Managing Chineseness: neurasthenia and psychiatry in Taiwan in the second half of the twentieth century.

The present study investigates the role of Taiwanese psychiatrists in turning neurasthenia into a culture-specific disease in the late twentieth century. It first delineates the shift in both explanatory models of psychoneuroses and patient population in post-World War II Taiwan. Neurasthenia became a focus of international attention in the 1970s and 1980s with the advance of cultural psychiatry, and, as China was closed to the outside world, Taiwanese psychiatrists were influential in framing the cultural meaning of neurasthenia. With the rise of post-socialist China, Taiwan lost its status as a key laboratory of Chinese studies. This paper argues that the history of neurasthenia during the period was closely associated with the professional development and national identity of Taiwanese psychiatrists.

Masturbation as a Cause of "Sexual Neurasthenia": Anton Chekhov's Medical Report (1883).

ABSTRACT: In the 18th and 19th centuries, in Europe and the United States, masturbation was seen not only as a deviant form of sexual activity but also as a cause of nervous diseases. Masturbation was originally thought to cause insanity, but with the introduction of George Miller Beard's concept of neurasthenia, it came to be considered a form of nervous exhaustion. In the current article, we analyzed the almost forgotten medical report of a "sexual neurasthenic," written by the famous Russian writer and physician Anton Chekhov (1860-1904). This report gives us detailed information about the treatment of a patient allegedly experiencing the effects of masturbation, and thus reflects the medical discourse on masturbation in Russia in the early 1880s. It shows that although the international debate on the causes of neurasthenia had just begun, the concept of neurasthenia toward masturbation had already been put into practice at the Moscow University Clinic in 1883.

"Our one great national malady": Neurasthenia and American Imperial and Masculine Anxiety at the Turn of the Twentieth Century.

White upper middle-class Americans at the turn of the twentieth century were entrenched in a battle with a newly discovered, or invented, mental illness called neurasthenia. This essay examines the ways in which the medical discourse of neurasthenia reflected late nineteenth- and early twentieth-century white Anglo-Saxon men's belief in, as well as anxiety over, American values bolstered by their idea of cultural, racial, and sexual superiority and consolidated through a conjunction of medicine and politics. The idea of neurasthenia as white American men's malady functioned as a mark both of whites' racial superiority to the "new" immigrants and African Americans as well as of women's intellectual inferiority to the opposite sex of their own race. Imposing a subtle distortion on the etiology and diagnosis of neurasthenia and associating it with specific groups of people, the "American disease" constituted the era's representative pathological symptoms which addressed Anglo-Saxon American men's anxieties about overcivilized effeminacy and racial and national decadence which was originated as a response to the racial and sexual heterogeneity. This essay also argues that neurasthenia was an imagined disease which addressed late nineteenth-century American men's spatial anxiety about the decline of the American pastoral ideal caused by the closure of the frontier. Given that the treatment for neurasthenic men was an escape to the frontier in the West in which they could rejuvenate withered American masculinity, their uneasiness about barbarous, unhygienic, and prolific immigrants and unruly white women, in fact, was tied to their spatial anxiety which symptomatically signifies the crisis of American masculinity. Channeled through the medical knowledge of neurology, it made American men's racial, sexual, and spatial anxieties function to act out their racist, misogynist, nativist, and imperialist impulses which legitimized exclusionary political techniques toward the racial and sexual others such as the U.S. imperial expansion in the 1890s and 1900s and a eugenic-influenced immigration policy from the 1900s through the1920s. In this sense, the decline of neurasthenia around 1920 should not be attributed solely to the continued efforts to professionalize American medicine accompanied by recent discoveries of chemical factors such as hormones and vitamins and the rise of psychiatry and psychology which offered physicians with a more specific theory of health built on clinical laboratory science. Like its rise, the decision to move away from the neurasthenic diagnosis was rather a cultural phenomenon, which reflected the American ascendancy to global power in the early twentieth century, particularly after the First World War. Sustaining a political order rested on racial and sexual hierarchies both within and outside the American continent, American men felt that they were no longer liable to specific, time-tested anxiety and somatic symptoms of neurasthenia, which was more an ideological and cultural construct than a clinical entity that dramatizes the racial, sexual, and imperial politics of the-turn-of-the-twentieth-century America.

