The term neurasthenia has had a chequered history, and although retained as a diagnostic entity in the ICD-10 it does not appear in the DSM-IV. In cultures where neurasthenia still enjoys popular professional and lay acceptance it has a variety of usages:

• a nosological entity

• an idiom for expressing distress

• a culturally sanctioned illness behaviour

• an explanatory model for a constellation of somatic symptoms

• a euphemism for avoiding the stigma of mental disorder.

Therefore, in diagnosing, understanding, and managing neurasthenia theclinician has to be aware of the context in which the term is used. Historical background

Future research and clinical data will determine whether neurasthenia will be replaced by chronic fatigue syndrome or somatoform disorders, and thus be relegated to a footnote in the history of medicine, or will enjoy a resurgence with a new set of diagnostic criteria.

The historical development of some concepts does not necessarily progress in a linear fashion. Some ideas may be revisited, albeit at differentlevels. Until very recently neurasthenia has been a malleable concept, and as such it has extended into the domains of psychiatry, general medicine, and social science. Currently, there are attempts to narrow its definition. An understanding of the history of neurasthenia provides insights into the trends in psychiatry and the interplay of scientific theory and cultural values in the fashioning of a disease entity. (1)

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