Neurasthenia

file:Venus de Milo Louvre Ma399 n4.jpg, the Venus de Milo was "neurasthenic as her stomach was not in the proper position".{{cite news |title=Says Venus de Milo was not a Flapper; Osteopath Says She Was Neurasthenic, as Her Stomach Was Not in Proper Place. |newspaper=The New York Times | date= April 29, 1922 |url=https://timesmachine.nytimes.com/timesmachine/1922/04/29/103588246.pdf |access-date= August 5, 2011}}]]

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.{{cite book |last1=Sandler |first1=Joseph |last2=Holder |first2=Alex |last3=Dare |first3=Christopher |last4=Dreher |first4=Anna Ursula |title=Freud's Models of the Mind |year=1997 |isbn=978-1-85575-167-5 |page=52 |publisher=Karnac Books}} In common with some other people of the time{{who|date=March 2022}}, 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. 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{{nbh}})intoxication.{{Cite book |last=Erwin |first=Edward |url=https://books.google.com/books?id=rX2w6QELtKgC&dq=freud+neurasthenia+coitus&pg=PA362 |title=The Freud Encyclopedia: Theory, Therapy, and Culture |date=2002 |publisher=Taylor & Francis |isbn=978-0-415-93677-4 |pages=362 |language=en}} Eventually he separated it from anxiety neurosis, though he believed that a combination of the two conditions existed in many cases.

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”.{{Cite journal|last=Ayonrinde|first=Oyedeji A.|date=2020-06-26|title='Brain fag': a syndrome associated with 'overstudy' and mental exhaustion in 19th century Britain|journal=International Review of Psychiatry|volume=32|issue=5–6|pages=520–535|doi=10.1080/09540261.2020.1775428|issn=0954-0261|pmid=32589474|doi-access=free}} This use was often synonymous with the term “brain fag”.

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.{{cite journal |last1=Taylor |first1=Ruth E. |title=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|journal=British Journal of Psychiatry |date=December 2001 |volume=179 |issue=6 |pages=550–557 |doi=10.1192/bjp.179.6.550|pmid=11731361 |doi-access=free }} 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.{{cite book | last=Bogousslavsky | first=Julien | title=Neurological Disorders in Famous Artists - Part 2 | chapter=Marcel Proust’s Diseases and Doctors: The Neurological Story of a Life | series=Frontiers of Neurology and Neuroscience | publisher=KARGER | publication-place=Basel | year=2007 | volume=22 | doi=10.1159/000102874 | pages=89–104| pmid=17495507 | isbn=978-3-8055-8265-0 }} 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.

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."{{cite book |author=Townsend, Kim |title=Manhood at Harvard: William James and others |publisher=W.W. Norton |location=New York |year=1996 |isbn=978-0-393-03939-9 |url=https://archive.org/details/manhoodatharvard00town }}

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 for "shell shock",{{cite book|author=Jack W. Tsao|title=Traumatic Brain Injury: A Clinician's Guide to Diagnosis, Management, and Rehabilitation|url=https://books.google.com/books?id=Bcs29D1rR84C&pg=PA104|date=15 February 2010|publisher=Springer Science & Business Media|isbn=978-0-387-87887-4|pages=104}} but its use declined a decade later.{{Citation needed|date=September 2009}} Soldiers who deserted their post could be executed even if they had a medical excuse, but officers who had neurasthenia were not executed.[http://www.historylearningsite.co.uk/world_war_one_executions.htm "World War One executions"], History Learning Site. Retrieved November 28, 2013.

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.{{cite journal |author1=Evangard B |author2=Schacterie R.S. |author3=Komaroff A. L. |title=Chronic fatigue syndrome: new insights and old ignorance |journal=Journal of Internal Medicine |volume=246 |date=Nov 1999 |issue=5 |pages=455–469 |pmid=10583715 |doi= 10.1046/j.1365-2796.1999.00513.x|doi-access= }}{{Cite web | url = https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f767044268|title=ICD-11 |format= |accessdate= 2023-04-24| author-link=World Health Organization|last=World Health Organization}}

The earlier ICD-10 system categorized neurasthenia under "F48 – Other neurotic disorders".{{Cite web |title = Chapter V Mental and behavioural disorders (F00-F99) |year = 2007 |url = http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gf40.htm+ |access-date = 2009-10-09 |author = WHO }} 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){{Cite web|author= ((Centers for Disease Control and Prevention, National Center for Health Statistics, Office of the Center Director, Data Policy and Standards)) |title=A Summary of Chronic Fatigue Syndrome and Its Classification in the International Classification of Diseases |publisher=Centers for disease Control |date=March 2001 |url=http://www.co-cure.org/ICD_code.pdf |access-date=November 26, 2022 |url-status=dead |archive-url=https://web.archive.org/web/20140611042505/http://www.co-cure.org/ICD_code.pdf |archive-date=June 11, 2014 |df=mdy-all }} and psychasthenia (F48.8).{{cite web |url=https://icd.who.int/browse10/2019/en#F48.0 |title=ICD-10 Version:2019 |format= |accessdate= November 26, 2022 |author=WHO|author-link=World Health Organization}}

