Neurasthenia, AKA "Americanitis"

Hey, all...

I find it fascinating to learn about the various mindbody conditions. As I've read more, one condition that comes up periodically is Neurasthenia, and I've always been curious to learn more. I looked into it yesterday and thought I'd share what I found.

It looks like Neurasthenia was a diagnosis popularized by American doctor, George Beard, starting in the 1869. In the paper in which he coins the term, he explains that the word roots of the term imply having not enough "strength in the nerve." Specifically, the word roots in neur-a-sthenia are correspond to nerves-not-strong. He compares his term to the better known term a-nemia, meaning not enough blood, where the word roots correspond to no-blood. Comparing the two diagnoses, he writes, "The one means want of blood; the other, want of nervous force." I bring the word roots up because the idea of neurasthenia is that the actual physical nerves are "broken" in that they are underperforming.

Later, on the same page, he writes, "Both anemia and neurasthenia are most frequently met with in civilized, intellectual communities. They are part of the compensation for our progress and refinement." [Repressed rage, anyone?]

The original page can be found here:
http://www.nejm.org/doi/full/10.1056/NEJM186904290801301

In Beard's view, neurasthenia caused everything that today we might associate with a psychological or psychosomatic condition. Basically, he lumped all of these diagnoses together and explained it in terms of "exhausted nerves." The resulting diagnosis isn't far from TMS.

The diagnosis became quite fashionable among the elite in the US, during the go-go period as the US was just rising to power. A recent article in the New Yorker, referring to Beard's 1881 magnum opus, connected the circumstances during this period to the rapid rise to power of China, one of the few places where the diagnosis is still made:

In 1881, at the height of the American industrial revolution, New York doctor George Beard published “American Nervousness,” about the fraying effects of modern life. Every person was born with a limited supply of nervous energy, Beard wrote, and depleting it in the hustle of modern civilization led to “neurasthenia,” a mix of fatigue and confusion named after the Greek for “tired nerves.” Neurasthenia rapidly became a household word in America, a fashionable affliction that carried the air of sophistication and striving. Its famous sufferers included Theodore Roosevelt, Jane Addams, and William James, who popularized its nickname, “Americanitis.” In 1925, a doctor estimated that a quarter of a million people were dying before the age of fifty every year because of “the hurry, bustle and incessant drive of the American temperament.” The Rexall drug company patented “Americanitis Elixir” for the “man of business, weakened by the strain of your duties.”

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Click on the picture to read
the label. It's pretty hilarious.Neurasthenia eventually lost favor among American psychiatrists—Sigmund Freud, among others, redirected the study of the mind toward the inner workings, not the outer pressures—and it was ultimately sidelined from American diagnostic manuals. But one of the only places in the world where Americanitis maintained a foothold well into the nineteen-nineties was China. It was an easy fit for China because it echoed traditional medical concepts of qi, the vital life force, and it allowed patients to avoid the stigma of mental illness by describing their symptoms as fatigue, headache, or other physical sensations. When Arthur Kleinman, the Harvard psychiatrist and China expert, studied a hospital in Hunan province in the early eighties—the first frantic moments of China’s economic rise—he found that the most common diagnosis at the hospital was none other than neurasthenia. China, in other words, had come down with an acute case of Americanitis.

These days, Americanitis has fallen out of use again; Chinese doctors are far more likely to apply more familiar diagnoses, such as depression and chronic fatigue syndrome.​

What fascinates me about the diagnosis is the way that it more or less disappeared in the early 20th century in the west. I'm fascinated by how that might have happened. For example, one of the main symptoms of neurasthenia was chronic fatigue. Did people just stop getting this symptom? What happened?

Any thoughts?

 

That is a fascinating reference, Bruce! It's so interesting how fads and fancies can develop. Based on the story you shared and some other reading I've done (see below), I wonder if this particular fad had anything to do with socioeconomic class.

The Claude Moore Health Sciences Library at the University of Virginia has a terrific 10-page mini-website on neurasthenia that touches on the class aspects of the diagnosis. In their introductory page, they write,

Beard saw neurasthenia as created by the hectic, fast-paced life in American cities – he even called it “American nervousness.” The nation’s leaders in business, government, and the arts were made ill by the stress and strain of modern life. The only cure was withdrawal from the pressures of urban life, rest, and a simpler, healthy lifestyle.

