Neurasthenia (from the Ancient Greek νεῦρον ''neuron'' "nerve" and ἀσθενής ''asthenés'' "weak") is a term that was first used at least as early as 1829 for a mechanical weakness of the
nerves
A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system.
A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the e ...
and became a major diagnosis in North America during the late nineteenth and early twentieth centuries after neurologist
George Miller Beard
George Miller Beard (May 8, 1839 – January 23, 1883) was an American neurologist who popularized the term neurasthenia, starting around 1869.
Biography
Beard was born in Montville, Connecticut, on May 8, 1839, to Reverend Spencer F. Beard, ...
reintroduced the concept in 1869.
As a
psychopathological
Psychopathology is the study of Abnormal psychology, abnormal cognition, behaviour, and experiences which differs according to social norms and rests upon a number of constructs that are deemed to be the social norm at any particular era.
Biol ...
term, the first to publish on neurasthenia was Michigan
alienist
Alienism is an obsolete term for psychiatry, the study and treatment of mental illnesses. In the early 20th century this term was replaced by that of psychiatrist.
Alienism or alienist may also refer to:
* ''Alienist'' (album), a 2016 album by th ...
E. H. Van Deusen of the Kalamazoo asylum in 1869, followed a few months later by New York neurologist George Beard, also in 1869, to denote a condition with symptoms of
fatigue
Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
,
anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
,
headache
Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Headaches can occur as a result ...
,
heart palpitations
Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart.
Symptoms include a rapi ...
,
high blood pressure
Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high bl ...
,
neuralgia
Neuralgia (Greek ''neuron'', "nerve" + ''algos'', "pain") is pain in the distribution of one or more nerves, as in intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal neuralgia.
Classification
Under the general heading of neuralg ...
, and
depressed mood
Depression is a mental state of low mood and aversion to activity, which affects more than 280 million people of all ages (about 3.5% of the global population). Classified medically as a mental and behavioral disorder, the experience of ...
. Van Deusen associated the condition with farm wives made sick by isolation and a lack of engaging activity, while Beard connected the condition to busy society women and overworked businessmen.
Neurasthenia was a diagnosis in the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
's
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
, but is no more diagnosed in
ICD-11
The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World He ...
, marked as deprecated. It also is no longer included as a diagnosis in the
American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
's ''
Diagnostic and Statistical Manual of Mental Disorders
The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
''.
The condition is, however, described in the
Chinese Society of Psychiatry
The Chinese Society of Psychiatry (CSP; ) is the largest organization for psychiatrists in China. It publishes the Chinese Classification of Mental Disorders ("CCMD"), first published in 1985. The CSP also publishes clinical practice guidelines; p ...
's
Chinese Classification of Mental Disorders The Chinese Classification of Mental Disorders (CCMD; ), published by the Chinese Society of Psychiatry (CSP), is a clinical guide used in China for the diagnosis of mental disorders. It is on a third version, the CCMD-3, written in Chinese and E ...
.
Americans
Americans are the Citizenship of the United States, citizens and United States nationality law, nationals of the United States, United States of America.; ; Although direct citizens and nationals make up the majority of Americans, many Multi ...
were said to be particularly prone to neurasthenia, which resulted in the nickname "Americanitis" (popularized by
William James
William James (January 11, 1842 – August 26, 1910) was an American philosopher, historian, and psychologist, and the first educator to offer a psychology course in the United States.
James is considered to be a leading thinker of the lat ...
). Another, rarely used, term for neurasthenia is nervosism.
Symptoms
The condition was explained as being a result of exhaustion of the
central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all par ...
's energy reserves, which Beard attributed to modern civilization. Physicians in the Beard school of thought associated neurasthenia with the stresses of
urbanization
Urbanization (or urbanisation) refers to the population shift from rural to urban areas, the corresponding decrease in the proportion of people living in rural areas, and the ways in which societies adapt to this change. It is predominantly t ...
and with stress suffered as a result of the increasingly competitive business environment. Typically, it was associated with
upper class
Upper class in modern societies is the social class composed of people who hold the highest social status, usually are the wealthiest members of class society, and wield the greatest political power. According to this view, the upper class is gen ...
people and with
professional
A professional is a member of a profession or any person who works in a specified professional activity. The term also describes the standards of education and training that prepare members of the profession with the particular knowledge and skil ...
s working in sedentary occupations, but really can apply to anyone who lives within the
monetary system
A monetary system is a system by which a government provides money in a country's economy. Modern monetary systems usually consist of the national treasury, the mint, the central banks and commercial banks.
Commodity money system
A commodity m ...
.
