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At least 19 recordsLinked to original sources
PubMed2001

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.

BACKGROUND: The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data. AIMS: To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder. METHOD: The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined. RESULTS: Neurasthenia accounted for 6-11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33-50% of cases. CONCLUSIONS: Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses.

History, 19th Century↗
PubMedDate not supplied

Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome.

The purpose of this study was to examine several conceptual and cross-cultural issues in neurasthenia, particularly in terms of their relationship to chronic fatigue syndrome. A review of this relationship led to the conclusion that these conditions are much more alike in Western countries than in countries such as China, where neurasthenia could almost be regarded as a "culture-bound syndrome." This may be a consequence of factors such as the heterogeneous nature of neurasthenia and different diagnostic practices in different countries, despite the ICD-10 definition of neurasthenia, intended for worldwide use. Likewise, there is no consensus on what the "core" characteristics of neurasthenia are, because its clinical presentation and key features in different countries are very different. Despite the finding of relatively low comorbidity rates between neurasthenia and other mental disorders, clinical experience suggests that features of neurasthenia frequently overlap with those of depression, chronic anxiety, and somatoform disorders. There is no convincing evidence that in cases of overlap or comorbidity, other diagnoses should automatically have "primacy" over neurasthenia nor should the diagnosis of neurasthenia thereby be excluded. Although some aspects of its validity have improved recently, especially its descriptive validity, the overall validity of the diagnosis of neurasthenia is still not satisfactory. Suggestions for further research, aimed at improving the diagnostic validity of neurasthenia, are offered in this paper.

Cross-Cultural Comparison↗
PubMed1994

Neurasthenia in a longitudinal cohort study of young adults.

This study examines the concept of neurasthenia in a longitudinal cohort of young adults selected from a community sample of the canton of Zurich, Switzerland. The major focus is on the validity of the case definition of neurasthenia. Close approximations of the proposed descriptive and research definitions of the ICD-10 are employed as well as the concept of 'irritable weakness' as described in 1831 by Kraus (1926-1932). The prevalence of neurasthenia defined according to the ICD-10 criteria was: 1% across 10 years and 0.9% in 1988 for a duration criterion of > or = 3 months; and 8.1% across 10 years and 12% in 1988 for a duration criterion of > or = 1 month. The duration criterion of > or = 3 months appeared to be excessively restrictive to represent individuals with neurasthenia in the community. Subjects with 1 month episodes of neurasthenia exhibited sufficient differences from controls and similarities to subjects with anxiety or depressive disorders to justify a 1 month duration criterion for neurasthenia in community samples. The clinical significance of neurasthenia was indicated by the magnitude of subjective distress, and occupational and social impairment reported by the majority of the cases. Prospective assessment of the longitudinal course of neurasthenia revealed that approximately 50% of the cases continued to exhibit this disorder at follow-up. Our findings suggest that neurasthenia is equally likely to represent an early manifestation of affective illness as it is a consequence in those neurasthenic subjects who exhibited comorbid affective disorders. The magnitude, chronicity, impairment, longitudinal stability and distinction from anxiety and depression associated with this condition in the general population, suggest that neurasthenia is an important diagnostic entity for which additional validation studies should be undertaken.

Adult↗
PubMed2001

Poor Beard!! Charcot's internationalization of neurasthenia, the "American disease".