The diagnosis and treatment for neurasthenia were distinctly American, but the concepts soon became part of standard medicine in Great Britain, France, Germany, the Netherlands (Holland), and eventually in China and Japan.

Also, the condition gradually spread to more and more groups of society, not merely the elite. Neurasthenia was almost a badge of social status. Further, anxious, and depressed patients were reassured that their symptoms were caused by a physical disease (exhausted nerves) and not by psychological weakness.​

The entire site is a great resource and has good links, too:
http://exhibits.hsl.virginia.edu/nerves/

For more on this, I also dug back into our old friend Edward Shorter's book, From Paralysis to Fatigue He has a whole section on Neurasthenia (the last section of chapter 8). It brings up some fascinating points that cut to the core of what TMS is, so I think it's definitely worth writing about.

For the benefit of people who don't know Professor Shorter, he is a Harvard educated historian who is now a full professor of medicine and of history at the University of Toronto. His book is interesting but it has a historian's depth, so I pity anyone who attempts to read it straight through.

Here's is what Dr. Sarno had to say about Prof. Shorter's contributions in The Divided Mind, on page 11:

One of the most intriguing aspects of both hysterical and psychosomatic disorders is that they tend to spread through the population in epidemic fashion, almost as if they were bacteriological in nature, which they are not. Edward Shorter, a medical historian, concluded from his study of the medical literature that the incidence of a psychogenic disorder grows to epidemic proportions when the disorder is in vogue. Strange as it may seem, people with an unconscious psychological need for symptoms tend to develop a disorder that is well known, like back pain, hay fever, or eczema. This is not a conscious decision. A second cause of such epidemics often results when a psychosomatic disorder is misread by the medical profession and is attributed to a structural abnormality, such as a bone spur, herniated disc, etc. ​

Returning to Bruce's point, here is another example of perceptions of neurasthenia from literature, taken from Shorter's book. It's quite funny, but you have to feel for the people who suffer from it. It focuses on how the TMS equivalent of the day seemed to make people's sense "too sensitive," so they couldn't bear even the softest of sounds. One has to wonder, why don't we have TMS equivalents like that as often today? Is it caused by the fads and fashions Bruce mentioned?

A final point about neurasthenia is that its symptoms clustered primarily on the sensory side of the nervous system. Even before neurasthenia was conceived as a diagnosis, “nervous weakness” was said to cause “hyperesthesia,” or feeling everything much too sensitively. The classic hyperesthetic, his nerves collapsing under the barrage of sensory input, was Mr. Fairlie, in Wilkie Collins’s novel of 1860, The Woman in White. In the novel we first encounter a sixtyish, wealthy Mr. Fairlie as he receives Hartright, the novel’s hero. Mr. Fairlie had “a frail, languidlyfretful, over-refined look—something singularly and unpleasantly delicate in its association with a man, and, at the same time, something which could by no possibility have looked natural and appropriate if it had been transferred to the personal appearance of a woman.” The story continues:

“Pray sit down,” said Mr. Fairlie to Hartright, “And don’t trouble yourself to move the chair, please. In the wretched state of my nerves, movement of any kind is exquisitely painful to me.”
Hartright made some remark.
“Pray excuse me,” said Mr. Fairlie, “But could you contrive to speak in a lower key? In the wretched state of my nerves, loud sound of any kind is indescribable torture to me. You will pardon an invalid?”
Mr. Fairlie decided to show Hartright some etchings and summoned Louis the servant to fetch them. “The portfolio with the red back, Louis. Don’t drop it! You have no idea of the tortures I should suffer, Mr. Hartright, if Louis dropped that portfolio.”
Mr. Fairlie apologized for the drawings in the portfolio. “They have come from a sale in a shocking state—I thought they smelt of horrid dealers’ and brokers’ fingers when I looked at them last. Can you undertake them?”
Hartright smelled nothing. He ventured an opinion about the drawings.
“I beg your pardon,” interposed Mr. Fairlie. “Do you mind my closing my eyes while you speak? Even this light is too much for them. Yes?”
Hartright began again. Mr. Fairlie suddenly opened his eyes again and turned them piteously towards the window.
“I entreat you to excuse me, Mr. Hartright,” he fluttered, “But surely I hear some horrid children in the garden—my private garden below?”
Hartright lifted a corner of the blind, mindful of Mr. Fairlie’s entreaties not to let in any sun. There were no children in the garden.
The interview then came to an end. “So glad to possess you at Limmeridge, Mr. Hartright. I am such a sufferer that I hardly dare hope to enjoy much of your society. Would you mind taking great pains not to let the doors bang.”116

This was de facto neurasthenia with overwhelmingly sensory symptoms.