Freud
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies explained as originating in conflicts in ...
included a variety of physical symptoms into this category, including fatigue,
dyspepsia
Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier t ...
with
flatulence
Flatulence, in humans, is the expulsion of gas from the intestines via the anus, commonly referred to as farting. "Flatus" is the medical word for gas generated in the stomach or bowels. A proportion of intestinal gas may be swallowed environm ...
, and indications of
intra-cranial pressure
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 mmHg for a supine adult. Th ...
and spinal irritation.
In common with some other people of the time, he believed this condition to be due to "non-completed coitus" or the non-completion of the higher cultural correlate thereof, or to "infrequency of emissions" or the infrequent practice of the higher cultural correlate thereof.
Later, Freud formulated that in cases of
coitus interruptus
''Coitus interruptus'', also known as withdrawal, pulling out or the pull-out method, is a method of birth control in which a man, during sexual intercourse, withdraws his penis from a woman's vagina prior to ejaculation and then directs his ej ...
as well as in cases of masturbation, there was "an insufficient libidinal discharge" that had a poisoning effect on the organism, in other words, neurasthenia was the result of (auto)intoxication. Eventually he separated it from
anxiety neurosis
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
, though he believed that a combination of the two conditions existed in many cases.
In 19th-century Britain and, by extension, across the British Empire, neurasthenia was also used to describe mental exhaustion or fatigue in “brain workers” or in the context of “overstudy”.
This use was often synonymous with the term “
brain fag”.
Diagnosis
From 1869, neurasthenia became a "popular" diagnosis, expanding to include such symptoms as
weakness
Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...
,
dizziness
Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness.
Dizziness is a common medical c ...
and
fainting
Syncope, commonly known as fainting, or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from ...
. A common treatment promoted by neurologist S. Weir Mitchell was the
rest cure
Bed rest, also referred to as the rest-cure, is a medical treatment in which a person lies in bed for most of the time to try to cure an illness. Bed rest refers to voluntarily lying in bed as a treatment and not being confined to bed because of ...
, especially for women. Data from this period gleaned from the Annual Reports of Queen Square Hospital, London, indicates that the diagnosis was balanced between the sexes and had a presence within Europe.
Virginia Woolf
Adeline Virginia Woolf (; ; 25 January 1882 28 March 1941) was an English writer, considered one of the most important modernist 20th-century authors and a pioneer in the use of stream of consciousness as a narrative device.
Woolf was born i ...
was known to have been forced to have rest cures, which she describes in her book ''
On Being Ill
''On Being Ill'' is an essay by Virginia Woolf, which seeks to establish illness as a serious subject of literature along the lines of love, jealousy and battle. Woolf writes about the isolation, loneliness, and vulnerability that disease may bri ...
''.
Charlotte Perkins Gilman
Charlotte Perkins Gilman (; née Perkins; July 3, 1860 – August 17, 1935), also known by her first married name Charlotte Perkins Stetson, was an American humanist, novelist, writer, lecturer, advocate for social reform, and eugenicist. She wa ...
's protagonist in ''
The Yellow Wallpaper
"The Yellow Wallpaper" (original title: "The Yellow Wall-paper. A Story") is a short story by American writer Charlotte Perkins Gilman, first published in January 1892 in '' The New England Magazine''. It is regarded as an important early work ...
'' also suffers under the auspices of rest cure doctors, much as Gilman herself did.
Marcel Proust
Valentin Louis Georges Eugène Marcel Proust (; ; 10 July 1871 – 18 November 1922) was a French novelist, critic, and essayist who wrote the monumental novel ''In Search of Lost Time'' (''À la recherche du temps perdu''; with the previous Eng ...
was said to suffer from neurasthenia.
To capitalize on this epidemic, the
Rexall
Rexall was a chain of American drugstores, and the name of their store-branded products. The stores, having roots in the federation of United Drug Stores starting in 1903, licensed the Rexall brand name to as many as 12,000 drug stores across th ...
drug company introduced a medication called 'Americanitis Elixir' which claimed to be a soother for any bouts related to neurasthenia.
Treatment
Beard, with his partner
A.D. Rockwell
The terms (AD) and before Christ (BC) are used to label or number years in the Julian and Gregorian calendars. The term is Medieval Latin and means 'in the year of the Lord', but is often presented using "our Lord" instead of "the Lord", ...
, advocated first
electrotherapy
Electrotherapy is the use of electrical energy as a medical treatment. In medicine, the term ''electrotherapy'' can apply to a variety of treatments, including the use of electrical devices such as deep brain stimulators for neurological dise ...
and then increasingly experimental treatments for people with neurasthenia, a position that was controversial. An 1868 review posited that Beard's and Rockwell's knowledge of the
scientific method
The scientific method is an empirical method for acquiring knowledge that has characterized the development of science since at least the 17th century (with notable practitioners in previous centuries; see the article history of scientific m ...
was suspect and did not believe their claims to be warranted.
