Abstract
Neurasthenia is both a Western disease construct and a popular Chinese illness concept (shenjing shuairuo, SJSR). Using a self-report questionnaire, we examined 148 Hong Kong Chinese undergraduates' concept of its epidemiology, symptomatology, etiology and treatment. Notwithstanding that fatigue is thesine qua non of neurasthenia in Western nosology, subjects believed that SJSR was compatible with a diversity of symptoms which fell, on factor analysis, into the “neurotic,” “psychotic”, “somatic” and “dysfunctional” subgroups. Contrary to the popular portrayal of SJSR as a physical or chronic fatigue disorder, the most common perceived symptoms were anxiety, insomnia, depression and fright. Logically, psychological etiology and remedy were highly emphasized. The perceived high prevalence, non-aggressive nature and symptomatic diversity of SJSR attested to the notion that it might camouflage and destigmatize psychiatric labels of insanity. The contextual study of neurasthenia illustrates how in its search for legitimacy an originally Western concept adapts, transforms, and acquires distinctive local meanings in a non-Western culture.
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References
Abbey, S. E., and P. E. Garfinkel 1991 Neurasthenia and Chronic Fatigue Syndrome: The Role of Culture in the Making of a Diagnosis. American Journal of Psychiatry 148:1638–1646.
American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV). Washington, DC: APA.
Baer, R. D., and D. Penzell 1993 Research report: Susto and Pesticide Poisoning among Florida Farmworkers. Culture, Medicine and Psychiatry 17:321–327.
Beard, G. M. 1869 Neurasthenia, or Nervous Exhaustion. Boston Medical and Surgical Journal 3:217–221.
1880 A Practical Treatise on Nervous Exhaustion (Neurasthenia): Its Symptoms, Nature, Sequences, Treatment, 2nd ed. New York, William Wood & Co.
Cheung, F. M. 1989 The Indigenization of Neurasthenia in Hong Kong. Culture, Medicine and Psychiatry 13:227–241.
Cheung, F. M., and B. W. K. Lau 1982 Situational Variations of Help-Seeking Behaviour among Chinese Patients. Comprehensive Psychiatry 23:252–262.
Eisenberg, L. 1977 Disease and Illness: Distinctions between Professional and Popular Ideas of Sickness. Culture, Medicine and Psychiatry 1:9–23.
Fabrega, H. Jr 1990 The Concept of Somatization as a Cultural and Historical Product of Western Medicine. Psychosomatic Medicine 52:653–672.
Good, B. J. 1993 Culture, Diagnosis and Comorbidity. Culture, Medicine and Psychiatry 16:427–446.
Holmes, G. P., J. E. Kaplan, N. M. Gantz et al. 1988 Chronic Fatigue Syndrome a Working Case Definition. Annals of Internal Medicine 108:387–389.
Kaptchuk, T. K. 1983 Chinese Medicine-The Web that has No Weaver. Rider: London.
Kirmayer, L. J. 1984 Culture, Affect and Somatization-Part I. Transcultural Psychiatric Research Review 21:159–188.
Kleinman, A. 1982 Neurasthenia and Depression: A Study of Somatization and Culture in China. Culture, Medicine and Psychiatry 6:117–190.
1988 Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: The Free Press.
Koo, L. C. 1987 Concepts of Disease Causation, Treatment and Prevention among Hong Kong Chinese: Diversity and Eclecticism. Social Science and Medicine 25:405–417.
Krupp, L. B., W. B. Mendelson, and R. Friedman (1991) An Overview of Chronic Fatigue Syndrome. Journal of Clinical Psychiatry 52:403–410.
Lau, S. K., and H. C. Kuan 1988 The Ethos of Hong Kong Chinese. Hong Kong: Chinese University Press.
Lee, S. 1993 Side Effects of Chronic Lithium Treatment in Hong Kong Chinese-An Ethnopsychiatric Perspective. Culture, Medicine and Psychiatry 17:301–320.
Lin, T. Y. 1989 Neurasthenia Revisited: Its Place in Modern Psychiatry. Culture, Medicine and Psychiatry 13:105–129.
Liu, S. X. 1989 Neurasthenia in China: Modern and Traditional Criteria for its Diagnosis. Culture, Medicine and Psychiatry 13:163–186.
Munakata, T. 1989 The Socio-cultural Significance of the Diagnostic Label “Neurasthenia” in Japan's Mental Health Care System. Culture, Medicine and Psychiatry 13:203–213.
Nice, C. M. 1908 Neurasthenia. Southern Medical Journal 1:104–112.
Rin, H., and M. G. Huang 1989 Neurasthenia as Nosological Dilemma. Culture, Medicine and Psychiatry 13:215–226.
Sharpe, M. C. 1991 A Report-Chronic Fatigue Syndrome: Guidelines for Research. Journal of the Royal Society of Medicine 84:118–121.
Ware, N. 1992 Suffering and the Social Construction of Illness: the Delegitimation of Illness Experience in Chronic Fatigue Syndrome. Medical Anthropology Quarterly 6:347–361.
Ware, N., and A. Kleinman 1991 Culture and Somatic Experience: The Social Course of Illness in Neurasthenia and Chronic Fatigue Syndrome. Psychosomatic Medicine 54:546–560.
Wei, X. B., B. Cui, K. M. Zhang, M. S. Zheng, S. J. Wang, Y. J. Chen, H. F. Liu, Y. C. Zhang and T. X. Wang 1993 A Prevalance Study of Shenjing Shuairuo in College Students. Chinese Journal of Nervous and Mental Diseases 19:80–82.
Weiss, M.G., D. R. Doongaji, S. Siddhartha, D. Wyypij, S. Pathare, M. Bhatawdekar, A. Bhave, A. Sheth, and R. Fernandes 1992 The Explanatory Model Interview Catalogue (EMIC)-Contribution to Cross-cultural Research Methods from a Study of Leprosy and Mental Health. British Journal of Psychiatry 160:819–830.
Wessely, S. 1990 Old Wine in New Bottless: Neurasthenia and ‘ME’. Psychological Medicine 20:35–53.
Wong, C. K., and T. S. C. Chan 1984 Somatic Symptoms among Chinese Psychiatric Patients. Hong Kong Journal of Mental Health 13:5–21.
World Health Organization 1978 Mental Disorder. Glossary and Guide to Their Classification in Accordance with ICD-9. Geneva: WHO.
1992 The ICD-10 Classification of Mental and Behaviour Disorders-Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO.
Yan, H. Q. 1989 The Necessity of Retaining the Diagnostic Concept of Neurasthenia. Culture, Medicine and Psychiatry 13:139–145.
Yung, C. 1988 Neurasthenia should be Erased from the Psychiatric Nosology. Paper presented in The 4th Scientific Meeting of the Pacific Rim College of Psychiatrists, 4–8 December, 1988, Hong Kong.
Zhang, M. Y. 1989 The Diagnosis and Phenomenology of Neurasthenia: A Shanghai Study. Culture, Medicine and Psychiatry 13:147–161.
Zheng, Y. P., K. M. Lin, J. Yamamoto, D. C. Zheng, G. Nakasaki, and H. K. Ferng 1992 Neurasthenia in Chinse Students and Visiting Scholars in the United States. Psychiatric Annals 22:194–198.
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Lee, S., Ching Wong, K. Rethinking neurasthenia: The illness concepts of Shenjing Shuairuo among Chinese undergraduates in Hong Kong. Cult Med Psych 19, 91–111 (1995). https://doi.org/10.1007/BF01388250
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DOI: https://doi.org/10.1007/BF01388250