Neurasthenia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Neurasthenia was a term first coined by George Miller Beard in 1869. Beard's definition of "neurasthenia" described a condition with symptoms of fatigue, anxiety, headache, impotence, neuralgia and depression.

Americans were supposed to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis" (popularized by William James).

Historical Perspective

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." (Townsend, 1996).

Skepticism

In 1895, Sigmund Freud reviewed electrotherapy and declared it a "pretense treatment." He highlighted 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,". See also placebo effect.

Nevertheless, neurasthenia was a common diagnosis in World War I - for example, every one of the c.1700 officers processed through the Craiglockhart War Hospital was diagnosed with neurasthenia - but its use declined a decade later.

Diagnosis

History and Symptoms

In the late 1800s, neurasthenia became a "popular" diagnosis, expanding to include such symptoms asweakness, 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.Virginia Woolf was known to have been forced to undergo rest cures, which she describes in her bookOn Being Ill. In literature, Charlotte Perkins Gilman's protagonist in The Yellow Wallpaper also rebels against her rest cure. 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.

It was explained as being a result of exhaustion of the central nervous system's energy reserves, which Beard attributed to civilization. Physicians in the Beard school of thought associated neurasthenia with the stresses of urbanization and the pressures placed on the intellectual class by the increasingly competitive business environment. Typically, it was associated with upper class individuals in sedentary employment.

Treatment

Medical Therapy

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 grasp of the scientific method was suspect and did not believe their claims to be warranted.

Today

The modern view holds that the main problem with the neurasthenia diagnosis was that it attempted to group together a wide variety of cases. In recent years, Richard M. Fogoros has posited that perhaps "neurasthenia" was a word that could include some psychiatric conditions, but more importantly, many physiological conditions marginally more understood by the medical community, such as fibromyalgia, chronic fatigue syndrome, and various forms of dysautonomia. He emphasizes that the majority of patients who would have once been diagnosed with neurasthenia have conditions that are "real, honest-to-goodness physiologic (as opposed to psychologic) disorders... and while they can make anybody crazy, they are not caused by craziness." (see reference, below)

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