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Terror Of Trains
It was once as big as fear of flying, and it helped show the way to psychotherapy and the modern treatment of traumatic stress
August/September 2003 | Volume 54, Issue 4
RAILWAY DOCTORS BECAME THE FIRST GROUP TO AGREE ON THE VALUE OF PSYCHOTHERAPY.
But a funny thing happened in the courts. Railway spine began to be transformed into railway neurosis, shifting slowly from a completely physical complaint to something closer to a mental or emotional state. Cases were brought (and won) in which plaintiffs, with no visible injuries, would complain of being too anxious to perform the duties of wife and mother after being in an accident, or of being tormented by terrifying dreams, or of experiencing unexplained numbness in parts of the body. Eventually, actual involvement in a train accident became almost beside the point. Simply witnessing an accident, or even, in one case, witnessing a frightening altercation on a train, was enough to induce neurosis. Sigmund Freud himself described his own train phobia in a letter to a friend in the 189Os, writing that a childhood rail trip in which he may have seen his mother undressed had triggered a later terror of trains.
This situation, not surprisingly, was not pleasing to the railway companies. Judges and juries so often sympathized with the seemingly hapless victims that the railways lost almost 70 percent of the railway-spine cases brought against them. As those cases reached their height in the last two decades of the nineteenth century, battle lines were drawn around three strongly opposing views of the condition. Railway spine was a matter of physical damage, whether or not clinically observable (Erichsen’s view); it was a case of out-and-out malingering or feigning of symptoms for personal gain (the railroad industry’s view); or it was a psychological affliction akin to neurasthenia or hysteria, induced by mental trauma or stress and possibly treatable through psychiatric means. The last view emerged among proponents of the new field of psychology, who were just at that moment beginning to entertain the notion that the mind, not the body, might be the source of, and even the cure for, certain illnesses.
One of those forward thinkers was a neurologist named George M. Beard, the father of neurasthenia, a condition of generalized nervous exhaustion and anxiety that many consider the forerunner of today’s chronic fatigue syndrome. Beard, writing in the 187Os, took what was at the time the monumental step of connecting the stresses of the modern world to what we would now call neurosis. In his book American Nervousness , he blamed Americans’ anxious state on five elements of modern society: the telegraph, the periodical press, the mental activity of women, science, and steam power (i.e., railroads). The notion that external emotional pressures on humans—and certainly the frightening power of the railways was one of them—could make us slightly crazy was novel in a world where everything that happened in the mind had hitherto been assumed to have a physical origin.
Ultimately, the psychological view of railway spine began to win out, laying the groundwork for an understanding of post-traumatic stress that persists to this day. But the reason for its triumph is somewhat ironic. It came mainly from doctors employed by the railroads. They were usually considered the most conservative in their profession, but the railroads had much less to lose in damages if cases were found to consist of “distress of mind” alone. Soon railway surgeons were writing articles and books citing experts on shock to explain the “emotions” aroused by the “vastness of the destructive forces” in a railway accident, feelings that “in themselves [are] quite sufficient to produce shock or even death.”
What these emotional cripples needed, the railway doctors suggested, was not spinal treatments (or huge monetary settlements to compensate them for bodily damage) but psychological therapy that combined rest, isolation, and “suggestive therapeutics”—a regimen of listening and suggesting positive outcomes to a receptive patient. By the early 189Os, when in Europe Freud and Breuer were working on their groundbreaking Studies in Hysteria , the railway surgeons had, in the words of the medical historian Eric Caplan, “unwittingly become the first American medical specialty to achieve a consensus regarding the therapeutic value of what would soon be known throughout the world as psychotherapy.”
By the first decade of the twentieth century, railway spine was quickly fading from the courts, and soon after it disappeared from the medical literature. It may be that people were beginning to incorporate the scale, and the risks, of train travel into the collective psyche—or that railroads were simply overtaken by myriad other sources of anxiety in the new world of modern America. Automobiles provided yet another method of moving faster than humans had thought possible; skyscrapers were shooting higher than anyone had ever foreseen (courtesy, in part, of the invention of elevator technology). Soon the horrors of the Great War would provide a large-scale opportunity to explore traumatic neurosis, as thousands of emotionally ravaged soldiers returned from the trenches of Europe.