Neurasthenic neurosis

Neurasthenia ICD-10 F48.0 ICD-9 300.5 OMIM {{{OMIM}}} DiseasesDB {{{DiseasesDB}}} MedlinePlus {{{MedlinePlus}}} eMedicine {{{eMedicineSubj}}}/{{{eMedicineTopic}}} MeSH {{{MeshNumber}}}

Neurasthenia is a psycho-pathological term first used by George Miller Beard in 1869 to denote a condition with symptoms of fatigue, anxiety, headache, impotence, neuralgia and depressed mood. It is currently a diagnosis in the World Health Organisation's International Classification of Diseases, and in the Chinese Classification of Mental Disorders under the translation 'shenjing shuairuo'.

Americans were supposed to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis" (popularized by William James). However, it is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders although there is a category of Undifferentiated Somatoform Disorders.

Symptoms

It 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 the pressures placed on the intellectual class by the increasingly competitive business environment. Typically, it was associated with upper class individuals in sedentary employment.

Freud included a variety of physical symptoms in this category, including fatigue, dyspepsia with flatulence, and indications of intra-cranial pressure and spinal irritation.. In common with many people at that time, he believed this condition to be due to "excessive masturbation" or to arise "spontaneously from frequent emissions". 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 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 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." (Townsend, 1996).

Diagnosis

In the late 1800s, 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. Virginia Woolf was known to have been forced to undergo 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 approximately 1700 officers processed through the Craiglockhart War Hospital was diagnosed with neurasthenia - but its use declined a decade later.

Contemporary view

One contemporary view of neurasthenia holds that it was actually dysautonomia, an imbalance of the autonomic nervous system.

In Asia

Despite being dropped by the American Psychological Association's DSM in 1980, the 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 primarily 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 harder work and a resumption of a previous social role. The diagnosis is now being used as a cover for serious mental illnesses such as schizophrenia and mood disorders. In China the condition is known as shenjingshuairuo (written with the same characters as shinkeisuijaku in Japanese), 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.

See also

• Combat stress reaction

References

• Beard, G (1869). Neurasthenia, or nervous exhaustion. The Boston Medical and Surgical Journal: 217-221.
• Weir Mitchell, S (1884), Fat and Blood: an essay on the treatment of certain types of Neurasthenia and hysteria, Philadelphia: J. D. Lippincott & Co., http://www.gutenberg.org/files/16230/16230-h/16230-h.htm, retrieved on 2008-09-11 
• includeonly>Marcus, G. "One Step Back; Where Are the Elixirs of Yesteryear When We Hurt?", The New York Times, 1998-01-26. Retrieved on 2008-09-11.
• White, Charlotte; Kimble, Gregory A.; Wertheimer, Michael (1991). Portraits of pioneers in psychology, 13–25, Washington: American Psychological Association.
• Schultz, Sydney Ellen; Schultz, Duane P. (2004). A history of modern psychology, 178–179, Belmont, CA: Thomson/Wadsworth.
• Townsend, Kim (1996). Manhood at Harvard: William James and others, New York: W.W. Norton.
• Gijswijt-Hofstra, Marijke (2001). Cultures of Neurasthenia: From Beard to the First World War (Clio Medica 63) (Clio Medica), Rodopi Bv Editions.
• Brown, EM An American Treatment for the 'American Nervousness'. American Association of the History of Medicine. URL accessed on 2008-09-11.
• Farmer A, Jones I, Hillier J, Llewelyn M, Borysiewicz L, Smith A (October 1995). Neuraesthenia revisited: ICD-10 and DSM-III-R psychiatric syndromes in chronic fatigue patients and comparison subjects. Br J Psychiatry 167 (4): 503–6.

{{enWP|Neurasthenia