Managing Chineseness: neurasthenia and psychiatry in Taiwan in the second half of the twentieth century

The present study investigates the role of Taiwanese psychiatrists in turning neurasthenia into a culture-specific disease in the late twentieth century. It first delineates the shift in both explanatory models of psychoneuroses and patient population in post-World War II Taiwan. Neurasthenia became a focus of international attention in the 1970s and 1980s with the advance of cultural psychiatry, and, as China was closed to the outside world, Taiwanese psychiatrists were influential in framing the cultural meaning of neurasthenia. With the rise of post-socialist China, Taiwan lost its status as a key laboratory of Chinese studies. This paper argues that the history of neurasthenia during the period was closely associated with the professional development and national identity of Taiwanese psychiatrists.

Elton Mayo and Thomas Henry Reeve Mathewson: the forgotten Australian pioneers of the treatment of patients with shell shock, neurasthenia and nervous breakdown

The contributions of Australians on shell shock are absent from the literature. However, two Australians were pioneers in the treatment of shell shock: George Elton Mayo (1880-1949) and Dr Thomas Henry Reeve Mathewson (1881-1975). They used psychoanalytic approaches to treat psychiatric patients and introduced the psychoanalytic treatment of people who suffered from shell shock. Their 'talking cure' was highly successful and challenged the view that shell shock only occurred in men who were malingering and/or lacking in fortitude. Their work demonstrated that people experiencing mental illness could be treated in the community at a time when they were routinely treated as inpatients. It also exemplified the substantial benefits of combining science with clinical knowledge and skill in psychology and psychiatry.

[Urology goes electric-electrotherapy : Modern therapies in the treatment of modern diseases-examples from urology]

The significance of electricity for medicine in the modern industrial age should not be underestimated. Particularly in connection with neurasthenia, electrotherapeutic approaches also experienced a boom for domestic use. Thus, electrotherapy reached urology just as it was becoming established as a medical specialty. We analyzed urological manuals and textbooks and objects in the W. P. Didusch Center for Urologic History and the Museum zur Geschichte der Urologie in Berlin to present the wide range of indications for electrotherapy in the emerging field of urology from impotence to urethral strictures and try to highlight the variability of their importance over time.

Neurasthenia, psy sciences and the 'great leap forward' in Maoist China

The present study looks into the much-neglected history of neurasthenia in Maoist China in relation to the development of psy sciences. It begins with an examination of the various factors that transformed neurasthenia into a major health issue from the late 1950s to mid-1960s. It then investigates a distinctive culture of therapeutic experiment of neurasthenia during this period, with emphasis on the ways in which psy scientists and medical practitioners manoeuvred in a highly politicized environment. The study concludes with a discussion of the legacy of these neurasthenia studies - in particular, the experiment with the famous 'speedy and synthetic therapy' - and of the implications the present study may have for future historical study of psychiatry and science.

A Disorder of Qi: Breathing Exercise as a Cure for Neurasthenia in Japan, 1900-1945

Neurasthenia became a common disease and caused widespread concern in Japan at the turn of the twentieth century, whereas only a couple of decades earlier the term "nerve" had been unfamiliar, if not unknown, to many Japanese. By exploring the theories and practices of breathing exercise-one of the most popular treatments for neurasthenia at the time-this paper attempts to understand how people who practiced breathing exercises for their nervous ills perceived, conceived, and accordingly cared for their nerves. It argues that they understood "nerve" based on their existing conceptions of qi Neurasthenia was for them a disorder of qi, although the qi had assumed modern appearances as blood and nervous current. The paper hopes to contribute to the understanding of how the concept of nerves has been accepted and assimilated in East Asia. It also points out the need to understand the varied cultures of nerves not only at the level of concept and metaphor, but also at the level of perception and experience.

Treating emotion-related disorders in Japanese traditional medicine: language, patients and doctors

This paper analyses how the conceptual and therapeutic formation of Japanese traditional medicine (Kampo) has been socially constructed through interactions with popular interpretations of illness. Taking the example of emotion-related disorders, this paper focuses on the changing meaning of constraint (utsu) in Kampo medicine. Utsu was once a name for one of the most frequently cited emotion-related disorders and pathological concerns during the Edo period. With the spread of Western medicine in the Meiji period, neurasthenia replaced utsu as the dominant emotion-related disorder in Japanese society. As a result, post-Meiji doctors developed other conceptual tools and strategies to respond to these new disease categories, innovations that continue to influence contemporary practitioners. I begin this history by focusing on Wada Tōkaku, a Japanese doctor of the Edo period who developed a unique theory and treatment strategy for utsu. Secondly, I examine. Yomuto Kyūshin and Mori Dōhaku, Kampo doctors of the early twentieth century, who privileged neurasthenia over utsu in their medical practice. The paper concludes with a discussion of the flexibility and complexity of Kampo medicine, how its theory and practices have been influenced by cross-cultural changes in medicine and society, while incorporating the popular experience of illness as well.

