Death of neurasthenia and its psychological reincarnation

Abstract

Background The diagnosis of neurasthenia appeared in 1869 and rapidly became fashionable and highly prevalent. It disappeared almost completely, producing ongoing debates about what happened to the disease, which have not so far been informed by empirical data. Aims To use empirical historical hospital data from one specific hospital to explore several controversies about neurasthenia, including what happened to the disorder. Method The annual reports of Queen Square Hospital were examined from 1870 to 1947. The prevalence of neurasthenia diagnoses as a proportion of total discharges was recorded. The possible diagnostic categories into which neurasthenia could have been reclassified were identified. Textbooks and writing by neurologists working at the hospital during this period were examined. Results Neurasthenia accounted for 6–11% of total discharges from the late 1890s to 1930, when it virtually disappeared. Men accounted for 33–50% of cases. Conclusions Neurasthenia affected both the upper and working classes and both men and women. Neurologists, not psychiatrists, continued to see the disorder well into the 20th century. Neurasthenia did not disappear, but was reclassified into psychological diagnoses.