'illness beliefs and mental visualizations of inner processes shape our experiences' is increasingly endorsed by our own exhausted age (234). Medical sciences and sub-disciplines like medical anthropology are turning to the patient experience of illness and disease, and taking individual ‘divergences’ in clinical medicine seriously. On a final note, Schaffner reflects that if approached cynically, many exhaustion theories are 'ultimately nostalgic, apocalyptic, technophobic and conservative in spirit,' demonstrating an aversion to social change (149). This is crucial in considering what exhaustion has done historically: how have labour laws and ideas of conservation changed in relation to the historical over-spending of human energy and planetary resources? Has exhaustion – far from being a lack of energy – instead acted as an important instigator of social change and mobilisation through history?
Evelien Lemmens, Queen Mary, University of London
1 Matthew Smith, Another Person’s Poison: A History of Food Allergy, Arts and Traditions of the Table: Perspectives on Culinary History (New York: Columbia University Press, 2015).
2 ‘Long Term Conditions’ <http://www.healthtalk.org/peoples-experiences/long-term-conditions> [accessed 17 November 2017].
3‘The Lancet Gastroenterology & Hepatology: Putting the Inside Out’, The Lancet Gastroenterology & Hepatology (2016), 1.1 , 1, p 1