From 1880 to 1920 neurasthenia was one of the diseases most frequentlydiscussed. From an 'American nervousness' it rapidly evolved into a Western European bourgeois illness. Practically every academic neurologist and psychiatrist wrote a major piece on neurasthenia (see Drinka (21>). Ballet/22) working in France, even sought to dispute Beard's claim that it was an American disease.

In England, neurasthenia was described in Osler's The Principles and Practice of Medicine,(23) published in 1900. During the First World War it was a common diagnosis used for invaliding out many soldiers. In order to cope with its diagnosis, treatment, and disposal, the Army instituted a short course of training for medical officers who graduated with the title of 'neurasthenic expert'.(24)

Russian psychiatry is largely based on Pavlovian psychophysiological theories. The Pavlovian classification of the principle of neuroses was adopted by all countries that came under the influence of the former USSR. Opinions on the subdivisions of neurasthenia were divided in Russia. One school of thought based its classification on the course of the illness, and the other was based on aetiology. (25) Neurasthenia as a cause of inefficiency and low productivity in the workplace was a recurrent theme in both Russia and Eastern Europe.

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