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Neurasthenia

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									                                     Neurasthenia


Shenjing shuairuo, or neurasthenia has been made famous by Arthur Kleinman (1981,
1986) as the Chinese version of major depressive disorder. It is commonly said of
Asian cultures, and in fact of most non-Western cultures generally, that they encourage
somatization -- the process of experiencing and expressing emotional stressors and
mental illness through bodily complaints. (Another way of describing this is to say that
Westerners tend to psychologize their symptoms and to experience and to express their
complaints in a psychological rather than somatic idiom.)

Neurasthenia was created as a diagnostic category in the 19th-century United States by a
neurologist, George Beard (Kleinman, 1988:100). 19th-century "neurology" was not
based on the same conceptions of biology held by modern neurology and neuroscience. It
seems in some cases to have operated on a quasi-humoral theory of "vital energy" in
which diseases were caused by "exhaustion" of the "nerves". Often it provided biological
explanations for existing psychiatric syndromes, as in the case of neurasthenia for
depression, or anorexia nervosa for hysteria. This reduced the stigma of the illness, and
allowed respectable members of the middle- and upper-classes to be treated in
respectable offices by respectable physicians rather than by alienists in asyla. Finally,
exhaustion of the nerves served as a mark of status, since elites were considered more
vulnerable to such ailments, in the way that ulcers or hypertension may serve as markers
of elite status today.

The concept of neurasthenia was introduced to the Chinese medical establishment along
with the rest of Western medicine, and it seems to have been enthusiastically adopted.
According to Kleinman (1981:258-259) neurasthenia is the second most common
diagnosis in Chinese psychiatric hospitals, and one of the most common
neuropsychological diagnoses in general. Neurasthenia seems to subsume a number of
indigenous terms: shen2jing1 shuai1ruo4 or (WG) shen-ch'ing shuai-jo; huo3qi4 da4
or (WG) huo-ch'i ta "excessive hot internal energy", a syndrome of irritability, anger,
and anxiety, along with gastrointestinal complaints; and sim1 chap8-chap8 (Taiwan) a
syndrome of chest pains and palpitations with anxiety; and shenkui (discussed elswhere)
are all used to express what would probably be diagnosed as major depressive disorder
or anxiety disorder in the West.

A typical case study of neurasthenia follows:

One patient was a 41-year-old man with headaches, pains in joints, insomnia, "too many
dreams", loss of appetite, weakness, and the belief that there was something wrong with
his brain that caused his scalp to sweat excessively. It seemed to us this patient had a
depressive syndrome associated with a fixed idea, which could have been a somatic
delusion. In treating him, the doctor diagnosed a skin disease of the scalp which he
claimed would improve the scalp problem and through it the patient's "brain function".
That in turn would cure the depression. In the entire exchange doctor and patient
discussed illness and treatment solely in somatic terms.
-- from Kleinman, Arthur, and Mechanic, David. "Mental illness and psychosocial
aspects of medical problems in China." In Kleinman, Arthur, and Lin Tsung-Yi (eds.)
(1981) Normal and Abnormal Behavior in Chinse Culture. Dordrecht, The Netherlands:
D. Reidel Publishing Company. p. 337.

The puzzle of neurasthenia in China is of how to reconcile it with Western diagnostic
categories. The World Health Organization's manual ICD-10 classification of mental and
behavioural disorders (1992:170-171)still recognizes neurasthenia as a diagnosis:

a.      either persistent or distressing complaints of increased fatigue after mental effort,
or persistent and distressing complaints of bodily weakness and exhaustion after minimal
effort;
b.      at least two of the following: feelings of muscular aches and pains; dizziness;
tension headaches; sleep disturbance; inability to relax; irritability; dyspepsia;
c.      any autonomic or depressive symptoms present are not sufficiently persistent and
severe to fulfill the criteria for any of the more specific disorders in this classification.

       Includes: fatigue syndrome.

These criteria emphasize the phenomenology of exhaustion, inability to concentrate, and
general bodily complaints, all of which typically occur in Western patients with
depression. Kleinman seems to believe that Chinese neurasthenia and various similar
Chinese syndromes mentioned above are variants manifestation of major depression or
anxiety disorders; however, he also wants to maintain the specificity of the Chinese
situation. Many of the neurasthenic patients examined by Kleinman are survivors of the
Cultural Revolution, a social upheaval which utterly transformed Chinese society. In
Kleinman's view, to gloss over the specific socially experienced trauma of the Cultural
Revolution, to pass lightly over the particular subjectivity of the Chinese neurasthenic
embedded in a complex web of family, Maoism, and traditional Chinese philosophy,
would be to ignore what is important about the Chinese experience of neurasthenia as
distinct from Western depression.

         Works on neurasthenia in China include:

         Kleinman, Arthur. (1986) Social Origins of Stress and Disease:
         depression, neurasthenia, and pain in modern China New Haven: Yale
         University Press.

         Kleinman, Arthur, and Lin Tsung-Yi (eds.) (1981) Normal and
         Abnormal Behavior in Chinse Culture. Dordrecht, The Netherlands: D.
         Reidel Publishing Company.

         For a discussion of 19th-century neurology, see also:


         Brumberg, Joan Jacobs. (1988) Fasting Girls: the emergence of
anorexia nervosa as a modern disease. Cambridge, MA: Harvard
University Press.

								
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