MITCHELL, SILAS WEIR (1829- 1914)

Mitchell, chief proponent of the “rest cure” approach, was a man of many talents, attaining distinction not only as a neurologist and practitioner, but as a poet and novelist. After graduating from the Jefferson Medical School he studied abroad with a noted physiologist, Claude Bernard, and returned to engage in research on blood chemistry. During the Civil War he served as a surgeon in the Union Army, and later published articles and books on gunshot wounds and nerve injuries. His volume Injuries of the Nerves and Their Consequences (1872) is considered an outstanding contribution to our knowledge of peripheral nerve functioning. Among his other neurological contributions were studies of cerebellum physiology, postparalytic chorea, and a detailed description of a rare but painful nerve disease, eurymelalgia, which involves the blood vessels of the feet and the hands—a disorder which became known as Weir Mitchell’s disease. See CAUSALGIA, HALLUCINOGEN.Mitchell’s interest in neurology led him to concentrate on somatic aspects of mental and emotional disorders. He served for over forty years at the Philadelphia Hospital and Infirmary for Nervous Diseases, making that institution a pioneering center in the diagnosis and treatment of the “nervous” patient. His book Wear and Tear, published in 1871, initiated a campaign for a new type of regimen. In it he pointed out that many people were suffering from nervous disorders as a result of the hectic pace of life in the “Railroad Age,” a life that did not provide an adequate amount of rest and recreation. He also maintained that many early breakdowns in women came about because these sensitive creatures were allowed to attend college. At any rate, his book struck a responsive chord and was widely read by doctor and layman alike.Mitchell’s first book on nervous disorders was followed by a number of articles advocating rest in the treatment of disease. In 1877 he brought his ideas together in an even more influential volume entitled Fat and Blood. In it he proposed a treatment plan which he had begun to formulate during the Civil War as a result of observation of states of exhaustion resulting from combat. He believed that the pressures of the business world produced a similar condition, neurasthenia, and recommended a treatment plan that included not only extended rest but physiotherapy, electrotherapy, massage, and adequate diet. He also recognized that subtle psychological factors may be involved in nervous disorders. He suggested, for example, that patients should be isolated from surroundings that have helped to bring about their illness; and he realized that they may sometimes use their ailment to dominate their families and demand extra care and attention. However, nutrition and rest—“Dr. Diet and Dr. Quiet,” as he called them—were the basic elements in what became known as the “Weir Mitchell Rest Cure.” See neurasthenia, SECONDARY GAIN.Mitchell’s book was translated into French, German, Italian, and Russian, and his regimen was widely adopted throughout the entire Western world during the 1880s. It should not be confused with mere “bed rest,” the simple solution of the layman, for it includes an active rebuilding of the patient’s body in surroundings that relieved him as much as possible from the emotional burdens of life. This remained the dominant approach to nervous disorders for over thirty years. But when psychoanalysis and other forms of psychotherapy came to the fore, its importance gradually diminished, and by 1920 rest cures had been relegated to a secondary role in the treatment of neurosis.