[Acupuncture in the treatment of neurasthenia]

Neurasthenia--is the exhaustion of the nervous system, mental disorder that belongs to a group of neuroses. Doctors sometimes briefly describing him "irritable weakness" or "irritable fatigue." This term is justified: a person who suffers asthenic-neurotic syndrome, while experiencing fatigue and increased nervous excitability. Reasons neurasthenia quite a lot. Unfortunately, the lifestyle of modern man gives many reasons for the emergence of asthenic-neurotic syndrome.

[Masked depression--history and present days]

Masked depression is a special form of an atypical depression. In the 70's and 80's years it was often identified at patients who complained on somatic diseases, without any distinguishable organic disorder. Depression symptoms were of secondary importance, with lesser intensification, some of them didn't appear at all. The psychiatrists of the time created a lot of terms to describe them, i.e.: a depression equivalent, a vegetative equivalent, a depression without a depression, a hidden depression. Current classifications: ICD-10 (International Classification of Diseases, 10th Revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, published by the American Psychiatric Association) do not contain the term masked depression. It doesn't mean that have disappeared the problem of atypical depression syndrome with a picture significantly different from the commonly known. The american scientists claim that such group contains 6-7% of depression disorders. The lack of proper diagnosis and disease entity qualification leads to serious somatic and psychological consequences for patients. Improper diagnosis and treatment of a patient limits his or her social and professional life, forms suicide rate and makes high costs of diagnosis and treatment.

["Smoked meat, full of rind, hardly edible"--patient's complaints and doctor's rebuttal in the first German state-run mental sanatory "Rasemühle" between 1903 and 1932]

Around 1900 a psychiatric reform movement propagated the foundation of sanatoriums for the lower middle class in Germany. These sanatoriums were supposed to cure patients suffering from neurasthenia and associated disorders. Many private sanatoriums existed for curing neurasthenia. Visiting them was a luxury beyond most of the patients' means. Therefore, the so called "Volksnervenheilstätten"-movement aimed at providing sanatorium care for free or at very low costs. One of the first sanatoriums that arose from this movement was the "Rasemühle" close to Goettingen. It was founded in 1903. As a governmentally funded institution for the less wealthy the "Rasemühle" constantly moved between legitimation and critique. Areas of conflict included on the one hand the need to operate economically (as requested by the sponsor) and on the other hand the demands of neurasthenic patients for optimal care and cure. Patients' complaints about the sanatorium addressed to the financiers or governmental institutions and the reactions of the sanatorium's director serve as a valuable tool for reconstructing these areas of conflict. An analysis of the complaint files of the "Rasemühle" between 1903 and 1932 reveals that complaints usually included food, accommodation and the doctors' behaviour. Before the First World War the sanatorium's reaction usually aimed at pathologising patients who put forward complaints. Complaining was described as a symptom of the treated disorder. After financiers and insurance companies had reduced their engagement for neurasthenics during the late 1920s financing the sanatorium became more difficult. With the vanishing neurasthenia discourse the "Rasemühle" had to enter the market of private patients to survive. Now the reaction to complaints shifted to understanding. The responsible government agency was asked to invest into the sanatorium to make it competitive on the market. Patients were not seen anymore as unwilling petitioners but as customers whose needs and demands should be fullfilled.

[Effectiveness of balneotherapy in patients with neurasthenia using baths of mineral water under conditions of low-mountain health-resort Nunisi]

Total of 118 patients with neurasthenia were investigated. Among them in 62 persons a hypersthenic form and in 56 -- a hyposthenic form of the pathology were noted. It has been established that balneotherapy using baths of mineral water, which is low-mineralised weakly sulfide, chloride-hydrocarbonate mineral sodic water under conditions of low-mountain health-resort Nunisi induces a decrease right up to disappearance of complaints and pathological changes in neurological status in patients with mentioned pathology. At the same time it improves indices of perception, attention and memory, state of vegetative nervous system and functional state of the brain, has a normalising action on the indices of cardiohemodynamics and lipid metabolism as well as on the excretion with urine of adrenaline and noradrenaline, neutral 17-ketosteroids, free and total 17-oxicorticosteroids. Mentioned positive shifts were more pronounced at hypersthenic form of neurasthenia. The treatment carried on had a positive influence in 62 (100%) patients with hypersthenic form of neurasthenia and in 51 (91,07%) -- with hyposthenic form.

