| Neurasthenia | |
|---|---|
| Classification and external resources | |
| ICD-10 | F48.0 |
| ICD-9 | 300.5 |
| MeSH | D009440 |
Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869[1] to denote a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood. 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 (and in the Chinese Classification of Mental Disorders, 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.
Americans were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis"[2] (popularized by William James). Today, the condition is still commonly diagnosed in Asia.
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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.
Freud included a variety of physical symptoms in 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] Eventually he separated it from anxiety neurosis, though he believed that a combination of the two conditions coexisted in many cases.[3]
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, and was quoted as saying, "I take it that no man is educated who has never dallied with the thought of suicide."[4]
From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms as weakness, dizziness 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.[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 like Gilman herself. Marcel Proust 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.
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."
Nevertheless, neurasthenia was a common diagnosis during World War I, but its use declined a decade later.
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.[6] The ICD-10 system of the World Health Organization categorizes neurasthenia under "F48 - Other neurotic disorders".[7]
One contemporary opinion of neurasthenia is that it was actually dysautonomia, an "imbalance" of the autonomic nervous system.[8]
Barbara Ehrenreich considers that neurasthenia was caused by the Calvinist gloom,[9] and it was healed by the New Thought, through replacing the "puritanical 'demand for perpetual effort and self-examination to the point of self-loathing'"[9] with a more hopeful faith.[9]
Despite being omitted by the American Psychiatric Association's DSM in 1980, neurasthenia is listed in an appendix as the culture-bound syndrome shenjing shuairuo [神经衰弱] 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 the condition is known as shinkeisuijaku, which translates as "nervousness or nervous disposition", and 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 as a disguise for serious mental illnesses such as schizophrenia and mood disorders.[10] In China 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" 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.[10]
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