Neurasthenia

“ It is met with in persons who are run down in their nervous system by mental worry or overwork—in other words, in persons who are suffering from neurasthenia. Such patients describe the pain as being constant and deep-seated—seldom acute, but dull and throbbing. It is accompanied by a sense of weight and pressure on the vertex, and sometimes by a feeling of constriction. Mental effort increases the pain, and the patient usually prefers solitude and quiet on account of the relief he obtains. The headache of neurasthenia often persists after other symptoms of the affection have disappeared. ”

“ Joffroy and Mignot differentiate what they call preparetic neurasthenia from other neurasthenic states, not only on the basis of its etiology but on the basis of its symptoms. They also call attention to the fact that neurasthenia, being a pure neurosis, develops either on a manifestly hereditary basis or upon some physical injury, weakening disease, or moral shock. The pure neurotic suffers a great deal more than the patient who is destined to become a victim of paresis. ”

“ When the word dread is used instead of the word phobia they are less likely to misunderstand the character of their affection and to realize that it is not a disease but only an unfortunate mental peculiarity that needs control and discipline, and not fostering care. Neurasthenia only means nervous weakness, as we have pointed out, but most people are rather rejoiced when informed that they have so high-sounding a disease as neurasthenia, while to be told that they are nervously weak or suffer from nervous weakness seems quite a come-down from their interesting Greek-designated affection. ”

“ Neurasthenia Simulation by Organic Disease.—Neurasthenia is especially a dangerous term since, like other words of this kind with wide connotation, many quite disconnected diseases may in early stages simulate it and give rise to the thought that there is only a functional nervous disease present, when the symptoms are really a manifestation of an underlying organic disease, heightened somewhat by a nervous organization or by worry on the patient's part. So-called neurasthenia in the old must always be looked upon with suspicion. ”

“ In the condition known as neurasthenia, which is often taken as a type of a functional disease, the basal and intrinsic cause is activity of the nervous system with the using up of material which is not compensated for by the renewal which comes in repose and sleep. Neurasthenia is one of the common conditions of our civilization, found among children and adults, the poor and rich, the idle and the factory worker; it is rife in the scholastic professions and among those who earn their living by brain work. ”

“ In the second half of the 19th century, an American physician, Beard, described Neurasthenia, a general disturbance of the body and mind, not properly classifiable as a disease, but serious enough to incapacitate or at least greatly limit the sufferer. The neurasthenic is to be recognized by the fact that the most painstaking objective examination of his organs reveals nothing the matter with them. Yet, according to his complaint, everything is the matter with him. He cannot sleep when he lies down, he cannot keep awake when he stands up. ”

“ It is necessary, therefore, in the outset, to recognize that neurasthenia is a bodily condition which is very frequently associated with various chronic disorders, or not rarely coexists with perverted functional activity of the nervous centres, which perverted nerve-functions may, however, exist independently of any perceptible neurasthenia, and are not simply the outcomes of the neurasthenia. ”

“ Above all, the overstrain of function, especially of emotional functions, may lead to that exhaustion which produces the state of neurasthenia. It is true that not a few would doubt whether we have the right to class neurasthenia here where we speak of the harm done to the normal brain. Many neurologists are inclined to hold that neurasthenia demands a special predisposition and is therefore dependent upon a neurotic constitution of the brain itself. ”

“ On the other hand it seemed to me undoubtedly imperative to separate from neurasthenia a neurotic symptom complex which depends on a totally divergent, strictly speaking, on a contrary etiology. The partial symptoms of this complex have been recognized by E. Hecker [1] as having a common character. They are either symptoms, or equivalents, or rudiments of anxiety manifestations, and it is for that reason that this complex, so different from neurasthenia, was called by me anxiety neurosis. ”

“ The actual causes producing neurasthenia and anxiety neurosis simultaneously play the rôle of inciting causes of the defense neuroses, and on the other hand, the specific causes of the defense neuroses, the infantile traumas, may simultaneously prepare the soil for the later developing neurasthenia. Finally it not seldom happens that the existence of a neurasthenia or anxiety neurosis is only preserved by continued recollection of an infantile trauma rather than by actual sexual injuries. ”

“ It is important to remember that the diagnosis of neurasthenia is, properly speaking, what is called by physicians a diagnosis of exclusion. That is to say, after one has excluded all possible illnesses that give rise to symptoms like neurasthenia, then and then only is the diagnosis justified. That is, a woman physically ill, with heart, lung, or kidney disease, or with derangements of the sexual organs, may act precisely like a nervous housewife,—may have pains and aches, changes in mood, loss of control of emotion ”

“ The symptoms of neurasthenia are moderate, quiet, subdued, passive; those of hysteria are acute, intense, violent, positive. Neurasthenia may occur in well-balanced intellectual organizations; hysteria is usually associated with great emotional activity and unbalanced mental organization. Neurasthenia is common in males, although more common in females; hysteria is rare in males. Neurasthenia is always associated with physical debility; hysteria in the mental or psychical form occurs in those who are in perfect physical health. ”

“ In this way it was found that neurasthenia really corresponds to a monotonous morbid picture in which, as shown by the analysis, "psychic mechanisms" play no part. From neurasthenia we sharply distinguished the compulsion neurosis (Zwangsneurose) [obsessions, doubts, impulses] , the neurosis of the genuine obsessions, in which we can recognize a complicated psychic mechanism, an etiology resembling the one of hysteria, and a far reaching possibility of an involution by psychotherapy. ”