OBJECTIVE: To analyze the role of the seminal 19th-century neurologist, Jean-Martin Charcot, in the internationalization of neurasthenia, previously known as "the American disease." BACKGROUND: The New York neurologist, George Beard, first described neurasthenia in 1869 and considered it a disorder related to the particular stress of modern civilization, most typified in the United States. METHODS: Charcot's personal files on neurasthenia from the Bibliothèque Charcot, Salpêtrière Hospital, Paris, were studied and his teaching lessons and lectures were examined. RESULTS: Charcot presented numerous cases of neurasthenia, always crediting Beard with the original name and description. Calling Beard's 1880 work a "remarkable monograph," Charcot emphasized that patients with neurasthenia also comprised the bulk of his own private practice. Focusing on the signs of sexual impotency, fatigue, and a tight band of pressure around the head, Charcot categorically distinguished patients with neurasthenica from patients with hysteria. Like Beard, Charcot concluded that the origin of neurasthenia was psychological stress and felt the European society also fostered the environment to precipitate the disease. Charcot adamantly opposed extrapolations that called for early childhood educational reforms to reduce current classroom stress. Charcot sympathized more with the treating physician than the patient, calling neurasthenics insufferable (insupportables). On the front sheet of his neurasthenia file, he wrote in large script, "Poor Beard!!" CONCLUSION: By emphasizing the prevalence of neurasthenia and extending Beard's observations, Charcot internationally legitimized the new diagnosis. Adding neurasthenia to the other neurologic descriptions from the United States by Hammond, Mitchell, and Dana, Charcot helped to foster the recognition of the American Neurologic School.

France↗
PubMed1989

Neurasthenia as nosological dilemma.

While researching concepts of neurasthenia as described by patients and physicians of various backgrounds, it was found that there is a great discrepancy between the two groups. In this study, questionnaires were administered to 70 psychiatric patients, 6 Chinese medicine men, 44 general physicians and 35 neuropsychiatrists, to inquire into the reasons for positive or negative attitudes toward neurasthenia. Half of the clinical patients believed that they were suffering from neurasthenia. Neurasthenia is a predominate term used for various types of distress arising mainly from psychiatric diseases. Chinese medicine men are aware that this term is a medical diagnosis introduced from the West. Through experience they regard neurasthenia as a kind of deficit of nerve. Apparently, the concept of neurasthenia has been integrated into the Chinese medical system, a fact substantiated by its longstanding, nosological use by the public. Younger generation physicians within both general and neuropsychiatric disciplines on the whole reject neurasthenia as a diagnostic term. However, one-third of neuropsychiatrists and 40% of general physicians use this term in their practice in order to improve the treatment of and to establish good communication and rapport with the patients whom they treat. Most of them, however, do not use the term in their formal diagnosis. The concept of the illness, neurasthenia, is historically rooted and today presents a nosological dilemma. It will eventually be transformed conceptually and disappear from the public mind.

Adult↗
PubMed2002

[On the history of the concept neurasthenia and its modern variants chronic-fatigue-syndrome, fibromyalgia and multiple chemical sensitivities].

This article deals with the history of the terminological and nosological development of the concept neurasthenia introduced in 1869 by George Miller Beard and in particular with its reappearance in western medicine in the 1980 s. Beginning with its predecessors in antiquity and continuing with hypochondria, which became a fashionable disease in the 18 th century, the concept neurasthenia reached a high point and world-wide medical acceptance at the end of the 19 th/beginning of the 20 th century. However, between the 1930 s and 1960 s it declined in popularity and gradually disappeared until finally it only had a rudimentary nosological role in the term "pseudoneurasthenia". In the countries of the Far East, on the contrary, the concept of neurasthenia has been in continual use since its importation in the first decades of the last century. In the 1980 s, when an interest in the symptoms of chronic fatigue was reawakened in western medicine, the concept neurasthenia reappeared, this time to define the particular form of a neurotic disorder. Parallel to these developments increasing importance was attached to clinical descriptions of illnesses which on account of their similarity to the symptoms of neurasthenia could be termed modern variants of the concept neurasthenia. These are "Chronic-Fatigue-Syndrome", "Fibromyalgia" and "Multiple Chemical Sensitivities" which have more or less adopted the organic inheritance of Beard's former concept of neurasthenia, despite the fact that so far the question of organicity could not be decisively answered in a single case. In order to clarify possible influences on the development of the concept neurasthenia and its variants, the theories and ideas of E. Shorter, medical historian at the University of Toronto, are discussed in the final part of the article, whereby the particular cultural background in each case has a decisive influence on the manifestation of the psychosomatic symptoms.