The role of neurasthenia in the formation of the physiotherapy profession.

Background: Neurasthenia was one of the most commonly diagnosed disorders in the later years of the 19th century. Its most widely used treatment, known as the Rest Cure, relied heavily on physical therapies, but little is known about the practitioners who administered the treatment. In this paper, I argue that the nurse-masseuses who delivered the massage and electricity so vital to the success of the Rest Cure, used the opportunity to develop approaches to treatment that would form the backbone of the physiotherapy profession in England after 1894. Methods: Extensive primary and secondary texts were drawn from a wide range of sources and critically reviewed. Findings: This study argues that the management of neurasthenic cases in the 1880s and 90s created the conditions necessary for the development of the profession's relationship with medicine and the establishment of new practice roles for women, and that these would play an important role in shaping the physiotherapy profession in Britain after 1894. Read through the critical sociological writings of Magali Sarfatti Larson and Anne Witz, I argue that the work of the nurse-masseuses can be seen as a complex gendered negotiation between the need to be deferential to the dominant male medical profession; distinct from emerging notions of the angelic, motherly nurse; obedient, technically competent and safe. The creation of a space in the clinic room for a third practitioner who could deliver a different form of care to the doctor or the nurse, established an approach to practice that physiotherapists would later adopt almost without amendment. Discussion: I argue that this approach owes much to the work done by nurse-massueses who established and tested its principles in treating cases of neurasthenia.

Con los nervios de punta: de la medicalización a la psicologización de los quebrantos mentales en el trabajo. Bogotá y Medellín, 1898-1961 / With the nerves on the top: from medicalization to psychologization of mental breakers at work. Bogota and Medellín, 1898-1961

En este artículo se analizará el modo en que la neurastenia y la fatiga fueron objetivadas por la medicina dentro del ámbito laboral en las ciudades de Bogotá y Medellín, durante la primera mitad del siglo XX. De ahí la necesidad de tomar como referencia la identificación de los presuntos padecimientos ligados a la esfera del trabajo intelectual y físico. A la reivindicación de los comportamientos frugales para aminorar los efectos de aquellos padecimientos, se le vino a adicionar la creciente psicologización del mundo del trabajo promediando dicha centuria. Aquella psicologización se volvió una herramienta que amplió el espectro de la anormalidad, en medio de la metamorfosis experimentada por el aparato productivo y la diversificación de la estructura laboral a nivel nacional

In this article it will analize the way in which nervous exhaustion and fatigue were objectified by the medicine inside the labour environment in the cities of Bogota and Medellin, during the first half of twentieth century. From there the necessity of taking as reference identification of alleged hardship related to intellectual and physical work sphere. To the demand of frugal behaviours to minimize the effects of that hardship, it added the growing psychologization of world work in the middle of the century. That psychologization was turned into a tool that extended the spectrum of anormality, in the midst of the metamorphosis experienced by the productive system and diversification of labour structure nationally

[Urology goes electric-electrotherapy : Modern therapies in the treatment of modern diseases-examples from urology]. / Die Urologie wird elektrisch ­ Elektrotherapie : Moderne Therapien zur Behandlung moderner Erkrankungen ­ Beispiele aus der Urologie.

The significance of electricity for medicine in the modern industrial age should not be underestimated. Particularly in connection with neurasthenia, electrotherapeutic approaches also experienced a boom for domestic use. Thus, electrotherapy reached urology just as it was becoming established as a medical specialty. We analyzed urological manuals and textbooks and objects in the W. P. Didusch Center for Urologic History and the Museum zur Geschichte der Urologie in Berlin to present the wide range of indications for electrotherapy in the emerging field of urology from impotence to urethral strictures and try to highlight the variability of their importance over time.

