(Not a recommendation) Neurasthenia Revisited: On Medically Unexplained Syndromes and the Value of Hermeneutic Medicine, Aho, 2018

Indigophoton

Indigophoton

Senior Member (Voting Rights)
I haven't looked at this yet. @Tom Kindlon posted it on twitter with the observation that it looks annoying...
The rise of medically unexplained conditions like fibromyalgia and chronic fatigue syndrome in the United States looks remarkably similar to the explosion of neurasthenia diagnoses in the late nineteenth century. In this paper, I argue the historical connection between neurasthenia and today’s medically unexplained conditions hinges largely on the uncritical acceptance of naturalism in medicine. I show how this cultural acceptance shapes the way in which we interpret and make sense of nervous distress while, at the same time, neglecting the unique social and historical forces that continue to produce it. I draw on the methods of hermeneutic philosophy to expose the limits of naturalism and forward an account of health and illness that acknowledges the extent to which we are always embedded in contexts of meaning that determine how we experience and understand our suffering.
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http://jah.journalhosting.ucalgary.ca/jah/index.php/jah/article/view/174

Link to pdf of full text, http://jah.journalhosting.ucalgary.ca/jah/index.php/jah/article/view/174/pdf
 
Let me just assure prospective readers that this is, in fact, an absolute gem. I majored in politics and read some stuff that was pretty out there. Derrida, postmodern feminist theory, etc.. This is one of the finer examples of postmodern BS I have ever encountered. +100 points for unusual levels of legibility and lucidity. Unfortunately, -50 points for no use of 'phallus' or derivative; a tragic oversight...

But seriously, after reading so many things like this you realize that they're all just a big word/thought-knot that simply needs to be tugged in the right couple of places to unravel. (Everybody here has probably learned that lesson, over and over...) For me the crux can be found in the final paragraphs under the heading 'Hermeneutics, Somatization, and Medically Unexplained Syndromes':

Hermeneutic philosophy dissolves the traditional scientific distinction between objective “facts” and subjective “values.” From the standpoint of hermeneutics, there are no brute, value-less facts when it comes to human experience. As Charles Taylor wrote, such “a reductive explanation of human experience in physiological and ultimately in physical and chemical terms” is a denial of the qualitative meaning and value we attribute to our experience" (1985, p. 47).
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This seems to be the center of the justification for insinuating anti-scientific thinking into medicine. It makes no sense. First of all, the whole endeavor of medicine is valuable in large part for its capacity to reduce qualitative suffering; but it always requires a lot of 'brute' facts to get there. More broadly, there is no insight or substance here because nobody in practice actually makes the mistake the author is warning against. There is no life lesson here, much less a medical lesson.

Thus, even though the majority of those labeled with fibromyalgia and chronic fatigue have an accompanying psychiatric disorder, and the treatment is often the same as the treatment for anxiety or major depression (e.g,. a combination of antidepressant medication, exercise, and/or some form of cognitive-behavioral therapy)
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This is just a series of pretty basic factual and logical errors that everybody here is familiar with. Well at least that would be the most charitable interpretation, but...

The uncritical assumption underlying somatization, then, is that it is only a matter of time before an authentic biochemical “fact” can be found that directly causes the syndrome. And excitement builds in the medical community with the scientific discovery of each new cause, whether it is measurable deficiencies in neurotransmitters like serotonin and dopamine, low levels of somatotropin or growth hormone, or the poor sensory functioning of “substance P” (Groopman, 2000). But it is this assumption that is precisely what a hermeneutic approach to medicine calls into question. Even if such a discovery is made, it is still up to the sufferer to understand and give meaning to their own subjective experience on the basis of the interpretative resources made available by their world.
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You hate to see a rookie mistake like this. If you're going to go through the effort of concocting such a highly-wrought aggregation of elaborately vacuous verbiage, don't spill the beans that you're arguing in bad faith because, actually, even if you're wrong, you're right, because, you know, truth is just a construct anyway, man. Hopefully some veteran postmodernists can take this young greenhorn under their wing and help bring his game up to big-league levels. I mean, the talent is there.

