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PubMedDate not supplied

Culture and somatic experience: the social course of illness in neurasthenia and chronic fatigue syndrome.

An anthropological view of culture and somatic experience is presented through elaboration of the notion that illness has a social course. Contemporary anthropology locates culture in local worlds of interpersonal experience. The flow of events and processes in these local worlds influences the waxing and waning of symptoms in a dialetic involving body and society over time. Conversely, symptoms serve as a medium for the negotiation of interpersonal experience, forming a series of illness-related changes in sufferers' local worlds. Thus, somatic experience is both created by and creates culture throughout the social course of illness. Findings from empirical research on neurasthenia in China, and chronic fatigue syndrome (CFS) in the United States, corroborate this formulation. Attributions of illness onset to social sources, the symbolic linking of symptoms to life context, and the alleviation of distress with improvement in circumstances point to the sociosomatic mediation of sickness. Transformations occasioned by illness in the lives of neurasthenic and CFS patients confirm the significance of bodily distress as a vehicle for the negotiation of change in interpersonal worlds. An indication of some of the challenges anthropological thinking poses for psychosomatic medicine concludes the discussion.

Cross-Cultural Comparison↗
PubMedDate not supplied

Do patients with "pure" chronic fatigue syndrome (neurasthenia) have abnormal sleep?

OBJECTIVE: To determine whether patients with "pure" chronic fatigue syndrome (neurasthenia) have sleep abnormalities which may contribute to subjective measures of daytime fatigue. METHOD: Sleep characteristics of 20 patients meeting research criteria for chronic fatigue syndrome (CFS) but not depression, anxiety, or sleep disorder were compared with sleep characteristics of 20 healthy subjects matched for age and sex. Measures of sleep included a) subjective interview reports and sleep diaries and b) home-based polysomnography. RESULTS: Patients with CFS complained of poor quality unrefreshing sleep. They also napped during the day. Polysomnograph data showed no difference in actual nocturnal sleep time between the two groups although patients with CFS spent significantly longer in bed (p < .01), slept less efficiently (p < .03), and spent longer awake after sleep onset (p < .05). The polysomnographs of seven patients with CFS and one healthy subject were regarded as significantly abnormal. Five patients and one healthy subject had difficulty maintaining sleep. One patient had a disorder of both initiating and maintaining sleep and one patient woke early. CONCLUSIONS: Patients with "pure" CFS complain of unrefreshing sleep but only a minority have a clearly abnormal polysomnograph. The most common abnormality is of long periods spent awake after initial sleep onset. Although sleep abnormalities may play a role in the etiology of CFS, they seem to be unlikely to be an important cause of daytime fatigue in the majority of patients. However, pharmacological and behavioral methods that improve sleep quality may be an important component of a pragmatically based treatment package for patients who do have abnormal sleep.

Activities of Daily Living↗
PubMedDate not supplied

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.

Body Image↗
PubMed1985

Do Vietnam veterans suffer from toxic neurasthenia?

This paper evaluates the claim that Vietnam veterans with psychiatric disorders are suffering from toxic neurasthenia--a neurasthenic syndrome caused by exposure to pesticides while serving in Vietnam.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1997

Biologizing social facts: an early 20th century debate on Kraepelin's concepts of culture, neurasthenia, and degeneration.

This paper uses an historical approach to elucidate two alternative modes of conceptualizing the relation between social factors and psychological phenomena perceived as pathological. The core features of Neo-Kraepelinian psychiatric nosology associated with the introduction of DSM-III in 1980 were also at the center of a debate in early 20th century Germany. The protagonists were Emil Kraepelin and Oswald Bumke. Kraepelin's empirical research selectively focused on somatic factors as independent variables, such as alcohol, syphilitic infection, and heredity. The ensuing nosology marginalised social factors which might contribute to the etiology and symptom formation of psychiatric conditions. For Bumke, the disorders in question (including the category of neurasthenia) did not represent qualitative deviations from normal psychological states, but quantitative variations of ubiquitous psychological functions caused by a multitude of somatic, psychological, and social factors. The main arguments of the historical debate are reconstructed, with special regard to the professional and political context. The paper illustrates the importance of context-bound pre-'scientific' decisions for the process of formulating theoretical concepts in psychiatry and related disciplines.

Biodegradation, Environmental↗
PubMed1989

[A scientific dialogue between Freud and Fliess. The research project on neurasthenia (1893)].

This study, following upon the publication of the letters written by Freud to Fliess, deals with the objective content of the relationship between Freud and Fliess as it appears in a joint research project drawn up in 1893 and that was never carried out. This project had been elaborated with an extensive use of practician's notes in mind, this practice being in accordance with Fliess's habits but contrary to Freud's: this is to be linked with the rivalry existing between practitioners with scientific ambitions and university doctors. One of the principal goals of the project was to establish a nosography of the diffuse clinical picture of "neurasthenia". It was with this aim in mind that Fliess had already published a book on "nasal reflex neurosis" which fully reveals his tendency to establish descriptive classifications; on the contrary, Freud endeavoured--following the principle that form is to be found in typical cases (the "initial cases")--to arrive at an etiological and theoretical understanding of phenomena, an ambition that he also opposed to Fliess. Even if an interest for sexuality could be detected in Fliess's work, it was only under Freud's influence that it became an explicit theme. His role consisted--and this remained valid throughout their relationship--in supplying an organic basis to Freud's theses, the corner-stone of which was a theory of sexuality. He thus aided Freud in ridding himself of his scientific scruples and facilitated the construction of the psychoanalytic theory under its psychological form.

Germany↗
PubMed1992

[Various indicators of serotonin metabolism in the cerebrospinal fluid of patients with neurasthenia and cerebral arachnoiditis].