William James was diagnosed with neurasthenia, which he nicknamed 'Americanitis', and was quoted as saying, "I take it that no man is educated who has never dallied with the thought of suicide."
In 1895,
Sigmund Freud
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
reviewed electrotherapy and declared it a "pretense treatment." He emphasized the example of Elizabeth von R's note that "the stronger these were the more they seemed to push her own pains into the background."
Nevertheless, neurasthenia was a common diagnosis during
World War I
World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
for "
shell shock
Shell shock is a term coined in World War I by the British psychologist Charles Samuel Myers to describe the type of post-traumatic stress disorder (PTSD) many soldiers were afflicted with during the war (before PTSD was termed). It is a react ...
",
but its use declined a decade later. Soldiers who deserted their post could be executed even if they had a medical excuse, but officers who had neurasthenia were not executed.
Current opinion
This concept remained popular well into the 20th century, eventually coming to be seen as a behavioural rather than physical condition. Neurasthenia has largely been abandoned as a medical diagnosis.
The
ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
system of the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
categorizes neurasthenia under "F48 – Other neurotic disorders".
Under "F48.0 Neurasthenia", there are notable differences in characteristics of the disorder among various cultures. Two main overlapping forms of symptoms can be present: Increased fatigue after mental exertion can be associated with a reduction in cognitive function. Minimal physical effort might be felt as extream fatigue along with pain and anxiety. Many other symptoms of bodily discomfort may be felt with either form. Excluded from this disorder are:
asthenia
Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...
NOS (R53),
burn-out (Z73.0),
malaise
As a medical term, malaise is a feeling of general discomfort, uneasiness or lack of wellbeing and often the first sign of an infection or other disease. The word has existed in French since at least the 12th century.
The term is often used ...
and
fatigue
Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
(R53),
postviral fatigue syndrome (includes Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS)) (G93.3)
and
psychasthenia
Psychasthenia was a psychological disorder characterized by phobias, obsessions, compulsions, or excessive anxiety. The term is no longer in psychiatric diagnostic use, although it still forms one of the ten clinical subscales of the popular self-r ...
(F48.8).
One modern opinion of neurasthenia is that it was actually
dysautonomia
Dysautonomia or autonomic dysfunction is a condition in which the autonomic nervous system (ANS) does not work properly. This may affect the functioning of the heart, bladder, intestines, sweat glands, pupils, and blood vessels. Dysautonomia has m ...
, an "imbalance" of the
autonomic nervous system
The autonomic nervous system (ANS), formerly referred to as the vegetative nervous system, is a division of the peripheral nervous system that supplies viscera, internal organs, smooth muscle and glands. The autonomic nervous system is a control ...
.
Barbara Ehrenreich
Barbara Ehrenreich (, ; ; August 26, 1941 – September 1, 2022) was an American author and political activist. During the 1980s and early 1990s, she was a prominent figure in the Democratic Socialists of America. She was a widely read and awar ...
, restating James's view, considered that neurasthenia was caused by the
Calvinist
Calvinism (also called the Reformed Tradition, Reformed Protestantism, Reformed Christianity, or simply Reformed) is a major branch of Protestantism that follows the theological tradition and forms of Christian practice set down by John Ca ...
gloom,
[ and it was helped by the ]New Thought
The New Thought movement (also Higher Thought) is a spiritual movement that coalesced in the United States in the early 19th century. New Thought was seen by its adherents as succeeding "ancient thought", accumulated wisdom and philosophy from ...
, through replacing the "puritanical 'demand for perpetual effort and self-examination to the point of self-loathing'"[ with a more hopeful faith.][Jenni Murray]
Smile or Die: How Positive Thinking Fooled America and the World by Barbara Ehrenreich. Jenni Murray salutes a long-overdue demolition of the suggestion that positive thinking is the answer to all our problems.
The Observer, 10 January 2010 at guardian.co.uk.
In Asia
The medical term ''neurasthenia'' is translated as Chinese ''shenjing shuairuo'' () or Japanese ''shinkei-suijaku'' (神経衰弱), both of which also translate the common term ''nervous breakdown
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
''. This loanword combines ''shenjing'' ( 神經) or ''shinkei'' ( 神経) "nerve(s); nervous" and ''shuairuo'' or ''suijaku'' ( 衰弱) "weakness; feebleness; debility; asthenia
Weakness is a symptom of a number of different conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, i ...
".
Despite being omitted by the American Psychiatric Association
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 37,000 members are involve ...
's DSM
DSM or dsm may refer to:
Science and technology
* Deep space maneuver
* Design structure matrix or dependency structure matrix, a representation of a system or project
* Diagnostic and Statistical Manual of Mental Disorders
** DSM-5, the fifth ed ...
in 1980, neurasthenia is listed in an appendix as the culture-bound syndrome
In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or cu ...
