Neurasthenia and George Miller Beard

   (from 1869)

   Although New York electrotherapist George Beard (1839–1883) did not coin the term "neurasthenia"—meaning literally tired nerves—he launched it on its century-long worldwide trajectory. A graduate of the College of Physicians and Surgeons in New York in 1866, 2 years later Beard began lecturing on nervous diseases at New York University; between 1870 and his death in 1883 he was on staff at the Demilt Dispensary there. In an 1869 article in the Boston Medical and Surgical Journal (the forerunner of the New England Journal of Medicine), Beard published an article on "Neurasthenia, or Nervous Exhaustion." For Beard, the key characteristic of the disorder was not that the patients were chronically tired, or had a psychiatric illness, but rather that "the central nervous system becomes dephosphorized, or, perhaps, loses somewhat of its solid constituents; probably undergoes slight, undetectable, morbid changes in its chemical structure, and, as a consequence, becomes more or less impoverished in the quantity of its nervous force" (p. 218). The symptoms of the disorder were manifold: "If a patient complains of general malaise, debility of all the functions, poor appetite, abiding weakness in the back and spine, fugitive neuralgic pains, hysteria, insomnia, hypochondriasis, disinclination for consecutive mental labor, severe and weakening attacks of sick headache . . . we have reason to suspect that . . . we are dealing with a typical case of neurasthenia" (p. 218). By the time Beard brought out his big book, A Practical Treatise on Nervous Exhaustion (Neurasthenia) in 1880, the symptoms had become even more protean, including such frank psychiatric phenomena as anxiety, phobias, and "hopelessness." The following year, Beard brought forth yet another hit: American Nervousness: Its Causes and Consequences, a Supplement to Nervous Exhaustion (Neurasthenia). Sexual Neurasthenia followed posthumously in 1884. Beard’s Practical Treatise reached a fifth U.S. edition in 1905; his Sexual Neurasthenia, a six edition in that year. Moreover, his numerous writings on electrotherapy stayed long in print. (It is actually inexact to call him a neurologist because he wrote little of a neurological nature: He was a specialist in the electrotherapy of neurasthenia.)

   No previous American medical writer had enjoyed the international prominence that Beard attained with his three volumes on neurasthenia. His book on sexual neurasthenia appeared in French in 1895; his Practical Treatise was translated at once (in 1881) into German and enjoyed three German editions; Sexual Neurasthenia had reached a second German edition by 1890. The reasons for this extraordinary literary success can only remain speculative. Yet, the concept of neurasthenia fitted perfectly the notion of the "rest cure" that Silas Weir Mitchell was simultaneously propagating; and the large number of private nervous clinics avid for the business of wealthy "neurasthenia" patients caused an international boomlet in electrotherapy, bed-rest, milk cures, massage, and the other appurtenances of "rest" for neurasthenia. As well, a middle-class that liked to believe it was continually tired from workaday urban occupations gratefully responded to the suggestion that their storage batteries were depleted and unable to recharge themselves by a night’s sleep. In any event, by the turn of the century an organic-sounding "neurasthenia" had trumped all competing "nervous" diagnoses, such as hysteria and hypochondria, to become illness-attribution number one in Western society.

   Neurasthenia began to lose favor as it became psychiatrized. It turned into a mental diagnosis rather than an organic-seeming one, as the brain and mind became its locus rather than those "exhausted spinal centers." Such influential papers as that of Kiel psychiatry professor Georg Stertz (1878–1959) on "exogenous neurasthenic reactions" (that appeared in Oswald Bumke’s [1877–1950] massive Handbook of Psychiatric Illnesses [Handbuch der Geisteskrankheiten] in 1928) were really the kiss of death for it as a popular diagnosis. Neurasthenia retained, however, a place in DSM-II, and the drafters of DSM-III saw it as the equivalent of "chronic depressive disorder," although that latter diagnosis did not make it into the published DSM-III in 1980. Yet, in the World Health Organization’s ICD-10 Classification of Mental and Behavioural Disorders, "neurasthenia" retained a prominent place, meaning either unusual fatigability or "feelings of bodily or physical weakness and exhaustion after only minimal effort" (p. 170). (See also Anxiety and Phobias: Beard’s neurasthenia [1880].)