One modern theory of neurasthenia is that it was actually dysautonomia, an "imbalance" of the autonomic nervous system.{{cite web |url = http://heartdisease.about.com/cs/womensissues/a/dysautonomia.htm |title = A family of misunderstood disorders |first = R |last = Fogoros |publisher = About.com |date = 29 May 2006 |access-date = 11 September 2008 }}{{Failed verification|date=November 2022}}

Barbara Ehrenreich, restating James's view, considered that neurasthenia was caused by the Calvinist gloom, 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'" with a more hopeful faith.Jenni Murray, [https://www.theguardian.com/books/2010/jan/10/smile-or-die-barbara-ehrenreich 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.{{cite book|last1=Ehrenreich|first1=Barbara|author-link1=Barbara Ehrenreich|title=Bright-sided. How the relentless promotion of positive thinking has undermined America|year=2009|publisher=Metropolitan Books, Henry Holt and Company, LLC|location=New York|isbn=978-0-8050-8749-9|page=[https://archive.org/details/brightsidedhowre00ehre/page/87 87]|chapter=Three. The Dark Roots of American Optimism|quote=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."|chapter-url=https://archive.org/details/brightsidedhowre00ehre/page/87}}

The medical term neurasthenia is translated as Chinese shenjing shuairuo ({{zh|s=神经衰弱|t=神經衰弱|p=shénjīng shuāiruò|cy=sàhngīng sēuiyeuhk}}) or Japanese {{Nihongo|2=神経衰弱|3=shinkei-suijaku}}, 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.{{cite journal |last=Schwartz |first=Pamela Yew |date=September 2002 |title=Why is neurasthenia important in Asian cultures? |journal=West. J. Med. |volume=176 |issue=4 |pages=257–8 |pmc=1071745 |pmid=12208833}} 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."Kleinman, Arthur (1986), Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China, Yale University Press, p. 115.

In Japan, {{Transliteration|ja|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.{{cite journal |last=Schwartz |first=Pamela Yew |title=Why is neurasthenia important in Asian cultures? |journal=West. J. Med. |volume=176 |issue=4 |pages=257–8 |date=September 2002 |pmid=12208833 |pmc=1071745 }}{{cite journal |last1=Lin |first1=Tsung-Yi |title=Neurasthenia revisited: Its place in modern psychiatry |journal=Culture, Medicine and Psychiatry |date=June 1989 |volume=13 |issue=2 |pages=105–129 |doi=10.1007/BF02220656|pmid=2766788 |s2cid=28936419 }}

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

{{Reflist}}

• {{cite web |url = http://bms.brown.edu/HistoryofPsychiatry/Beard.html |title = An American Treatment for the 'American Nervousness' |access-date = 2008-09-11 |year = 1980 |last = Brown |first = EM |publisher = American Association of the History of Medicine |url-status = dead |archive-url = https://web.archive.org/web/20080907212129/http://bms.brown.edu/HistoryofPsychiatry/Beard.html |archive-date = 2008-09-07 }}
• {{cite book |author=Gijswijt-Hofstra, Marijke |title=Cultures of Neurasthenia: From Beard to the First World War (Clio Medica 63) (Clio Medica) |publisher=Rodopi Bv Editions |year=2001 |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.
• {{cite book |author-link=Silas Weir Mitchell (physician) |last = Weir Mitchell |first = S |year = 1884 |title = Fat and Blood: an essay on the treatment of certain types of Neurasthenia and hysteria |location = Philadelphia |publisher = J. D. Lippincott & Co. |url = http://www.gutenberg.org/files/16230/16230-h/16230-h.htm |access-date = 2008-09-11 }}
• {{cite journal |vauthors=Farmer A, Jones I, Hillier J, Llewelyn M, Borysiewicz L, Smith A |title=Neuraesthenia revisited: ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects |journal=Br J Psychiatry |volume=167 |issue=4 |pages=503–6 |date=October 1995 |pmid=8829720 |doi= 10.1192/bjp.167.4.503|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.
• The book The Invisible Rainbow by Arthur Firstenberg.

{{Medical resources

|ICD10 = {{ICD10|F|48|0|f|40}}

|ICD9 = {{ICD9|300.5}}

|MeshID = D009440

}}

{{Mental and behavioural disorders|selected = neurotic}}

{{Authority control}}

Category:Anxiety disorders

Category:Neurological disorders

Category:Military psychiatry

Category:Obsolete terms for mental disorders