“ Neurasthenia is especially prevalent, not only with members of certain families (we all know people peculiarly liable to suffer from the “nerves”) , but certain races are more prone to it than others—the French and American more than ourselves; and this fact must not be lost sight of, nor the fact that the relatives of many of these patients—probably afflicted themselves with a latent form of the same condition—are frequently but ill-fitted to help the patient to recovery, so that a temporary removal from their care is sometimes advisable. ”

“ Therefore, predisposition, aided by the storm and stress of active competition and abetted by the use of stimulants, must be looked upon as the main cause for the premature collapse of nerve force which we call neurasthenia; so it will be found that the majority of neurasthenics are between twenty-five and fifty years of age, and that their occupations are those which are attended by worry, undue excitement, uncertainty, excessive wear and tear, and thus we find mentally active persons more easily affected than those whose occupation is solely physical. ”

“ Neurasthenia in the young may be a purely functional nervous disease, though it is probable that in most cases the nervous system is congenitally defective, or at least is unable to perform the functions which have been assumed by the patient. ”

“ Certainly there exists a constitutional neurasthenia sometimes but we have hardly a right to deny that overstrain in the brain activity may produce a series of neurasthenic symptoms in any brain, and the special predisposition is responsible rather for the particular selection among the innumerable symptoms. ”

“ While the dizziness of neurasthenia is never profound, certainly never repeats the agony of Menière's vertigo, it is apt to be but a too constant symptom, and to be, like the other disqualifying cerebral symptoms of neurasthenia, almost the last to get well. Usually there is little, often no, tinnitus, no deafness, no nausea, slight but a pretty constant sense of unsteadiness, and rarely or but for a few moments any false subjective visual illusions. ”

“ As a matter of fact, the good results have been obtained chiefly by the patient being placed in better conditions, and I have seen many such cases, who have been entered in the doctor’s book as cured, relapse again on the smallest provocation. Yet, as I have said before, neurasthenia can be cured, and ought to be cured; and if we fail in our efforts, there must be a screw loose in our mode of treatment. ”

“ My penis is up all the time I am with her; and when I go home my testicles are sore, and I lie awake all [69] night.” This is typical, as a cause from continuance; and if the female is as amorous as the male, she will also become nervous and irritable. The restlessness, following the protracted turgescence of the genitals, is a fruitful cause of neurasthenia. Yet all will gradually pass away after marriage, which should be advised speedily. With nymphomania, there commonly exists a neurasthenia that long remains after all signs of any organic disease have disappeared. ”

“ The sudden occurrence of neurasthenic disorders in a male of middle age without any evident cause therefor is always suspicious. Yet it must be emphasized that a complaint of occasional dizziness, slight speech defect, tremor of tongue, and a moderate increase of tendon reflexes do not possess any marked diagnostic significance. Clear insight and understanding of the nature of the disease phenomena, a persistent search for recovery, reasonableness in conversation, progressive improvement under appropriate treatment, speak for neurasthenia. ”

“ The early mental symptoms may simulate those of cerebral neurasthenia, in which the patient thinks that there is decided mental impairment, although there is no progressive dementia. The tremor in neurasthenia is greater and more universal than in the stage of general paralysis with which it might be confounded, and the subjective symptoms are much more prominent. ”

“ Causes must be removed in every line of life, political, social, and economical, before normal physical and mental conditions can be restored. Then neurasthenia, in all its forms, will be a disease of the past, but not before—not withstanding the frequent alleged discoveries of serums and antidotes of wonder-working properties so triumphantly heralded from the "Halls of Science."
(d) . Dose: Twice daily, 1 gram or one-fourth heaping teaspoonful or, it in tablet form, 1 tablet, dry or with a little water or in foodstuffs ”

“ Physical, intellectual, or emotional strain can cause neurasthenia suddenly or gradually. Where it comes on without obvious cause there is commonly a bad family history of nervousness or alcoholism. Anaemia makes it worse; eye-strain, too, is a provoking factor. In some cases a renal congestion is the cause. In many cases a lack of restraint, bad education, uncontrolled passion, are a marked influence in fixing the neurasthenic habit. A sedulous parent nags at a neurasthenic child that is too weak for exertion until the child's susceptibility to correction is blunted. ”

“ He is a man of much intelligence, and decidedly of masculine appearance, with abundant growth of beard, deep voice, and normal genitals. The eye has a neuropathic expression. No signs of degeneration. Symptoms of spinal neurasthenia. It was possible to reassure the patient, and give him hope of his future.
The medical advice consisted in means for combating the neurasthenia, and the interdiction of masturbation and indulgence of the fancy in images of boots, in the hope that, with the removal of the neurasthenia, cohabitation without ideas of boots would become possible ”

“ It may be questioned whether our exceeding unrest, our yearning for notoriety, our eagerness to overwork ourselves, i.e., to draw on our nerve-capital at the risk of breaking the bank, are not symptoms of widespread nervous disease in the community rather than its causes; just as, in the individual, the restless excitement regarded often as the cause of the after-malady is in reality but a symptom of the disintegration which has already begun. We may console ourselves with the reflection that, neurasthenia in the individual being curable, neurasthenia in the community is curable also ”

“ Krafft-Ebing has declared his opinion that masturbation is a cause of neurasthenia. Christian, Leyden, Erb, Rosenthal, Beard, Hummel, Hammond, Hermann Cohn, Curschmann, Savill, Herman, Fürbringer, all attach chief importance to neurasthenia as a result of masturbation. Collins and Phillip (Medical Record, March 25, 1899) , in an analysis of 333 cases of neurasthenia, found that 123 cases were apparently due to overwork or masturbation. Freud concludes that neurasthenia proper can nearly always be traced to excessive masturbation, or to spontaneous pollutions. ”