The term neurasthenia was coined in English by the American psychiatrist George Beard (1839-1883) to describe an illness characterized by its etiology and its clinical manifestations; it appeared in Beard's Neurasthenia As a Cause of Inebriety (1879) and Sexual Neurasthenia (Nervous Exhaustion), Its Hygiene, Causes, Symptoms and Treatment (1884). Sigmund Freud retained the word, although he gave it a more limited meaning, and included it among the defense neuroses, alongside anxiety neurosis and, later, hypochondria.
In Beard's work, neurasthenia is characterized by the appearance, in subjects who had no family or personal history suggesting mental degeneration, and who, men and women alike, had previously lived the active life of "managers" peculiar to the feverish lifestyle of the New World, of a chronic symptomatology that was both somatic and mental. Somatic symptoms included fatigue that is not alleviated by rest, cephalgias with constriction, back pains, dyspepsia, flatulence, constipation, and dysurea; mental symptoms included insomnia, sadness, lack of interest, anhedonia, impoverishment of sexual activity that had previously been satisfying, and morosity. He attributed this neurasthenia to an excess of activity by those who, in the brutal world of business, must expend an excessive daily energy, and he thus contrasted it to the spleen and melancholia of idlers. As early as 1879, Beard stigmatized alcohol use as a fallacious remedy to this condition, and one that could lead to a secondary pathology.
In Freud's view, expressed in "On the Grounds for Detaching a Particular Syndrome from Neurasthenia under the Description 'Anxiety Neurosis,"' Beard's clinical description was too general and the etiology was imprecise, but it was appropriate to keep the term in medical terminology, on the condition that its semiology be restricted and its origins specified. He retained physical fatigue, somatic disorders, and the impoverishment of sexual life (in particular masturbation that fails to resolve libidinal tension) as neurasthenic symptoms, but he excluded chronic states of anxious expectation and acute anxiety attacks (some-times with a substantial somatic component), which he held to be typical of "anxiety neurosis." From an etiological point of view, neurasthenia is a defense neurosis whose symptomatology is not a symbolic and overdetermined expression, and whose etiology must be sought not in childhood conflicts, but rather in a present frustration.
See also: Actual; Actual neurosis/defense neurosis; Conversion; "Heredity and the Aetiology of the Neuroses"; "Neurasthenia and 'Anxiety Neurosis"'; Traumatic neurosis; United States.
Beard, George. (1879). Neurasthenia as a cause of inebriety. New York: E. B. Treat.
——. (1881). American nervousness: Its causes and consequences. New York: E. B. Treat.
——. (1884). Sexual neurasthenia (nervous exhaustion), its hygiene, causes, symptoms and treatment. New York: E. B. Treat.
Freud, Sigmund. (1895b ). On the grounds for detaching a particular syndrome from neurasthenia under the description "anxiety neurosis." SE, 3: 85-115.
Pichot, Pierre. (1994). La neurasthénie. Encéphale, 20 (3), 540-550.
neur·as·the·ni·a / ˌn(y)oŏrəsˈ[unvoicedth]ēnēə/ • n. an ill-defined medical condition characterized by lassitude, fatigue, headache, and irritability, associated chiefly with emotional disturbance. DERIVATIVES: neur·as·then·ic / -ˈ[unvoicedth]enik/ adj. & n.