Modern-Day Relics of Psychiatry, 2019, Tripathi et al

Andy

Retired committee member
Constantly shifting cultural views influence public perceptions of psychiatric diagnoses, sometimes accommodated by changes in diagnostic terminology. Evolving scientific knowledge of the era is at times used to justify and support mental illnesses. Too often, however, remasked nomenclatures fail to alter social stigma, in part because political arguments are used. Scientific validations of variant behaviors as symptoms with a pathologic status are unfortunately overshadowed.

Examples of cultural bias effects on recurring diagnostic challenges illustrate a need for scientific validation. Renaming fails to improve stigma or diagnostic clarity. For example, neurasthenia, or nervous exhaustion, was attributed to fast-paced urban life through the late 1970s. Its symptoms are now largely, to no real advantage, retitled as chronic fatigue syndrome. Diagnoses like “hysteria” have evolved into histrionic personality disorder and somatoform spectrum disorders, although less as a result of demonic possession or a “wandering uterus.” Decriminalized and depathologized homosexuality remains a political football, where religious “sin” conceptualizations have not been displaced by studies documenting healthy adjustments among groups with diverse sexual orientations and preferences.

Each of these remains severely socially stigmatized. The pseudoscience of “drapetomania,” once used to rationalize and pathologize a slave's freedom, is perceived now as psychiatric incarcerations of mentally healthy individuals, more commonly in totalitarian regimes—a politicization of stigma. Research reviews and funding efforts need to emphasize a sound basis for individuals caught in perpetuated diagnostic challenges, not remedied by simple shifts in nomenclature.
Paywall, https://journals.lww.com/jonmd/Abstract/2019/09000/Modern_Day_Relics_of_Psychiatry.1.aspx
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For example, neurasthenia, or nervous exhaustion, was attributed to fast-paced urban life through the late 1970s. Its symptoms are now largely, to no real advantage, retitled as chronic fatigue syndrome.

I suspect neurasthenia never referred specifically to the entity chronic fatigue syndrome. In a textbook published in 1921, neurasthenia is only briefly described as condition twice as common in men than in women, characterized by rapid fatigueability and somehow closely related to hysteria, although no reason is given. The only risk factor mentioned appears to be overwork.

If neurasthenia was the older term for CFS, they major risk factor of infection would have been recognized, and the gender distribution would have been different.
 
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In my mother's nursing textbooks (she would have trained in the early 1950s) neurasthenia was described as affecting men of a sensitive, delicate nature, and the treatment suggested was rest and withdrawal from stress and demands to a quiet environment.

Women weren't mentioned under this diagnosis- lumped into hysteria I expect.

In a different book of the time, Soldiers' heart or Da Costa's Syndrome (possible OI/POTS) seemed to be viewed very much in class terms which affected the lower ranks in the infantry who were regarded as lacking in moral fibre, rather than the officer chaps in the navy or air force.
 
Renaming fails to improve stigma or diagnostic clarity
I don't understand how anyone can be confused by this. This is the exact same logic behind "it's not racist if you don't use explicit racist insults".

It's the substance and its consequences that cause stigma, not the actual words. Of course bad word choice will often increase stigma, but that is almost universally when words are repurposed specifically to cause confusion, which still remains a substance problem. Fatigue isn't stigmatized because of what the word means, it's stigmatized because of the overwhelming belief that it is interchangeable with low motivation and of otherwise no significant consequence, meaning no help, no support, no research, no progress. It has become as meaningless as anxiety and depression, things we cannot see, measure, define or falsify and are therefore used to mean anything and everything to avoid saying "I don't know and there should be efforts to understand why".

And here for example the destruction of all useful meaning of the word fatigue has caused enormous stigma to other diseases as well. It's well-established that fatigue is one of the primary complaints for MS, Parkinsons', RA and several other autoimmune diseases yet as far as the experts are concerned it's basically irrelevant, in large part because fatigue has been more and more associated with psychosomatic illness, which means "not their problem".

I don't think relic is the right word. Relics have no purpose other than as mementos, they are not used in practice. Psychosomatic medicine still very much applies the old ideas, even straight up Freudian nonsense, with different words of course but that's a distinction without a difference, and so they are not so much relics are anachronistic failures. They are not restricted to history, those ideas are in fact so alive we are probably in the golden age of psychosomatic ideology, more influential than ever. None of the historical baggage has been shed, stuff simply keeps being added to it.
 
For example, neurasthenia, or nervous exhaustion, was attributed to fast-paced urban life through the late 1970s.

