Prior to Freud, the term neurasthenia was essentially an amorphous concept that covered all neurotic diseases. ICD-10 still recognizes the syndrome of persistent exhaustion as a diagnosis. But according to DSM-IV, persistent fatigue has no specific classification and merely belongs to the undifferentiated somatoform disorder residual group (with fatigue as the symptom).
According to the ICD-10, neurasthenia is characterized by an unpleasant and persistent complaint of increasing weariness after mental effort or a distressing and persistent complaint of weakness and exhaustion after little exertion. Neurasthenia is similar to chronic fatigue syndrome in many ways.
The most common complaint of neurasthenia patients is physical and mental exhaustion, which is made worse by effort. Although they frequently exhibit signs of worry and depression, weariness predominates. These patients frequently obtain diagnoses like post-viral tiredness or occasionally myalgia encephalomyelitis (ME) and are more frequently observed in medical settings than psychiatric ones. They may hold steadfast views that their problem has a medical cause, which makes psychiatric management less acceptable.
As of right now, the etiology is thought to be complex, much like pain. There is some proof that there is a hereditary propensity. There is no doubt that a severe Epstein-Barr virus infection can lead to neurasthenia (glandular fever). A diagnosis of neurasthenia may later be changed to one of depression or anxiety. Although this hasn’t been proven, it has been suggested that there exist subgroups of neurasthenia with distinctive organic aetiologies.
In the general population, fatigue is widespread, although neurasthenia is less frequently diagnosed. According to one study, although 13% of people report having persistent and extreme fatigue, less than 2% of those people actually had neurasthenia, and less than 0.5% of those people did not also have comorbid anxiety or depression. In women, neurasthenia (and CFS) is more prevalent.
According to Beard, modern civilization is to blame for the condition’s onset since the central nervous system’s energy reserves have been depleted. In accordance with the Beard school of Medicine, stress brought on by an increasingly competitive business environment and urbanization’s stressors were linked to neurasthenia. Although it was typically associated with professionals in sedentary jobs and members of the upper class, it can actually apply to everyone who lives within the financial system.
Numerous bodily symptoms, such as weariness, dyspepsia with flatulence, signs of intracranial pressure, and spinal discomfort were all included in this group by Freud. His belief that this state was caused by “non-completed coitus” or the non-completion of the higher cultural correlate thereof, or by “infrequency of emissions” or the infrequent practice of the higher cultural correlate thereof, was similar to that of some other people of the time. Later, Freud proposed that both coitus interruptus and masturbation were caused by “an inadequate libidinal discharge” that poisoned the organism, leading to neurasthenia. In other words, neurasthenia was caused by (auto)intoxication. He eventually distinguished it from anxiety neurosis, but he thought that the two disorders frequently coexisted.
Together with his associate A.D. Rockwell, Beard promoted increasingly experimental therapies for those with neurasthenia, starting with electrotherapy. This was a divisive stance. A critique published in 1868 said that Beard and Rockwell’s understanding of the scientific method was questionable and that their assertions were unjustified.
William James was once cited as saying, “I take it that no man is educated who has never dallied with the possibility of death.” William James was diagnosed with neurasthenia, which he dubbed “Americanistic.”
Long into the 20th century, this idea was still widely accepted, but finally, it was realized that it was more of a behavioral issue than a physical one. The diagnosis of neurasthenia has mainly been disregarded by doctors.
The World Health Organization’s ICD-10 system classifies neurasthenia as “F48 – Other neurotic illnesses.” There are noticeable cultural variations in the characteristics of the condition under “neurasthenia.” There are two primary overlapping types of symptoms that can exist: Cognitive function can be affected by increased weariness following mental effort. Extreme weariness, pain, and anxiety may be felt even after doing minimal physical effort. With either form, a great deal of additional bodily discomfort symptoms may be experienced. Asthenia NOS, burnout, malaise and weariness, and post-viral fatigue syndrome are not included in this disease.