Neurasthenia

Template:Infobox medical condition (new) Neurasthenia (Template:Etymology and Template:Lang (Template:Transliteration) 'weak') is a term that was first used as early as 1829<ref>Template:Cite book</ref> for a mechanical weakness of the nerves.Template:Clarify 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.<ref name="Connor2022"/>

As a psychopathological term, the first to publish on neurasthenia was Michigan alienist E. H. Van Deusen of the Kalamazoo asylum in 1869.<ref>Template:Cite journal</ref> Also in 1868, New York neurologist George Beard used the term in an article published in the Boston Medical and Surgical Journal<ref name="Miller1869">Template:Cite journal</ref> 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.<ref name="Connor2022">Template:Cite journal</ref><ref>Template:Cite web</ref> It also is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.<ref name="DimsdaleXin2009">Template:Cite book</ref> 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"<ref>Template:Cite news</ref> (popularized by William James<ref>Template:Cite news</ref>). Another (albeit rarely used) term for neurasthenia is nervosism.<ref>Template:Cite web</ref>

Symptoms

According to a 1922 osteopath, the Venus de Milo was "neurasthenic as her stomach was not in the proper position".<ref>Template:Cite news</ref>

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.<ref name="Models">Template:Cite book</ref> In common with some other people of the timeTemplate: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.<ref name="Models" /> 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 (autoTemplate:Nbh)intoxication.<ref name="Freud">Template:Cite book</ref> Eventually he separated it from anxiety neurosis, though he believed that a combination of the two conditions existed in many cases.<ref name="Models" />

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”.<ref name="Ayonrinde-2020">Template:Cite journal</ref> This use was often synonymous with the term “brain fag”.<ref name="Ayonrinde-2020" />

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.<ref name="Taylor2001">Template:Cite journal</ref> 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.<ref name="Bogousslavsky 2007 pp. 89–104">Template:Cite book</ref> 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."<ref>Template:Cite book</ref>

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."<ref name="Freud"/>

Nevertheless, neurasthenia was a common diagnosis during World War I for "shell shock",<ref name="Tsao2010">Template:Cite book</ref> but its use declined a decade later.Template: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.<ref>"World War One executions", History Learning Site. Retrieved November 28, 2013.</ref>

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.<ref name="pmid 10583715">Template:Cite journal</ref><ref name="Connor2022"/><ref>Template:Cite web</ref>

The earlier ICD-10 system categorized neurasthenia under "F48 – Other neurotic disorders".<ref name="Who Neurasthenia">Template:Cite web</ref> 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)<ref name="CDC_Class">Template:Cite web</ref> and psychasthenia (F48.8).<ref name="ICD_10_raw">Template:Cite web</ref>

One modern theory of neurasthenia is that it was actually dysautonomia, an "imbalance" of the autonomic nervous system.<ref>Template:Cite web</ref>Template:Failed verification

Barbara Ehrenreich, restating James's view, considered that neurasthenia was caused by the Calvinist gloom,<ref name=jenni/> 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'"<ref name=jenni/> with a more hopeful faith.<ref name=jenni>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.</ref><ref>Template:Cite book</ref>

In Asia

The medical term neurasthenia is translated as Chinese shenjing shuairuo (Template:Zh) or Japanese Template:Nihongo, 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 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.<ref name="Asia3">Template:Cite journal</ref> 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."<ref>Kleinman, Arthur (1986), Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China, Yale University Press, p. 115.</ref>

In Japan, Template:Transliteration 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.<ref name="Asia">Template:Cite journal</ref><ref>Template:Cite journal</ref>

See also

• Burnout syndrome
• Chronic fatigue syndrome (ME/CFS)
• Combat stress reaction
• Newyorkitis (satirical)
• Placebo effect
• Psychogenic disease

Further reading

• Template:Cite web
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• Gosling, F. G. Before Freud: Neurasthenia and the American Medical Community, 1870-1910. Urbana: University of Illinois Press, 1987.
• Template:Cite book
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• 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.
• The book The Invisible Rainbow by Arthur Firstenberg.