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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[1] in 1869 to denote a condition with symptoms of fatigue, anxiety, headache, neuralgia and depressed mood.[footnotes 1] It is currently a diagnosis in the World Health Organisation'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 supposed to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis"[2] (popularized by William James).

Contents

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 stress suffered as a result of the increasingly competitive business environment. Typically, it was associated with upper class people or professionals with 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.[3] In common with some other people of the time, he believed this condition to be due to "excessive masturbation" or to arise "spontaneously from frequent emissions".[3] Eventually he separated it from anxiety neurosis though he believed that a combination of the two conditions coexisted in many cases.[3]

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, and was quoted as saying, "I take it that no man is educated who has never dallied with the thought of suicide."[4]

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.[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.

Skepticism

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.

Contemporary opinion

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]

In Asia

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 now being used as a disguise 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.[9]

See also

Notes

  1. ^ 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.

References

  1. ^ Beard, G (1869). "Neurasthenia, or nervous exhaustion". The Boston Medical and Surgical Journal: 217–221.  
  2. ^ Marcus, G (1998-01-26). "One Step Back; Where Are the Elixirs of Yesteryear When We Hurt?". The New York Times. http://query.nytimes.com/gst/fullpage.html?res=9A05E1DB133BF935A15752C0A96E958260. Retrieved 2008-09-11.  
  3. ^ a b c Sandler, Joseph; Holder, Alex; Dare, Christopher; Dreher, Anna Ursula (1997). Freud's Models of the Mind. Karnac Books. p. 52. ISBN 1 85575 167 4.  
  4. ^ Townsend, Kim (1996). Manhood at Harvard: William James and others. New York: W.W. Norton. ISBN 0-393-03939-0.  
  5. ^ Taylor, Ruth E (2001). "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". British Jnl of Psychiatry 179: 550-557.  
  6. ^ Evangard B, Schacterie R.S., Komaroff A. L. (1999). "Chronic fatigue syndrome: new insights and old ignorance". Journal of Internal Medicine Nov;246 (5): 455–469. doi:10.1046/j.1365-2796.1999.00513.x. PMID 10583715. http://www3.interscience.wiley.com/cgi-bin/fulltext/119095441/PDFSTART. Retrieved 2009-06-25.  
  7. ^ Chapter V Mental and behavioural disorders (F00-F99), Version 2007, http://apps.who.int/classifications/apps/icd/icd10online/index.htm?gf40.htm+, retrieved 2009-10-09  
  8. ^ Fogoros, R (2006-05-29). "A family of misunderstood disorders". About.com. http://heartdisease.about.com/cs/womensissues/a/dysautonomia.htm. Retrieved 2008-09-11.  
  9. ^ Schwartz, Pamela Yew (September 2002). "Why is neurasthenia important in Asian cultures?". West. J. Med. 176 (4): 257–8. PMID 12208833. PMC 1071745. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1071745. Retrieved 2008-09-11.  

Further reading


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

NEURASTHENIA (Gr. veiipov, nerve, and aa6Evaa, weakness), the general medical term for a condition of weakness of the nervous system. The symptoms may present themselves as follows: (I) general feeling of malaise, combined with a mixed state of excitement and depression; (2) headache, sometimes with the addition of vertigo, deafness and a transitory clouding of consciousness simulating petit mal or migraine; (3) disturbed and restless, unrefreshing sleep, often troubled with dreams; (4) weakness of memory, especially for recent events; (5) blurring of sight, noises or ringing in the ears; (6) variable disturbances of sensibility, especially scattered analgesia (partial and symmetrical) affecting the backs of the hands especially, and in women the breasts; (7) various troubles of sympathetic origin, notably localized coldness, particularly in the extremities, morbid heats, flushings and sweats; (8) various phenomena of nervous depression associated with functional disturbances of organs, e.g. muscular weakness, lack of tone, and sense of fatigue upon effort, dyspepsia and gastric atony with dilatation of the stomach and gastralgia; pseudo-anginal attacks and palpitation of the heart; loss of sexual power with nocturnal pollutions and premature ejaculations leading to apprehension of oncoming impotence. Objective signs met with in organic disease are absent, but the knee-jerks are usually exaggerated.

According to the complexity of symptoms, the neurasthenia is more particularly defined as cerebral, spinal, gastric and sexual. The cerebral form is sometimes termed psychasthenia, and is liable to present morbid fears or phobias, e.g. agoraphobia (fright in crowds), monophobia (fright of being alone), claustrophobia (fright of being in a confined place), anthropophobia (fright of society), batophobia (fright of things falling), siderodromophobia (fright of railway travelling). There may also be mental ruminations, in which there is a continuous flow of connected ideas from which there is no breaking away, often most insistent at night and leading to insomnia. Sometimes there is arithmomania (an imperative idea to count). Such cases often exhibit a marked emotionalism and readily manifest joy or sorrow; they may be cynical, pessimistic, introspective and self-centred, only able to talk about themselves or matters of personal interest, yet they frequently possess great intellectual ability, and although there may be mental depression, there is an absence of the insane ideas characteristic of melancholia.

Traumatic neurasthenia is the neurasthenia following shock from injury; it is sometimes termed "railway spine," "railway brain," from the frequency with which it occurs after railway accidents, especially in people of a nervous temperament. The physical injury at the time may be slight, so that the patient is able to resume work, but symptoms develop later which may simulate serious organic disease. As in all forms of neurasthenia, the subjective symptoms may be numerous and varied, whereas the objective signs are but few and slight. Many difficulties, therefore, present themselves in arriving at a sound opinion as to the future in such cases. It is desirable not only to study the case carefully, but to obtain some knowledge of the previous history of an individual who is claiming damages on account of traumatic neurasthenia. (F. W. Mo.)


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