Yeah, this really takes me back to politics class seminars. Actually, this reminds me in a strange way of a very famous piece called 'The End of History?' Not because they're similar, but because there's an interesting connection to be made between them, I think. Nice find.
 
James Morris-Lent said:
Let me just assure prospective readers that this is, in fact, an absolute gem. I majored in politics and read some stuff that was pretty out there. Derrida, postmodern feminist theory, etc.. This is one of the finer examples of postmodern BS I have ever encountered. +100 points for unusual levels of legibility and lucidity. Unfortunately, -50 points for no use of 'phallus' or derivative; a tragic oversight...

But seriously, after reading so many things like this you realize that they're all just a big word/thought-knot that simply needs to be tugged in the right couple of places to unravel. (Everybody here has probably learned that lesson, over and over...) For me the crux can be found in the final paragraphs under the heading 'Hermeneutics, Somatization, and Medically Unexplained Syndromes':


This seems to be the center of the justification for insinuating anti-scientific thinking into medicine. It makes no sense. First of all, the whole endeavor of medicine is valuable in large part for its capacity to reduce qualitative suffering; but it always requires a lot of 'brute' facts to get there. More broadly, there is no insight or substance here because nobody in practice actually makes the mistake the author is warning against. There is no life lesson here, much less a medical lesson.


This is just a series of pretty basic factual and logical errors that everybody here is familiar with. Well at least that would be the most charitable interpretation, but...


You hate to see a rookie mistake like this. If you're going to go through the effort of concocting such a highly-wrought aggregation of elaborately vacuous verbiage, don't spill the beans that you're arguing in bad faith because, actually, even if you're wrong, you're right, because, you know, truth is just a construct anyway, man. Hopefully some veteran postmodernists can take this young greenhorn under their wing and help bring his game up to big-league levels. I mean, the talent is there.

Yeah, this really takes me back to politics class seminars. Actually, this reminds me in a strange way of a very famous piece called 'The End of History?' Not because they're similar, but because there's an interesting connection to be made between them, I think. Nice find.
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My thoughts too. It's dross.
 
Funny thing happened then. I sat on the phone and it somehow sent the post. Try again.

He might have been advised to study Shorter more closely. I am serious, for once.

The problem in assuming a one-to-one coincidence between neurasthenia and chronic fatigue is that the diagnosis was used in a variety of different contexts:1 as a synonym for general nervousness and evolving psychosis; 2 as the male equivalent of hysteria in women;3 as a synonym for minor depression; and 4 as a diagnosis of fatigue states in patients who were not obviously depressed.

This last group is of particular interest, as it corresponds today with ME and CFS. A limited percentage of neurasthenic patients did suffer primarily from sensations of chronic fatigue...

Chronic fatigue in historical perspective. Edward Shorter. 1993 Chronic fatigue syndrome. Wiley, Chichester (Ciba Foundation Symposium 173) p6-22.
In chapter "was neurasthenia an early instance of chronic fatigue?"

A second problem in assuming a direct equivalence between neurasthenia and chronic fatigue is that many fatigued patients did not receive the diagnosis of neurasthenia... P12
 
There is actually a direct thread between neurasthenia and CFS. It is that psychologists use empty theories because they cannot look at the brain the way you can look at microbes under a microscope. This was sort of OK in 1890, but shocking in 2018.

We have the unreal situation where blood clotting is known to be a complicated system with lots of points at which it can fail but the functioning of the brain - the most complicated thing on Earth - is reduced to a set of facile "theories".

A few minutes thought can give a long list of diseases that were once considered hysterical. The experiment has been done. Does hysteria or somatisation have any facts to back it up? NO.
 
chrisb said:
The problem in assuming a one-to-one coincidence between neurasthenia and chronic fatigue(...)
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I think this is a good point. Why even dredge up neurasthenia (or hysteria, etc.)? How valid were these diagnoses given the state of medical science and technology at the time they were in use? Who knows what was really going on in each case? It's a very tenuous link and I think it's more judicious for those who are sincerely trying to make things better now to not get bogged down trying to read into the past too deeply. There's enough to go on here and now that we can get a much better look at.

