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NEURASTHENIA: HERE AND THERE, NOW AND THEN

Neurasthenia was first identified in the United States by George Beard in 1869. Beard, a neurologist, created this diagnostic label to describe a set of symptoms consisting of fatigue, anxiety, headache, impotence, neuralgia, and depression (1869, 1905). It was explained as being the result of exhaustion of the central nervous system’s energy reserves due to the stresses of modern life. It was associated with the pressures placed on the intellectual class by the increasingly competitive business environment. Typically, it occurred in middle and upperclass men in sedentary employment. The diagnosis provided a biological explanation for this syndrome thereby reducing the stigma associated with psychiatric illness. Exhaustion of the nerves also served as a mark of status, since upper class persons were considered more vulnerable to this illness. The medical treatment provided for neurasthenia included nutrition, massage, mild exercise, electrotherapy, hydrotherapy, rest, a therapeutic (healing) environment, and improving eliminations to help the body cleanse itself of toxins. Psychotherapy for neurasthenia was considered of little or no use (Beard, 1905; Musser & Kelly, 1912). The diagnosis of neurasthenia reached its highpoint in the late 19th and early 20th centuries and was accepted world-wide, including in the countries of the Far East. It declined in popularity in the U.S. and western world during the 1930s to 1960s and gradually disappeared from use, although remnants of it still remain in expressions such as “nervous breakdown” and “a case of nerves” (Flaskerud, 1980). It is still included in the ICD-10 (World Health Organization, 1992) and comes with well-defined inclusion criteria: mental and/or physical fatigue, dizziness, dyspepsia, muscle aches and pain, headaches, irritability, sleep disturbance, and inability to relax. It is now found in the appendix section of the DSM-IV (American Psychiatric Association, 1994, p. 48) as a culture bound syndrome: shenjing shuairuo, a diagnosis used currently in Taiwan and China. It is described as a condition “characterized by physical and