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Marina Morrison

House of Wits

Anne Dalke

5/13/2010

Neurasthenia: Modern Equivalents and Abroad

            Neurasthenia has survived throughout the years in many different forms and in various cultures despite its general decline in western medical manuals and diagnoses.  Neurasthenia was excluded from the Diagnostic and Statistic Manual, a western standard in diagnosing mental disorders, in 1980; yet, it is still included in the appendix under the glossary of cultural-bound syndromes as “shenjing shuaiuo.” Despite the medical practices of the west and its general decline as a diagnosable medical disorder, neurasthenia is still invluded in many international medical manuals including the World Health Organization’s International Classification of Diseases, often abbreviated as the ICD-10, which continues to include Neurasthenia as a mental illness due to its common recognition and diagnosis throughout many Asian cultures (Schwartz 257). Many Asian cultures stigmatize psychiatric disorders which can often lead to the social downfall of an individual and their family; this negative attitude towards psychological disorders may explain the common diagnosis of neurasthenia among Asian communities. The diagnosis of neurasthenia is seen as more biological, physical and something that one can be overcome whereas mental illness is seen as much more shameful, uncertain, and may be due to the inability to control one self. Often, Asian doctors will diagnose neurasthenia in place of a more socially stigmatized mental illness, such as anxiety or schizophrenia, to save the patient from shame and social isolation. Western medicine has not continued to diagnose individuals with the disorder but instead has taken to relabeling and repackaging neurasthenia by diagnosing the antiquated disorder as depression or chronic fatigue syndrome (258).  

            Neurasthenia was officially inducted into western medical vocabulary in 1869 by prominent neurologist George Miller Beard and later further popularized by fellow neurologist S. Weir Mitchell. The name of the disorder was Greek in origin and can be interpreted to mean “lacking in nerve strength.” Beard postulated the existence of varying subtypes of Neurasthenia including Cerebrasthenia, Myelasthemia, and Digestive Asthenia. Cerebresthenia was thought to be a strain of neurasthenia that caused cerebral exhaustion either physically or psychically and would result in tenderness of the scalp, eye and ear disorders, a feeling of fullness of the head, and possible emotional symptoms. Myelasthemia was specific to the spine and would cause muscle spasms, back pain, feet pain, sexual difficulties, and sensitivity to the weather. Digestive Asthenia was more specific to the gastrointestinal organs and would often result in an upset stomach or overindulgence in food and wine (Abbey 1639). Beard suggested that Neurasthenia was the result of depleting one’s nervous energy as well as a psychological reaction to rapid social and technological change. Modern trappings of industrialized American cities put urban populations and the wealthy especially at risk for the disorder as they were most exposed to the latest developments in modern society. Treatment for the disorder became something of a cultural sensation as potions, pills, tranquilizers, and tonics were heavily advertised in newspapers and periodicals to cure the nervous disorder (Tone 10). Neurologist S. Weir Mitchell who described Neurosthenia as a “disorder of capitalist modernity” developed the popular “rest cure” that was prescribed to the more serious cases of civilian Neurasthenia and encouraged sufferers to partake in bed rest, sponge baths, massage, and a diet of milk and eggs (11).  The rest cure proved to be largely unsuccessful as many sufferers, especially females, found the treatment to worsen their condition.

Psychiatrists were largely absent from the early stages of neurasthenia due to its attachment to the discipline of nervous medicine and neurology making it much more of a biological disorder than psychological. This reflected the sentiments of Americans at the time as Psychiatry was stigmatized and associated with oppressive mental institutions and mental instability. Neurasthenics provided a sharp contrast to the latter as they were typically cared for and treated in a professional office or an exclusive nerve spa (12).  As a result of the more professional settings and lack of social stigma, neurology was seen as a more legitimate and respectable practice than psychology, and people were more apt to visit neurologists for their nervous tensions than psychologists. Neurology quickly started gaining more respect in the academic world and many medical schools began establishing neurology departments; neurology had gained a place in the laboratory sciences. The respect of neurology over psychiatry was also due to the major discoveries in cerebral localization, motor deficits, neurosurgery, and advancements in epilepsy while the discipline of psychology had failed to make such significant discoveries. Psychiatric asylums did little to help the reputation as they were known for uncomfortable and dreary settings as a result of overcrowding and neglectful caretakers (14). Therefore, the 1950s marked a strong divide between those suffering from neurasthenia or “nervous tension” and those suffering from more serious mental illness. As a result, neurasthenia was projected as an ailment of the wealthy and privileged as sufferers were cared for in expensive spas and professional settings while psychiatric treatment was considered reserved for those who were socially outcast or poor.

