From rest cure to work cure

For most of the 19th century, neurologists and psychiatrists rejected highly psychological treatments and theories. These physicians attributed mental suffering to brain pathology; they excluded emotions, beliefs and ideas as possible contributors to one’s mental health.

But by the 1890s, physicians began to reconsider their hostility to psychological concepts. As Harvard neurologist James Jackson Putnam put it in 1899:

“It is a matter for congratulations that this wave is being reinforced by another, which is sweeping us toward a better knowledge of the secrets of the mental life in health and disease.”

He was referring to psychotherapy, the newly coined term and increasingly popular therapy for somatic and psychological suffering. By 1909 — the year Sigmund Freud visited America — psychotherapy had won the allegiance of psychologists, clergy and diverse medical specialties. In fact, by then, more Americans were advocates of psychotherapy than of Freud’s theories.

Before psychotherapy gained popularity, the dominant philosophy was that the demands of modern, industrial society exhausted the nervous system. While the Gilded Age promised wealth for those who could compete, it also led to nervous breakdowns. As a remedy, neurologist S. Weir Mitchell, a wealthy and influential Philadelphia neurologist, created the rest cure, a regimen of forced bed rest, restricted diet, and a combination of massage and electrical muscle stimulation in place of exercise. Mitchell, author of “Wear and Tear; or, Hints for the Overworked” (1871), was known for treating “hysterics” (mostly women) and earned the scorn of feminists.

But by the turn of the last century, psychotherapists had a new view of the nervous system. For them, the psyche was not like a storage battery prone to depletion. Rather, they saw humans as more like streetcars — they could draw upon sources of power beyond themselves. In fact, wrote psychotherapy proponent Richard Cabot, MD, a founder of medical social work, people who suffered from neurosis and neurasthenia were like trolleys detached from overhead power lines. The therapist’s job, he said, was to connect the person with reserves of energy, which lay in the unconscious and in collective activity.

In the place of Mitchell’s rest cure, Cabot offered a work cure. To treat his patients’ morbid thoughts, he prescribed useful activities: taking a college course, helping manage an office, or taking up pottery or carpentry. Relearning the skills of “healthy people” was the most important tenet of Cabot’s treatment. This called for patients to inhibit their negative thoughts and persevere despite fatigue or distraction. Work also provided a routine for people unable to manage their affairs. The result was a restored moral and spiritual “efficiency,” Cabot believed.

As Jackson Lears explains in his book “Rebirth of a Nation” (Harper, 2009), the shift from rest cure to work cure was part of a broader, sociocultural transformation. By 1909, economists and politicians had proclaimed “that the U.S. had passed from an ‘era of scarcity’ to an ‘era of abundance,’” (Lears, 2009, p. 247). As the national spirit was changing, each citizen’s psyche could shift from negative to positive thinking. Just as the nation prospered from natural resources and new technologies, individuals could draw strength from their inner resources. Useful work would tap those reserves and restore good health and spiritual abundance.

Given the cultural resonance of the work cure, it is not surprising that numerous practitioners of the theory emerged in the early 1900s. In Marblehead, Mass., Herbert Hall, MD, created a pottery, weaving and carpentry workshop to treat hysteria, neurasthenia and neurosis.

Perhaps the most successful work-cure practice was that of John G. Gehring, MD, of Bethel, Maine, whose patient list read like a who’s who of professors, politicians, businessmen and club women. He restored the health of so many Harvard professors that Bethel became known as the “Cambridge of the North” and Gehring was called “the Wizard of the Androscoggin” (referring to the nearby river). Housed in Gehring’s home and a nearby inn, his patients chopped and sawed wood, worked in the garden, and took daily plunges in an outdoor pool. They met regularly with Gehring, took meals together and performed theatricals after dinner. Gehring designed all the activities to teach good habits, impart hope, foster spiritual uplift and inhibit negative thoughts. This earned Gehring the loyalty of his patients, a novel based on his life (Robert Herrick’s “Master of the Inn,” 1908, Charles Scribner & Sons) and a very good living.

By the 1920s and ’30s, psychoanalysis and other forms of psychotherapy supplanted the idiosyncratic therapies of people like Gehring. But a hundred years ago, there was still room for a heroic, lone figure using a unique version of positive psychology to cure one patient at a time.

Ben Harris, PhD, is a professor of psychology at the University of New Hampshire, where Courtney Stevens is a senior honors major in psychology. Katharine S. Milar, PhD, of Earlham College, is the historical editor for “Time Capsule.”