Exhaustion is a vague and forgiving concept. Celebrities say they’re suffering from it when they go to rehab and don’t want to admit to depression or addiction. You can attribute your low mood or your short temper to exhaustion, and it can mean anything from “had a couple of bad nights’ sleep” to “about to have a nervous breakdown.” It also seems like a peculiarly modern affliction. Relentless email, chattering social media, never-ending images of violence and suffering in the news, the lingering effects of the financial crisis, and looming environmental catastrophe: Who’s going to blame you if you confess to having had enough of it all?

Anna Katharina Schaffner’s Exhaustion: A History opens with the resignation of Pope Benedict XVI in 2013. He cited deteriorating physical and mental strength as a major factor in his decision to step down, and Schaffner teasingly holds him up as an emblem of our age, exhausted by the demands placed upon him. Then she points out that the only other pope to resign voluntarily gave reasons very similar to Benedict’s for doing so. That was Celestine V and the year was 1294.

Exhaustion, in popes as in less exalted subjects, is nothing new. But if exhaustion is eternal, our understanding of exhaustion is always changing. Schaffner, who is a lecturer in comparative literature at the University of Kent, shows how each era remakes the condition in its own image, reflecting its medical, technological and cultural developments, as well as its fears. Dangerous precisely because it keeps us from action, exhaustion has for centuries done double duty as a sign of weakness and a badge of honor. 

Exhaustion is a floating symptom, and has been attached to numerous different conditions over the past two millennia. Schaffner’s book is more a history of these conditions, many of which are some version of what we call depression, than it is a history of exhaustion itself. The book starts with Galen’s popularization of humoral theory in the second century, and the idea that illnesses were the product of imbalances among the four humors. In Galen’s writing, exhaustion occurs mainly as “lethargy, torpor, weariness, sluggishness, and lack of energy,” all of which he regarded as symptoms of melancholia, produced by an excess of black bile. In this understanding, an exhausted, melancholic mind is the product of a sick body.    

In late antiquity, exhaustion was spiritualized rather than medicalized. Under the name of “acedia” (literally “non-caring”), exhaustion signified a lack of faith and an inability to feel and participate in the joy of God’s creation. Monks were particularly at risk from this spiritual sickness, which threatened more than the individual monk suffering from it: A monastic community only functions smoothly when all of its members are pulling their weight. Acedia’s threat to the social order may be part of the reason why religious thinkers viewed it not merely as regrettable but as sinful. Another word for acedia is Sloth, the worst of the Seven Deadly Sins.

EXHAUSTION: A HISTORY by Anna K. SchaffnerColumbia University Press, 304 pp., $30

So it goes on. In the Renaissance, melancholia was associated with the influence of Saturn; in the eighteenth and nineteenth centuries, excessive masturbation produced exhausted bodies and minds. In the mid-nineteenth century, the diagnostic concept of melancholia gave way to that of neurasthenia, which was caused by weak or exhausted nerves. Well into the twentieth century, neurasthenia was the go-to diagnosis for those suffering from exhaustion, anxiety and low mood, alongside an array of other—and to modern eyes, unrelated—symptoms: phobias, hay fever, ticklishness. Melancholia and neurasthenia don’t map perfectly onto one another, and neither maps perfectly onto depression. Nevertheless, many of the melancholics and neurasthenics of the past would be diagnosed as depressed today.

Late capitalism and modern technology might seem to us especially conducive to exhaustion, but nineteenth-century capitalism and nineteenth-century technology seemed equally dangerous to our ancestors. Industrialization radically changed work rhythms, placing workers at the mercy of machines and clock time, changing their sleep patterns and grinding them down physically and mentally. Capitalist discourse gave rise to capitalist metaphors: nineteenth-century commentators writing about “nerve force”—roughly, energy—often spoke of it in the way that they might speak of capital, sometimes directly comparing the two. You could save nerve force or spend it, but once it was gone, it was gone.

Sometime in the eighteenth century, doctors and philosophers stopped blaming exhaustion on the weakness of the individual and started blaming it on changes in society. Ever since, exhaustion has been associated with the demands of modern life. Those who fret about exhaustion epidemics are usually cultural conservatives, calling for a return to older, slower, sometimes more godly ways to cure the disease they so readily diagnose. But Schaffner points out that many critics, even as they call for a cure, frame exhaustion as a mark of distinction. This idea dates back at least to Aristotle. “Why is it that all men who have become outstanding in philosophy, statesmanship, poetry or the arts are melancholic?” he wonders in Problemata.

