**Neurasthenia** (Neurasthenia). - Few terms in scientific medicine have enjoyed the success and widespread use of this one, introduced by the American physician Beard (1869) as an etiopathogenetic concept synonymous with "nervous exhaustion," yet few terms have given rise to as many nosographic distinctions and divergent opinions.
At the present state of knowledge, it can be considered that neurasthenia, properly speaking, is a morbid form characterized by a peculiar emotion (distinct from anxiety), designated as "alarm." Neurasthenic alarm (Bini) is a "prevalent, unpleasant feeling of mistrust and fear, with an element of doubt, directed toward one's own abilities or, more generally, one's own health, often justified by psychotesthesiae," i.e., abnormal sensations whose erroneous nature originates at a psychic level.
This syndrome of neurasthenic alarm may appear:
1) as a psychogenic reaction, i.e., an unusual, abnormal but comprehensible manifestation that arises following emotionally charged events (Erlebnis), influenced psychically, and disappears without leaving traces after the removal of the causative event;
2) as inherent in a type of psychopathic personality, i.e., in that abnormally stable personality which, according to K. Schneider's definition, "suffers or causes suffering";
3) as a psychoneurotic episode, i.e., a morbid form in which there are no signs of a clear psychopathic personality and in which there is no true causative event, as in psychogenic reactions. In older descriptions of neurasthenia, distinctions were made according to the bodily region to which the disturbances and their alarm reaction were referred, leading to terms such as cerebral, spinal, sexual, gastric neurasthenia, etc. These designations were based on the pathogenic concept of "exhaustion of a specific part of the nervous system." With the decline of this theory, more recent nosographic descriptions have abolished such distinctions, although some authors still maintain a subdivision based on the predominance of somatic or psychopathic symptoms: e.g., K. Schneider distinguishes "somatic asthenics" from "psychic asthenics." Under the term "somatopathy," the following should be included and distinguished:
1) vegetative reactions of emotion (e.g., the neurasthenic who fixates on the tormenting doubt of a cardiac condition, anxiously counting their pulse, which may objectively alter due to this emotion alone);
2) neuroses (q.v.) and neurovegetative dystonias, without a conscious emotional genesis (e.g., paroxysmal tachycardia, spastic constipation, etc.);
3) psychotesthesiae of alarm, i.e., a host of abnormal sensations for which there is no corresponding objective change. Alongside "psychotesthetic alarm neurasthenia," which is neurasthenia proper, two varieties are distinguished: "phobic alarm neurasthenia" and "hypochondriacal neurasthenia" (in which the persistent belief in illness takes center stage).
Regarding the causality of neurasthenia, many neurasthenics trace the onset of their disturbances to events of particular emotional significance, such as bereavements, financial setbacks, romantic disappointments, overwork under unsatisfactory conditions, or general mental strain. Often, these references correspond to that "need for causality," that "post hoc ergo propter hoc" to which the judgments of patients and their families generally succumb. These situations of affective distress are often perceived and lived with darker hues than reality: the suffering caused by the environmental situation is more an effect than a cause of emotional disturbances, which have a fundamentally constitutional basis. A psychopathic heredity, whether generic or specific, is not uncommon. Neurasthenia can appear in all somatic constitutions and all social classes, though intellectuals tend to suffer more intensely from alarm due to their ability to elaborate situations more complexly. The most affected age group is adulthood, with a peak between 25 and 35 years (Braun, 1935), and, in women, another peak during the climacteric period. All statistics agree in stating that during wartime periods, no increase in neurasthenia is observed.
Regarding symptomatology, the neurasthenic reacts to their disturbances with characteristic behavior. Psychotesthesiae are initially interpreted as due to organic disease, and alarm as an appropriate emotional expression; thus, they consult specialists rather than psychiatrists. They describe their disturbances with acuity and wealth of detail, often recording them on paper ("malade au petit papier" of Charcot) to avoid forgetfulness. They demand special investigations, the negative results of which only briefly reassure them; the improvement following "restorative treatment" is slight and transient. Distrust toward the physician's judgment grows, and they seek "celebrities," accumulating laboratory tests and medications. Gradually, even family members begin to label them as "fixated," "suggestible," and consider them "hypochondriacs," "lacking in goodwill." The neurasthenic reacts with vivacity and bitterness to these criticisms, adopting an exacting and hostile attitude. For the most part, their social and work activities are not severely impaired, even if their judgment is excessively pessimistic. The impairment of intellectual work does not stem from a primary deficit in intellectual activity but from emotional disturbance.
Objective examination reveals nothing abnormal; only in pseudo-neurasthenic syndrome may minor signs in the vegetative sphere be objectified.
In "post-traumatic (q.v.)" and "compensation neuroses" (see also PSYCHONEUROSIS), a neurastheniform syndrome is very frequent. These are morbid forms that arise after accidents or misfortunes, in which physical trauma was once considered to have predominant etiopathogenetic importance (Oppenheim); today, however, the subsequent psychic elaboration of the trauma is emphasized, and the "functional" nature of the condition is underscored. Especially in compensation psychoneuroses ("litigation neurosis"), the importance of the trauma is entirely secondary to the insured's insurance situation. A subacute course of 4-5 months is not rare; however, it is more common for the condition to last several years, with significant variations in intensity.
Drug therapy is of no causal use; it has only symptomatic value. Electroshock (q.v.) may be attempted if an anxious or dysphoric component exists. Psychotherapy (q.v.) is the treatment of choice.