Neurasthenia

Neurasthenia

Discussion
Ask a question about 'Neurasthenia'
Start a new discussion about 'Neurasthenia'
Answer questions from other users
Full Discussion Forum
 
Encyclopedia
Neurasthenia is a psycho-pathological term first used by George Miller Beard
George Miller Beard
George Miller Beard was a U.S. neurologist who popularized the term neurasthenia, starting around 1869.-Biography:...

 in 1869 to denote a condition with symptoms of fatigue
Fatigue (physical)
Fatigue is a state of awareness describing a range of afflictions, usually associated with physical and/or mental weakness, though varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles...

, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

, neuralgia
Neuralgia
Neuralgia is pain in one or more nerves that occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central...

 and depressed mood
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

. The term had been used at least as early as 1829 to label a mechanical weakness of the actual nerves, rather than the more metaphorical "nerves" referred to by Beard in 1869.

Neurasthenia is currently a diagnosis in the World Health Organization's International Classification of Diseases
ICD
The International Statistical Classification of Diseases and Related Health Problems is a medical classification that provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease...

 (and in the Chinese Classification of Mental Disorders
Chinese Classification of Mental Disorders
The Chinese Classification of Mental Disorders , published by the Chinese Society of Psychiatry , is a clinical guide used in China for the diagnosis of mental disorders. It is currently on a third version, the CCMD-3, written in Chinese and English...

, translated as 神经衰弱). However, it is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

.

Americans were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis" (popularized by William James
William James
William James was a pioneering American psychologist and philosopher who was trained as a physician. He wrote influential books on the young science of psychology, educational psychology, psychology of religious experience and mysticism, and on the philosophy of pragmatism...

). Today, the condition is still commonly diagnosed in Asia.

Symptoms


The condition was explained as being a result of exhaustion of the central nervous system
Central nervous system
The central nervous system is the part of the nervous system that integrates the information that it receives from, and coordinates the activity of, all parts of the bodies of bilaterian animals—that is, all multicellular animals except sponges and radially symmetric animals such as jellyfish...

's energy reserves, which Beard attributed to modern civilization. Physicians in the Beard school of thought associated neurasthenia with the stresses of urbanization
Urbanization
Urbanization, urbanisation or urban drift is the physical growth of urban areas as a result of global change. The United Nations projected that half of the world's population would live in urban areas at the end of 2008....

 and with stress suffered as a result of the increasingly competitive business environment. Typically, it was associated with upper class
Upper class
In social science, the "upper class" is the group of people at the top of a social hierarchy. Members of an upper class may have great power over the allocation of resources and governmental policy in their area.- Historical meaning :...

 people and with professional
Professional
A professional is a person who is paid to undertake a specialised set of tasks and to complete them for a fee. The traditional professions were doctors, lawyers, clergymen, and commissioned military officers. Today, the term is applied to estate agents, surveyors , environmental scientists,...

s working in sedentary occupations.

Freud included a variety of physical symptoms in this category, including fatigue, dyspepsia
Dyspepsia
Dyspepsia , also known as upset stomach or indigestion, refers to a condition of impaired digestion. It is a medical condition characterized by chronic or recurrent pain in the upper abdomen, upper abdominal fullness and feeling full earlier than expected when eating...

 with flatulence
Flatulence
Flatulence is the expulsion through the rectum of a mixture of gases that are byproducts of the digestion process of mammals and other animals. The medical term for the mixture of gases is flatus, informally known as a fart, or simply gas...

, and indications of intra-cranial pressure and spinal irritation. 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. Eventually he separated it from anxiety neurosis, though he believed that a combination of the two conditions coexisted in many cases.

Treatment


Beard, with his partner A.D. Rockwell, advocated first electrotherapy
Electrotherapy
Electrotherapy is the use of electrical energy as a medical treatment In medicine, the term electrotherapy can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological disease. The term has also been applied specifically to the use of...

 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
Scientific method
Scientific method refers to a body of techniques for investigating phenomena, acquiring new knowledge, or correcting and integrating previous knowledge. To be termed scientific, a method of inquiry must be based on gathering empirical and measurable evidence subject to specific principles of...

 was suspect and did not believe their claims to be warranted.

William James was diagnosed with neurasthenia, and was quoted as saying, "I take it that no man is educated who has never dallied with the thought of suicide."

Diagnosis


From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms as weakness, dizziness
Dizziness
Dizziness refers to an impairment in spatial perception and stability. The term is somewhat imprecise. It can be used to mean vertigo, presyncope, disequilibrium, or a non-specific feeling such as giddiness or foolishness....

 and fainting, and a common treatment was the rest cure, especially for women, who were the gender primarily diagnosed with this condition at that time. Recent analysis, however, of data from this period gleaned from the Annual Reports of Queen Square Hospital, London, indicates that the diagnosis was more evenly balanced between the sexes than is commonly thought. Virginia Woolf
Virginia Woolf
Adeline Virginia Woolf was an English author, essayist, publisher, and writer of short stories, regarded as one of the foremost modernist literary figures of the twentieth century....

 was known to have been forced to have rest cures, which she describes in her book On Being Ill
On Being Ill
On Being Ill is an essay by Virginia Woolf that appeared in T. S. Eliot's The Criterion in January, 1926; The essay was later reprinted, with revisions, in Forum in April 1926, under the title Illness: An Unexploited Mine....