Mithriel said:
There is actually a direct thread between neurasthenia and CFS. It is that psychologists use empty theories(...)

A few minutes thought can give a long list of diseases that were once considered hysterical. The experiment has been done. Does hysteria or somatisation have any facts to back it up? NO.
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I think this is a good answer for the question above - why dredge up neurasthenia? It's a seductive connection to make if you're trying to build and bolster a compelling story that is based mostly on speculation. I think there are some instances where you can reasonably prove exotic sorts of psychogenic functional disorder (functional blindness, paralysis or such) but for the most part I think this is on point - these lines of thought have not panned out to have broad medical applicability.

NelliePledge said:
There’s probably a big word for pompous bullshit dressed up as academic research but I don’t know it I’m obviously a lesser mortal
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'Intellectual masturbation' expresses it best for me. There's nothing wrong with the activity so much as there is with trying to pass it off as something substantial and illuminating.
 
https://www2.fgcu.edu/CAS/1066.asp

Professor of Philosophy and Chair, Department of Communication & Philosophy
Phone: (239) 590-7422
E-Mail: kaho@fgcu.edu
Office: RH 220



Ph. D. University of South Florida

Teaching Interests: 19th/20th Century European Philosophy, Heidegger, Existentialism and Phenomenology

Research Interests: Medical Humanities with a focus on hermeneutic critiques of the biomedical model in psychiatry.

Full C.V.

SELECTED PUBLICATIONS

Authored Books

  • Heidegger’s Neglect of the Body (Albany, NY: State University of New York Press, 2009)
  • Body Matters: A Phenomenology of Sickness, Disease, and Illness, with James A. Aho (Lanham, MD: Lexington Books, 2008)
  • Existentialism: An Introduction (Polity, 2014)
Edited Books

  • Existential Medicine: Essays on Health and Illness (London: Rowman and Littlefield International, 2018)
  • Dostoevsky, Notes from the Underground, edited and introduction with Charles Guignon (Cambridge, MA: Hackett Publishing Company, 2009
Journal Articles and Book Chapters

