Neurasthenia

Neurasthenia is an old (19th Century) name for weakness of the physical nerves. It was first used in 1829 to be a mechanical weakness of the actual nerves. In 1869, an American neurologist, George Miller Beard, started using the term to mean metaphorical nerves, i.e., anxiousness, stress, or depression. In 1871, an American physician, S. Weir Mitchell, wrote the book, Wear and Tear, or Hints for the Overworked, detailing his belief that the condition was a result of the demands of modern life in the industrial era. The term began to transition out of use in medical pathophysiology to being used in psychopathology.

When used in psychology, the term describes a vague disorder marked by chronic abnormal fatigability, moderate depression, inability to concentrate, loss of appetite, insomnia, and other symptoms. The secondary symptoms were ill-defined and abundant, including headaches, muscle aches and pain, dizziness, weight loss, irritability, inability to relax, anxiety, impotence, “a lack of ambition,” lethargy, insomnia or hypersomnia, "racing heart", and excessive sweating.

It became a catch-all for nearly any kind of discomfort or unhappiness that couldn't be explained with a known medical condition. Since ME/CFS presents with similar symptoms, many patients with ME/CFS were given the psychological diagnosis of neurasthenia.

Simon Wessely has written about neurasthenia and ME. In the essay, Old wine in new bottles: neurasthenia and 'ME', he wrote: "'Evidence is presented of the striking resonances between neurasthenia and ME. A simple explanation is that clinicians in both the modern and Victorian periods are describing a similar neurobiological syndrome, of excessive fatigability: supported by the similarity of the clinical case histories. Current medical research into the relationship of viruses to fatigue states (Yousef et al. 1988), which is of undeniable importance, may therefore be seen as an renewed effort to solve a clinical problem common to both contemporary and nineteenth century medicine. Such work attempts to answer the question posed by Wechsler (1930): 'The suspicion is justified that 'true' neurasthenia is an organic disease in the sense that as yet undemonstrable pathologic changes are the cause of the symptom and not the result of psychogenic processes. How much truth there is in such a view only further studies will determine.' However, further studies have failed to fully answer the question, and will continue to fail as neither neurasthenia nor ME fits into such a simple medical model.'"

The term, neurasthenia, has been retired as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, however, it is still used as a diagnosis in the 2016 version of the World Health Organization's International Classification of Diseases (ICD-10) under the diagnostic code F48.0. The World Health Organization's ICD-11 has removed the definition, but is not yet in use worldwide.

Learn more

 * Wikipedia - Neurasthenia
 * 2016, ‘Americanitis’: The Disease of Living Too Fast