De la neurastenia a la enfermedad postesfuerzo: evolución de los criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica / From neurasthenia to post-exertion disease: Evolution of the diagnostic criteria of chronic fatigue syndrome/myalgic encephalomyelitis

Presentamos la evolución de la terminología y los criterios diagnósticos para el síndrome de fatiga crónica/encefalomielitis miálgica. Este síndrome es una entidad compleja y controvertida, de etiología desconocida, que aparece en la literatura médica en 1988, si bien desde el siglo XIX se identificaron cuadros clínicos de fatiga crónica idiopática con diferentes nombres, desde neurastenia, neuromiastenia epidémica y encefalomielitis miálgica benigna hasta la actual propuesta de enfermedad de intolerancia al esfuerzo (postesfuerzo). Todos ellos aluden a un estado crónico de fatiga generalizada de naturaleza desconocida, con limitaciones al esfuerzo físico y mental, acompañado de un conjunto de síntomas que comprometen diversos sistemas orgánicos. La Clasificación Internacional de Enfermedades (CIE-10) encuadra este síndrome en el apartado de trastornos neurológicos (G93.3), aunque todavía no se hayan encontrado hallazgos anatomopatológicos que lo clarifiquen. Se han documentado múltiples alteraciones orgánicas, pero no se ha establecido una biología común que aclare los mecanismos que subyacen a esta dolencia. Se enuncia como una disfunción neuroinmunoendocrina, con un diagnóstico exclusivamente clínico y por exclusión. Diversos autores han propuesto incluir el síndrome de fatiga crónica/encefalomielitis miálgica dentro de los síndromes de sensibilidad central, aludiendo a la sensibilización central como el sustrato fisiopatológico común para este síndrome y otros. El papel del médico de familia es clave en la enfermedad, para la detección de aquellos pacientes que presenten una fatiga de naturaleza desconocida que se prolonga de forma continua o intermitente durante más de 6 meses, al objeto de realizar un diagnóstico temprano y establecer un plan de actuación frente a una enfermedad crónica con unos altos niveles de morbilidad en la esfera física y mental. Objetivo: Realizar una revisión bibliográfica de la terminología y criterios diagnósticos del síndrome de fatiga crónica/encefalomielitis miálgica, al objeto de aclarar conceptualmente la enfermedad, como utilidad en el diagnóstico a los médicos de Atención Primaria

Changes in the terminology and diagnostic criteria for chronic fatigue syndrome/myalgic encephalomyelitis are explained in this paper. This syndrome is a complex and controversial entity of unknown origins. It appears in the medical literature in 1988, although clinical pictures of chronic idiopathic fatigue have been identified since the nineteenth century with different names, from neurasthenia, epidemic neuromyasthenia, and benign myalgic encephalomyelitis up to the current proposal of disease of intolerance to effort (post-effort). All of them allude to a chronic state of generalised fatigue of unknown origin, with limitations to physical and mental effort, accompanied by a set of symptoms that compromise diverse organic systems. The International Classification of Diseases (ICD-10) places this syndrome in the section on neurological disorders (G93.3), although histopathological findings have not yet been found to clarify it. Multiple organic alterations have been documented, but a common biology that clarifies the mechanisms underlying this disease has not been established. It is defined as a neuro-immune-endocrine dysfunction, with an exclusively clinical diagnosis and by exclusion. Several authors have proposed to include CFS/ME within central sensitivity syndromes, alluding to central sensitisation as the common pathophysiological substrate for this, and other syndromes. The role of the family doctor is a key figure in the disease, from the detection of those patients who present a fatigue of unknown nature that is continuous or intermittent for more than 6 months, in order to make an early diagnosis and establish a plan of action against a chronic disease with high levels of morbidity in the physical and mental sphere. Objective: To carry out a bibliographic review of the terminology and diagnostic criteria of the chronic fatigue syndrome/myalgic encephalomyelitis, in order to clarify the pathology conceptually, as a usefulness in the diagnosis of Primary Care physicians

[The energy metaphor for the human body and its effect on the rise of neurasthenia, neurosis and depression]. / La metáfora energética del ser humano y su incidencia en el auge de la neurastenia, la neurosis y la depresión.

This article aims to provide a historical critique of the rise of three diagnostic categories: neurasthenia (late nineteenth century), neurosis (first half of the twentieth century) and depression (mid-twentieth century to the present). The hypothesis is that their broad dissemination can be explained through their link to the energy metaphor for the human body. From the mid-nineteenth century on, the concept of energy spread through western culture, encouraging certain fictions about what we are - the ontological dimension - and what we could be - the ethical dimension. The article shows that these pathologies have codified and made intelligible a set of life trajectories that did not obey the imperatives of those onto-ethical fictions.

