Commercialising everyday distress: neurasthenia and traditional Chinese medicine in colonial Hong Kong, 1950s to 1980s

The persistent use of neurasthenia in Asia, an out-dated diagnostic category in modern psychiatry, has confounded many psychiatrists from the 1960s. This paper attempts to understand the prevalence of neurasthenia among the lay public in post-World War II Hong Kong. It examines the social history of psychiatry and focuses on the roles of traditional Chinese medicine in shaping public perceptions and responses towards neurasthenia. This research reveals that, when psychiatrists discarded the term as an ineffective label in the 1950s, practitioners and pharmaceutical companies of Chinese medicine seized on the chance to reinvent themselves as experts in neurasthenia. By commericialising everyday distress, they provided affordable, accessible and culturally familiar healing options to the Chinese public. A case study of neurasthenia, therefore, is not simply about changing disease categories but an important example to illustrate the tensions between traditional medicine and Western psychiatry in Asia.

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.

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 19^th 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.

Neurasthenia: tracing the journey of a protean malady

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.

Characteristics of neurasthenia: examination and cross-cultural applicability of ICD-10 Diagnostic Criteria for Research

The purpose of this study was to examine characteristics of Yugoslav patients with neurasthenia diagnosed according to the ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), and to examine the ICD-10-DCR symptoms of neurasthenia and applicability of the corresponding diagnostic criteria to Yugoslav patients with this condition. Thirty-four patients with the ICD-10-DCR neurasthenia and 31 patients with mixed anxiety and depressive disorder were compared in terms of demographic variables, results of several questionnaires, symptom profiles and comorbidity with other mental disorders. Patients with neurasthenia were less educated and more often held jobs as unskilled and semiskilled workers; they had a more chronic course of illness, tended to report more symptoms, manifested more hostility, somatization and hypochondriacal tendencies and received a comorbid diagnosis of hypochondriasis more frequently. In addition to exhaustion and weakness, the most prominent features of neurasthenia were irritability, anger, nervousness, various somatic symptoms and tension. An ICD-10-DCR diagnosis of neurasthenia could not be made in slightly over one-third of patients who would have otherwise met criteria for this diagnosis because of the imposed diagnostic hierarchy, ie, due to current comorbidity with affective disorders and generalized anxiety disorder in such patients. It is concluded that the ICD-10-DCR concept of neurasthenia is generally suitable for Yugoslav patients, except for the diagnostic hierarchy requirement. The diagnostic criteria therefore require revision in order to reflect more accurately the variability in clinical presentation of neurasthenia in different countries.

Personality and social attitudes in chronic fatigue syndrome

One hundred one chronic fatigue syndrome (CFS) patients attending a specialist CFS clinic were compared with 45 rheumatoid arthritis (RA) patients on a range of standardized questionnaire measures, to investigate whether CFS patients are characterized by particular personality traits or social attitudes. No differences were found between CFS and RA patients in measures of perfectionism, attitudes toward mental illness, defensiveness, social desirability, or sensitivity to punishment (a concept related to neuroticism), on either crude or adjusted analyses. Alexithymia scores were greater in the RA patient group (p<0.05). Social adjustment, based on subjective assessment of overall restriction in activities and relationship difficulties, was substantially poorer in the CFS group (p<0.001). This was highly associated with depressive symptoms, but remained significant even after adjusting for depressive symptomatology. There was no evidence from this study of major differences between the personalities of CFS patients and RA patients. The stereotype of CFS sufferers as perfectionists with negative attitudes toward psychiatry was not supported.

Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome

The purpose of this study was to examine several conceptual and cross-cultural issues in neurasthenia, particularly in terms of their relationship to chronic fatigue syndrome. A review of this relationship led to the conclusion that these conditions are much more alike in Western countries than in countries such as China, where neurasthenia could almost be regarded as a "culture-bound syndrome." This may be a consequence of factors such as the heterogeneous nature of neurasthenia and different diagnostic practices in different countries, despite the ICD-10 definition of neurasthenia, intended for worldwide use. Likewise, there is no consensus on what the "core" characteristics of neurasthenia are, because its clinical presentation and key features in different countries are very different. Despite the finding of relatively low comorbidity rates between neurasthenia and other mental disorders, clinical experience suggests that features of neurasthenia frequently overlap with those of depression, chronic anxiety, and somatoform disorders. There is no convincing evidence that in cases of overlap or comorbidity, other diagnoses should automatically have "primacy" over neurasthenia nor should the diagnosis of neurasthenia thereby be excluded. Although some aspects of its validity have improved recently, especially its descriptive validity, the overall validity of the diagnosis of neurasthenia is still not satisfactory. Suggestions for further research, aimed at improving the diagnostic validity of neurasthenia, are offered in this paper.

Sociosomatics and illness in chronic fatigue syndrome

OBJECTIVE

This study examines social processes that construct the course of chronic illness. Specifically, it identifies and describes mechanisms that constitute the process of role constriction in employment for individuals with chronic illness.

METHOD

Sixty-six persons meeting the Centers for Disease Control case definition of chronic fatigue syndrome (CFS) participated in a longitudinal study involving three waves of data collection over 3 years. Qualitative and quantitative methods were combined in the research, which included face-to-face semistructured interviews, telephone interviews, and self-report questionnaires. Materials presented in this study are drawn principally from the Year 1 face-to-face and telephone interviews.

RESULTS

When patterns of symptoms and of the illness course in CFS intersect with work requirements, they impede performance and place ill individuals at risk for job loss. Persons with CFS devise and implement specific strategies to resist role constriction and remain in the work force.

CONCLUSIONS

Role constriction is a social process of marginalization in chronic illness. Opposing forces of marginalization and resistance define the social course in chronic illness and suggest that chronicity can be thought of as a marginalized position in social space.

Estranged bodies, simulated harmony, and misplaced cultures: neurasthenia in contemporary Chinese society

OBJECTIVE

To study the sociocultural transformation of neurasthenia (shenjing shuairuo, SJSR), as both disease and illness, in Chinese society.

METHOD

This is based on a critical review of evidence drawn from the psychiatric and anthropological literature, and the use of a single case study.

RESULTS

SJSR remains a ubiquitous illness in socio-politically different Chinese societies, but the Americanization of Chinese psychiatry has paradoxically made the "same" disease category languish rapidly in professional practice. Although it engages bodily modes of attention, SJSR is far from being a physical, somatoform, or chronic fatigue disorder.

CONCLUSIONS

Psychiatric disease and illness do not run a "natural" course independent of social and historical contexts. SJSR usefully muddles the Cartesian mind-body dichotomy and is readily compatible with psychosocial manifestations and explanatory models. From a sociosomatic perspective, the embodied world of SJSR may arbitrate as well as critique the conjunctures of large-scale political, economic, and moral transformations in Chinese communities. These macrosocial forces and their local manifestations need to be considered in deriving a cross-culturally valid paradigm of psychosomatic medicine.