Railway Neurosis and the Birth of Psychotherapy

When four airplanes used as missiles in acts of terrorism on September 11, 2001, killing almost 3000 people, many of the millions who watched the horror on television made a secret vow: I am not going to step onto an airplane again. They knew this decision was irrational, and ultimately untenable, but it seemed the one small thing that a terrorized populace could do. We could opt out of the technological sophistication that had made such wholesale slaughter of innocents possible. We could return to seemingly simpler, more controllable ways to be transported: automobiles, buses, and trains. In the days after September 11, those modes began to seem comforting—even, in the case of trains, gently nostalgic. Air travel dropped almost 40 percent in the United States right after the attacks.

Therapists and phobia specialists talk about how our collective “illusion of safety” was temporarily torn away on that day, but a portion of the population has always been afraid to fly. Being lifted 35,000 feet into the air and carried through the sky at 500 miles per hour somehow defies the basic rules of our Earth-bound human physical reality. To see an already intimidating technology twisted into an obscene and unimagined vehicle of death struck a deep, almost inchoate, chord of fear.

Air travel has since rebounded almost to pre-September 11 levels, and the everyday miracle of flying has been reincorporated into most Americans’ mental and emotional geography. But that step could never have been possible without a much larger one that took place a century before the jet age, when a new kind of vehicle changed forever the way Americans could travel. That swift and powerful vehicle was the very one that now appears so reassuringly low-tech and safe: the railway train.

In the mid-nineteenth century, before which humans were never transported any faster than a horse could gallop, trains provoked in many people not only excitement, but a raw fear at least as strong as today’s fear of flying, and for similar reasons. The trepidation became so marked and so common that it acquired its own name—railway neurosis—and, ultimately, its place in history as perhaps the first recognized psychosomatic illness. Many historians credit railway neurosis, and the battles that the diagnosis caused among doctors, with a key role in the development of the field of psychotherapy. The arguments that raged about railway neurosis pointed the way toward the treatment of shell shock in World War I and even toward our understanding of the lingering effects of the trauma of September 11.

Railway neurosis began as a condition called railway spine, which was not considered psychological at all. This condition was first described at length in 1866 by a British surgeon, John Eric Erichsen, who defined it as a physical reaction to being in a train accident, not too unusual an event in the early days of railroading. Erichsen outlined an exhaustive list of symptoms - all, he speculated, caused by “concussion of the spine” and resulting in “chronic inflammation of the spinal membranes and cord.” These included “defective memory; confused thoughts; diminished business aptitude; ill temper; disturbed sleep; a hot head; impaired vision and hearing; perverted taste and smell; impaired sense of touch; attitude changes; gait changes; loss of limb power; numbness; coldness; weight loss; sexual impotence.” Many of these symptoms arose quite a while after an accident, and in victims who did not appear outwardly to be injured—signs, in today’s post-Freudian world, that at least some of those problems might be psychological in origin.

Erichsen himself, even as he insisted that railway spine was corporeal, seemed to hint at the role of the emotional in it, that there was something truly new and different about the interaction between humans and trains. “In no ordinary accident can the shock be so great as in those that occur on railways,” he wrote. “The rapidity of the movement, the momentum of the persons injured, the suddenness of its arrest, the helplessness of the sufferers, and the natural perturbation of the mind that must disturb the bravest are all circumstances that, of necessity, greatly increase the severity resulting to the nervous system.”

The perturbation of the mind induced by train mishaps was indeed natural. Railroads were unlike anything people had experienced before - huge, loud, preternaturally fast, thrilling—and terrifying. So great was their effect on people’s imaginations that H. G. Wells wrote in 1902 that the nineteenth century would “almost certainly have as its symbol a steam engine running upon a railway.” Trains were the ultimate expression of the leap into modern life. The historian Stephen E. Ambrose argued in Nothing Like It in the World, his account of the making of the transcontinental railroad, that people in the second half of the nineteenth century lived through greater societal change than in any generation before or since, and largely because of railroads. The nation shrank precipitously the moment the transcontinental railway was completed, and a journey that had taken several months became, instantly, a seven-day jaunt. But trains also encompassed the dark side of technology and industrialization. When they ran amok, they did so on an uncontrollable and inhuman scale.

