Shenjing shuairuo (神经衰弱), often translated in English as neurasthenia, has been made famous by Arthur Kleinman (1981, 1986) as the Chinese version of major depressive disorder. It is commonly said of Asian cultures, and in fact of most non-Western cultures generally, that they encourage somatization -- the process of experiencing and expressing emotional stressors and mental illness through bodily complaints. (Another way of describing this is to say that Westerners tend to psychologize their symptoms and to experience and to express their complaints in a psychological rather than somatic idiom.)
Neurasthenia was created as a diagnostic category in the 19th-century United States by a neurologist, George Beard (Kleinman, 1988:100). 19th-century "neurology" was not based on the same conceptions of biology held by modern neurology and neuroscience. It seems in some cases to have operated on a quasi-humoral theory of "vital energy" in which diseases were caused by "exhaustion" of the "nerves". Often it provided biological explanations for existing psychiatric syndromes, as in the case of neurasthenia for depression, or anorexia nervosa for hysteria. This reduced the stigma of the illness, and allowed respectable members of the middle- and upper-classes to be treated in respectable offices by respectable physicians rather than by alienists in asyla. Finally, exhaustion of the nerves served as a mark of status, since elites were considered more vulnerable to such ailments, in the way that ulcers or hypertension may serve as markers of elite status today.
The concept of neurasthenia was introduced to the Chinese medical establishment along with the rest of Western medicine, and it seems to have been enthusiastically adopted. According to Kleinman (1981:258-259) neurasthenia is the second most common diagnosis in Chinese psychiatric hospitals, and one of the most common neuropsychological diagnoses in general. Neurasthenia seems to subsume a number of indigenous terms: shen2jing1 shuai1ruo4 or (WG) shen-ch'ing shuai-jo; huo3qi4 da4 or (WG) huo-ch'i ta "excessive hot internal energy", a syndrome of irritability, anger, and anxiety, along with gastrointestinal complaints; and sim1 chap8-chap8 (Taiwan) a syndrome of chest pains and palpitations with anxiety; and shenkui (discussed elswhere) are all used to express what would probably be diagnosed as major depressive disorder or anxiety disorder in the West.
A typical case study of neurasthenia follows:
One patient was a 41-year-old man with headaches, pains in joints, insomnia, "too many dreams", loss of appetite, weakness, and the belief that there was something wrong with his brain that caused his scalp to sweat excessively. It seemed to us this patient had a depressive syndrome associated with a fixed idea, which could have been a somatic delusion. In treating him, the doctor diagnosed a skin disease of the scalp which he claimed would improve the scalp problem and through it the patient's "brain function". That in turn would cure the depression. In the entire exchange doctor and patient discussed illness and treatment solely in somatic terms.
-- from Kleinman, Arthur, and Mechanic, David. "Mental illness and psychosocial aspects of medical problems in China." In Kleinman, Arthur, and Lin Tsung-Yi (eds.) (1981) Normal and Abnormal Behavior in Chinse Culture. Dordrecht, The Netherlands: D. Reidel Publishing Company. p. 337.
The puzzle of neurasthenia in China is of how to reconcile it with Western diagnostic categories. The World Health Organization's manual ICD-10 classification of mental and behavioural disorders (1992:170-171) still recognizes neurasthenia as a diagnosis:
- either persistent or distressing complaints of increased
fatigue after mental effort, or persistent and distressing
complaints of bodily weakness and exhaustion after minimal effort;
- at least two of the following: feelings of muscular aches
and pains; dizziness; tension headaches; sleep disturbance;
inability to relax; irritability; dyspepsia;
- any autonomic or depressive symptoms present are not
sufficiently persistent and severe to fulfill the criteria for any
of the more specific disorders in this classification.
Includes: fatigue syndrome.
These criteria emphasize the phenomenology of exhaustion, inability to concentrate, and general bodily complaints, all of which typically occur in Western patients with depression. Kleinman seems to believe that Chinese neurasthenia and various similar Chinese syndromes mentioned above are variants manifestation of major depression or anxiety disorders; however, he also wants to maintain the specificity of the Chinese situation. Many of the neurasthenic patients examined by Kleinman are survivors of the Cultural Revolution, a social upheaval which utterly transformed Chinese society. In Kleinman's view, to gloss over the specific socially experienced trauma of the Cultural Revolution, to pass lightly over the particular subjectivity of the Chinese neurasthenic embedded in a complex web of family, Maoism, and traditional Chinese philosophy, would be to ignore what is important about the Chinese experience of neurasthenia as distinct from Western depression.
Works on neurasthenia in China include:
Kleinman, Arthur. (1986) Social Origins of Stress and Disease: depression, neurasthenia, and pain in modern China New Haven: Yale University Press.
Kleinman, Arthur, and Lin Tsung-Yi (eds.) (1981) Normal and Abnormal Behavior in Chinse Culture. Dordrecht, The Netherlands: D. Reidel Publishing Company.
For a discussion of 19th-century neurology, see also:
Brumberg, Joan Jacobs. (1988) Fasting Girls: the emergence of anorexia nervosa as a modern disease. Cambridge, MA: Harvard University Press.