Neurasthenia  

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"In the fin-de-siècle disposition, in the tendencies of contemporary art and poetry, in the life and conduct of men who write mystic, symbolic and 'decadent' works and the attitude taken by their admirers in the tastes and aesthetic instincts of fashionable society, the confluence of two well-defined conditions of disease, with which he [the physician] is quite familiar, viz. degeneration and hysteria, of which the minor stages are designated as neurasthenia.' "--Degeneration (1892) by Max Nordau


"It is certain also that a great many neurasthenic people, and particularly those who are sexually neurasthenic, are peculiarly susceptible to olfactory influences. A number of eminent poets and novelists--especially, it would appear, in France--seem to be in this case. Baudelaire, of all great poets, has most persistently and most elaborately emphasized the imaginative and emotional significance of odor; the Fleurs du Mal and many of the Petits Poemes en Prose are, from this point of view, of great interest. There can be no doubt that in Baudelaire's own imaginative and emotional life the sense of smell played a highly important part; and that, in his own words, odor was to him what music is to others." --Studies in the Psychology of Sex, Volume 4 (1905) Havelock Ellis

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Neurasthenia (from the Ancient Greek νεῦρον neuron "nerve" and ἀσθενής asthenés "weak") is a term that was first used at least as early as 1829 for a mechanical weakness of the nerves and 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.

As a psychopathological term, the first to publish on neurasthenia was Michigan alienist E. H. Van Deusen of the Kalamazoo asylum in 1869, followed a few months later by New York neurologist George Beard, also in 1869, 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, while Beard connected the condition to busy society women and overworked businessmen.

Neurasthenia was a diagnosis in the World Health Organization's ICD-10, but is no more diagnosed in ICD-11, marked as deprecated. It also is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. 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" (popularized by William James). Another, rarely used, term for neurasthenia is nervosism.

Contents

Symptoms

Americans were supposed to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis" (popularized by William James). It was explained as being a result of exhaustion of the central nervous system's energy reserves, which Beard attributed to civilization. Physicians in the Beard school of thought associated neurasthenia with the stresses of urbanization and the pressures placed on the intellectual class by the increasingly competitive business environment. Typically, it was associated with upper class individuals in sedentary employment.

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 grasp of the scientific method was suspect and did not believe their claims to be warranted.

William James suffered from neurasthenia, and was quoted as saying, "I take it that no man is educated who has never dallied with the thought of suicide." (Townsend, 1996).

Diagnosis

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. 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.

Skepticism

In 1895, Sigmund Freud reviewed electrotherapy and declared it a "pretense treatment." He highlighted 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,". See also placebo effect.

Nevertheless, neurasthenia was a common diagnosis in World War I - for example, every one of the c.1700 officers processed through the Craiglockhart War Hospital was diagnosed with neurasthenia - but its use declined a decade later.

Today

The modern view holds that the main problem with the neurasthenia diagnosis was that it attempted to group together a wide variety of cases. In recent years, Richard M. Fogoros has posited that perhaps "neurasthenia" was a word that could include some psychiatric conditions, but more importantly, many physiological conditions marginally more understood by the medical community, such as fibromyalgia, chronic fatigue syndrome, and various forms of dysautonomia. He emphasizes that the majority of patients who would have once been diagnosed with neurasthenia have conditions that are "real, honest-to-goodness physiologic (as opposed to psychologic) disorders... and while they can make anybody crazy, they are not caused by craziness." (see reference, below)

See also




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