The precursor to the train was born at the dawn of the nineteenth century, in 1802, when the high-pressure stationary steam engine was invented. The first railroad engine was made in England in 1804, and, by 1830, the Baltimore and Ohio Railroad’s steam locomotives had attained speeds of 14 miles per hour. On September 15, 1830, the very first fatality on a passenger railway was recorded. An engine of the Liverpool and Manehester Railway ran over a member of Parliament who had come to observe opening-day festivities. The train had no brakes and no whistle; the main problem in those early days was simply moving forward at all, while stopping or warning people was, until then, anyway, an afterthought. A mere two years after that, speeds of 60 miles an hour were being reached on American railways.

In 1840, the United States had 2800 miles of railroad track; by 1872, it had 52,000. With the huge increase in train travel came inevitable mishaps. Figures from 1889 show that, for every 117 trainmen employed in the United States, one was killed, and for every 12, one was injured. When the victims were passengers, the news reports were vivid and graphic. Train accidents, like plane crashes today, killed far fewer people than other disasters of the time. Shipwrecks, construction accidents, and road misfortunes like overturned carriages claimed many more lives, but train wrecks struck people as more deadly and horrific.

A particularly gruesome crash in Rhode Island in April 1873 riveted New Englanders with its images of fiery destruction. A train on the Shore Line approached a washed-out bridge in the middle of the night at full speed and crashed into the opposite riverbank; three coaches smashed together, splintered, and burst into flames, fueled by the train’s coal stoves and oil lamps. The newspapers emphasized the most grotesque details of the accident. ONE MORE HORROR, proclaimed a headline in the New York Herald, above an article describing “victims roasted and crushed to death in the debris.” The engineer and the fireman were “burned to a crisp at their posts,” the paper reported, and a survivor saw “numerous pieces of flesh and bones lying upon the bank of the river.”

Even the more staid New York Times called the accident a “fearful catastrophe” and “a great sacrifice of human life,” including that of a woman who could be identified only by the corset around her waist. The paper told of the agonizing death of a passenger trapped halfway out a window who “was calling wildly, ‘Oh, save me! I am burned to death!’ His screams and moans were not heeded, and death put an end to his sufferings.” Other passengers walked away from the wreck virtually unscathed.

A British magazine writer commented after a local train wreck in 1868 that it was not the number of victims or the horror of the event that had riveted the public, but “its nearness to us all,” for “we are all railway travelers; these trains and collisions, these stations and engines…are not only household words, but part of our daily life.” Readers in New York could easily imagine that they themselves might have been taking the Shore Line train to Providence that fateful night, and also that, had an accident occurred, it might have claimed them and left a fellow passenger uninjured. Freakish tales abounded of the arbitrariness of train disasters in which one railway car was destroyed while another was untouched, or even in which one passenger received not a scratch, while a person across the aisle was killed. One’s death or survival on a train seemed completely random and unpredictable, subject only to some grim technological calculus of mortality.

All these ambient fears and suspicions regarding the marvelous new trains began to coalesce by the 1860s, prompting both a flurry of medical writings on the subject and, eventually, a bunch of lawsuits against railroads alleging that railway spine had resulted. The English medical journal The Lancet published an eight-part report in 1862 on “The Influences of Railway Travelling on Public Health,” emphasizing the “severe mental impression of fright” induced by railway accidents, and the fact that such collisions “exceed in violence any other kind of shock to which human beings are exposed in traveling.” Once Erichsen’s railway-spine thesis became the accepted diagnosis, within a few years, the stage was set for a legal testing of the idea that trains made people sick.

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 experiencing unexplained numbness in various 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 1800s, 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 1870s, 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 before 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 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 1890s, 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 massive-scale opportunity to explore traumatic neurosis, as thousands of emotionally ravaged soldiers returned from the trenches of Europe.

Today, in the aftermath of our most recent national trauma, we have many more psychological tools with which to address the emotional state that is the descendant of railway neurosis: post-traumatic stress disorder. And, in the way of the field of psychology in general, we continue to learn. Many health-care professionals were surprised to find symptoms of PTSD turning up in people (including children) who had been far from ground zero. The events of September 11 also reminded psychologists that we humans possess a powerful mental tool called habituation, a feature that may help explain the disappearance of railway neurosis.

Habituation occurs on a molecular level in the brain, and it is the human animal’s way of adjusting to change in its environment; if we didn’t habituate, we would live in a constant state of anxiety and vigilance. Citizens of the early twentieth century had no choice but to habituate to the overwhelming emotional challenges of modern industrial life, including trains, with their dual capacity to excite and terrify. Similarly, we now accept the reality of armed guards at airports, and most of us have become willing once more to step onto an airplane. The act of flying defies the reality that humans used to know, as does the possibility of destruction by civilian weapons from the sky. But we have learned to adapt and to move on to the next challenge of living in this age.