Essay — From the December 2015 issue

The Bed-Rest Hoax

The case against a venerable pregnancy treatment

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When John Hilton published Rest and Pain, his influential 1863 treatise on the beneficial effects of rest, he was writing for an audience that was generally suspicious of the idea of taking to bed. The hospital ward in particular was seen as synonymous with death, in part because of the ease with which infections spread from patient to patient before sanitation standards were adopted.

Hilton sought to change that perception. He argued that nature was the primary agent of healing and that the physician’s best course of action was to let the body rest, so that it might heal itself. The physician could be seen as nature’s assistant, a helpful nurse: “In fact,” wrote Hilton, “nearly all our best considered operations are done for the purpose of making it possible to keep the structures at rest, or freeing Nature from the disturbing cause which was exhausting her powers, or making her repeated attempts at repair unavailing.”

Illustration by Shonagh RaePhysicians took Hilton’s recommendations to heart, and rest became the guiding principle of medical interventions, leaving nurses responsible only for the maintenance of good hygiene and the prevention of bedsores. Soon, myocardial infarction, congestive heart failure, tuberculosis, peptic ulcers, and rheumatic fever were all being treated with bed rest. Because rest was an unlimited good, patients were often put to bed at home or in the hospital for indefinite periods of time — the longer the better.

One of the most well respected of these therapies was a “rest cure” that was developed by Silas Weir Mitchell, a physician and author, to treat neurasthenia, a bundle of physical and psychological symptoms that we might diagnose today as depression or anxiety. One monograph on neurasthenia contains a list of eighty-one symptoms, including insomnia, bad dreams, mental irritation, rapid decay of the teeth, dizziness, hopelessness, deficient thirst, vague pains, vertigo, cold hands and feet, and “fear of everything” — a list that the author admits is “not exhaustive.” Women were especially susceptible to neurasthenia, Mitchell wrote, above all “nervous women, who, as a rule, are thin and lack blood.” Their bodies were continually in flux, passing from puberty to pregnancy to menopause, and so were an inherent source of destabilization and pathology.

Women who suffered from nervous pathologies were isolated from friends and family and confined to bed for weeks at a time. In the beginning stages of treatment, patients were forbidden to sit up, sew, read, write, or use their hands for any activity except cleaning the teeth. Each day involved a regimen of “passive exercise,” which consisted of full-body massage and electrical stimulation of the muscles. To counteract the loss of body mass, women were fed a diet that started with a week on an all-milk regimen; patients were conditioned to consume two quarts a day. Over time, they worked up to rich meals comprising mutton chops, cod-liver oil, malt extract, more milk, and doses of a raw-beef soup that was made by dissolving meat with a few drops of hydrochloric acid.

The aim was to produce a more resilient woman by cushioning her systems with blood and fat, and to make her psyche resemble the stillness of her outer flesh at rest rather than the mercurial, reactive processes of the womb. But there was also a punitive dimension to Mitchell’s treatment: he believed that his weak-nerved patients had been coddled by those around them. The neurasthenic woman was “a vampire who sucks the blood of the healthy people about her,” her morality spoiled by undisciplined care and concern. “The moral uses of enforced rest are readily estimated,” Mitchell writes. “From a restless life of irregular hours, and probably endless drugging, from hurtful sympathy and overzealous care, the patient passes to an atmosphere of quiet, to order and control, to the system and care of a thorough nurse, to an absence of drugs, and to simple diet.” Mitchell directed women who had lived selfishly, governed by concern for their own well-being and mental life, to turn their thoughts away from their condition and to focus instead on their duty to others.

This brand of paternalism has mostly disappeared from modern medicine, but its vestiges can be seen in the way we care for pregnant women, whose perceived selfishness (the impulse to continue working or to have a cup of coffee or a glass of wine) is often cast as a threat to their unborn children. When other branches of medicine have abandoned bed rest as a therapeutic tool, why does it linger on in prenatal care? Maybe the answer has to do with the hold that a particular kind of androcentric worldview has over women’s bodies. Though men and women are both made of flesh, women have long been viewed as the fleshier sex, their mental processes unavoidably interwoven with those of their reproductive organs. But even though women were understood to be controlled by their bodies, they were paradoxically capable of obstructing the body’s natural order by exercising autonomy — which could mean deciding not to bear children or threatening gestation through excessive activity and worry. Meanwhile, after doctors observed that wounded veterans returning from the Second World War recovered more completely from their injuries when they spent less time confined to bed, the treatment was essentially abandoned for male patients.

One of the best-known fictional treatments of Mitchell’s rest cure is Charlotte Perkins Gilman’s short story “The Yellow Wallpaper,” about a woman who is confined to bed by her doctor husband and forbidden intellectual stimulation. Gilman was a patient of Mitchell’s, and she spent a month at his clinic. When he sent her home, he instructed her to live “as domestic a life as possible,” lying down after every meal, restricting intellectual activity to a maximum of two hours a day, and heeding his warning to “never touch pen, brush, or pencil as long as you live.” Under Mitchell’s instructions, Gilman’s mental agony only increased, a “mental torment . . . so heavy in its nightmare gloom that it seemed real enough to dodge.” At the end of “The Yellow Wall paper,” Gilman’s protagonist goes insane.

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