Neurasthenia

Neurasthenia (from the Ancient Greek νεῦρον neuron "nerve" and ἀσθενής asthenés "weak") is a term that was first used as early as 1829[6] for a mechanical weakness of the nerves. It became a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologist George Miller Beard reintroduced the concept in 1869.[2]

Not to be confused with Asthenia, Chronic fatigue, Fatigue, Lethargy, or Malaise.
Neurasthenia
Pronunciation
  • /ˌnjʊərəsˈθiːniə/ NURE-əs-THEE-nee-ə
SpecialtyPsychiatry, psychology, psychotherapy Edit this on Wikidata
Symptomsfatigue, lethargy, stress-related headache, insomnia, irritability, malaise, restlessness, stress, and weariness[1][2]
Differential diagnosisanxiety, asthenia, chronic fatigue, fatigue, lethargy[3][2][4]
TreatmentElectrotherapy, rest[5]

As a psychopathological term, the first to publish on neurasthenia was Michigan alienist E. H. Van Deusen of the Kalamazoo asylum in 1869.[7] Also in 1868, New York neurologist George Beard used the term in an article published in the Boston Medical and Surgical Journal[1] to denote a condition with symptoms of fatigue, anxiety, headache, heart palpitations, high blood pressure, neuralgia, and depressed mood. Van Deusen associated the condition with farm wives made sick by isolation and a lack of engaging activity; Beard connected the condition to busy society women and overworked businessmen.

Neurasthenia was a diagnosis in the World Health Organization's ICD-10, but deprecated, and thus no more diagnosable, in ICD-11.[2][8] It also is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.[9] The condition is, however, described in the Chinese Society of Psychiatry's Chinese Classification of Mental Disorders.

Americans were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis"[10] (popularized by William James[11]). Another (albeit rarely used) term for neurasthenia is nervosism.[12]

Symptoms

The condition was explained as being a result of exhaustion of the central nervous system's energy reserves, which Beard attributed to modern civilization. Physicians in the Beard school of thought associated neurasthenia with the stresses of urbanization and with stress suffered as a result of the increasingly competitive business environment. Typically, it was associated with upper class people and with professionals working in sedentary occupations, but really can apply to anyone who lives within the monetary system.

Freud included a variety of physical symptoms into this category, including fatigue, dyspepsia with flatulence, and indications of intra-cranial pressure and spinal irritation.[3] In common with some other people of the time, 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 of coitus 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.[13] Eventually he separated it from anxiety 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”.[14] This use was often synonymous with the term “brain fag”.[14]

Diagnosis

From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms as weakness, dizziness and fainting. A common treatment promoted by neurologist S. Weir Mitchell was the rest 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 book On Being Ill. Charlotte Perkins Gilman's protagonist in The Yellow Wallpaper also suffers under the auspices of rest cure doctors, much as Gilman herself did. Marcel Proust was said to suffer from neurasthenia.[15] To capitalize on this epidemic, the Rexall drug company introduced a medication called 'Americanitis Elixir' which claimed to be a soother for any bouts related to neurasthenia.

Treatment

Beard, with his partner A.D. Rockwell, advocated first electrotherapy 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 the scientific 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."[16]

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."[13]

Nevertheless, neurasthenia was a common diagnosis during World War I for "shell shock",[17] but its use declined a decade later. Soldiers who deserted their post could be executed even if they had a medical excuse, but officers who had neurasthenia were not executed.[18]

Modern diagnosis

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 the ICD-11 classification system of the World Health Organization.[19][2][20]

The earlier ICD-10 system categorized neurasthenia under "F48 – Other neurotic disorders".[21] 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 and fatigue (R53), postviral fatigue syndrome (includes Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)) (G93.3)[22] and psychasthenia (F48.8).[4]

One modern theory of neurasthenia is that it was actually dysautonomia, an "imbalance" of the autonomic nervous system.[23]

Barbara Ehrenreich, restating James's view, considered that neurasthenia was caused by the Calvinist gloom,[24] and it was helped by the New Thought, through replacing the "puritanical 'demand for perpetual effort and self-examination to the point of self-loathing'"[24] with a more hopeful faith.[24][25]

In Asia

The medical term neurasthenia is translated as Chinese shenjing shuairuo (simplified Chinese: 神经衰弱; traditional Chinese: 神經衰弱; pinyin: shénjīng shuāiruò; Cantonese Yale: sàhngīng sēuiyeuhk) or Japanese shinkei-suijaku (神経衰弱), both of which also translate the common term nervous breakdown. This loanword combines shenjing (神經) or shinkei (神経) "nerve(s); nervous" and shuairuo or suijaku (衰弱) "weakness; feebleness; debility; asthenia".