Mark Twain and his family's health: Livy Clemens' neurasthenia in the gilded age and chronic fatigue syndrome of today

Our purpose is to compare and contrast the 19th century diagnosis and disease neurasthenia with the contemporary illness known as Chronic Fatigue Syndrome. The health of Mark Twain's wife, Olivia (Livy) Clemens, will then be discussed and evaluated with respect to these two medical conditions.

[Balneotherapy of children with complications of craniocerebral injuries]

Children with aftereffects of craniocerebral trauma have received sanatorium treatment including exercises, massage, mineral baths of different chemical composition. Adequate therapeutic measures taken in due time diminish the number of the aftereffects and their severity.

[The effect of potable mineral waters on the hormonal and psychological status (experimental and clinical research)]

Experiments on 80 Wistar rats revealed the ability of Essentuki mineral waters to stimulate the reserves and sensitivity of the intestinal serotonin-producing system. A clinical trial on two groups of children (exposed to low-dose ionizing radiation or with posttraumatic astheno-neurotic syndrome) found out pronounced positive changes in the psychological status of the children which progressed in correlation with an increase of the blood serotonin levels.

Recognition, management and outcome of psychological disorders in primary care: a naturalistic follow-up study

This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and the association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS). Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 'new' patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrollment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders. Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

Parallels between neurasthenia and premenstrual syndrome

Neurasthenia and premenstrual syndrome became medical diseases because of the historical recognition of menstruation as a medical disease. Both the nineteenth and twentieth century cultural views of women were important in the establishment of menstruation, neurasthenia and premenstrual syndrome as medical conditions. Uncertainty of diagnosis with ever expanding diagnostic criteria, therapy undertaken without an adequate physiological basis, and often adverse effects from therapy, were characteristic of the medicalization of neurasthenia and premenstrual syndrome. A recognition of the cultural basis of these conditions is essential to a better understanding of women as human beings.

The concept of neurasthenia and its treatment in Japan

The term neurasthenia, which had been widely used in Japan before the Second World War, came to be replaced by the term neurosis thereafter. With this change in terminology, there seems to have been a shift in the popular ideas of minor psychiatric disorders towards a more psychological view. Unlike in the West where psychoanalysis was a major contributing factor, in Japan it was Shoma Morita who contributed to this change by questioning the somatic basis of conditions then diagnosed as neurasthenia and by developing the concept shinkeishitsu in the early 1920's, rejecting the concept of neurasthenia. In his theory, the development of shinkeishitsu symptoms is explained in terms of certain psychic dispositions and as a vicious cycle of sensation and attention; he formulated a psychological treatment, Morita therapy, which has been very effective for that condition. With the advent of modernization in this country, doubts have been raised whether this form of psychotherapy will continue to be acceptable to modern Japanese. However, in reality many neurotic patients are still being treated with Morita therapy, although analytically oriented psychotherapy is coming to be practiced more and more in recent years. The indigenous psychotherapies represented by Morita therapy and Naikan therapy have deep-seated roots in Buddhist tradition: its values and ideas have been redefined and reformulated into forms of therapy acceptable to modern Japanese.

The indigenization of neurasthenia in Hong Kong

Despite its origin in Western psychiatry, neurasthenia has become a popular concept in Chinese folk medicine, referring to a variety of somatic and psychological symptoms. Review of Chinese medicinal materials and patent medicines shows that neurasthenia is associated more often with somatic symptoms in tonic type medicine and with psychological and psychosomatic symptoms in sedative and tranquilizer type medicine. Popular Chinese books on neurasthenia suggest that causes might be attributed to lifestyle, psychological factors, and health problems. Recommendations on treatment emphasize self-help approaches through changing lifestyle, examining attitudes, tonic care, and relaxation. As a broad term used loosely by professionals and the lay public in Hong Kong, neurasthenia serves the important function of destigmatizing psychiatric disorders. Psychosexual problems may also be conveyed discreetly through somatic presentation. The indigenization of neurasthenia exemplifies how an originally Western concept acquires cultural meaning. Implications of illness conceptualization and the medical paradigm are discussed.

Patterns of psychiatric consultation in a Chinese general hospital

The authors conducted a study of psychiatric consultation in a Chinese general hospital. Seventy-five inpatients (0.74% of the patients in the hospital) were referred by different services over a 1-year period. Internal medicine referred the most patients, and organic brain syndromes were the most common diagnoses. Depression was not a frequent diagnosis, but neurasthenia was a fairly common one. None of the referred patients had a diagnosis of alcoholism, drug abuse, or personality disorder. The authors compare these data with those of Western studies and discuss the possible factors influencing psychiatric consultation in China.