The Medical-Historical Context: Asthma and Neurasthenia 

Throughout his distinguished career, Professor Adrien Proust made significant contributions to the field of medicine by editing seventeen handbooks on various medical topics, each providing practical guidelines for healthcare professionals. 

In 1896, a notable publication within this series was Dr. Edouard Brissaud’s book “L’hygiène des asthmatiques” (The Hygiene of Asthmatics). Professor Adrien Proust penned the foreword for this book, lending his expertise and credibility to the work. 

Dr. Brissaud, a respected figure in the medical community, asserted in his book that asthma was a consequence of neurosis, a belief prevalent at the time. He further stated that there was no definitive cure or treatment for asthma, although he acknowledged that it was rarely fatal. 

Around the time of the book’s publication, Marcel, likely on his father’s recommendation, sought consultation from Dr. Brissaud⁷. Their correspondence reveals that Marcel had not only carefully read the book but had studied it multiple times. 

While Dr. Brissaud’s work was considered authoritative in its time, modern medical understanding recognizes that it contained significant inaccuracies. However, the combined authority of Dr. Brissaud and Professor Adrien Proust elevated this book to the status of cutting-edge knowledge on asthma, especially in the eyes of Marcel, who held his father’s expertise in high regard. 

Despite its authoritative status, Dr. Brissaud’s book offered little in terms of practical help, hope, or encouragement for Marcel’s asthma. Instead, it may have even had a detrimental impact on his mindset. Marcel himself wrote, “And now I have just read in Brissaud that each attack that we thus bring on ourselves upsets something or other in the organism and hastens the final moment⁸’. 

We emphasize the phrase means “what you bring upon yourself.” Marcel’s repeated readings of the book and the terrifying description of the deterioration process left a profound impression on him. Let’s delve into this chilling passage: 

“When asthma attacks occur in rapid succession, without remission, without rest, for days, weeks, months, nervous resistance is exhausted; the effort is too great, especially too prolonged for the patient’s energy, measured in advance, to suffice. […] Asthma also seems, in truth, to choose a few victims to make them pay for the invulnerability of others. Neurosis then ceases to be protective. It undermines the organism so deeply, it redoubles its blows so mercilessly, that even the most robust succumb to it; at least, if they do not die, they are reduced to a state of such physiological misery that only the material and destructive lesions of anatomical elements can produce a similar one. […] it is the asthmatics of this fortunately rare species that cachexia threatens more especially. It sets in gradually, takes hold of them slowly, emaciates them, weakens them, deprives them of all moral resilience; they give up, stop eating, no longer sleep; anasarca infiltrates them, their myocardium dilates, the bases of their lungs become congested, their extremities turn cyanotic, cool down, and they die’⁹. 

In essence, this book quote tells the reader that if you belong to those unfortunate souls who fall prey to asthma, nothing can protect you, and you are condemned to a prolonged and slow process of decline, where your body and mind gradually die until death releases you. 

Moreover, Dr Brissaud writes in the same book: 

“In many respects, patients know what is good and what is bad for them. He has an experience that is at least as good as ours, and before which we should wisely bow”. 

To the attentive reader that Proust certainly was, that reads as: do what you think best for yourself, or more sharply: you are on your own. And Marcel will do just that. He consults everyone but listens to no one but to himself. 

Despite consulting with Dr. Brissaud regularly until 1905, Marcel Proust’s correspondence reveals a somewhat low opinion of the esteemed professor. He writes in a letter to his friend Countess de Noailles: “I went that day to see our dear ‘Médecin malgré lui’, the one you almost have to beat to make him talk medicine, Brissaud, more handsome and charming than ever.¹⁰.” 

In 1897, Professor Proust and his colleague Dr. Gilbert Ballet published the book “L’Hygiène du neurasthénique” (The Hygiene of the Neurasthenic) within the same series. They defined neurasthenia as “a lasting weakening of nervous strength, therefore a neurosis, that is, a disease of the nervous system without known organic lesion.” The authors asserted that neurasthenia primarily affected men from higher social circles who indulged in a hectic lifestyle, cramming their time with various “unhygienic” activities such as social outings, frequenting theaters, elaborate dinners, flitting from one soirée to another, and so on. They neglected to take the time to recuperate at home from all this hustle and bustle. In essence, the afflicted were those who could afford to live without working for a living and dedicated themselves solely to cerebral pursuits. According to the learned doctors, neurasthenia was hardly seen among laborers. 

In their detailed description of various symptoms, complaints, and their triggering factors, it seems as if Dr. Proust was providing a case study of his own son, as noted by William C. Carter¹¹. 

The combined perspectives presented in Dr. Brissaud’s and Professor Proust and Dr. Ballet’s books suggest that asthma was perceived as a purely psychological issue stemming from neurasthenia (weakness of will). They maintained that there was no organic basis for the condition and, consequently, the prognosis was poor. 

It is plausible to consider that the combination of these beliefs, coupled with Marcel’s personal experiences with asthma and the lack of effective treatment options, could have contributed to his eventual loss of trust in conventional medicine. This may have led him to seek alternative approaches, including self-medication, even if these did not provide significant relief.