El artículo tiene por objetivo realizar una historia crítica del auge de tres categorías diagnósticas: la neurastenia (fin del siglo XIX), la neurosis (primera mitad del siglo XX) y la depresión (segunda mitad del siglo XX hasta nuestros días). La hipótesis es que su amplia difusión se explicaría debido al vínculo que ellas han tenido con la metáfora energética del ser humano. Desde mediados del siglo XIX, la concepción energética se difundió por la cultura occidental, habilitando ciertas ficciones acerca de lo que somos ­ dimensión ontológica ­ y lo que podríamos llegar a ser ­ dimensión ética. El artículo muestra que estas patologías han codificado y tornado inteligible determinadas trayectorias vitales que no cumplían con los imperativos de tales ficciones onto-éticas.

La metáfora energética del ser humano y su incidencia en el auge de la neurastenia, la neurosis y la depresión / The energy metaphor for the human body and its effect on the rise of neurasthenia, neurosis and depression

Resumen El artículo tiene por objetivo realizar una historia crítica del auge de tres categorías diagnósticas: la neurastenia (fin del siglo XIX), la neurosis (primera mitad del siglo XX) y la depresión (segunda mitad del siglo XX hasta nuestros días). La hipótesis es que su amplia difusión se explicaría debido al vínculo que ellas han tenido con la metáfora energética del ser humano. Desde mediados del siglo XIX, la concepción energética se difundió por la cultura occidental, habilitando ciertas ficciones acerca de lo que somos - dimensión ontológica - y lo que podríamos llegar a ser - dimensión ética. El artículo muestra que estas patologías han codificado y tornado inteligible determinadas trayectorias vitales que no cumplían con los imperativos de tales ficciones onto-éticas.

Abstract This article aims to provide a historical critique of the rise of three diagnostic categories: neurasthenia (late nineteenth century), neurosis (first half of the twentieth century) and depression (mid-twentieth century to the present). The hypothesis is that their broad dissemination can be explained through their link to the energy metaphor for the human body. From the mid-nineteenth century on, the concept of energy spread through western culture, encouraging certain fictions about what we are - the ontological dimension - and what we could be - the ethical dimension. The article shows that these pathologies have codified and made intelligible a set of life trajectories that did not obey the imperatives of those onto-ethical fictions.

Neurasthenia: Modern Malady or Historical Relic?

Neurasthenia was a popular diagnosis from 1869 through 1930. Despite being discarded, the core symptoms of neurasthenia can still be found throughout modern society. The present article reviews the symptoms, common course, proposed causes, and common treatments for neurasthenia. Similarities are seen in several familiar diagnoses, including depression, chronic fatigue syndrome, and fibromyalgia. Through reviewing the trends of neurasthenia, modern doctors may learn more about the subtleties of the diagnostic process, as well as the patient-physician relationship. The goal is to learn from the past as it relates to current problems that may be related to the stress of modern living. The history of neurasthenia is presented as it relates to problems that may remain today.

Is Today's 21st Century Burnout 19th Century's Neurasthenia?

This essay addresses the relevance of the concept of "burnout" to concerns about the mental and physical health of today's physicians and those training to join the medical profession. Comparisons are made with the diagnosis of neurasthenia in the 19th century. Social contributors to and the influence of stress on the phenomena in each instance are presented.

Traumatic Hystero-Neurasthenia in Professor Charcot's Leçons du Mardi.

At the end of the 19th century, several authors became interested in the physical and psychological symptoms resulting from traumatic life events. Oppenheim presented 42 detailed clinical observations. He suggested the term "traumatic neurosis." Charcot, who was interested in male hysteria, published over 20 cases of traumatic hysteria between 1878 and 1893. The symptoms were considered to have a dynamic or functional origin. The role of horror and terror during the trauma was emphasized. However, Charcot opposed the idea of traumatic neuroses as specific syndromes as he considered them to be only an etiological form of hystero-neurasthenia. In The Tuesday Lessons (Les Leçons du Mardi), he presents several observations. They are surprising when compared with the current criteria for posttraumatic stress disorder (PTSD). Although he had rejected this new entity, a hundred years before the appearance of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Charcot described most of the symptoms mentioned for a diagnosis of PTSD such as intrusion (reliving the trauma, nightmares, and severe emotional distress), avoidance, negative changes in thinking and mood (negative thoughts, lack of interest, etc.), arousal, and reactivity (trouble sleeping, trouble concentrating, being easily startled or frightened, irritability, etc.).