Depression↗
PubMed1991

Neurasthenia: a paradigm of social psychopathology in a transitional society.

A particular social aspect of an illness is reflected in an emphasis on those symptoms that the society considers socially detrimental and/or destabilizing. Thus, in the work- and production-oriented society, chronic fatigue, which affects one's productivity and ability to work, becomes a hallmark of neurasthenia or neurasthenia-like syndrome. In a society based on rigid social structures and severely limited possibilities for social change, excessive irritability and outbursts of anger are perceived as a greater threat to the stability of the existing social order, and therefore they come to dominate the concept of neurasthenia. In Yugoslavia, neurasthenia has been primarily conceived of as a manifestation of an accumulated social frustration and anger; neurasthenia has then been constructed as a mental disorder because anger was expressed in a way that the society considered inappropriate, maladaptive, and pathological. A far-reaching, underlying purpose of this conceptualization of neurasthenia has been a preservation of the social status quo. While neurasthenia as a distinct mental disorder remains controversial, its dependence on the social context cannot be denied. Although the designation of neurasthenia so often seems provisional, because it symbolizes limitations and failures of our diagnostic and nosological systems, it serves a definite social purpose, which varies from time to time, and from one culture to another.

Anger↗
PubMed1989

The indigenization of neurasthenia in Hong Kong.

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.

Combined Modality Therapy↗
PubMedDate not supplied

Clinical validity of ICD-10 neurasthenia.

BACKGROUND: Neurasthenia was defined over a century ago. In view of a questionable clinical validity, it was omitted from the 3rd edition of the American Psychiatric Association's DSM, while it remains as an own diagnostic category in the WHO's ICD-10. The purpose of this study was, therefore, to examine the clinical validity of ICD-10 neurasthenia in a consecutive sample of chronic pain patients. PATIENTS AND METHODS: We included 193 patients (mean age 45.1, SD +/- 10.2, 63% females) in the study. Psychiatric diagnoses were established by the use of ICD-10 Diagnostic Criteria for Research. In addition, the Screening List for Somatization Symptoms was administered: self-rating of 53 medically unexplained somatic symptoms, and 11 additional screening questions concerning weakness after slight mental or physical exertion and disease conviction. RESULTS: Thirty-three percent of the patients who fulfilled the criteria of ICD-10 neurasthenia also fulfilled the criteria of ICD-10 somatization disorder, 69% the criteria of ICD-10 undifferentiated somatoform disorder, 14% the criteria of ICD-10 hypochondriacal disorder, 66% the criteria of ICD-10 somatoform autonomic dysfunction, 85% the criteria of ICD-10 persistent somatoform pain disorder and 14% the criteria for sexual dysfunction not caused by organic disorder or disease. The symptom profile of ICD-10 neurasthenia was not clearly distinguishable from the symptom profiles of ICD-10 somatoform disorders and ICD-10 sexual dysfunction. DISCUSSION: Due to this substantial diagnostic overlap, the clinical validity of ICD-10 neurasthenia remains questionable.

Female↗
PubMed2002

Neurasthenia: prevalence, disability and health care characteristics in the Australian community.

BACKGROUND: Neurasthenia imposes a high burden on primary medical health care systems in all societies. AIMS: To determine the prevalence of ICD-10 neurasthenia and associated comorbidity, disability and health care utilisation. METHOD: Utilisation of a national sample of Australian households previously surveyed using the Composite International Diagnostic Interview and other measures. RESULTS: Prolonged and excessive fatigue was reported by 1465 people (13.29% of the sample). Of these, one in nine people meet current ICD-10 criteria for neurasthenia. Comorbidity was associated with affective, anxiety and physical disorders. People with neurasthenia alone (<0.5% of the population) were less disabled and used less services than those with comorbid disorders. CONCLUSIONS: Fatigue is frequent in the Australian community and is common in people attending general practice. Neurasthenia is disabling and demanding of services largely because of its comorbidity with other mental and physical disorders. Until a remedy for persistent fatigue is provided, doctors should take an active psychological approach to treatment.

