Neurasthenia

Symptoms

The condition was explained as exhaustion of the central nervous system's energy reserves, attributed by Beard to modern civilization. Physicians in his school associated it with urbanization and the stress of a competitive business environment, typically in upper-class individuals and sedentary professionals. Freud included physical symptoms such as fatigue, dyspepsia with flatulence, and indications of intracranial pressure and spinal irritation.

He initially believed the condition resulted from 'non-completed coitus' or infrequency of emissions, later formulating that insufficient libidinal discharge from coitus interruptus or masturbation had a poisoning effect. He eventually separated neurasthenia from anxiety neurosis, though he thought many cases combined both. In 19th-century Britain and the British Empire, neurasthenia described mental exhaustion in 'brain workers' or from 'overstudy', often synonymous with 'brain fag'.

Diagnosis

Starting in 1869, neurasthenia was a frequently given diagnosis, with symptoms like weakness, dizziness, and fainting. Neurologist S. Weir Mitchell pushed the rest cure, mainly for women.

Records from Queen Square Hospital in London show the diagnosis appeared equally in men and women across Europe. Writers Virginia Woolf, Charlotte Perkins Gilman, and Marcel Proust were linked to the condition. The Rexall company sold "Americanitis Elixir" to soothe neurasthenia.

Treatment

Beard and his partner A.D. Rockwell advocated electrotherapy and increasingly experimental treatments, a controversial position. An 1868 review questioned their knowledge of the scientific method and found their claims unwarranted. William James, diagnosed with neurasthenia, was quoted saying, 'I take it that no man is educated who has never dallied with the thought of suicide.' In 1895, Freud reviewed electrotherapy and declared it a 'pretense treatment', citing Elizabeth von R's note that stronger treatments seemed to push her own pains into the background. Neurasthenia was a common diagnosis for 'shell shock' during World War I, but its use declined a decade later; soldiers who deserted could be executed even with a medical excuse, but officers with neurasthenia were not.

Modern diagnosis

Neurasthenia remained popular into the 20th century, eventually seen as a mental and behavioural rather than physical condition. It was largely abandoned as a medical diagnosis by the 21st century and is deprecated in the ICD-11. The earlier ICD-10 categorized it under 'F48 – Other neurotic disorders', with characteristics differing across cultures; two overlapping symptom forms involve fatigue after mental exertion with reduced cognition, or extreme fatigue from minimal physical effort with pain and anxiety.

Excluded are asthenia NOS, burn-out, malaise and fatigue, postviral fatigue syndrome (including ME/CFS), and psychasthenia. One modern theory holds that neurasthenia was actually dysautonomia, an imbalance of the autonomic nervous system. Barbara Ehrenreich, restating James's view, considered it caused by Calvinist gloom and helped by New Thought's replacement of puritanical self-examination with hopeful faith. The term translates as Chinese shenjing shuairuo and Japanese 神経衰弱, both also meaning 'nervous breakdown'.

Though removed from the DSM in 1980, it appears in an appendix as the culture-bound syndrome shenjing shuairuo and in ICD-10. The condition persists in Asia as a culturally acceptable diagnosis avoiding the stigma of mental disorder.