I don't know about this. Even self-proclaimed history of fatigue expert Edward Shorter has written that the diagnosis of neurasthenia had become rare by WWI, and was virtually gone by WWII.


This 1984 article appeared in the New York Times:
HYSTERIA WAS FOR WOMEN, NEURASTHENIA FOR MEN
https://www.nytimes.com/1984/09/09/books/hysteria-was-for-women-neurasthenia-for-men.html


This 2016 article in The Atlantic,
‘Americanitis’: The Disease of Living Too Fast,
is quite hilarious in relating how non-specific the diagnosis was. It makes the late-1980's notion that neurasthenia was synonymous with Chronic Fatigue Syndrome seem ridiculous, simply because neurasthenia was apparently synonymous with nearly everything, including physical diseases and forms of mental illness that had not yet been distinguished.
https://www.theatlantic.com/health/archive/2016/03/the-history-of-neurasthenia-or-americanitis-health-happiness-and-culture/473253/
 
For men, the frontier held the cure. Doctors would often send male neurasthenics westward to ride horses, rope cattle, do pushups, and slap each others’ butts until the sheer manliness of it all restored their nervous energy. None other than the 26th president of the United States, Teddy Roosevelt, received such a “West cure” for his neurasthenia. Before his cure, when he was a New York state legislator, Roosevelt had a reputation as a dandy, and people called him names like “Young Squirt” and “Punkin-Lily,” Lutz writes. Some called him an American Oscar Wilde. His neurasthenia was seen as an “effeminizing sickness” that the West cure got rid of, making him buff and tough enough to be elected president. Such were the times.

Fun times.

The women were treated with enforced rest, to the point of not being allowed to feed themselves.
 
Then why did a psychiatrist attempt to diagnose me with it in 2010, huh?

o_O

I got neurasthenia as my first Dx from my GP in 2011 when I got sick. Even wrote in on my insurance forms. It took a psychiatrist to tell him he was wrong and cleared me of all mental disorders for that matter and told my GP I needed biological investigation. My GP stopped treating me and investigating altogether after that.
 
Doctors would often send male neurasthenics westward to ride horses, rope cattle, do pushups, and slap each others’ butts until the sheer manliness of it all restored their nervous energy. None other than the 26th president of the United States, Teddy Roosevelt, received such a “West cure” for his neurasthenia.
Did they 'Go West' like this?

Or even this?

That does indeed make me feel more mainly already! All the bum slapping goodness...
 
Fun times.

The women were treated with enforced rest, to the point of not being allowed to feed themselves.
Because if there's one thing the Wild West was known for it's that it was all easy-going and relaxing.

Also apparently stress appeared in 1970's America, or something like that. Life before then was a utopian ideal of fun and games and no threats whatsoever, abundance and good health. That's really the thing life was known for before the 20th century: good health all-around. Obviously.

Even as parody this would be too hamfisted.
 
UpToDate.com refers to neurasthenia as a historical term for ME/CFS. This is what doctors reference.

Shocking really. Then again, Komaroff is the editor, so perhaps not so surprising.
UpToDate said:
Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is an illness of uncertain cause.
...
The condition has long been recognized, and many different terms have been used to describe it (eg, DaCosta's syndrome, effort syndrome, soldier's heart, neurasthenia, myalgic encephalitis/encephalomyelitis, Iceland disease, Akureyri disease, Royal Free disease, and chronic fatigue and immune dysfunction syndrome) [2,3].

https://www.uptodate.com/contents/c...ic-encephalomyelitis-chronic-fatigue-syndrome
 
UpToDate.com refers to neurasthenia as a historical term for ME/CFS. This is what doctors reference.

Shocking really. Then again, Komaroff is the editor, so perhaps not so surprising.
Mistakes of the past shouldn't be hidden. It's definitely true that some self-proclaimed experts argued they are the same thing, just as it's true that MS used to be called hysterical paralysis.

Problem is those mistakes are still being made, not that they ever were. The beliefs behind neurasthenia are still very much alive, just as hysteria and conversion disorder are, mixed and matched in endless combinations. They're alive because people keep them alive, some very influential.

Frankly, the failure lies more in the institutions that continue enabling this. Bad ideas are as common as air. It's just disappointing that they are still very much in demand by people who absolutely should know better, but clearly don't.

And now as we see with the "actually, bias is A-OK" coming from Cochrane, it seems we are entering a golden age of magical psychological pseudoscience. Freud would be just as proud as he was high on cocaine.
 
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