Adolescent↗
PubMed1982

Neurasthenia and depression: a study of somatization and culture in China.

The author reviews conceptual and empirical issues regarding the interaction of neurasthenia, somatization and depression in Chinese culture and in the West. The historical background of neurasthenia and its current status are discussed, along with the epidemiology and phenomenology of somatization and depression. Findings are presented from a combined clinical and anthropological field study of 100 patients with neurasthenia in the Psychiatry Outpatient Clinic at the Hunan Medical College. Eighty-seven of these patients made the DSM-III criteria of Major Depressive Disorder; diagnoses of anxiety disorders were also frequent. Forty-four patients were suffering from chronic pain syndromes previously undiagnosed, and cases of culture-bound syndromes also were detected. For three-quarters of patients the social significances and uses of their illness behavior chiefly related to work. Although from the researcher's perspective 70% of patients with Major Depressive Disorder experienced substantial improvement and 87% some improvement in symptoms when treated with antidepressant medication, fewer experienced decreased help seeking, and a much smaller number perceived less social impairment and improvement in illness problems (the psychosocial accompaniment of disease including maladaptive coping and work, family and school problems). These findings are drawn on to advance medical anthropology and cultural psychiatry theory and research regarding somatization in Chinese culture, the United States and cross culturally. The author concludes that though neurasthenia can be understood in several distinctive ways, it is most clinically useful to regard it as bioculturally patterned illness experience (a special form of somatization) related to either depression and other diseases or to culturally sanctioned idioms of distress and psychosocial coping.

Adolescent↗
PubMed1990

Old wine in new bottles: neurasthenia and 'ME'.

The history of neurasthenia is discussed in the light of current interest in chronic fatigue, and in particular the illness called myalgic encephalomyelitis ('ME'). A comparison is made of the symptoms, presumed aetiologies and treatment of both illnesses, as well as their social setting. It is shown that neurasthenia remained popular as long as it was viewed as a non-psychiatric, neurological illness caused by environmental factors which affected successful people and for which the cure was rest. The decline in neurasthenia was related to the changes which occurred in each of these views. It is argued that similar factors are associated with the current interest in myalgic encephalomyelitis. It is further argued that neither neurasthenia nor 'ME' can be fully understood within a single medical or psychiatric model. Instead both have arisen in the context of contemporary explanations and attitudes involving mental illness. Future understanding, treatment and prevention of these and related illnesses will depend upon both psychosocial and neurobiological explanations of physical and mental fatigability.

Europe↗
PubMedDate not supplied

[The differential use of trace element electrophoresis in neurasthenia].

Copper and cobalt deficiencies were found in the blood of hypersthenic neurasthenia, while hyposthenic neurasthenia patients lacked manganese. Pathogenetic physiotherapeutic methods are proposed for differentiated treatment of neurasthenia--cobalt or copper electrophoresis in hypersthenic and manganese electrophoresis in hyposthenic neurasthenia.

Adult↗
PubMed1995

Rethinking neurasthenia: the illness concepts of shenjing shuairuo among Chinese undergraduates in Hong Kong.

Neurasthenia is both a Western disease construct and a popular Chinese illness concept (shenjing shuairuo, SJSR). Using a self-report questionnaire, we examined 148 Hong Kong Chinese undergraduates' concept of its epidemiology, symptomatology, etiology and treatment. Notwithstanding that fatigue is the sine qua non of neurasthenia in Western nosology, subjects believed that SJSR was compatible with a diversity of symptoms which fell, on factor analysis, into the "neurotic," "psychotic," "somatic" and "dysfunctional" subgroups. Contrary to the popular portrayal of SJSR as a physical or chronic fatigue disorder, the most common perceived symptoms were anxiety, insomnia, depression and fright. Logically, psychological etiology and remedy were highly emphasized. The perceived high prevalence, non-aggressive nature and symptomatic diversity of SJSR attested to the notion that it might camouflage and destigmatize psychiatric labels of insanity. The contextual study of neurasthenia illustrates how in its search for legitimacy an originally Western concept adapts, transforms, and acquires distinctive local meanings in a non-Western culture.

