Neurasthenia as nosological dilemma

Abstract

While researching concepts of neurasthenia as described by patients and physicians of various backgrounds, it was found that there is a great discrepancy between the two groups. In this study, questionnaires were administered to 70 psychiatric patients, 6 Chinese medicine men, 44 general physicians and 35 neuropsychiatrists, to inquire into the reasons for positive or negative attitudes toward neurasthenia. Half of the clinical patients believed that they were suffering from neurasthenia. Neurasthenia is a predominate term used for various types of distress arising mainly from psychiatric diseases. Chinese medicine men are aware that this term is a medical diagnosis introduced from the West. Through experience they regard neurasthenia as a kind of deficit of nerve. Apparently, the concept of neurasthenia has been integrated into the Chinese medical system, a fact substantiated by its longstanding, nosological use by the public. Younger generation physicians within both general and neuropsychiatric disciplines on the whole reject neurasthenia as a diagnostic term. However, one-third of neuropsychiatrists and 40% of general physicians use this term in their practice in order to improve the treatment of and to establish good communication and rapport with the patients whom they treat. Most of them, however, do not use the term in their formal diagnosis. The concept of the illness, neurasthenia, is historically rooted and today presents a nosological dilemma. It will eventually be transformed conceptually and disappear from the public mind.

Neurasthenia and the Social Construction of Psychiatric Knowledge

“…In Hong Kong, neurasthenia is a socially acceptable idiom through which to articulate acknowledged psychological distress (Wong, 1992).2 If legitimation of symptoms is among the most important of neurasthenia's &dquo;social uses,&dquo; another is the role of the diagnosis in facilitating patient-provider relationships. Chinese scholars (Cheung, 1989;Rin & Huang, 1989) have noted a tendency among health care professionals to use neurasthenia &dquo;for convenience&dquo; in discussing &dquo;neurotic&dquo; anxiety and depression, and sometimes more severe psychiatric disorders, with patients-partly because the designation is familiar, partly because the terms &dquo;anxiety&dquo; and &dquo;depression&dquo; are not easy to translate, and partly because the condition is generally recognized to be a &dquo;legitimate illness.&dquo; Unlike anxiety or depression, a diagnosis of neurasthenia confers a number of benefits on the sufferer, who is then entitled not only to trace his or her distress to an &dquo;honorable&dquo; origin (overwork), but also to enjoy the &dquo;sick role,&dquo; & d q u o ; with its decreased responsibilities in family, workplace and community (Zhang, 1989). Benefits also accrue to the practitioner, who does not have to make an unwelcome diagnosis understood and acceptable to patients and their families.…”

Rethinking neurasthenia: The illness concepts of Shenjing Shuairuo among Chinese undergraduates in Hong Kong

“…This conformed to its customary designation as an "urban disease" or a "disease of modem civilization" (Beard 1880;Lin 1989;Liu 1989;Wessely 1990;Yan 1989). Nonetheless, as our subjects also considered that psychotic symptoms might occur and psychiatrists could be required for the treatment of SJSR, the term probably allowed a ranking of severity, and could disguise severe mental disorders (Munakata 1989;Rin and Huang 1989). Instead it could be perceived as a sort of "stress syndrome" that erases stigmatism without overlooking subjects' psychological concerns.…”

“…Rin and Huang (1989) referred to a "considerable confusion in the use of the term neurasthenia by the general public, patients and physicians in Taiwan today." Rin and Huang (1989) referred to a "considerable confusion in the use of the term neurasthenia by the general public, patients and physicians in Taiwan today."…”

Prevalence of neurasthenia, comorbidity, and association with impairment among a nationally representative sample of US adults

“…The nosological criteria for neurasthenia have been arduously debated within the psychiatric epidemiological literature [1–3], without arriving at a consensus on whether it is an important diagnostic entity [4, 5] or agreement on its clinical significance [6–8]. Presently the Diagnostic and Statistical Manual of Mental Disorders , 4th edition (DSM-IV) [9] classifies neurasthenia as a subtype of undifferentiated somatoform disorders [6], whereas the International Classification of Disease [ICD-10; 10] currently considers neurasthenia as a separate disorder [11].…”