Thirty patients with cerebral arachnoiditis and 26 with neurasthenia were found to have differences in the content of serotonin, 5-hydroxyindoleacetic++ acid and melatonin in the cerebrospinal fluid, which depended in arachnoiditis on the degree of intracranial pressure elevation. The data on serotonin metabolism can be used in objective evaluation of the organic background in neurotic patients and serve for estimating the intensity of hypertension in patients with cerebral arachnoiditis.

Adult↗
PubMed1989

[Work capacity of patients with neurasthenia].

Clinical and experimental examination of 127 patients suffering from neurasthenia, performed during three stages of the disease development (hyperasthenic, irritative weakness, hypoasthenic++), enabled one to identify an appreciable decrease of a number of the parameters of tolerance to isometric exercise. Thus, force decreased 1.3--2-fold, endurance 2.4--3.4-fold, and work fitness 3.8--6.8-fold as compared to normal persons. Isometric exercise tolerance that increases progressively by the hyposthenic disease stage can be instrumental as an objective diagnostic criterion for evaluation of work fitness during carrying out the rehabilitation measures in neurasthenic patients.

Adult↗
PubMed1989

[Clinical differential diagnosis of depressive neurosis and neurasthenia].

This article reported diagnostic findings in application of Chinese diagnostic criteria of neurosis published by Chinese Journal of Neurology and Psychiatry (1986; 19: 318-321) to a series of neurotic patients. 66 cases and 50 cases were met criteria of depressive neurosis and neurasthenia respectively. Two groups were compared. The results revealed some similarities and a lot of differences between these two disorders. According to clinical features authors proposed main points of differential diagnosis between these two disorders.

Adolescent↗
PubMed1989

[The renin-angiotensin system in patients with neurasthenia with normal and decreased arterial blood pressure].

Baseline activity of renin-angiotensin system (RAS) and its reactance (active orthostatic transition) were compared in 36 healthy women, 22 neurasthenic normotensive female patients and 22 female patients with borderline hypotension aged about 46 years. In normotensive patients the baseline RAS activity tended to be lower that was not related to juxtaglomerular exhaustion, as manifested by normal orthostatic RAS responses. In hypotensive patients RAS activation had apparently compensatory nature. In neurotic patients, hypotension was unrelated to weakening of the RAS. The lack in RAS activation in chronic emotional stress at the stage of cortical functions decompensation (neurasthenia) is quite different from RAS response to acute emotional stress which is reportedly increasing the RAS activity.

Adult↗
PubMed1981

[Clinico-pathophysiologic characteristics of general sensation in patients with neurasthenia and hysterical neuroses].

The authors have found that disturbances of general sensitivity are characteristic of not only patients with hysterical neurosis, but also of patients with neurasthenia. The clinical structure and the time course of those disturbances in both groups of the patients were found to be rather close. In general, they differ substantially from the sensitivity disturbances in neuroses described earlier. The leading mechanism of the development of those sensitivity disturbances consists in an impairment of the function of the limbico-reticular complex structures.

Adult↗
PubMed1997

Randomised, double-blind, placebo-controlled study of pivagabine in neurasthenia.

One hundred and eighteen patients with neurasthenia, as defined by ICD 10 (International Classification of Diseases), participated in a randomised, double-blind, placebo-controlled trial of pivagabine (4-[(2,2-dimethyl-1-oxopropyl)amino]butanoic acid, CAS 69542-93-4, Tonerg). Pivagabine 1800 mg/d was administered orally for four weeks. At the end of the trial, active medication was significantly superior to placebo on the Clinical Global Impression (CGI) improvement of illness scale. In addition, pivagabine treatment reduced the physical and mental fatigability of patients, and increased their sense of well-being.

Adolescent↗
PubMed1997

Biologizing social facts: an early 20th century debate on Kraepelin's concepts of culture, neurasthenia, and degeneration.

This paper uses an historical approach to elucidate two alternative modes of conceptualizing the relation between social factors and psychological phenomena perceived as pathological. The core features of Neo-Kraepelinian psychiatric nosology associated with the introduction of DSM-III in 1980 were also at the center of a debate in early 20th century Germany. The protagonists were Emil Kraepelin and Oswald Bumke. Kraepelin's empirical research selectively focused on somatic factors as independent variables, such as alcohol, syphilitic infection, and heredity. The ensuing nosology marginalised social factors which might contribute to the etiology and symptom formation of psychiatric conditions. For Bumke, the disorders in question (including the category of neurasthenia) did not represent qualitative deviations from normal psychological states, but quantitative variations of ubiquitous psychological functions caused by a multitude of somatic, psychological, and social factors. The main arguments of the historical debate are reconstructed, with special regard to the professional and political context. The paper illustrates the importance of context-bound pre-'scientific' decisions for the process of formulating theoretical concepts in psychiatry and related disciplines.

Biological Psychiatry↗
PubMed1998

Basal activity of the hypothalamic-pituitary-adrenal axis in patients with the chronic fatigue syndrome (neurasthenia).

BACKGROUND: Impairments in both basal activity and activation of the hypothalamic-pituitary-adrenal axis (HPA) have been reported in chronic fatigue syndrome (CFS; neurasthenia). We sought to replicate these findings and examined basal activity of the HPA in a carefully selected sample of patients with CFS. METHODS: Basal activity of the HPA was assessed using salivary and urinary cortisol collection over a 24-hour period in 22 (12 male; 10 female) patients meeting criteria for CFS and appropriate controls. RESULTS: Salivary and urinary cortisol measures did not differ between CFS patients and controls. CONCLUSIONS: Basal activity of the HPA was not reduced in CFS patients. Reasons for the failure to replicate previous findings are discussed.

Adult↗