Neurasthenia
An obsolete (and sexist) medical condition, and a couple of side-notes in the early history of ME/CFS.
Neurasthenia is unfamiliar to most people today, but it was a common diagnosis in the US in the late nineteenth and early twentieth centuries. It rose to medical prominence in 1869 when the American neurologist George Beard published his classic article ‘Neurasthenia, or nervous exhaustion’. The symptoms included exhaustion not relieved by rest, weakness, irritability, low mood, pain, insomnia and headaches. These symptoms were thought to arise from an exhaustion of nervous energy brought on by the stresses of modern life. This was in a time period when society was becoming more industrialised and urban, and women were participating more in the workplace, with some women even demanding the right to participate in politics. Neurasthenia was also known informally as ‘Americanitis’; it was seen as a particularly American disease, brought on by the fast-paced American way of life, although it came to be recognised in the UK and elsewhere in the world as well. Neurasthenia was seen as a condition that particularly affected refined, upper-middle class people, but in retrospect this may have simply been because only the well-off could afford doctors and the expensive therapies they prescribed.
From a twenty-first century perspective, it seems likely that the people diagnosed with neurasthenia in fact had a range of different medical problems. Some may have had depression, anxiety or stress, some may have had a sleep disorder, and some may have had a serious physical illness such as cancer or multiple sclerosis which caused their fatigue and pain. Similarly, it’s likely that people who went to their doctor with the symptoms of ME/CFS in this time period may have come away with a diagnosis of neurasthenia.
Neurasthenia has an interesting history. The renowned neurologist Silas Weir Mitchell, who has been called the ‘Father of American Neurology’, developed the famous ‘rest cure’ for women suffering from neurasthenia or hysteria. This ‘cure’ consisted in being isolated in a single room with nothing to do for six to eight weeks. The patient was not allowed to read, write, paint, or engage in conversation; she was advised to stay in bed as much as possible and to eat a high-fat diet. At the time, the rest cure was seen as therapeutic, and for a few decades it was very popular. However from a modern perspective this cure, with its isolation, boredom and sensory deprivation seems like a punishment; a genteel version of solitary confinement. One interpretation of the rest cure is that it was a way for sexist male doctors to deal with their own anxieties about the changing role of women in society by punishing women and removing them from public life, at least for a time.
The harmful effects of the rest cure were famously described by the author Charlotte Perkins Stetson in her novella ‘The Yellow Wallpaper’, a gothic horror story about a woman who undergoes the rest cure and is slowly driven mad.
While both men and women could suffer from neurasthenia, the rest cure was only for women. Men were prescribed the ‘West cure’; they went to stay at a ranch, where they did physical work in the outdoors. Whereas the rest cure sounds like a punishment, the West cure sounds like a holiday, a sort of summer camp for adult men.
There was disagreement about the medical cause of neurasthenia. Beard and Mitchell, who were both neurologists, saw it as a disease of the nerves. However Sigmund Freud, the famous ‘Father of Psychoanalysis’, believed that a subset of neurasthenia was actually a psychological illness which he called ‘anxiety neurosis’, and which he believed was related to ‘a disturbance of sexual function’.
Neurasthenia sounds like the sort of outdated idea that should have disappeared as medicine became more scientific and evidence-based in the twentieth century. However although it became less popular after the 1940s, it stuck around for a surprisingly long time. It was included in the Diagnostic and Statistical Manual of Mental Disorders DSM-3 (1987), but not in later versions. Neurasthenia was included in the World Health Organisation’s International Classification of Diseases ICD-10 (1994), but not in the ICD-11 (2018). The ICD-10 specified that post-viral syndrome and ME/CFS were not part of neurasthenia.
Epidemic neuromyasthenia
Beginning in the 1930s a series of outbreaks of an unusual illness took place. Today, they are known as the classic early outbreaks of ME. The outbreaks occurred in locations all over the world, and over a span of several decades, but they were recognised as being the same illness. Experts struggled to agree on what to call it, and proposed various names including atypical poliomyelitis, Icelandic disease, benign myalgic encephalomyelitis, and epidemic neuromyasthenia. 'Neuromyasthenia' was a new word, created by combining 'neurasthenia' and 'myasthenia'.[1]
Today, myasthenia gravis is known to be an autoimmune disease in which the immune system attacks receptors at the junction between nerve and muscle leading to muscle weakness, especially in the face. But in the 1950s, little was known about it; myasthenia was simply understood as a disease of muscle weakness caused by some sort of neurological problem. The doctors who created the name 'neuromyasthenia' were saying that the condition had the symptoms of neurasthenia plus neurological muscle weakness (myasthenia). 'Neuromyasthenia' is not a term that anyone would use in the twenty-first century, but it made sense to some people in the 1950s.
Neurasthenia and chronic fatigue syndrome
In the 1980s in the US and Canada there was a massive rise in people developing an illness that would be recognised today as ME/CFS. The Centers for Disease Control (CDC) treated this illness as something new, and gave it the official name ‘chronic fatigue syndrome’ in 1988. Chronic fatigue syndrome was immediately controversial, with some experts arguing that it was a serious physical illness caused by a virus, while others wrote it off as ordinary tiredness, stress, anxiety, depression, or ‘somatisation’ – physical symptoms arising from emotional distress. Chronic fatigue syndrome rose to prominence so quickly that some doctors assumed it must be a form of media hysteria. In the 1990s a few experts argued that chronic fatigue syndrome was in fact simply a new name for an old condition – neurasthenia. The psychiatrist Simon Wessely in particular wrote several papers in which he argued that neurasthenia was similar or identical to myalgic encephalomyelitis and/or chronic fatigue syndrome. However the idea that neurasthenia was similar to ME/CFS never gained much traction, and was eventually abandoned.
References and further reading
1. Henderson DA, Shelokov A. Epidemic neuromyasthenia; clinical syndrome. N Engl J Med. 1959 Apr 16;260(16):814-8 concl. doi: 10.1056/NEJM195904162601606. PMID: 13644592
• Beard, George. 1869. Neurasthenia, or Nervous Exhaustion. The Boston Medical and Surgical Journal, 80(13), 217–221. doi:10.1056/NEJM186904290801301
• Wessely S. Old wine in new bottles: neurasthenia and 'ME'. Psychol Med. 1990 Feb;20(1):35-53. doi: 10.1017/s0033291700013210. PMID: 2181519.
• Wessely S. Neurasthenia and Chronic Fatigue: Theory and Practice in Britain and America. Transcultural Psychiatric Research Review. 1994;31(2):173-209. doi:10.1177/136346159403100206
• Taylor RE. Death of neurasthenia and its psychological reincarnation: A study of neurasthenia at the National Hospital for the Relief and Cure of the Paralysed and Epileptic, Queen Square, London, 1870–1932. British Journal of Psychiatry. 2001;179(6):550-557. doi:10.1192/bjp.179.6.550
• Silas Weir Mitchell and the Rest Cure: Brilliant Doctor or Cruel Tyrant? by Bipin Dimri. Historic Mysteries, July 29, 2022
• Neurasthenia at Mepedia
• 'Americanitis': The Disease of Living Too Fast by Julie Beck, The Atlantic, 2016
• Neurasthenia and 'Anxiety Neurosis' at encyclopedia.com
Adding The Yellow Wallpaper to my to-read list
Hey, I went to include your Incline Village posts in my upcoming post, but it kept saying “page not found.” Were they taken down?