Neurasthenia: tracing the journey of a protean malady, 2020, Bhola and Chaturvedi

[Andy]

Neuresthenia has had its popularity waxing and waning over the years. This review article traces the path and trajectory of the concept of this disorder, how it changed and varied over time, to the current times, when it has been almost forgotten and the concept is heading towards oblivion. Although its place in the diagnostic systems is currently in question, neurasthenia is still part of professional conversations and practice.

The concept of neurasthenia emerged at the intersections of clinical, cultural and sociological dimensions of society. A deeper examination of how neurasthenia was situated at the intersections of race, class and gender exemplifies how psychiatric diagnoses may reflect and shape societal biases. The neurasthenia label has all but disappeared from contemporary nosological frameworks, however, there is a proliferation of other disorders, e.g. chronic fatigue syndrome, fibromyalgia, that try to capture the experience of fatigue, pain, weakness, and distress even in the absence of clear-cut medical aetiologies. Only time will tell, if this concept has indeed been buried, or will rise as a phoenix in the years to come. Newer nervous fatigue syndromes are expected to emerge from the use of technology, screen time and the virtual world.

Paywall, https://www.tandfonline.com/doi/full/10.1080/09540261.2020.1758638
Sci hub, https://sci-hub.tw/https://www.tandfonline.com/doi/full/10.1080/09540261.2020.1758638

 

[cassava7]

Newer nervous fatigue syndromes are expected to emerge from the use of technology, screen time and the virtual world.

Are they saying people are going to self-diagnose with "nervous fatigue syndromes" because they can now research their symptoms on Internet without the avail of a medical doctor? Or are they saying that you can get burnt out from social media etc?

In the former case, well, yes, I can go to the ME/CFS page on the CDC website and check if my symptoms match. I can also download diagnosis criteria for fibromyalgia online. I can now bring these good quality, helpful resources to my doctor or a specialist to see if they would diagnose me with either condition. But I'm certainly not self-diagnosing.

 

[Mithriel]

Neurasthenia was thought to be caused by the experience of "modern living" in the cities of the 1800s which people were thought to be bad for the nerves. This was particularly true of the delicate physiologies of women who were often not allowed to read newspapers in case it overloaded their brains.

They are saying here that the new modern technologies will have the same damaging effects on weak minds that are not robust enough to cope.

 

[rvallee]

 

[Webdog]

UpToDate still tells doctors that neurasthenia is a historical term for ME/CFS, in an entry about ME/CFS written by Gluckman and edited by Komaroff.

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

 

[cassava7]

A few weeks ago I remember discussing the ICD-10 description of neurasthenia with someone who has ME. From https://icd.who.int/browse10/2019/en#/F48.0, bolding mine:

Considerable cultural variations occur in the presentation of this disorder, and two main types occur, with substantial overlap. In one type, the main feature is a complaint of increased fatigue after mental effort, often associated with some decrease in occupational performance or coping efficiency in daily tasks. The mental fatiguability is typically described as an unpleasant intrusion of distracting associations or recollections, difficulty in concentrating, and generally inefficient thinking. In the other type, the emphasis is on feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax. In both types a variety of other unpleasant physical feelings is common, such as dizziness, tension headaches, and feelings of general instability. Worry about decreasing mental and bodily well-being, irritability, anhedonia, and varying minor degrees of both depression and anxiety are all common. Sleep is often disturbed in its initial and middle phases but hypersomnia may also be prominent.

We were worried that a doctor who has no knowledge of ME might diagnose neurasthenia -- according to this description -- for patients with ME who haven't received a diagnosis yet. There are a few differences:

- the "two main types" of neurasthenia are respectively mental and physical, whereas in ME, both neurological/cognitive and physical symptoms are present
- "exhaustion after only minimal effort" doesn't mean *prolonged* exhaustion that comes from PEM, and other common PEM symptoms aren't mentioned (e.g. flu-like symptoms);
- "unpleasant intrusion of distracting associations or recollections", anhedonia, and, more generally, primary mental components of neurasthenia are not symptoms of ME

But these differences might be too subtle for a doctor/GP/psychiatrist who is not very interested in listening to a patient, especially if they're trigger-happy with diagnosing "medically unexplained symptoms"...

