Modern-Day Relics of Psychiatry, 2019, Tripathi et al

Paywall, https://journals.lww.com/jonmd/Abstract/2019/09000/Modern_Day_Relics_of_Psychiatry.1.aspx
Sci hub, not available

 

I suspect neurasthenia never referred specifically to the entity chronic fatigue syndrome. In a textbook published in 1921, neurasthenia is only briefly described as condition twice as common in men than in women, characterized by rapid fatigueability and somehow closely related to hysteria, although no reason is given. The only risk factor mentioned appears to be overwork.

If neurasthenia was the older term for CFS, they major risk factor of infection would have been recognized, and the gender distribution would have been different.

 

SW said it was the new name for neurasthenia in his paper "New Wine in Old Bottles" Rationality and science had no part, just ideology.

 

In my mother's nursing textbooks (she would have trained in the early 1950s) neurasthenia was described as affecting men of a sensitive, delicate nature, and the treatment suggested was rest and withdrawal from stress and demands to a quiet environment.

Women weren't mentioned under this diagnosis- lumped into hysteria I expect.

In a different book of the time, Soldiers' heart or Da Costa's Syndrome (possible OI/POTS) seemed to be viewed very much in class terms which affected the lower ranks in the infantry who were regarded as lacking in moral fibre, rather than the officer chaps in the navy or air force.

 

I don't understand how anyone can be confused by this. This is the exact same logic behind "it's not racist if you don't use explicit racist insults".

It's the substance and its consequences that cause stigma, not the actual words. Of course bad word choice will often increase stigma, but that is almost universally when words are repurposed specifically to cause confusion, which still remains a substance problem. Fatigue isn't stigmatized because of what the word means, it's stigmatized because of the overwhelming belief that it is interchangeable with low motivation and of otherwise no significant consequence, meaning no help, no support, no research, no progress. It has become as meaningless as anxiety and depression, things we cannot see, measure, define or falsify and are therefore used to mean anything and everything to avoid saying "I don't know and there should be efforts to understand why".

And here for example the destruction of all useful meaning of the word fatigue has caused enormous stigma to other diseases as well. It's well-established that fatigue is one of the primary complaints for MS, Parkinsons', RA and several other autoimmune diseases yet as far as the experts are concerned it's basically irrelevant, in large part because fatigue has been more and more associated with psychosomatic illness, which means "not their problem".

I don't think relic is the right word. Relics have no purpose other than as mementos, they are not used in practice. Psychosomatic medicine still very much applies the old ideas, even straight up Freudian nonsense, with different words of course but that's a distinction without a difference, and so they are not so much relics are anachronistic failures. They are not restricted to history, those ideas are in fact so alive we are probably in the golden age of psychosomatic ideology, more influential than ever. None of the historical baggage has been shed, stuff simply keeps being added to it.

 

I don't know about this. Even self-proclaimed history of fatigue expert Edward Shorter has written that the diagnosis of neurasthenia had become rare by WWI, and was virtually gone by WWII.


This 1984 article appeared in the New York Times:
HYSTERIA WAS FOR WOMEN, NEURASTHENIA FOR MEN
https://www.nytimes.com/1984/09/09/books/hysteria-was-for-women-neurasthenia-for-men.html

This 2016 article in The Atlantic,
‘Americanitis’: The Disease of Living Too Fast,
is quite hilarious in relating how non-specific the diagnosis was. It makes the late-1980's notion that neurasthenia was synonymous with Chronic Fatigue Syndrome seem ridiculous, simply because neurasthenia was apparently synonymous with nearly everything, including physical diseases and forms of mental illness that had not yet been distinguished.
https://www.theatlantic.com/health/archive/2016/03/the-history-of-neurasthenia-or-americanitis-health-happiness-and-culture/473253/

 

Neurasthenia had disappeared entirely from the UK medical vocabulary by 1970 judging by my training period.

 

Then why did a psychiatrist attempt to diagnose me with it in 2010, huh?

 

Maybe he had been listening to Dr W.

 

I suppose that is possible, because he sure wasn't listening to me!

 

Fun times.

The women were treated with enforced rest, to the point of not being allowed to feed themselves.

 

I got neurasthenia as my first Dx from my GP in 2011 when I got sick. Even wrote in on my insurance forms. It took a psychiatrist to tell him he was wrong and cleared me of all mental disorders for that matter and told my GP I needed biological investigation. My GP stopped treating me and investigating altogether after that.

 

Did they 'Go West' like this?

https://www.youtube.com/watch?v=1wc-AQJ2MYo

Or even this?

https://www.youtube.com/watch?v=LNBjMRvOB5M

That does indeed make me feel more mainly already! All the bum slapping goodness...

 

Because if there's one thing the Wild West was known for it's that it was all easy-going and relaxing.

Also apparently stress appeared in 1970's America, or something like that. Life before then was a utopian ideal of fun and games and no threats whatsoever, abundance and good health. That's really the thing life was known for before the 20th century: good health all-around. Obviously.

Even as parody this would be too hamfisted.

 

UpToDate.com refers to neurasthenia as a historical term for ME/CFS. This is what doctors reference.

Shocking really. Then again, Komaroff is the editor, so perhaps not so surprising.

 

so the mistakes of ignorant fools in the past is being dragged out once again to prove what that the ignorant fools of today are incapable of learning anything that gets in the way of their paychecks .

 

Mistakes of the past shouldn't be hidden. It's definitely true that some self-proclaimed experts argued they are the same thing, just as it's true that MS used to be called hysterical paralysis.

Problem is those mistakes are still being made, not that they ever were. The beliefs behind neurasthenia are still very much alive, just as hysteria and conversion disorder are, mixed and matched in endless combinations. They're alive because people keep them alive, some very influential.

Frankly, the failure lies more in the institutions that continue enabling this. Bad ideas are as common as air. It's just disappointing that they are still very much in demand by people who absolutely should know better, but clearly don't.

And now as we see with the "actually, bias is A-OK" coming from Cochrane, it seems we are entering a golden age of magical psychological pseudoscience. Freud would be just as proud as he was high on cocaine.

 

I was corrected when I posted recently as I had always read neuromyasthenia, the US name for ME, as neurasthenia. That could be the mistake made in uptodate.com.

We have a history of unfortunate names.

 

Maybe not quite on topic, but I suggest The Yellow Wallpaper is a good read. Read for free here.

 

Does anyone have access to the full paper?