“Especially here in America are people forced into surroundings for which they have never been fitted,” the alienist asserts, “and especially here are premature demands made upon their nervous systems before they are mature and properly qualified.  The lack of proper training deprives many of the workers, in all branches, of the best protection against functional nervous diseases which any person can have, namely, a well-trained nervous system.  This struggle for existence by the congenital neuropath or the educationally unfit forces many to the use, and then to the abuse, of stimulants and excitants, and herein we have another important exciting cause.  This early and excessive use of coffee, tea, alcohol, and tobacco is especially deleterious in its action upon the nervous system of those very ones who are most prone to go to excess in their use.

“Therefore, predisposition, aided by the storm and stress of active competition and abetted by the use of stimulants, must be looked upon as the main cause for the premature collapse of nerve force which we call neurasthenia; so it will be found that the majority of neurasthenics are between twenty-five and fifty years of age, and that their occupations are those which are attended by worry, undue excitement, uncertainty, excessive wear and tear, and thus we find mentally active persons more easily affected than those whose occupation is solely physical.  Authors, actors, school-teachers, governesses, telegraph and telephone operators, are among those most frequently affected, and the increase of neurasthenia among women dates from the modern era which has opened to them new channels of work and has admitted them more generally into the so-called learned professions.  But whatever may be the occupation in which persons have broken down, it is never the occupation alone which has been the cause.

“This cannot be too often repeated.  The emotional fitness or unfitness of an individual for his occupation is of the utmost importance as a causative factor, and overwork alone, without any emotional cause and without any errors in mode of life, will never act to produce such a collapse.  It is therefore not astonishing that this class of functional nervous diseases is not confined to the wealthy, and that the rich and the poor are indiscriminately affected.  But certain causes are of greater influence in the one class, while different ones obtain in the other.  Poverty in itself, with its limitations of proper rest and recuperation, is a very positive cause.  Years of neurological dispensary work among the poor have convinced me that nervousness, neurasthenia, hysteria, etc., are quite as prevalent among the indigent as among the well-to-do.”