Starting with this paragraph:
1. Introduction
Severe fatigue that impairs usual function long has been described throughout recorded human history. The neurologists Beard [
1] and Charcot [
2] were among the first to characterize the health condition ‘neurasthenia’ in the latter half of the 19th century. Based on this common historical root in neurasthenia, two divergent scholarly and clinical paths have taken shape over time. The first path involves a pathogenic disease model rooted in the scientific process, resulting in a rich literature describing pathobiology and various attempts at creating specific case definition criteria. This path has resulted in the label of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The second path is a psychosomatic/sociogenic illness construction that has incorporated ideas from contemporary neuroscience into an unbroken conceptual chain linking back to neurasthenia. This path has resulted in the label of functional neurologic disorders (FND).
This part is just plain wrong in my opinion:
The first path involves a pathogenic disease model rooted in the scientific process, resulting in a rich literature describing pathobiology and various attempts at creating specific case definition criteria. This path has resulted in the label of [ME/CFS].
Definitions of neurasthenia and ME/CFS are based on descriptions of symptoms, not on causes.
For example:
Definition of Neurasthenia:
The
Tenth Revision of the World Health Organization's InternationalClassification of Diseases (ICD-10) presents a set of well-defined inclusion and exclusion criteria for thediagnosis.
2 The core symptoms are identified as mental and/or physical fatigue, accompanied by at least two of seven symptoms (dizziness, dyspepsia, muscular aches or pains, tension headaches, inability to relax, irritability, and sleep disturbance).To make the diagnosis, it must be a persistent illness. Exclusion criteria include the presence of mood, panic, or generalized anxiety disorders.
This describes a pattern of symptoms that could well lead to the people diagnosed with neurasthenia in the 19th century being diagnosed with ME/CFS today. Equally it could lead to some being diagnosed with burnout, stress related fatigue and all sorts of other fatiguing illnesses that do have clear pathology such as MS.
There is a clear path from neurasthenia to current BPS models of ME/CFS, and has been since the 1980's and probably earlier.
For example, 34 years ago:
Old wine in new bottles: neurasthenia and 'ME' S Wessely
. . . the true successor to neurasthenia only appeared in the 1980s, with the arrival of chronic fatigue syndrome (CFS).
Wessely S. Neurasthenia and chronic fatigue syndrome: theory and practice. Transcultural Psychiatric Review 1994;31:173-209.
I have a particular fascination with the history of neurasthenia, which I think is now accepted as the precursor of CFS/ME. The parallels between neurasthenia and CFS are many and inescapable.
Wessely S. “To tell or not to tell”: The problem of medically unexplained symptoms. In ; Ethical Dilemmas in Neurology (eds Zeman & Emanuel), WB Saunders, 1999, 41-53
Wessely also equates CFS with burnout:
If the work-relatedness was left out of the equation then burnout would indeed equate to CFS or fatigue, not least given the 96% overlap between CFS and neurasthenia, for example, reported from one CFS clinic.
Leone S, Wessely S, Huibers M, Knottnerus J, Kant U. Two sides of the same coin? On the history and phenonomology of burnout. Psychology & Health 2011: 26: 449-464.
And Michael Sharpe in 2010
Neurotic, stress-related and somatoform disorders
Michael Sharpe, ... Jane Walker, in
Companion to Psychiatric Studies (Eighth Edition), 2010
Neurasthenia as defined in ICD-10 is characterised by a persistent and distressing complaint of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort. Neurasthenia is broadly equivalent to chronic fatigue syndrome (CFS)
Neurasthenia
The term neurasthenia has a long history, and before Freud was essentially an amorphous concept covering all neurotic disorders. It remains a diagnosis in ICD-10 to describe a syndrome of chronic fatigue. In DSM-IV, however, chronic fatigue enjoys no special status and simply falls into the residual category of undifferentiated somatoform disorder (with fatigue as the symptom).
