| Neurasthenia | |
|---|---|
| Pronunciation | |
| Specialty | Psychiatry,psychology,psychotherapy  |
| Symptoms | fatigue,lethargy, stress-relatedheadache,insomnia,irritability,malaise,restlessness,stress, andweariness[1][2] |
| Differential diagnosis | anxiety,asthenia,chronic fatigue,fatigue,lethargy[3][2][4] |
| Treatment | Electrotherapy,rest[5] |
Neurasthenia (from Ancient Greek νεῦρον (neuron) 'nerve' andἀσθενής (asthenés) 'weak') is a term that was first used as early as 1829[6] for a mechanical weakness of thenerves.[clarification needed] It became a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologistGeorge Miller Beard reintroduced the concept in 1869.[2]
As apsychopathological term, the first to publish on neurasthenia was Michiganalienist E. H. Van Deusen of theKalamazoo asylum in 1869.[7] Also in 1868, New York neurologist George Beard used the term in an article published in theBoston Medical and Surgical Journal[1] to denote a condition with symptoms offatigue,anxiety,headache,heart palpitations,high blood pressure,neuralgia, anddepressed mood. Van Deusen associated the condition with farm wives made sick by isolation and a lack of engaging activity; Beard connected the condition to busysociety women and overworked businessmen.
Neurasthenia was a diagnosis in theWorld Health Organization'sICD-10, but deprecated, and thus no more diagnosable, inICD-11.[2][8] It also is no longer included as a diagnosis in theAmerican Psychiatric Association'sDiagnostic and Statistical Manual of Mental Disorders.[9] The condition is, however, described in theChinese Society of Psychiatry'sChinese Classification of Mental Disorders.
Americans were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis"[10] (popularized byWilliam James[11]). Another (albeit rarely used) term for neurasthenia isnervosism.[12]
The condition was explained as being a result of exhaustion of thecentral nervous system's energy reserves, which Beard attributed to modern civilization. Physicians in the Beard school of thought associated neurasthenia with the stresses ofurbanization and with stress suffered as a result of the increasingly competitive business environment. Typically, it was associated withupper class people and withprofessionals working in sedentary occupations, but really can apply to anyone who lives within themonetary system.
Freud included a variety of physical symptoms into this category, including fatigue,dyspepsia withflatulence, and indications ofintra-cranial pressure and spinal irritation.[3] In common with some other people of the time[who?], he believed this condition to be due to "non-completed coitus" or the non-completion of the higher cultural correlate thereof, or to "infrequency of emissions" or the infrequent practice of the higher cultural correlate thereof.[3] Later, Freud formulated that in cases ofcoitus interruptus as well as in cases of masturbation, there was "an insufficient libidinal discharge" that had a poisoning effect on the organism, in other words, neurasthenia was the result of (auto‑)intoxication.[14] Eventually he separated it fromanxiety neurosis, though he believed that a combination of the two conditions existed in many cases.[3]
In 19th-century Britain and, by extension, across the British Empire, neurasthenia was also used to describe mental exhaustion or fatigue in “brain workers” or in the context of “overstudy”.[15] This use was often synonymous with the term “brain fag”.[15]
From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms asweakness,dizziness andfainting. A common treatment promoted by neurologist S. Weir Mitchell was therest cure, especially for women. Data from this period gleaned from the Annual Reports of Queen Square Hospital, London, indicates that the diagnosis was balanced between the sexes and had a presence within Europe.[5]Virginia Woolf was known to have been forced to have rest cures, which she describes in her bookOn Being Ill.Charlotte Perkins Gilman's protagonist inThe Yellow Wallpaper also suffers under the auspices of rest cure doctors, much as Gilman herself did.Marcel Proust was said to suffer from neurasthenia.[16] To capitalize on this epidemic, theRexall drug company introduced a medication called "Americanitis Elixir" which claimed to be a soother for any bouts related to neurasthenia.
Beard, with his partnerA.D. Rockwell, advocated firstelectrotherapy and then increasingly experimental treatments for people with neurasthenia, a position that was controversial. An 1868 review posited that Beard's and Rockwell's knowledge of thescientific method was suspect and did not believe their claims to be warranted.