''shenjing shuairuo'' as well as appearing in the ICD-10
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
. The condition is thought to persist in Asia
Asia (, ) is one of the world's most notable geographical regions, which is either considered a continent in its own right or a subcontinent of Eurasia, which shares the continental landmass of Afro-Eurasia with Africa. Asia covers an area ...
as a culturally acceptable diagnosis that avoids the social stigma
Social stigma is the disapproval of, or discrimination against, an individual or group based on perceived characteristics that serve to distinguish them from other members of a society. Social stigmas are commonly related to culture, gender, rac ...
of a diagnosis of mental disorder
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
.
In Japan
Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north ...
, ''shinkei-suijaku'' is treated with Morita therapy
Morita therapy is a therapy developed by Shoma Morita.
The goal of Morita therapy is to have the patient accept life as it is and places an emphasis on letting nature take its course. Morita therapy views feeling emotions as part of the laws of ...
involving mandatory rest and isolation, followed by progressively more difficult work, and a resumption of a previous social role. The diagnosis is sometimes used as a disguise for serious mental illnesses such as schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
and mood disorder
A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
s.
In China
China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
, traditional Chinese medicine
Traditional Chinese medicine (TCM) is an alternative medical practice drawn from traditional medicine in China. It has been described as "fraught with pseudoscience", with the majority of its treatments having no logical mechanism of action ...
describes ''shenjingshuairuo'' as a depletion of '' qi'' "vital energy" and reduction of functioning in the ''wuzang'' "five internal organs" (heart, liver, spleen, lungs, kidneys). The modern CCMD The Chinese Classification of Mental Disorders (CCMD; ), published by the Chinese Society of Psychiatry (CSP), is a clinical guide used in China for the diagnosis of mental disorders. It is on a third version, the CCMD-3, written in Chinese and Eng ...
classifies it as a persistent mental disorder diagnosed with three of these five symptoms: "'weakness' symptoms, 'emotional' symptoms, 'excitement' symptoms, tension-induced pain, and sleep disturbances" not caused by other conditions. Arthur Kleinman
Arthur Michael Kleinman (born March 11, 1941) is an American psychiatrist, Psychological anthropology, psychiatric anthropologist and a professor of medical anthropology and cross-cultural psychiatry at Harvard University. He is well known for ...
described Chinese neurasthenia as a "biculturally patterned illness experience (a special form of somatization), related to depression or other diseases or to culturally sanctioned idioms of distress and psychosocial coping."[Kleinman, Arthur (1986), ''Social Origins of Distress and Disease: Depression, Neurasthenia, and Pain in Modern China'', Yale University Press, p. 115.]
See also
* Burnout syndrome
According to the World Health Organization (WHO), occupational burnout is a syndrome resulting from chronic work-related stress, with symptoms characterized by "feelings of energy depletion or exhaustion; increased mental distance from one’s ...
* Chronic fatigue syndrome
Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME) or ME/CFS, is a complex, debilitating, long-term medical condition. The causes and mechanisms of the disease are not fully understood. Distinguishing core symptoms are ...
(ME/CFS)
* Combat stress reaction
Combat stress reaction (CSR) is acute behavioral disorganization as a direct result of the trauma of war. Also known as "combat fatigue", "battle fatigue", or "battle neurosis", it has some overlap with the diagnosis of acute stress reaction used ...
* Newyorkitis
''Newyorkitis'' is a 1901 book by surgeon John H. Girdner describing "a condition of mind, body, and soul" that he had observed among patients living in the New York City borough of Manhattan.
John Harvey Girdner (author)
John H. Girdner (March ...
* Placebo effect
A placebo ( ) is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like Saline (medicine), saline), sham surgery, and other procedures.
In general ...
* Psychogenic disease Classified as a "conversion disorder" by the DSM-IV, a psychogenic disease is a disease in which mental stressors cause physical symptoms of different diseases. The manifestation of physical symptoms without biologically identifiable causes results ...
References
Further reading
*
*
* Gosling, F. G. ''Before Freud: Neurasthenia and the American Medical Community, 1870-1910''. Urbana: University of Illinois Press, 1987.
*
*
* Schuster, David G. ''Neurasthenic Nation: America's Search for Health, Comfort, and Happiness, 1869-1920''. New Brunswick, NJ: Rutgers University Press, 2011.
* Lutz, Tom. ''American Nervousness, 1903''. Ithaca, NY: Cornell University Press, 1991.
External links
{{Mental and behavioural disorders, selected = neurotic
Anxiety disorders
Neurological disorders
Military psychiatry
Obsolete terms for mental disorders