The same general unaccepting attitude towards psychiatric disorders can be found in Japanese culture. Neurasthenia in Japan, much like in 1950s America, is considered a curable physical condition thus saving sufferers from the stigma of a mental illness. However, Japanese medical professionals often purposefully misuse the diagnosis of neurasthenia to camouflage serious mental disorders (Schwartz 258). As a result, many serious mental disorders go untreated while an increasing number of false diagnoses for neurasthenia are made. This is done with the intention to protect mentally ill individuals and their families from social prejudice despite the risks involved in neglecting psychiatric disorders. Japan has already experienced the backlash of this cultural practice as a pilot, recently diagnosed with neurasthenia, turned out to have a serious case of schizophrenia. As a result of the misdiagnosis, the pilot was responsible for a plane crash that killed 24 people. This shows just how strong the social prejudice against mentally ill individuals is in Japan. In addition to camouflaging disorders like schizophrenia and anxiety, they even diagnose neurasthenia in cases of cancer (Munakata 204). Certain mental illnesses are strongly shamed upon as they can result in a variety of consequences including bringing shame to the family, losing a job, destroy marriage prospects, or even panic or shock. Munakata describes a typical Japanese reaction to a Schizophrenia diagnosis, “They freeze, become pale, stare at the doctor not knowing what to say only mumbling such questions as ‘are you sure of the diagnosis?’ Their behavior can only be compared to that of convicts given a death sentence or patients receiving a diagnosis of cancer” (209). Schizophrenia is particularly offensive to the Japanese culture as it is seen as an inability to control one’s behavior and Japanese culture puts high priority on following social convention (208).  This practice of disguise diagnosis is a widespread practice in Japan as many families do not want to hear that their loved ones are suffering from a serious and potentially life altering disorder and live with the social implications.

This is strengthened by the fact that Japanese culture expects families to take care of any ill loved ones as mental health and care facilities in general are looked upon as absolute last resort efforts in the case that the responsible family cannot provide sufficient care; it would often take many years for a Japanese family to allow a mental health facility to take over caring for a loved one. In the past, Japanese health facilities were so limited that mentally ill individuals were often banished to a dark room of a house, a barn, and sometimes Buddhist temples. Even those who enter care systems are only there temporarily or until the family can again provide care for their loved one (205). This hesitation for Japanese families to leave their mentally ill loved ones in the care of mental professionals has significantly influenced the facilities themselves. The Japanese mental hospital is typically very small and operates as its own family unit to provide a sort of surrogate family for the mentally ill patient. This is a stark contrast to the huge 10,000 patient facilities seen in the United States and Europe (207).  Yet, Japanese mental hospitals also suffer from cultural stigma as they operate as closed institutions leaving the public oblivious to what goes on inside; as a result, whenever accidents or scandal occurs the image of the mental hospital is further tarnished and feared by the Japanese public.

Doctor-Patient relations are also crucial factors when disguising diagnoses in Japan. Often, Japanese doctors form strong emotional bonds with their patients and as a result feel responsible to lessen any psychological or emotional pain the family may suffer as a result of a severe psychiatric diagnosis (210). In Japanese society, doctors often feel obligated to their patients as a result of the patient and their family disclosing their complaints and weaknesses to him or her. In fact, if the doctor does not exhibit the emotional ties that Japanese patients seek out, the patients may not fully trust the doctor. The relationship can be best compared to that of a parent and child (212). Due to this intense emotional bonding between doctor and patient, Japanese doctors have a sense of wanting to protect their patients from any alienation or shame that could arise from a serious psychiatric disorder.

In order to treat the commonly diagnosed Neurasthenia, the Japanese have used the psychiatric tool of Morita psychotherapy. Morita therapy is very similar to George Beard’s rest cure and requires the patient to complete isolation and bed rest (Reynolds 257). Morita therapy was developed by Japanese psychiatrist Shoma Morita and was largely influenced by Zen Buddhism. Morita therapy stresses accepting one’s feelings as they are and working through them. According to Morita, “Trying to control the emotional self willfully by manipulative attempts is like trying to choose a number on a thrown die or to push back the water of the Kamo River upstream. Certainly, they end up aggravating their agony and feeling unbearable pain because of their failure in manipulating their emotions” (Morita). Morita’s practice recommends isolated bed rest coupled with counseling and therapy to help become one and accept one’s feelings. Morita therapy provides a striking parallel to the western rest cure which also used isolation methods to attempt to cure neurasthenics.

Japan is not the only Asian country to continue to diagnose individuals with neurasthenia as it is often diagnosed in China as well. The Chinese-English Terminology of Traditional Chinese Medicine includes the disorder and describes it as a “decrease in vital energy” caused by reduced functioning in the five internal organ systems (heart, liver, spleen, lungs, kidneys) (Schwartz 258). Neurasthenia is also included in the Chinese Classification of Mental Disorders as “Shenjingshuairou” or weakness of nerves. China’s diagnoses of neurasthenia are similar to that of Japan’s as it is used as a cover for more serious mental illnesses.

