(Not a recommendation) Neurasthenia Revisited: On Medically Unexplained Syndromes and the Value of Hermeneutic Medicine, Aho, 2018

I haven't looked at this yet. @Tom Kindlon posted it on twitter with the observation that it looks annoying...

http://jah.journalhosting.ucalgary.ca/jah/index.php/jah/article/view/174

Link to pdf of full text, http://jah.journalhosting.ucalgary.ca/jah/index.php/jah/article/view/174/pdf

 

more bs basing anything on previous historical attitudes and the widely acknowledged ignorance of the times does not equate to science . this is just spreading the same ignorance and claiming it as factual evidence.

 

Let me just assure prospective readers that this is, in fact, an absolute gem. I majored in politics and read some stuff that was pretty out there. Derrida, postmodern feminist theory, etc.. This is one of the finer examples of postmodern BS I have ever encountered. +100 points for unusual levels of legibility and lucidity. Unfortunately, -50 points for no use of 'phallus' or derivative; a tragic oversight...

But seriously, after reading so many things like this you realize that they're all just a big word/thought-knot that simply needs to be tugged in the right couple of places to unravel. (Everybody here has probably learned that lesson, over and over...) For me the crux can be found in the final paragraphs under the heading 'Hermeneutics, Somatization, and Medically Unexplained Syndromes':

This seems to be the center of the justification for insinuating anti-scientific thinking into medicine. It makes no sense. First of all, the whole endeavor of medicine is valuable in large part for its capacity to reduce qualitative suffering; but it always requires a lot of 'brute' facts to get there. More broadly, there is no insight or substance here because nobody in practice actually makes the mistake the author is warning against. There is no life lesson here, much less a medical lesson.

This is just a series of pretty basic factual and logical errors that everybody here is familiar with. Well at least that would be the most charitable interpretation, but...

You hate to see a rookie mistake like this. If you're going to go through the effort of concocting such a highly-wrought aggregation of elaborately vacuous verbiage, don't spill the beans that you're arguing in bad faith because, actually, even if you're wrong, you're right, because, you know, truth is just a construct anyway, man. Hopefully some veteran postmodernists can take this young greenhorn under their wing and help bring his game up to big-league levels. I mean, the talent is there.

Yeah, this really takes me back to politics class seminars. Actually, this reminds me in a strange way of a very famous piece called 'The End of History?' Not because they're similar, but because there's an interesting connection to be made between them, I think. Nice find.

 

My thoughts too. It's dross.

 

Old wine in pop bottles would be more po-mo! Champagne in a cream soda bottle.

 

Funny thing happened then. I sat on the phone and it somehow sent the post. Try again.

He might have been advised to study Shorter more closely. I am serious, for once.

The problem in assuming a one-to-one coincidence between neurasthenia and chronic fatigue is that the diagnosis was used in a variety of different contexts:1 as a synonym for general nervousness and evolving psychosis; 2 as the male equivalent of hysteria in women;3 as a synonym for minor depression; and 4 as a diagnosis of fatigue states in patients who were not obviously depressed.

This last group is of particular interest, as it corresponds today with ME and CFS. A limited percentage of neurasthenic patients did suffer primarily from sensations of chronic fatigue...

Chronic fatigue in historical perspective. Edward Shorter. 1993 Chronic fatigue syndrome. Wiley, Chichester (Ciba Foundation Symposium 173) p6-22.
In chapter "was neurasthenia an early instance of chronic fatigue?"

A second problem in assuming a direct equivalence between neurasthenia and chronic fatigue is that many fatigued patients did not receive the diagnosis of neurasthenia... P12

 

Wish i could like your post ten times just for the description

 

Glad you liked it!

 

There is actually a direct thread between neurasthenia and CFS. It is that psychologists use empty theories because they cannot look at the brain the way you can look at microbes under a microscope. This was sort of OK in 1890, but shocking in 2018.

We have the unreal situation where blood clotting is known to be a complicated system with lots of points at which it can fail but the functioning of the brain - the most complicated thing on Earth - is reduced to a set of facile "theories".

A few minutes thought can give a long list of diseases that were once considered hysterical. The experiment has been done. Does hysteria or somatisation have any facts to back it up? NO.

 

I think this is a good point. Why even dredge up neurasthenia (or hysteria, etc.)? How valid were these diagnoses given the state of medical science and technology at the time they were in use? Who knows what was really going on in each case? It's a very tenuous link and I think it's more judicious for those who are sincerely trying to make things better now to not get bogged down trying to read into the past too deeply. There's enough to go on here and now that we can get a much better look at.

I think this is a good answer for the question above - why dredge up neurasthenia? It's a seductive connection to make if you're trying to build and bolster a compelling story that is based mostly on speculation. I think there are some instances where you can reasonably prove exotic sorts of psychogenic functional disorder (functional blindness, paralysis or such) but for the most part I think this is on point - these lines of thought have not panned out to have broad medical applicability.

'Intellectual masturbation' expresses it best for me. There's nothing wrong with the activity so much as there is with trying to pass it off as something substantial and illuminating.

 

https://www2.fgcu.edu/CAS/1066.asp

 

I have never seen a decent explanation for any sort of "functional" disorder. A lot of them lie along the lines of "there is no damage to the optic nerve so the blindness can't be physical" when the brain has to process what comes along the nerve so the problem could be anywhere there. It is an arrogant "we know everything that is possible" science and I have seen so many of them fall in my lifetime.