  • “Notes from a Heart Attack: A Phenomenology of an Altered Body,” Phenomenology of a Broken Body, C. Falke and E. Erikson (eds.) (London: Routledge, forthcoming)
  • “Neurasthenia Revisited: On Medically Unexplained Syndromes and the Value of Hermeneutic Medicine,” Journal of Applied Hermeneutics (2018)
  • "Temporal Experience in Anxiety: Embodiment, Selfhood, and the Collapse of Meaning," Phenomenology and the Cognitive Sciences, 2018
  • "Existential Medicine: Heidegger and the Lessons from Zollikon,” Existential Medicine: Essays on Health and Illness, K. Aho (ed.) (London: Rowman and Littlefield International, 2018)
  • “Affectivity and its Disorders,” Oxford Handbook of Phenomenological Psychopathology, G. Stanghellini, M. Broome, P. Fusar-Poli, A. Raballo, R. Rosfort, and A. Fernandez (eds.) (Oxford University Press, 2018).
  • "Authenticity and Social Critique,” with Charles Guignon, The Cambridge History of Philosophy, 1945-2015, K. Becker and I. Thomson (eds.) (Cambridge, UK: Cambridge University Press, forthcoming).
  • “Alienation and Belongingness,” with Charles Guignon. After Heidegger, R. Polt and G. Fried (eds.) (London: Rowman and Littlefield International, forthcoming).
  • “Existentialism,” with Charles Guignon, 2nd ed. Routledge Encyclopedia of Philosophy (London: Routledge, 2016).
  • “A Hermeneutics of the Body and Place in Health and Illness,” B. Janz (ed.) Place, Space, and Hermeneutics (Dordrecht: Springer, 2017)
  • “Kierkegaard on Boredom and Self-Loss in the Age of Online Dating,” M. Gardiner and J. J. Haladyn (eds.) Boredom Studies Reader: Frameworks and Perspectives (London: Routledge, 2016)
  • “Heidegger, Ontological Death, and the Healing Professions,” Medicine, Healthcare, and Philosophy (2015)
  • “Guignon on Self-Surrender and Homelessness in Dostoevsky and Heidegger,” Horizons of Authenticity in Existentialism, Phenomenology, and Moral Psychology, M. Altman and H. Pedersen (eds.) (Dordrecht: Springer, 2014)
  • “Depression and Embodiment: Phenomenological Reflections on Motility, Affectivity, and Transcendence,” Medicine, Healthcare, and Philosophy (2013)
  • “The Body,” The Bloomsbury Companion to Heidegger, François Raffoul and Eric Sean Nelson (eds.) (New York: Bloomsbury Press, 2013)
  • “Diversity in Philosophy: Reflections on the Legacy of Ofelia Schutte,” APA Newsletter on Hispanic/Latino Issues in Philosophy, Vol. 12 (1) 2012, 2-5
  • “Assessing the Role of Virtue Ethics in Psychology: A Commentary on the Work of Blaine Fowers, Frank Richardson, and Brent Slife,” Journal of Theoretical and Philosophical Psychology, Vol. 32 (1), 2012, 43-49
  • “Medicalized Psychiatry and the Talking Cure: A Hermeneutic Intervention,” with Charles Guignon, Human Studies, Vol. 34 (3), 2011, 293-308
  • “Dostoevsky and Modern Rage: On the Possibility of Counseling the Underground Man,” Philosophical Practice, Vol. 6 (2), 2011, 793-80
  • “The Psychopathology of American Shyness: A Hermeneutic Reading,” Journal for the Theory of Social Behavior, Vol. 40 (4) 2010, 190-206
  • “Phenomenological Reflections on Work and Leisure in America,” with Charles Guignon, in The Value of Time and Leisure in the World of Work, Mitch Haney and David Kline, eds. (Lanham, MD: Lexington Books, 2010), 25-39
  • “Medicalizing Mental Health: A Phenomenological Alternative,” Journal of Medical Humanities, Vol. 29 (4) 2008, 243-259
  • “Rethinking the Psychopathology of Depression: Existentialism, Buddhism, and the Aims of Philosophical Counseling,” Philosophical Practice, Vol. 3 (1) 2008, 207-218
  • “Logos and the Poverty of Animals: Rethinking Heidegger’s Humanism,” The New Yearbook for Phenomenology and Phenomenological Philosophy, Vol. 7 2007, 109-126
  • “Recovering Play: On the Relationship between Leisure and Authenticity in Heidegger’s Thought,” Janus Head, Vol. 10 (1) 2007, 217-238
  • “Simmel on Acceleration, Boredom, and Extreme Aesthesia,” Journal for the Theory of Social Behavior, Vol. 37 (4) 2007, 447-462
  • “Gender and Time: Revisiting the Question of Dasein’s Neutrality,” Epoche: A Journal for the History of Philosophy, Vol. 12 (1) 2007, 137-155
  • “Acceleration and Time Pathologies: The Critique of Psychology in Heidegger’s Beiträge,” Time and Society, Vol. 16 (1) 2007, 25-42
  • “Animality Revisited: The Question of Life in Heidegger’s Early Freiburg Lectures,” Existentia: An International Journal of Philosophy, Vol. 16 (5-6) 2006, 379-392
  • “Metontology and the Body-Problem in Being and Time,” Auslegung, Vol. 28 (2) 2006, 1-20
  • “The Missing Dialogue Between Heidegger and Merleau-Ponty: On the Importance of the Zollikon Seminars,” Body and Society, Vol. 11 (2) 2005, 1-23
  • “Why Heidegger is not an Existentialist: Interpreting Authenticity and Historicity in Being and Time,” Florida Philosophical Review, Vol. 3 (2) 2003, 5-22
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I have never seen a decent explanation for any sort of "functional" disorder. A lot of them lie along the lines of "there is no damage to the optic nerve so the blindness can't be physical" when the brain has to process what comes along the nerve so the problem could be anywhere there. It is an arrogant "we know everything that is possible" science and I have seen so many of them fall in my lifetime.
 
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