Neurasthenia Revisited: On Medically Unexplained Syndromes and the Value of Hermeneutic Medicine

  • Kevin Aho Florida Gulf Coast University
Keywords: neurasthenia, fibromyalgia, chronic fatigue syndrome, somatization, naturalism, hermeneutics



The rise of medically unexplained conditions like fibromyalgia and chronic fatigue syndrome in the United States looks remarkably similar to the explosion of neurasthenia diagnoses in the late nineteenth century. In this paper, I argue the historical connection between neurasthenia and today’s medically unexplained conditions hinges largely on the uncritical acceptance of naturalism in medicine. I show how this cultural acceptance shapes the way in which we interpret and make sense of nervous distress while, at the same time, neglecting the unique social and historical forces that continue to produce it. I draw on the methods of hermeneutic philosophy to expose the limits of naturalism and forward an account of health and illness that acknowledges the extent to which we are always embedded in contexts of meaning that determine how we experience and understand our suffering.



Author Biography

Kevin Aho, Florida Gulf Coast University
Kevin Aho, PhD
Professor and Chair
Dept. of Communication and Philosophy
Florida Gulf Coast University


Abbey, S., & Garfinkel, P. (1991). Neurasthenia and chronic fatigue syndrome: The role of culture in the making of a diagnosis. American Journal of Psychiatry, 148(12), 1638-1646.

Aho, K. 2007. Simmel on acceleration, boredom, and extreme aesthesia. Journal for the Theory of Social Behavior, 37(4), 447-462.

Aho, K., & Aho, J. (2008). Body Matters: A phenomenology of Sickness, Illness, and Disease. Lanham, MD: Lexington Books.

Aronowitz, R. (1991). Lyme Disease: The Social Construction of a New Disease and its Social Consequences. The Milbank Quarterly, 69(1), 79-112.

Barker, K. (2002). Self-help literature and the making of an illness identity: The case of fibromyalgia syndrome (FMS). Social Problems, 49 (3), 279-300.

Beard, G. (1880). A practical treatise on nervous exhaustion (neurasthenia). New York, NY: William Wood.

Beard, G. (1881). American nervousness, its causes and consequences: A supplement to nervous exhaustion (neurasthenia). New York, NY: G. P. Putnam’s Sons.

Chatel, J., & Peele, R. (1970). The concept of neurasthenia. International Journal of Psychiatry, 9, 36-49.

Conrad, P. (1987). The experience of illness: Recent and new directions. Research in the Sociology of Health Care, 6, 1-31.

Freedman, A. (1987). Introduction. Before Freud: Neurasthenia and the American medical community, 1870-1910. Urbana and Chicago, IL: University of Illinois Press.

Freud, S. (1895). In J. Strachey (Ed.), On the grounds of detaching a particular syndrome from neurasthenia under the description of ‘anxiety neurosis’ (Standard ed.; Vol. 3; pp. 87-115). London, UK: Hogarth Press.

Ghaemi, N. (2013). Requiem for the DSM. Psychiatric Times, Accessed April 6, 2016.

Gilman, C. (1975). The living of Charlotte Perkins Gilman: An autobiography. New York, NY: Harper Colophon

Gosling, F.G. (1987). Before Freud: Neurasthenia and the American medical community, 1870-1910. Urbana and Chicago, IL: University of Illinois Press.

Greenberg, D. (1990). Neurasthenia in the 1980s: Chronic mononucleosis, chronic fatigue syndrome and anxiety and depressive disorders. Psychosomatics, 31(2), 129-137.

Groopman, J. (2000). Hurting all over: With so many people in so much pain, how could fibromyalgia not be a disease? The New Yorker, November 13, 2000.

Hearn, G. (2009). No clue—what shall we do? Physicians and functional syndromes. International Review of Modern Sociology, 35, 95-113.

Heidegger, M. (1982). Basic problems of phenomenology (A. Hofstadter, Trans.). Bloomington, IN: Indiana University Press.

Heidegger, M. (1927/1962). Being and time (J. Macquarrie & E. Robinson, Trans.). New York, NY: Harper and Row.

Horwitz, A. (2002). Creating mental illness. Chicago, IL: University of Chicago Press.

Jimenez, X., & Mayer, P. (2015). Medically unexplained symptoms and mental models: From failure to fusion and back to illness behavior. Journal of Ethics in Mental Health, Open Volume. ISSN: 1916-2405

Kutchins, H., & Kirk, S. (1997). Making us crazy: DSM, the psychiatric bible and the creation of mental disorders. New York, NY: The Free Press.

Lewis, B. (2006). Moving beyond Prozac: DSM and the new psychiatry: The birth of postpsychiatry. Ann Arbor, MI: University of Michigan Press.

Lipowski, Z. (1988). Somatization: The concept and its clinical application. American Journal of Psychiatry, 14, 1358-1368.

Macmillan, M. (1991). Freud evaluated: The completed arc. Amsterdam, The Netherlands: Elsevier.

Osnos, E. (2011). Americanitis vs. Chinitis. The New Yorker. Jan. 4, 2011.

Payer, L. (1989). Medicine and culture. Varieties of treatments in the United States, England, West Germany, and France. New York, NY: Penguin.

Ratcliffe, M. (2009). Phenomenology, neuroscience, and intersubjectivity. In H. Dreyfus & M. Wrathall (Eds.), A companion to existentialism and phenomenology (pp. 329-345). Oxford, UK: Blackwell.

Shorter, E. (1992). From paralysis to fatigue: A history of psychosomatic illness in the modern era. New York, NY: Free Press.

Shorter, E. (1997). A history of psychiatry. New York, NY: Wiley.

Showalter, E. (1985). The female malady: Women, madness and English culture, 1830-1980. New York, NY: Pantheon Books.

Shuster, D. (2003). Neurasthenia and a modernizing America. Journal of the American Medical Association, 290(17), 2327-2328.

Shuster, D. (2011). Neurasthenic nation: America’s search for health, happiness, and comfort, 1869-1920. New Brunswick, NJ: Rutgers University Press.

Simmel, G. (1903/1997). The metropolis and mental life. In D. Frisby & M. Featherstone (Eds.), Simmel on culture ( pp. 174-186). London, UK: Sage.

Taylor, C. (1985). Self-interpreting animals. In Philosophical papers: Vol. 1. Human agency and language (pp. 45-76). Cambridge, UK: Cambridge University Press.

U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.

Ware, N., & Weiss, M. (1994). Neurasthenia and the social construction of psychiatric knowledge. Transcultural Psychiatric Research Review, 31, 101-124.

Wessely , S. (1990). Old wine in new bottles: Neurasthenia and ‘ME’. Psychological Medicine, 20, 35-53.

Young, R. (2003). Patients like Linda. Journal of the American Medical Association, 290(2), 165-166.