Definition
Neurasthenia as defined in ICD-10 is characterised by a persistent and distressing complaint of increased fatigue after mental effort, or persistent and distressing complaints of bodily weakness and exhaustion after minimal effort. Neurasthenia is broadly equivalent to chronic fatigue syndrome (CFS) (Fukuda et al 1994).
Clinical features
Patients with neurasthenia present with the predominant compliant of physical and mental fatigue, exacerbated by exertion. They commonly have symptoms of depression and anxiety, but fatigue is predominant. These patients are more commonly seen in medical than psychiatric settings, and often receive diagnosis such as postviral fatigue, or sometimes myalgic encephalomyelitis (ME). They may have strong beliefs about a medical aetiology for their condition which reduces the acceptability of psychiatric management.
Aetiology
The current understanding of aetiology is that, like pain, it is probably multifactorial (Afari & Buchwald 2003). There is some evidence for a genetic predisposition. There is also some evidence for precipitating life events, and possibly a triggering role for medical conditions such as viral infection. Neurasthenia can certainly develop after acute Epstein–Barr virus infection (glandular fever). Neurasthenia is not necessarily a stable diagnosis, and may change to cases of depression or anxiety. It has been proposed that there are subgroups of neurasthenia that have different and specific organic aetiologies, although this remains to be established.
Epidemiology
Fatigue is common in the general population, but the diagnosis of neurasthenia less so. One study found that although 13% of the population complain of prolonged and excessive fatigue, less than 2% met ICD-10 criteria for neurasthenia, and less than 0.5% neurasthenia without comorbid anxiety and depression (Hickie et al 2002). Neurasthenia (and CFS) is more common in women.
Treatment
The available evidence suggests that antidepressant treatments are of limited value, but there is good evidence for rehabilitative psychological treatments, including CBT and simple graded exercise therapy (Whiting et al 2001).
Prognosis
Mild cases of fatigue tend to fluctuate, although established cases of neurasthenia tend to persist and to follow a chronic course.
I think the
Oxford criteria (Sharpe 1991), the clear history of equating ME and/or CFS with Neurasthenia, and its psychosomatic attibution is an essential part of the history of ME/CFS.
I think it's also notable that the Oxford criteria, with its requirement only for chronic disabling fatigue, is an even broader umbrella than neurasthenia which required at least 2 other symptoms and which explicitly excluded 'the presence of mood, panic, or generalized anxiety disorders'. The Oxford paper specifically includes these mental disorders, and only excludes major psychiatric disorders such as schizophrenia.
I think by muddling together causes and symptoms this section confuses rather than enlightens.
As far as I can see, neurasthenia is a symptom description, not an attribution of aetiology.
Getting back to the article in this thread, the introduction ends:
However, psychosomatic/sociogenic illness constructs continue to influence the contemporary discourse related to long COVID [
34]. This clinical perspective will anchor the current discourse regarding long COVID into the historical context involving a parallel development of ME/CFS (predominately pathobiological) and FND (predominately psychosomatic/sociogenic) diagnostic constructs. This perspective will now review the clinical findings and neurobiological pathology of long COVID, developing a clinical and scientific rationale for why it is inappropriate to consider long COVID as FND.
I don't feel qualified to comment on the FND history of association with neurasthenia, nor with its psychosomatic attibution, but it seems to me that ME/CFS and FND have followed very similar paths of a set of symptoms, largely focused on fatigue in ME/CFS and on neurological signs and sympoms in FND, and with some links back to the set of symptoms described in neurasthenia, have been developed along two paths, but not split in the way the authors of this paper describe.
Rather than the split being, as they suggest, between ME/CFS = biomedical path, FND = psychosomatic path.
This is my understanding of the split:
Biomedical scientists and some clinicians: ME/CFS and unexplained neurological signs/symptoms = biomedical but biology not yet fully elucidated, diagnostic criteria for both overlap with those for neurasthenia
BPS proponents, mostly psychiatrists and neurologists: ME/CFS and FND are psychosomatic and the successors of neurasthenia/conversion disorder/hysteria.