Anyway, I think that "somatic functional syndrome" and other flavors of this term are preferred in psychiatry nowadays because there is less history/stigma attached to them than the old "neurasthenia".

 

[Sean]

Old wine in old bottles?

 

[Obermann]

Neurasthenia is an obsolete concept. George Beard introduced the term in an article in 1869. He never tried to define a group of patients described by certain signs or symptoms, but instead started with a presumed illness mechanism: nerve weakness. It was a parallell to anemia, which "is to the vascular system what neurasthenia is to the nervous." Beard then associated the presumed neural weakness with many different diffuse symptoms. As there neither is scientific support for the presumed illness mechanism nor a well-defined clinical presentation of the condition, the diagnostic label neurasthenia does not define a meaningful clinical entity.

 

[spinoza577]

... He never tried to define a group of patients described by certain signs or symptoms, but instead started with a presumed illness mechanism: nerve weakness. It was a parallell to anemia, which "is to the vascular system what neurasthenia is to the nervous."

So far I can´t see that there is anything wrong with such a guess. No psychology included.

Beard then associated the presumed neural weakness with many different diffuse symptoms.

Yes, this is completely logical. Nerves are key in movable organisms.

As there neither is scientific support for the presumed illness mechanism nor a well-defined clinical presentation of the condition, the diagnostic label neurasthenia does not define a meaningful clinical entity.

So there hadn´t occured any substantial progress since 160 years. Not even a surprise, but "interesting" that some researcher (special kind of them) are not willing to admit that there is rather still small knowledge.

 

[Obermann]

So far I can´t see that there is anything wrong with such a guess. No psychology included.

There is nothing wrong with hypothesizing an illness mechanism. However, if the proposed mechanism doesn't hold up and the proposed symptoms don't define a clearly distinguishable group of patients, there is nothing that connects the patients with those symptoms. Therefore, it isn't meaningful to use the label neurasthenia in diagnostics anymore.

I should add that I generally think it is a bad idea to base diagnostics on a hypothesis. When the underlying illness mechanisms are unknown, diagnostics should be based on patterns in signs, symptoms, and illness trajectory. The lack of understanding should also be clearly acknowledged.

 

[spinoza577]

... However, if the proposed mechanism doesn't hold up and the proposed symptoms don't define a clearly distinguishable group of patients, there is nothing that connects the patients with those symptoms. Therefore, it isn't meaningful to use the label neurasthenia in diagnostics anymore.

Honestly I don´t know much about the historical label "neurasthenia" and its implications as they - in fact and possibly strangely - may have been made.

The term though is Greek and means "nerve-weakness". I cannot agree that this isn´t meaningful, as I cannot agree that any therm that refers to a dysfunction of nerves is, e.g. "FND".

Another question is the further interpretation ...

And this is rather the problem. When today some researchers say that there has been an old attempt that would have been sadly abandoned, they want to reestablish a certain interpretation, conveying that all the effort for biological determinations have failed so far ... despite the fact that luckily this bold guess "conversion disorder" has been abandoned only recently.

These guys are awkward.


But therefore it is even more important to hold to that momentums that might be true.

I should add that I generally think it is a bad idea to base diagnostics on a hypothesis. When the underlying illness mechanisms are unknown, diagnostics should be based on patterns in signs, symptoms, and illness trajectory. The lack of understanding should also be clearly acknowledged.

I agree certainly with the last sentence. Otherwise,

symptoms may differ a lot, e.g. in ME/CFS. Maybe it´s even not one illness.

Or maybe all really possible FND´s originate in the same area and could be healed by the same treatment (or by the same range of treatments).

Nobody knows.


So, I would be cautious to discard attempts only because they are currently made by people who behave like idiots or sadists.

Accordingly, the problem may not be a diagnosis which is in fact based on a kind of uncertainty, but the underlying assumed treatment based on any wishful thinking.

In fact, as there is a need for classification (attempt to understand), there may be currently no better one than to say that there may be some dysfunction.

So I think, Beard may have corrected his interpretation ("caused by civilization"), but Freud would have completely lost his approach (because he wanted to overcome an - admittedly - wide term by particular - but speculative - interpretations).

 

[rvallee]

Old wine in old bottles?

Old piss, is more like it.