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.
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- Mitchell, S.W.(1891).Wear and Tear, or Hints for the Overworked. Philadelphia, PA:J.B. Lippincott Company. Retrieved from http://www.gutenberg.org/files/13197/13197-h/13197-h.htm
- Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved July 13 2016 from http://medical-dictionary.thefreedictionary.com/neurasthenia
- International Statistical Classification of Diseases and Related Health Problems 10th Revision Retrieved from http://apps.who.int/classifications/icd10/browse/2016/en#/F48.0
- McGraw-Hill Concise Dictionary of Modern Medicine. (2002). Retrieved July 13 2016 from http://medical-dictionary.thefreedictionary.com/neurasthenia
- Beck, Julie (March 2016). "'Americanitis': The Disease of Living Too Fast". The Atlantic.
- Wessely, S. (1990) Old wine in new bottles: neurasthenia and 'ME.' Psychological Medicine, 20, pp 35-53. Retrieved from http://www.simonwessely.com/Downloads/Other/OldWine.pdf
- World Health Organization (2016). "International Statistical Classification of Diseases and Related Health Problems" (10th Revision ed.).
myalgic encephalomyelitis (ME) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.
American Psychiatric Association (APA) - The main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. Not to be confused with the American Psychological Association (also APA).
Diagnostic and Statistical Manual of Mental Disorders (DSM) - A psychiatric reference book published by the American Psychiatric Association, often referred to as "the psychiatrist's Bible". Although the most recent version (DSM-5) purports to be the authoritative guide to the diagnosis of mental disorders, the editors of both previous versions of the manual have heavily criticized the current version due to the climate of secrecy that shrouded the development of the latest version. 69% of the people who worked on DSM-5 reported having ties to the pharmaceutical industry. Dr. Allen Frances, who headed the development of the previous version, warned of dangerous unintended consequences such as new false 'epidemics'. The British Psychological Society criticized DSM-5 diagnoses as "clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements" and expressed a major concern that "clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences". A petition signed by over 13,000 mental health professionals stated that the lowered diagnostic thresholds in DSM-5, combined with entirely subjective criteria based on western social norms, would "lead to inappropriate medical treatment of vulnerable populations". The director of the US National Institute of Mental Health, Dr. Thomas R. Insel, pointed out that the diagnoses in DSM-5 had no scientific validity whatsoever. (Learn more: www.scientificamerican.com)
International Classification of Diseases (ICD) - A system of medical diagnostic codes, created by the World Health Organization (WHO), to classify diseases and other health related conditions for the purpose of international diagnostic consistency. By having common diagnostic codes around the world, health researchers are better able to quantify and track disease burdens. The most current version is called ICD-11. (Learn more: www.who.int)