Despite being removed from the American Psychiatric Association's DSM in 1980, neurasthenia is listed in an appendix as the culture-bound syndrome shenjing shuairuo as well as appearing in the ICD-10. The condition is thought to persist in Asia as a culturally acceptable diagnosis that avoids the social stigma of a diagnosis of mental disorder.

In Japan, shinkei-suijaku is treated with Morita 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 as schizophrenia and mood disorders.[26][27]

In China, traditional Chinese medicine describes shenjingshuairuo as a depletion of qi "vital energy" and reduction of functioning in the wuzang "five internal organs" (heart, liver, spleen, lungs, kidneys). The modern CCMD 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.[26] 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]

See also

References
  1. Beard, G (1869). "Neurasthenia, or nervous exhaustion". The Boston Medical and Surgical Journal. 80 (13): 217–221. doi:10.1056/NEJM186904290801301.
  2. Connor, Henry (2022-10-20). "Doctors and 'Educational Overpressure' in Nineteenth-Century Britain: A Fatigue State that Divided Medical Opinion". European Journal for the History of Medicine and Health. -1 (aop): 1–36. doi:10.1163/26667711-bja10026. ISSN 2666-7703.
  3. Sandler, Joseph; Holder, Alex; Dare, Christopher; Dreher, Anna Ursula (1997). Freud's Models of the Mind. Karnac Books. p. 52. ISBN 978-1-85575-167-5.
  4. WHO. "ICD-10 Version:2019". Retrieved November 26, 2022.
  5. Taylor, Ruth E. (December 2001). "Death of neurasthenia and its psychological reincarnation: A study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870–1932". British Journal of Psychiatry. 179 (6): 550–557. doi:10.1192/bjp.179.6.550. PMID 11731361.
  6. Good, John Mason (1829). The study of medicine. New York: Harper and Brothers. pp. (ed. 3) IV. 370.
  7. Van Deusen, E. H. (April 1869). "Observations on a form of nervous prostration, (neurasthenia) culminating in insanity". American Journal of Insanity. 25 (4): 445–461. doi:10.1176/ajp.25.4.445.
  8. World Health Organization. "ICD-11 for Mortality and Morbidity Statistics". Retrieved 2023-04-24.
  9. Dimsdale, Joel E.; Xin, Yu; Kleinman, Arthur; Patel, Vikram; Narrow, William E.; Sirovatka, Paul J.; Regier, Darrel A. (2 March 2009). Somatic Presentations of Mental Disorders: Refining the Research Agenda for DSM-V. American Psychiatric Pub. p. 58. ISBN 978-0-89042-656-2.
  10. Marcus, G (1998-01-26). "One Step Back; Where Are the Elixirs of Yesteryear When We Hurt?". The New York Times. Retrieved 2008-09-11.
  11. Daugherty, Greg (25 March 2015). "The Brief History of "Americanitis"". Smithsonian. Retrieved 6 April 2015.
  12. "Nervosism - Biology-Online Dictionary - Biology-Online Dictionary". www.biology-online.org. December 2020.
  13. Erwin, Edward (2002). The Freud Encyclopedia: Theory, Therapy, and Culture. Taylor & Francis. p. 362. ISBN 978-0-415-93677-4.
  14. Ayonrinde, Oyedeji A. (2020-06-26). "'Brain fag': a syndrome associated with 'overstudy' and mental exhaustion in 19th century Britain". International Review of Psychiatry. 32 (5–6): 520–535. doi:10.1080/09540261.2020.1775428. ISSN 0954-0261. PMID 32589474.
  15. Bogousslavsky, Julien (2007). "Marcel Proust's Diseases and Doctors: The Neurological Story of a Life". Neurological Disorders in Famous Artists - Part 2. Frontiers of Neurology and Neuroscience. Vol. 22. Basel: KARGER. pp. 89–104. doi:10.1159/000102874. ISBN 978-3-8055-8265-0. PMID 17495507.
  16. Townsend, Kim (1996). Manhood at Harvard: William James and others. New York: W.W. Norton. ISBN 978-0-393-03939-9.
  17. Jack W. Tsao (15 February 2010). Traumatic Brain Injury: A Clinician's Guide to Diagnosis, Management, and Rehabilitation. Springer Science & Business Media. p. 104. ISBN 978-0-387-87887-4.
  18. "World War One executions", History Learning Site. Retrieved November 28, 2013.
  19. Evangard B; Schacterie R.S.; Komaroff A. L. (Nov 1999). "Chronic fatigue syndrome: new insights and old ignorance". Journal of Internal Medicine. 246 (5): 455–469. doi:10.1046/j.1365-2796.1999.00513.x. PMID 10583715.
  20. World Health Organization. "ICD-11". Retrieved 2023-04-24.
  21. WHO (2007). "Chapter V Mental and behavioural disorders (F00-F99)". Retrieved 2009-10-09.
  22. Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Center Director, Data Policy and Standards (March 2001). "A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases" (PDF). Centers for disease Control. Archived from the original (PDF) on June 11, 2014. Retrieved November 26, 2022.
  23. Fogoros, R (29 May 2006). "A family of misunderstood disorders". About.com. Retrieved 11 September 2008.
  24. Jenni Murray, Smile or Die: How Positive Thinking Fooled America and the World by Barbara Ehrenreich. Jenni Murray salutes a long-overdue demolition of the suggestion that positive thinking is the answer to all our problems. The Observer, 10 January 2010 at guardian.co.uk.
  25. Ehrenreich, Barbara (2009). "Three. The Dark Roots of American Optimism". Bright-sided. How the relentless promotion of positive thinking has undermined America. New York: Metropolitan Books, Henry Holt and Company, LLC. p. 87. ISBN 978-0-8050-8749-9. 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."
  26. Schwartz, Pamela Yew (September 2002). "Why is neurasthenia important in Asian cultures?". West. J. Med. 176 (4): 257–8. PMC 1071745. PMID 12208833.
  27. Lin, Tsung-Yi (June 1989). "Neurasthenia revisited: Its place in modern psychiatry". Culture, Medicine and Psychiatry. 13 (2): 105–129. doi:10.1007/BF02220656. PMID 2766788. S2CID 28936419.
  28. Kleinman, Arthur (1986), Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China, Yale University Press, p. 115.

