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

Abstract

Neurasthenia is both a Western disease construct and a popular Chinese illness concept (shenjing shuairuo, SJSR). Using a self-report questionnaire, we examined 148 Hong Kong Chinese undergraduates' concept of its epidemiology, symptomatology, etiology and treatment. Notwithstanding that fatigue is the sine qua non of neurasthenia in Western nosology, subjects believed that SJSR was compatible with a diversity of symptoms which fell, on factor analysis, into the "neurotic," "psychotic," "somatic" and "dysfunctional" subgroups. Contrary to the popular portrayal of SJSR as a physical or chronic fatigue disorder, the most common perceived symptoms were anxiety, insomnia, depression and fright. Logically, psychological etiology and remedy were highly emphasized. The perceived high prevalence, non-aggressive nature and symptomatic diversity of SJSR attested to the notion that it might camouflage and destigmatize psychiatric labels of insanity. The contextual study of neurasthenia illustrates how in its search for legitimacy an originally Western concept adapts, transforms, and acquires distinctive local meanings in a non-Western culture.

Depression in the Planet’s Largest Ethnic Group: The Chinese

“…The concept of neurasthenia as a nervous system disorder fits well with the traditional Chinese epistemology of disease causation on the basis of disharmony of vital organs and imbalance of qi (22,23). The concepts of balance and conservation, in particular a balance of positive and negative forces (yin and yang) and proper proportions of the five elements (wood, fire, earth, metal, and water) influence Chinese interpretations of physical and mental health and illness.…”

Filial piety as a protective factor for depression in survivors of childhood abuse

“…Neurasthenia became widely used by psychiatrists in China, who viewed it as a state of illness determined by dynamic interaction between inherited vulnerability to neurosis and environmental stress (Yan, 1985). This concept of nervous system disorder and its view on disharmony of vital organs and energy fit well with the traditional Chinese concept of illness as an imbalance of yin and yang (the balance of the positive and negative forces in the body, which is essential for the normal functions of the vital fluids and visceral systems, including the vital energy circulation), caused by external pathogens like cold or damp weather (Lee & Wong, 1995). Neurasthenia is therefore understandably a non-stigmatizing diagnosis that is conceptually distant from a psychiatric label.…”

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