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Neurasthenia ( and ἀσθενής () 'weak') is a term that was first used as early as 1829 for a mechanical weakness of the nerves. It 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 Psychopathology term, the first to publish on neurasthenia was Michigan Psychiatrist E. H. Van Deusen of the Kalamazoo asylum in 1869. Also in 1868, New York neurologist George Beard used the term in an article published in the Boston Medical and Surgical Journal 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; Beard connected the condition to busy Socialite and overworked businessmen.
Neurasthenia was a diagnosis in the World Health Organization's ICD-10, but deprecated, and thus no more diagnosable, in ICD-11. 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 (albeit rarely used) term for neurasthenia is nervosism.
Freud included a variety of physical symptoms into this category, including fatigue, dyspepsia with flatulence, and indications of intra-cranial pressure and spinal irritation. (1997). 9781855751675, Karnac Books. ISBN 9781855751675 In common with some other people of the time, 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)intoxication. 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”. This use was often synonymous with the term “brain fag”.
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."
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", but its use declined a decade later. Soldiers who deserted their post could be executed even if they had a medical excuse, but officers who had neurasthenia were not executed. "World War One executions", History Learning Site. Retrieved November 28, 2013.
The earlier ICD-10 system categorized neurasthenia under "F48 – Other neurotic disorders". 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) and psychasthenia (F48.8).
One modern theory of neurasthenia is that it was actually dysautonomia, an "imbalance" of the autonomic nervous system.
Barbara Ehrenreich, restating James's view, considered that neurasthenia was caused by the Calvinism 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, 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.
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. 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, 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 .
(2025). 9780805087499, Metropolitan Books, Henry Holt and Company, LLC. ISBN 9780805087499
In Asia
The medical term neurasthenia is translated as Chinese shenjing shuairuo () or Japanese 3=shinkei-suijaku, both of which also translate the common term nervous breakdown. This loanword combines shenjing () or shinkei () "nerve(s); nervous" and shuairuo or suijaku () "weakness; feebleness; debility; asthenia".
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