Adolescent↗
PubMed1989

The diagnosis and phenomenology of neurasthenia. A Shanghai study.

Neurasthenia is one of the commonest diagnostic terms in psychiatric practice in China, but it is employed less and less by psychiatrists in the Western world. In order to investigate what diagnoses would be given in terms of modern Western standard diagnostic systems, 40 patients who were diagnosed as suffering from neurasthenia by two Chinese psychiatrists were rediagnosed according to ICD-9 descriptive criteria, using the Catego computerized system based upon PSE findings and DSM-III criteria based on findings of the Diagnostic Interview Schedule (DIS). Furthermore a set of self-report or observer rating scales, including the SAS, SDS, HAMA, HAMD and BPRS, were administered to evaluate their psychopathological characteristics. The main findings are the following: (1) the distribution of the results of rediagnosis is widely dispersed from mild character disorder to severe affective disorder; (2) most of these patients are diagnosed as having an anxiety or depressive illness in different diagnostic systems; (3) the majority of diagnoses belong to the field of neurosis in all systems except DIS/DSM-III; (4) there is a group of patients who do not belong to any diagnostic entity in these systems; (5) the prominent psychopathological features are anxiety and depression and often a combination of both, which adds to the complexity of the clinical picture; and (6) these patients tend to over-report their suffering or symptoms, which results in a discrepancy of findings between objective assessment and self-reporting. The author suggests that the term neurasthenia represents a disease spectrum and should be refined in future study, but that it seems too early to discard it from psychiatric nosology.

China↗
PubMed1989

The concept of neurasthenia and its treatment in Japan.

The term neurasthenia, which had been widely used in Japan before the Second World War, came to be replaced by the term neurosis thereafter. With this change in terminology, there seems to have been a shift in the popular ideas of minor psychiatric disorders towards a more psychological view. Unlike in the West where psychoanalysis was a major contributing factor, in Japan it was Shoma Morita who contributed to this change by questioning the somatic basis of conditions then diagnosed as neurasthenia and by developing the concept shinkeishitsu in the early 1920's, rejecting the concept of neurasthenia. In his theory, the development of shinkeishitsu symptoms is explained in terms of certain psychic dispositions and as a vicious cycle of sensation and attention; he formulated a psychological treatment, Morita therapy, which has been very effective for that condition. With the advent of modernization in this country, doubts have been raised whether this form of psychotherapy will continue to be acceptable to modern Japanese. However, in reality many neurotic patients are still being treated with Morita therapy, although analytically oriented psychotherapy is coming to be practiced more and more in recent years. The indigenous psychotherapies represented by Morita therapy and Naikan therapy have deep-seated roots in Buddhist tradition: its values and ideas have been redefined and reformulated into forms of therapy acceptable to modern Japanese.

Buddhism↗
PubMed1989

Parallels between neurasthenia and premenstrual syndrome.

Neurasthenia and premenstrual syndrome became medical diseases because of the historical recognition of menstruation as a medical disease. Both the nineteenth and twentieth century cultural views of women were important in the establishment of menstruation, neurasthenia and premenstrual syndrome as medical conditions. Uncertainty of diagnosis with ever expanding diagnostic criteria, therapy undertaken without an adequate physiological basis, and often adverse effects from therapy, were characteristic of the medicalization of neurasthenia and premenstrual syndrome. A recognition of the cultural basis of these conditions is essential to a better understanding of women as human beings.

Female↗