William James was diagnosed with neurasthenia, which he nicknamed "Americanitis", and was quoted as saying, "I take it that no man is educated who has never dallied with the thought of suicide."[17]
In 1895,Sigmund Freud reviewed electrotherapy and declared it a "pretense treatment". He emphasized the example of Elizabeth von R's note that "the stronger these were the more they seemed to push her own pains into the background."[14]
Nevertheless, neurasthenia was a common diagnosis duringWorld War I for "shell shock",[18] but its use declined a decade later.[citation needed] Soldiers who deserted their post could be executed even if they had a medical excuse, but officers who had neurasthenia were not executed.[19]
This diagnosis remained popular well into the 20th century, eventually coming to be seen as a mental and behavioural rather than physical condition. Neurasthenia had largely been abandoned as a medical diagnosis by the 21st century, and is deprecated in theICD-11 classification system of theWorld Health Organization.[20][2][21]
The earlierICD-10 system categorized neurasthenia under "F48 – Other neurotic disorders".[22] Under "F48.0 Neurasthenia", the characteristics of the disorder differ among various cultures. Two overlapping symptoms can be present: Increased fatigue after mental exertion can be associated with a reduction in cognitive function. Minimal physical effort might be felt as extreme fatigue along with pain and anxiety. Many other symptoms of bodily discomfort may be felt with either form. Excluded from this disorder are:asthenia NOS (R53),burn-out (Z73.0),malaise andfatigue (R53),postviral fatigue syndrome (includesmyalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)) (G93.3)[23] andpsychasthenia (F48.8).[4]
One modern theory of neurasthenia is that it was actuallydysautonomia, an "imbalance" of theautonomic nervous system.[24][failed verification]
Barbara Ehrenreich, restating James's view, considered that neurasthenia was caused by theCalvinist gloom,[25] and it was helped by theNew Thought, through replacing the "puritanical 'demand for perpetual effort and self-examination to the point of self-loathing'"[25] with a more hopeful faith.[25][26]
The medical termneurasthenia is translated as Chineseshenjing shuairuo (simplified Chinese:神经衰弱;traditional Chinese:神經衰弱;pinyin:shénjīng shuāiruò;Cantonese Yale:sàhngīng sēuiyeuhk) or Japaneseshinkei-suijaku (神経衰弱), both of which also translate the common termnervous breakdown. This loanword combinesshenjing (神經) orshinkei (神経) "nerve(s); nervous" andshuairuo orsuijaku (衰弱) "weakness; feebleness; debility;asthenia".
Despite being removed from theAmerican Psychiatric Association'sDSM in 1980, neurasthenia is listed in an appendix as theculture-bound syndromeshenjing shuairuo as well as appearing in theICD-10. The condition is thought to persist inAsia as a culturally acceptable diagnosis that avoids thesocial stigma of a diagnosis ofmental disorder.
InChina,traditional Chinese medicine describesshenjingshuairuo as a depletion ofqi "vital energy" and reduction of functioning in thewuzang "five internal organs" (heart, liver, spleen, lungs, kidneys). The modernCCMD classifies it as a persistent mental disorder diagnosed with three of these five symptoms: "'weakness' symptoms, 'emotional' symptoms, excitement' symptoms, tension-induced pain, and sleep disturbances" not caused by other conditions.[27]Arthur Kleinman described Chinese neurasthenia as a "biculturally patterned illness experience (a special form of somatization), related to depression or other diseases or to culturally sanctioned idioms of distress and psychosocial coping."[28]
InJapan,shinkei-suijaku is treated withMorita therapy involving mandatory rest and isolation, followed by progressively more difficult work, and a resumption of a previous social role. The diagnosis is sometimes used to disguise serious mental illnesses such asschizophrenia andmood disorders.[29][30]
New Thought had won its great practical victory. It had healed a disease—the disease of Calvinism, or, as James put it, the "morbidness" associated with "the old hell-fire theology."
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