Neurasthenia, psy sciences and the 'great leap forward' in Maoist China.

The present study looks into the much-neglected history of neurasthenia in Maoist China in relation to the development of psy sciences. It begins with an examination of the various factors that transformed neurasthenia into a major health issue from the late 1950s to mid-1960s. It then investigates a distinctive culture of therapeutic experiment of neurasthenia during this period, with emphasis on the ways in which psy scientists and medical practitioners manoeuvred in a highly politicized environment. The study concludes with a discussion of the legacy of these neurasthenia studies - in particular, the experiment with the famous 'speedy and synthetic therapy' - and of the implications the present study may have for future historical study of psychiatry and science.

Diagnoses in and out of time: historical and medical perspectives on the diagnoses of distress.

Focusing on the medical approach to the subjective forms of distress, this article has a three-fold argument. First, the historical starting point of diagnosing distress was neurasthenia during the last two decades of the 19th century. Second, the diagnosis of neurasthenia that initially contained more somatic than mental symptoms was gradually replaced by the more psychologically conceptualized neuroses. Such a psychiatrization of neurosis gradually separated mental and somatic syndromes into two distinct diagnostic categories, those of mental and somatic. Third, when modern "neuroses" are seen in the framework of distress rather than disease, it provides tools for new kinds of interventions, in which the principal aim is to alleviate the subjective distress with all possible and reasonable means and methods. As the social context constitutes a crucial "etiology" to medicalized forms of distress, we need new, context-based approaches to both analyze and alleviate such distress. In our historical and medical approach to these "diagnoses of distress", we are guided by the belief that analyzing diagnostic categories can provide important insight into the mechanisms behind our changing conceptions of health and wellbeing.

"MY RESISTING GETTING WELL": NEURASTHENIA AND SUBCONSCIOUS CONFLICT IN PATIENT-PSYCHIATRIST INTERACTIONS IN PREWAR AMERICA.

This study examines experiences of individual patients and psychiatrists in the Henry Phipps Psychiatric Clinic at Johns Hopkins between 1913 and 1917. The dynamics of these patient-psychiatrist interactions elucidate the well-known conceptual shift in explanations of mental illness during the twentieth century, from somatic models rooted in the logic of "neurasthenia" and damaged nerves to psychodynamic models based on the notion of "subconscious conflict." A qualitative analysis of 336 cases categorized as functional disorders (a catchall term in this period for illnesses that could not be confirmed as organic diseases), shows that patients explained their symptoms and suffering in terms of bodily malfunctions, and, particularly, as a "breakdown" of their nervous apparatus. Psychiatrists at the Phipps Clinic, on the other hand, working under the direction of its prominent director, Adolf Meyer, did not focus their examinations and therapies on the body's nervous system, as patients expected. They theorized that the characteristic symptoms of functional disorders-chronic exhaustion, indigestion, headaches and pain, as well as strange obsessive and compulsive behaviors-resulted from a distinct pathological mechanism: a subconscious conflict between powerful primal and social impulses. Phipps patients were often perplexed when told their physical symptoms were byproducts of an inner psychological struggle; some rejected the notion, while others integrated it with older explanations to reconceptualize their experiences of illness. The new concept also had the potential to alter psychiatrists' perceptions of disorders commonly diagnosed as hysteria, neurasthenia, or psychoneuroses. The Phipps records contain examples of Meyer and his staff transcending the frustration experienced by many doctors who had observed troubling but common behaviors in such cases: morbid introspection, hypochondria, emotionalism, pity-seeking, or malingering. Subconscious conflict recast these behaviors as products of "self-deception," which both absolved the sufferer and established an objective clinical marker by which a trained specialist could recognize functional disorder. Using individual case studies to elucidate the disjunction between patients' and psychiatrists' perspectives on what all agreed were debilitating illnesses, this analysis helps to illuminate the origins of a radical transformation in psychiatric knowledge and popular culture in the twentieth century-from somatic to psychodynamic explanations of mental illness.