Further reading
  • Brown, EM (1980). "An American Treatment for the 'American Nervousness'". American Association of the History of Medicine. Archived from the original on 2008-09-07. Retrieved 2008-09-11.
  • Gijswijt-Hofstra, Marijke (2001). Cultures of Neurasthenia: From Beard to the First World War (Clio Medica 63) (Clio Medica). Rodopi Bv Editions. ISBN 978-90-420-0931-8.
  • Gosling, F. G. Before Freud: Neurasthenia and the American Medical Community, 1870-1910. Urbana: University of Illinois Press, 1987.
  • Weir Mitchell, S (1884). Fat and Blood: an essay on the treatment of certain types of Neurasthenia and hysteria. Philadelphia: J. D. Lippincott & Co. Retrieved 2008-09-11.
  • Farmer A, Jones I, Hillier J, Llewelyn M, Borysiewicz L, Smith A (October 1995). "Neuraesthenia revisited: ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects". Br J Psychiatry. 167 (4): 503–6. doi:10.1192/bjp.167.4.503. PMID 8829720. S2CID 45684552.
  • Schuster, David G. Neurasthenic Nation: America's Search for Health, Comfort, and Happiness, 1869-1920. New Brunswick, NJ: Rutgers University Press, 2011.
  • Lutz, Tom. American Nervousness, 1903. Ithaca, NY: Cornell University Press, 1991.
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