The American neurologist George M. Beard, neurasthenia’s foremost theorist, associated the disease with the middle and upper classes, in 1881 describing the neurasthenic type as having “fine, soft hair, delicate skin, nicely chiseled features, small bones… It is the organization of the civilized, refined and educated, rather than of the barbarous and low-born and untrained”. Small wonder that neurasthenia became such a topic of fascination, promising superiority to those who could detect it in themselves. Doctors, meanwhile, could flatter their patients as they treated them.

Today, exhaustion still hints at status, but of a different sort. To say that you’re exhausted is to telegraph that you’re important, in demand, and successful. It’s akin to the humblebrag of ruefully describing yourself as “so busy”—naturally, since exhaustion follows from busyness. In Schaffner’s telling, the associations of exhaustion with prestige have crystallized in the form of burnout. First used in the 1970s to describe exhaustion suffered by workers in the social sector, “burnout” was characterized by increased cynicism and apathy, and a decreased sense of personal accomplishment. Since then, its application has widened to include all worn down, overburdened workers, especially in Germany, Sweden and the Netherlands, where burnout is a subject of regular media debate. Burnout, caused by workplace conditions rather than by a worker’s mental and physical composition, is depression’s more palatable, more prestigious cousin. As the German journalist Sebastian Beck puts it: “Only losers become depressive. Burnout is a diagnosis for winners, or, more specifically: for former winners.”

When Schaffner reaches the turn of the twentieth century, she introduces the biggest problem in her book: the gulf between theories about exhaustion and actual experiences of exhaustion. This gulf is at its widest in her chapter on Chronic Fatigue Syndrome, a condition about which medical practitioners and patients often have extremely divergent opinions. Although most doctors and researchers agree that there is a microbiological trigger for the syndrome, they also see patients’ behavioral and psychological responses as perpetuating the condition. At its extreme, this view holds that CFS is a psychological illness with physical symptoms. Most patients, meanwhile—often housebound, even bedbound, unable to do the simplest task without suffering debilitating exhaustion—vehemently reject this model, arguing that CFS is a physical, and only physical, disease.

 In writing about CFS, Schaffner returns to an idea she first mentions in her introduction, borrowed from the medical historian Edward Shorter: that patients, absorbing the medical and cultural discourses of their time, unconsciously display the psychosomatic symptoms that doctors will take seriously. Shorter is convinced that CFS is all in the mind, a twentieth-century version of hysteria with subjective symptoms (fatigue, muscle pain) both impossible to disprove and in line with what “doctors under the influence of the central-nervous paradigm [expect] to see”.

Autobiographical accounts of exhaustion and its related illnesses provide the most vivid moments in Schaffner’s book, and highlight the gaps between thinking about and experiencing psychological states. In The Noonday Demon: An Atlas of Depression, the writer Andrew Solomon describes his depression growing on him as a vine growing upon an oak, surrounding the tree until, from a distance, the two are indistinguishable. None of the medical models that Schaffner recounts comes close to conveying the suffocation and helplessness of the exhausted. 

It’s frustrating, then, that almost all of the personal accounts of exhaustion that Schaffner includes date from the last hundred and fifty years (indeed, more than half the book focuses on this period.) It’s true that, right from the beginning of her book, she discusses literary works that take exhaustion as a key theme, or depict exhausted characters, including The Canterbury Tales and The Divine Comedy. But until she reaches the mid-nineteenth century these works, in Schaffner’s interpretation at least, largely serve to illustrate the theories that she identifies as typical of their time. Too often they are schematic or dogmatic, rather than giving a sense of how it might really feel to be an exhausted fourteenth-century monk, for example, believing your exhaustion to be sinful, or an early nineteenth-century laborer, experiencing rather than pontificating about the changes to sleeping and eating wrought by industrialization.

I don’t know whether or how this laborer would feel his exhaustion differently from the way I feel mine, after a day spent staring at my laptop, shoulders at my ears, writing this article while fielding emails and alternately checking the news and Twitter. If the two of us do have different experiences of exhaustion, it will surely be both because we spend our days in different ways and because we believe different things about our condition. What difference, if any, does it make to the way you feel exhausted if you’ve unconsciously absorbed a cultural discourse that says your exhaustion is caused by a planet, or by weak nerves, or by too much thinking about sex? Schaffner doesn’t speculate. But knowing this would give us a clearer sense of perspective on our individual experiences of exhaustion; it would indicate whether this feeling is a product of our surroundings or something more universal, an unchanging malaise that finds its home in any and every human society.

For all her insistence that exhaustion is not a modern phenomenon, Shaffner’s book gives the misleading sense that, until relatively recently, the condition was far more theorized than lived. When Exhaustion does bring theory and experience together, it becomes engrossing—which makes it all the more regrettable that for so many centuries, our exhausted ancestors remained silent.