Even before the description of neurasthenia, this kind of extreme sensitivity was said in medicine to be pathological. What the laity call “nervous weakness,” wrote Joseph Amann in 1868, director of the university outpatient gynecology clinic in Munich, “is really hyperaesthesia. Such patients experience extreme discomfort in the presence of relatively minor stimuli. Loud noises, thoughtless slamming of doors, heavy stomping while walking, sometimes even loud conversations impress hysterical women unfavorably or cut them to the quick. All loud and bright colors, especially red, are repellent to them, the same for bright light, and some cannot even tolerate the normal light of day. One always finds them therefore in darkened rooms. To many, the tiniest amounts of salt or seasoning in the soup tastes unpleasant and they return it to the kitchen.117 Although Amann called this condition “hysteria,” such hyperesthesias would soon be ranked under neurasthenia.​

It all seems relevant to TMS in that psychosomatic ills seem to be determined by, as Bruce wrote, the fads and fancies of the time. As Sarno mentioned, this was the main point of Shorter's book.

It fascinates me how symptoms can change over time... Why are oversensitivities so much less common these days? Why is paralysis so much less common these days?

And I'm also curious about class and how this fits in. For example, in the example Bruce references, I wonder if part of the reason that Ennui Grand became something to be proud of was that for working people, it simply wasn't an option. Keeping moving kept working people healthy. (I believe that, as Steve Ozanich wrote, the body matters, and keeping it moving helps us.) On the other hand, for wealthier people, who wanted to show off their leisure, decadence became a badge of pride.

Was this "aspirational" TMS? If so, how very sad.

And, if so, does this relate to the controversial quote in the "So THAT'S why I don't want to work for a living" thread? Is it possible that our unconscious can pick symptoms that unconsciously make us feel better? .... for example because they fulfill our aspirations by making us feel wealthy (as above) or by helping us avoid things that intimidate us (as in the other thread)

It's just ideas, but that's what a forum is for, right?

 

That's a fascinating question, @chickenbone. I don't know much about neuropathic pain, but my bet is it has a mindbody component.

@Cap'n Spanky, I decided to check and Dr. Sarno does talk about neurasthenia in The Divided Mind. He mostly discusses it his overview of the TMS equivalents. He categorizes them based on which system 'transfers the mindbody disorders from the mind to the body:' the Autonomic Nervous System, the immune system, and the neuroendocrine (hormone) system. He writes,

 

Heya, @Cap'n Spanky, thanks for updating your post about how Dr. Sarno compared neurasthenia to fibromyagia. Also very interesting to read Bruce connecting it with his Bay Area observations of CFS. If only those people knew what was most likely really going on!

Let's not get the thread too far off topic, but I thought it was interesting to compare your observations about Silicon Valley CFS with Jon Slavet's case of TMS. Jon is an accomplished Silicon Valley entrepreneur who healed his own back pain and is now starting up a Mind-Body program of his own called MindOver (I've been watching the videos, and I've found them quite good). I don't know him well yet, but he seems like a nice guy and I'm pretty excited that he'll be working alongside us to spread the word. Hopefully his talents will help him to reach a lot of people. Anyway, I suspect that he identifies pretty strongly as a driven, Type-A guy, and I think it was the tension of working in a startup that brought on his own symptoms. Check out this video to see what I mean:
http://www.mindoverbackpain.com/video-3

As you mentioned in your post, "It's all fairly obvious what goes on: a perfectionist placing insanely high self-demands on themselves eventually develops CFS in very much the same manner as someone with those same personality traits develops TMS." I thought the parallel between Jon's experience and your story about Silicon Valley CFS was interesting.