Men among the leading families carried heavy burdens, whether in business, government, or their social obligations. They were responsible for the well being of their families and for society as a whole. The constant mental demands as well as the physical labor of fulfilling their responsibilities depleted their nerve energy.
Worse, the fast pace of modern life and constant hustle of city life drained their nervous energy. Most elite families lived in major cities and therefore faced the noise, dirt, and constant jostling of cities, plus the hectic pace of modern life.
A list of prominent American men treated for neurasthenia would cover leaders in all areas of professional and artistic life. No leading family was untouched. Examples are:
Theodore Roosevelt, later Assistant Secretary of the Navy, leader of the Rough Riders in the Spanish American War, Vice President and then President of the United States, explorer and naturalist.
The James Family of New York City:
Women in leading families faced most of the same modern, urban environment as men. They were not usually leaders in government and business, but they had demanding social responsibilities and were often involved in the arts. Most important, however, they were responsible for the health, education, and moral development of their children, plus the running of their large households and assuring the wellbeing of everyone attached to it (including servants).
Women were, according to medical opinion of the time, constitutionally weaker and more prone to nervous problems than men were. Therefore, the demands of their lives made them especially susceptible to the headaches, poor indigestion, depression, and anxiety that were the hallmarks of neurasthenia (nervous exhaustion). Also, because their reproductive systems made heavy demands on their bodies, they had a harder time replenishing their nervous energy than men did.
Neurasthenia is often remembered incorrectly as primarily a woman's disease because so many American women were treated for it. Examples of prominent American women are: