Neurasthenia

Question 1

What is Neurasthenia?

Answer 1

A condition that was attributed to the wealthy, it was associated with exhaustion of the central nervous system energy reserves due to stress from modern life. It’s symptoms were considered fatigue, anxiety, depressed mood, etc.

Question 2

When was Neurasthenia first termed and who made it popular?

Answer 2

It was first termed in 1829 and made popular by the neurologist George Miller Beard around 1869, when he published a book about nervous exhaustion (or Neurasthenia).

Question 3

Where was Neurasthenia treated?

Answer 3

In the private practice of a neurologist.

Question 4

Who was “Mr Smith”?

Answer 4

An undergraduate at the University of Sydney diagnosed with Neurasthenia in 1890.

Question 5

Who was “Mr Smith” treated by?

Answer 5

Dr Wheeler.

Question 6

What did “Mr Smith’s” doctor think caused his condition? And what is the theory behind this cause?

Answer 6

Too much masturbation, which released too much bodily energy, so little was left for “Mr Smith”.

Question 7

How was “Mr Smith’s” condition treated? What was the result?

Answer 7

He went to the gym, ate a hearty diet with lots of red meat and… he became strong and gained healthy weight. The treatment was considered successful.

Question 8

But… what did the doctor think he did wrong with “Mr Smith’s” treatment?

Answer 8

Well, Mr Smith no longer wanted to study politics, or was interested in poetry, he became solely interested in the gym and exercise. Dr Wheeler thought he could have been a great politician or writer, so wondered if he was wrong in his treatment of Mr Smith.

Question 9

Why was George Miller Beard’s book so popular?

Answer 9

It was a book about nervous exhaustion, and a lot of people related to its content.

Question 10

What happened after George Miller Beard published his book?

Answer 10

Neurasthenia became a “fashionable” disorder.

Question 11

What are two reasons why a specific diagnosis/disorder may appear at a certain period of time?

Answer 11

1. Grass roots/discovery model:
   - many individuals have the complaints.
   - eventually doctors talk to each other and it is medically recognised.
2. Medical entrepreneur/hysteria model:
   - physicians make up a new disease category and individuals recognise the symptoms.
   - “making up people” (diagnosis comes first AND THEN people say, that’s me!

Question 12

What is one of the new “varieties” of Neurasthenia?

Based on what model did it appear?

Where did it first appear?

Answer 12

Chronic fatigue syndrome.

It appeared in the way of the grass roots/discovery model.

It first appeared in Salt Lake City in Utah, lots of middle aged women appeared with it.

Question 13

What are some of the more unusual symptoms of Neurathenia?

Answer 13

Fear of responsibility, fear of open places or closed places, fear of society, fear of being alone, fear of fears… fear of everything.

Question 14

Neurasthenia has a long list of symptoms… but what do we know about large lists of symptoms?

Answer 14

That the more symptoms there are, the more people that will recognise as having the disorder.

Question 15

If you want to be a “medical entrepreneur” what do you need to do?

Answer 15

Make up a disorder with a huge list of symptoms.

Question 16

What did a diagnosis of Neurasthenia do for patients?

Answer 16

• it legitimised the complaints.
• it gave evidence for neurology as a medical specialty.
• could provide treatment.

Question 17

Why did Neurasthenia make the early neurologists happy?

Answer 17

Because they had very little to do before, very little options for treatment, etc. When Neurasthenia came around, all of a sudden there were a heap of options for treatment and they had more to do!

Question 18

What did the psychologist and philosopher William James say?

Answer 18

If “x” is true, then “x” is good for us to believe.

(it was good for too many people to believe that Neurasthenia is real).

Question 19

What explained Neurasthenia?

Answer 19

1. Everyone has a “nervous diathesis” - a limited supply of energy.
2. Neurasthenia occurs when the demands of the environment exceed the available energy of the individual (the challenges you face in life exceed the amount of energy available).
3. When the body is depleted of energy, it travels through the body from one organ to another because of “reflex irritation”.
4. The centres of the reflex action: the brain, the digestive system, the reproductive system are affected the most.

Question 20

Why was Neurasthenia treated using electricity?

Answer 20

Well, the nervous system works by transmitting small electrical pulses. If the nervous system does not do this well, add a bit of electricity using a machine.
The patient places their feet on metal plates and an electrical current would go through the patient.

Question 21

Although the treatments for Neurasthenia did not always work, why did patients feel as though it did?

Answer 21

Because of a placebo effect, they felt as though something really important was being done.

Question 22

Why is so much money around medicine that is not quite medicine?

Answer 22

Because “treatments” are targeted toward people, promising to rid them of whatever ails them.

Question 23

Who was S. Weir Mitchell?

Answer 23

A leading neurologist of his time from Philadelphia, he published a book on Neurasthenia called “Fat and Blood”. He believed that Neurasthenia resulted from a lack of both and from expending too much energy.

Question 24

What was the “Rest Cure”?

Answer 24

Introduced by S. Weir Mitchell predominantly to cure women, the person much reserve their energy by taking away all external stimuli, place someone in isolation, prohibit reading/any entertainment and feed them fatty porridge 5 times a day.

Question 25

Was the “Rest Cure” popular?

Answer 25

Yes, the waitlists for the treatment were very long, even though it was incredibly boring.

Question 26

What was the popular treatment (introduced by S. Weir Mitchell) for men who suffered from Neurasthenia?

Answer 26

Sports were often prescribed.

• Great outdoors.
• Hiking, camping.
• Commune with nature.
• Strenuous work.

Question 27

Neurology was a new medical specialty… what was it trying to do?

Answer 27

It was looking for a way to legitimise itself by treating wealthy patients in cities, who had vague complaints.

Question 28

What are some modern “treatments” everyday people use to treat fatigue and other issues?

Answer 28

Today, we treat fatigue, etc. with:

• red bull, v, mother.
• berocca.
• ginseng.
• coffee.

Question 29

What do we want our medication to do?

Answer 29

Take away something negative and add something positive.

Question 30

What was the broader, theoretical framework for Neurasthenia? (hint: it had something to do with evolution and psychiatry).

Answer 30

1. Darwin publishes “On the Origin of Species” in 1869.
2. His theory was applied to the “Development of Society” (a.k.a “social darwinism”).
3. Theory was applied to “individual development” (ontogeny repeats philogeny).
4. Mental illness was seen as regression (that civilisation was taxing for our brains).
5. Theories about “degeneration” came around (people/civilisation are moving backwards).
6. Psychiatry can stop the regression/degeneration.

Question 31

What do theories on societal and individual development tell us about mental illness?

Answer 31

That the incidence of mental illness is related to social factors, to a specific time and place.
Civilisation can even be seen as a cause of mental disorder.

Question 32

What is happening in China surrounding Neurasthenia?

Answer 32

Neurasthenia is still diagnosed in China and other parts of Asia.
What the West would consider depression, is diagnosed as headaches, insomnia, irritability, etc., in China.

Question 33

To conclude, when new diseases appear… ?

Answer 33

• Investigate the context.
• Understand how the diseases are defined.
• Look and the benefits of diagnosis for an individual.
• Take the history of the disease into account.