. Charlotte Perkins Gilman
Charlotte Perkins Gilman
Charlotte Perkins Gilman was a prominent American sociologist, novelist, writer of short stories, poetry, and nonfiction, and a lecturer for social reform...

's protagonist in The Yellow Wallpaper
The Yellow Wallpaper
"The Yellow Wallpaper" is a short story by the American writer Charlotte Perkins Gilman, first published in January 1892 in The New England Magazine. It is regarded as an important early work of American feminist literature, illustrating attitudes in the nineteenth century toward women's physical...

also suffers under the auspices of rest cure doctors, much like Gilman herself. Marcel Proust
Marcel Proust
Valentin Louis Georges Eugène Marcel Proust was a French novelist, critic, and essayist best known for his monumental À la recherche du temps perdu...

 was said to suffer from neurasthenia. 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.

Controversy


In 1895, Sigmund Freud
Sigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...

 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."

Nevertheless, neurasthenia was a common diagnosis during World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...

, but its use declined a decade later.

Contemporary opinion


This concept remained popular well into the 20th century, eventually coming to be seen as a behavioural rather than physical condition, with a diagnosis that excluded postviral syndromes. Neurasthenia has largely been abandoned as a medical diagnosis. The ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

 system of the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

 categorizes neurasthenia under "F48 - Other neurotic disorders".

One contemporary opinion of neurasthenia is that it was actually dysautonomia
Dysautonomia
Dysautonomia is a broad term that describes any disease or malfunction of the autonomic nervous system. This includes postural orthostatic tachycardia syndrome , inappropriate sinus tachycardia , vasovagal syncope, mitral valve prolapse dysautonomia, pure autonomic failure, neurocardiogenic...

, an "imbalance" of the autonomic nervous system
Autonomic nervous system
The autonomic nervous system is the part of the peripheral nervous system that acts as a control system functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiration rate, salivation, perspiration, diameter of the pupils,...

.

Barbara Ehrenreich
Barbara Ehrenreich
-Early life:Ehrenreich was born Barbara Alexander to Isabelle Oxley and Ben Howes Alexander in Butte, Montana, which she describes as then being "a bustling, brawling, blue collar mining town."...

 considers that neurasthenia was caused by the Calvinist gloom, and it was healed by the New Thought
New Thought
New Thought promotes the ideas that "Infinite Intelligence" or "God" is ubiquitous, spirit is the totality of real things, true human selfhood is divine, divine thought is a force for good, sickness originates in the mind, and "right thinking" has a healing effect.Although New Thought is neither...

, through replacing the "puritanical 'demand for perpetual effort and self-examination to the point of self-loathing'" with a more hopeful faith.

In Asia


Despite being omitted by the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

's DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

 in 1980, neurasthenia is listed in an appendix as the culture-bound syndrome
Culture-bound syndrome
In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture...

 shenjing shuairuo [神经衰弱] as well as appearing in the ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

. The condition is thought to persist in Asia
Asia
Asia is the world's largest and most populous continent, located primarily in the eastern and northern hemispheres. It covers 8.7% of the Earth's total surface area and with approximately 3.879 billion people, it hosts 60% of the world's current human population...

 as a culturally acceptable diagnosis that avoids the social stigma
Social stigma
Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...

 of a diagnosis of mental disorder. In Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...

 the condition is known as shinkeisuijaku, which translates as "nervousness or nervous disposition", and is treated with Morita therapy
Morita therapy
Morita Therapy is a purpose-centered, response oriented therapy from Japan, created in the 1930s by Dr. Shoma Morita.-Background:Dr Shoma Morita was a psychiatrist and department chair at Jikei University School of Medicine in Tokyo...

 involving mandatory rest and isolation followed by progressively more difficult work and a resumption of a previous social role. The diagnosis is sometimes used as a disguise for serious mental illnesses such as schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 and mood disorder
Mood disorder
Mood disorder is the term designating a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders classification system where a disturbance in the person's mood is hypothesized to be the main underlying feature...

s. In China
China
Chinese civilization may refer to:* China for more general discussion of the country.* Chinese culture* Greater China, the transnational community of ethnic Chinese.* History of China* Sinosphere, the area historically affected by Chinese culture...

 the condition is known as shenjingshuairuo (the Japanese term shinkeisuijaku is written with the same kanji characters), translated as "weakness of nerves", and is believed caused by a depletion of "qi
Qi
In traditional Chinese culture, qì is an active principle forming part of any living thing. Qi is frequently translated as life energy, lifeforce, or energy flow. Qi is the central underlying principle in traditional Chinese medicine and martial arts...

" and is classified as a mental disorder diagnosed with three of five "'weakness' symptoms, 'emotional' symptoms, 'excitement' symptoms, tension-induced pain, and sleep disturbances" not caused by other conditions.

Further reading

  • Gosling, F. G. Before Freud: Neurasthenia and the American Medical Community, 1870-1910. Urbana: University of Illinois Press, 1987.