            In China, neurasthenia is often used as a cover for depression and as a result many cases of neurasthenia are present in China while there are far fewer active cases of depression. Neurasthenia ranks as the second most common diagnosis in Chinese mental hospitals, many of which would probably be considered depression or anxiety disorder if diagnosed in the West. However, Arthur Kleinman suggests that the high volume of neurasthenia diagnoses may be a product of poor health care in China. Klienman argues that many Chinese live in severely impoverished environments and those lucky enough to see a psychiatrist may only be seen for a matter of minutes through a purely biomedical lense so patients can be quickly diagnosed and treated. Additionally, it is not uncommon for Chinese practitioners to skip over psychiatric evaluation to evaluate for more organic, life threatening conditions (Kleinman 380). This may be influenced by the fact that many Asian cutures prefer somatization or “the process of experiencing and expressing emotional stressors and mental illness through bodily complaints” (Shenjing). This is supported by the strong social backlash that occurs when one complains of a psychological rather than bodily ailment in many Asian communities.  

            In the United States, neurasthenia has been largely removed from western psychiatric medical diagnoses but lives on in the more recent chronic fatigue syndrome which strongly resembles neurasthenia as they both are characterized by major social and cultural developments. Chronic fatigue syndrome is marked by a reduction in activity and general fatigue; lightheadedness and dizziness may also be present. Sufferers of chronic fatigue syndrome may even experience a reduction in their functional capacity rendering them unable to work or partake in activities they once found fulfilling (Abbey 1639). The parallel between chronic fatigue syndrome and neurasthenia is mainly due to their similar symptomologies and their similar theme of “overloading the body’s natural reserves.” Chronic fatigue syndrome is thought to be the body’s response to an overloaded immune system while neurasthenia is thought to be the result of overloading one’s supply of nervous energy. Additionally, both developed during eras of significant social and technological change. Neurasthenia developed during significant changes in technology and communication such as the development of the telegraph and telephone. Chronic fatigue syndrome developed during similar change as the telephone, fax, and personal computers increased in popularity and common use. Additionally, due to the new improvements in technology and the speed of communication a rushed quality of life began to spread and people became more concerned with financial success and the acquisition of power (1643).

There seems to be evidence of similarity between chronic fatigue syndrome and neurasthenia when it comes to gender roles. Neurasthenia was imbalanced in diagnoses as it was more often diagnosed to men than to women. Neurasthenia was generally seen as the result of the general physical weakness of women and their lack of satisfaction with life. Around the same time as the rising occurrences of neurasthenia, women began to become more involved in professional careers rather than staying at home which many believed to be the root cause of the spike of neurasthenia, anorexia, and hysteria in women. Yet, Dr. Margaret A. Cleaves blamed the illness on society’s inability to fulfill female ambitions rather than categorizing the illness as a result of overworking (1643). Interestingly, male sufferers of neurasthenia are credited with giving the disease respectability and legitimacy. For men, neurasthenia was seen as acceptable and even complimentary for it proved their masculinity, devotion to work, and success. Many cases were diagnosed to prominent figures in society such as lawyers and members of the clergy. This gender pattern continues today in chronic fatigue syndrome as more women are diagnosed with the disorder than men. Society still suffers from not being able to fully provide women with satisfying opportunities in some areas and most sufferers feel overworked or conflicted with their work and family lives (1644).

Ultimately, neurasthenia has continued to persevere as a mental disorder despite its initial decline in the 1950s. Asian communities and cultures in particular seem to rely on the disorder as a way to avoid the social stigma of other more serious psychological disorders. Japan and China have proven to be the most effected by neurasthenia as patients suffer from symptoms similar to anxiety and depression. The rise in diagnosis of neurasthenia seems to be heavily influenced by the negative portrayal of mental illness in Japan and China. Additionally, China’s large population causes a large number of patients to be neglected when it comes to sufficient mental health evaluations and treatment. In the United States, neurasthenia may be an extinct disorder but it lives on under the name of chronic fatigue syndrome which describes similar symptoms and developed under similar cultural circumstances.

Works Cited

Abbey, Susan E., and Paul E. Garfinkel. "Neurasthenia and Chronic Fatigue   Syndrome:    The Role of         Culture in the Making of a Diagnosis." American      Journal of Psychiatry. 148.12 (1991): 1638-1646. Print.

Kleinman, Arthur. "The Moral Economy of Depression and Neurasthenia in China." Culture, Medicine, and Psychiatry. 23. (1999): 389-392. Print.

"Morita Therapy." The ToDo Institute. N.p., n.d. Web.  9 May 2010.             <http://www.todoinstitute.org/morita.html>.

Munakata, Tsunetsugu. "The Socio-Cultural Significance of the Diagnostic Label       "Neurasthenia" in Japan's Mental Health Care System.." Culture, Medicine,          and Psychiatry. 13. (1989): 203-213. Print.

"Shenjing Shuairuo: The Case of Neurasthenia." Culture-Bound Syndromes in            China. N.p., 1998. Web. 8 May 2010.

Reynolds, David K. "Review Article: Morita Therapy." Culture, Medicine, and   Psychiatry. 12. (1988): 257-258. Print.

Schwartz, Pamela Yew. "Why is Neurasthenia Important in Asian Cultures?."             Western Journal of  Medicine. 176.4 (2002): 257-258. Print.

Tone, Andrea. The age of anxiety. New York: Perseus Books Group, 2008. 8-14. Print