Straighten the Back to Sit: Belly-Cultivation Techniques as "Modern Health Methods" in Japan, 1900-1945.

In Japan, the first half of the twentieth century saw a remarkable revival of concern with the cultivation of the belly, with a variety of belly-cultivation techniques, particularly breathing exercise and meditative sitting, widely practiced for improving health and treating diseases. This article carefully examines some practitioners' experiences of belly-cultivation practice in attempting to understand its healing effects for them within their life histories and contemporary intellectual, social and cultural contexts. It shows that belly-cultivation practice served as a medium for some practitioners to reflect on and retell their life stories, and that the personal charisma of certain masters and the communities developing around them provided practitioners with a valuable sense of belonging in an increasingly industrialized and urbanized society. Moreover, these belly-cultivation techniques provided an embodied way for some to explore and affirm their sense of self and develop individual identity. While they were increasingly promoted as cultural traditions capable of cultivating national character, they also served as healing practices by inspiring practitioners with a sense of collective identity and purpose. With these analyses, this article sheds light on the complicated meanings of belly-cultivation for practitioners, and provides illustrative examples of the multitude of meanings of the body, bodily cultivation and healing.

A Disorder of Qi: Breathing Exercise as a Cure for Neurasthenia in Japan, 1900-1945.

Neurasthenia became a common disease and caused widespread concern in Japan at the turn of the twentieth century, whereas only a couple of decades earlier the term "nerve" had been unfamiliar, if not unknown, to many Japanese. By exploring the theories and practices of breathing exercise-one of the most popular treatments for neurasthenia at the time-this paper attempts to understand how people who practiced breathing exercises for their nervous ills perceived, conceived, and accordingly cared for their nerves. It argues that they understood "nerve" based on their existing conceptions of qi Neurasthenia was for them a disorder of qi, although the qi had assumed modern appearances as blood and nervous current. The paper hopes to contribute to the understanding of how the concept of nerves has been accepted and assimilated in East Asia. It also points out the need to understand the varied cultures of nerves not only at the level of concept and metaphor, but also at the level of perception and experience.

Medical constructions of long-term exhaustion, past and present.

Culture and history affect the ways in which medical knowledge is shaped, sustained and changed. The less knowledge we have, the larger the space for the cultural imprint becomes. Based on these assumptions, we ask: how have medical constructions of long-term exhaustion changed over time, and how are changing constructions related to societal change? To discuss these questions we conducted a comparative study of medical texts from two historical periods: 1860-1930 and 1970-2013. Our data are limited to two diagnoses: neurasthenia and encephalomyelitis. After comparing the two periods by identifying diverging and converging aspects, we interpreted observed continuities and interruptions in relation to historical developments. We found that in the medical literature, long-term exhaustion became transformed from a somatic ailment bred by modern civilisation to a self-inflicted psychiatric ailment. At the same time, it changed from being a male-connoted high-status condition to a female-connoted low-status condition. We interpret these changes as contingent upon culturally available modes of interpretations. Medical knowledge thereby becomes infused with cultural norms and values which give them a distinct cultural bias. The historical controversies surrounding this medically contested condition neatly display the socially contingent factors that govern the social construction of medical knowledge.

The borderland with neurasthenia ('functional syndromes').

At the end of the 19th century, neurasthenia and hysteria were considered distinct diseases. Specifically, neurasthenia was regarded as a disease of the body, whereas hysteria was regarded as a disease of the psyche. However, immediately before World War I, due to their common characteristics, both hysteria and neurasthenia were thought to be 'functional diseases'. Moreover, it was suggested that heredity and the presence in both of the predisposing condition called 'nervous weakness' were other shared factors. Nervous weakness was considered essential for the definition of neurasthenia, but it was also considered a precondition for the development of hysteria. Because of this, it is still difficult to demarcate a line between neurasthenia and hysteria; therefore, the two diseases should be considered as sharing a common borderland with each other.