Chronic Fatigue: The Fatigue Neurosis
Francis X. Dercum in Rest, Suggestion, 2019
As I have elsewhere pointed out, the symptoms of neurasthenia resolve themselves into two great groups: First, those which belong essentially to the affection and which always present the phenomena of chronic fatigue; secondly, those which are adventitious or secondary outgrowths of various disturbances of function, themselves symptomatic of fatigue. The first, I have termed primary or essential symptoms, and the latter, secondary or adventitious symptoms. Viewed in this light, the symptomatology of neurasthenia becomes clear and readily comprehensible. The primary or essential symptoms manifest themselves as weakness and irritability of various functions, whether these be motor, sensory, psychic, or visceral. Thus, the patient almost invariably complains of muscular weakness, which in the majority of cases can readily be demonstrated to be real. When tested by the dynamometer, it is usually found that the grip is weak. Occasionally, however, the grip at first seems to be normal, but if the patient be made to repeat the test a number of times in succession, we find that the grip rapidly grows weaker. In other words, we can easily establish the symptom of ready exhaustion. The various statements which the patient makes are in keeping with this finding. He will state, for instance, that slight efforts at walking induce great fatigue, or that slight muscular exercise of any kind rapidly exhausts him. Most frequently the weakness is referred to the legs and back, but occasionally it is referred to the arms.
Neurological Disease in Herpes Simplex Virus Type 2 (HSV-2) Infection
Marie Studahl, Paola Cinque, Tomas Bergström in Herpes Simplex Viruses, 2017
Clinical symptoms of HSV-2-induced meningitis are mainly the same as those found in asentic meningitides caused by other viruses Headache, usually described as intense, develops during 2–3 days (10), together with varying degrees of other signs and symptoms of meningeal irritation such as neck stiffness, photophobia, nausea, and vomiting. Fever is common but not an obligatory finding [present in 63% of 71 patients in one study (14)]. In most cases, the acute symptoms of primary meningitis resolve spontaneously within a week, although sometimes only after a protracted illness (8,7,10,19,25). Neurasthenic symptoms such as mild headache, lability, concentration disabilities, and fatigue may, however, last for several weeks (8,22). One case of chronic meningitis with predominantly headache and meningism lasting for 4 weeks has been reported (35). Cerebrospinal fluid typically shows a mild to moderate, predominantly monocytic, pleocytosis of 400 (mean) leukocytes × 10/mL (range 5–1100) in primary meningitis (10,7), slightly increased protein 1.6 g/L (range 0.4–3.0 g/L) (10), a CSF:serum glucose ratio of more than 0.5, and normal lactate. Hypoglycorrhea has been reported in a number of cases (28,35–37) and occasionally a slightly increased lactate concentration can be found. Meningitis due to HSV-2 has some characteristics that distinguish it from meningitis of other origins: the association with mucocutaneous herpetic lesions and with additional neurological symptoms, along with the appearance of recurrent disease.
Naming the Mad Mind
Petteri Pietikainen in Madness, 2015
Physicians did not believe that ‘functional’ meant ‘non-organic’, but to their frustration they could not detect any anatomic lesion or alteration in the nervous system. Thanks to the germ theory of disease, developed by Louis Pasteur in France and Robert Koch in Germany, late nineteenth-century physicians began to be able to determine the underlying aetiology behind symptoms. The discovery of micro-organisms responsible for major diseases (such as general paralysis) also confirmed the belief that ‘functional’ denoted ‘conditions which had no gross anatomical changes, but were nevertheless thought to have molecular disturbances’ (Beer 1996, 241) Neurasthenia became a popular illness for almost half a century in many European countries and in North America. It has been shown that its history in different countries has different characteristics so that, for example, neurasthenia in the United States was not the same as neurasthenia in Germany, or the Netherlands, or Sweden (Gijswijt-Hofstra & Porter 2001; Pietikainen 2007; Schuster 2011). During the fin de siècle (ca. 1890–1914), it was neurasthenia, even more than hysteria, that represented the most widespread and talked-about neurosis. Compared to hysteria, neurasthenia was a more ‘heroic’ illness, because it initially afflicted the intellectual classes who worked hard and overtaxed their brain day in day out. Initially, neurasthenics were both paragons and victims of modern life; they represented the vanguard of cultural progress, but they were also victims of a modern, increasingly hectic and nerve-wracking urban lifestyle. It was no coincidence that Beard had his office in Manhattan. In the early decades of the twentieth century, neurasthenia shifted from a predominantly somatic to a predominantly psychological disease entity. In Vienna, Sigmund Freud had created the influential ‘anxiety neurosis’ in the 1890s; in Paris, Freud’s rival Pierre Janet developed a sort of psychological version of neurasthenia that he called ‘psychasthenia’ in 1903; and, in Bern, Switzerland, the nerve pathologist Paul Dubois introduced the term ‘psychoneurosis’ in 1904. Neurasthenia, psychasthenia and psychoneurosis (as well as ‘traumatic neurosis’) formed the illness category of ‘neurosis’, a generic term for milder mental afflictions. During the first half of the twentieth century, neurosis (including its sub-categories) became the most common mental malady in the western world and a major diagnostic category in psychiatry and neurology (Pietikainen 2007). A significant component of neurosis was sexuality. George Beard devoted a whole book to sexual neurasthenia and claimed that sexual problems, especially impotence, constituted a major factor in nervous illnesses (Beard 1884). His book set the tone for the later conceptualizations of the relationship between ‘weak nerves’ and disturbances in the sexual sphere. Sexuality was not only a medical, but also a moral problem. Moralistic judgements with regard to sexuality were rampant in western Europe at least until the 1920s and the 1930s. Doctors, clergy and pedagogues formed an unofficial vice squad that monitored and regulated sexuality, condemning, for example, masturbation either as a sin or as a pathology that weakened and eventually damaged both the nervous system and the brain (Laqueur 2003). Likewise, sexual ‘deviations’, such as homosexuality, were judged negatively both morally and medically (through pathologization). By and large, the European medical community joined forces with the Church in seeing sexuality as a creature from the black lagoon, lying in wait to emerge from the oily water and devour men and women who failed to practise continence or restrict sex to marriage (Pietikainen 2007, 151–9).
Neurasthenia: tracing the journey of a protean malady
Published in International Review of Psychiatry, 2020
Poornima Bhola, Santosh K. Chaturvedi
Neuresthenia has had its popularity waxing and waning over the years. This review article traces the path and trajectory of the concept of this disorder, how it changed and varied over time, to the current times, when it has been almost forgotten and the concept is heading towards oblivion. Although its place in the diagnostic systems is currently in question, neurasthenia is still part of professional conversations and practice. The concept of neurasthenia emerged at the intersections of clinical, cultural and sociological dimensions of society. A deeper examination of how neurasthenia was situated at the intersections of race, class and gender exemplifies how psychiatric diagnoses may reflect and shape societal biases. The neurasthenia label has all but disappeared from contemporary nosological frameworks, however, there is a proliferation of other disorders, e.g. chronic fatigue syndrome, fibromyalgia, that try to capture the experience of fatigue, pain, weakness, and distress even in the absence of clear-cut medical aetiologies. Only time will tell, if this concept has indeed been buried, or will rise as a phoenix in the years to come. Newer nervous fatigue syndromes are expected to emerge from the use of technology, screen time and the virtual world.
Railway spine: The advent of compensation for concussive symptoms
Published in Journal of the History of the Neurosciences, 2020
The introduction of railway transportation in Great Britain in the early-nineteenth century saw an increased frequency of trauma cases involving persisting symptoms without objective evidence of injury. In 1866, a prominent surgeon, Sir John Eric Erichsen, attributed such symptoms to concussion of the spine (popularized as “railway spine”) that involved an organic pathology, inflammation of the spinal cord in the absence of spinal fracture, with potential psychological overlay. This was widely accepted within the medico-legal context throughout the 1870s, whereby passengers sought compensation for collision-related injuries. In 1883, a railway surgeon named Herbert William Page countered the assertion that many of Erichsen’s cases likely had sustained direct physical injury to the spine, the cord, and/or the spinal nerves; and in cases without such injury, the symptoms were psychogenic, as in traumatic neurasthenia and/or hysteria. Similarities between Erichsen’s and Page’s medico-legal positions, such as conscious and unconscious forms of symptom exaggeration that would both resolve upon settlement of the case, ushered in the era of medical injury compensation.
‘Neurasthenia gastrica’ revisited: perceptions of nerve-gut interactions in nervous exhaustion, 1880–1920
Published in Microbial Ecology in Health and Disease, 2018
In this paper, some of the medical literature on the historical disease-concept of ‘neurasthenia gastrica’ is reviewed. Neurasthenia gastrica was defined as a sub-unit of the wider category of neurasthenia, also referred to as nervous exhaustion or nervous weakness. Neurasthenia was a commonly used diagnostic label at the end of the nineteenth century and a few decades onwards, and was used to describe a wide variety of symptoms for which no ‘organic’ basis could be found. In neurasthenia gastrica, however, the gastrointestinal symptoms predominated, and there was considerable debate as to how the gut interacted with the central nervous system in the development of these ailments. Some of these discussions may be seen as historical precedents for the current debates on the brain–gut–microbiota axis, particularly in relation to the so-called functional gastrointestinal disorders.
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