Causation

Neurasthenia is a condition of loss of tone of the nervous system which is of a functional rather than an organic character. It is also called nervous exhaustion or nervous prostration. Strictly speaking, it is not a disease, but rather a functional derangement of considerable duration, which, however, with proper care and dietetic treatment results usually in complete recovery. The most apparent cause of neurasthenia is overwork of the nervous system due to continued excitement or strain or prolonged emotional depression and anxiety. It is far more apt to be produced by overwork of the nervous system than of the muscular system, although it may be occasioned by the latter. Different individuals are endowed with varying degrees of nerve force, and the complex demands and great activity of highly developed civilisation tempt or compel many people to draw upon their physiological capital of energy at the expense of its income, with the result of exciting the entire central nervous system, including both brain and spinal cord, to an unwonted and sometimes dangerous degree. For this reason neurasthenia is essentially an affection incident to the occupations and customs of city life, rare or comparatively unknown in the repose of the country.

It is a curious but undeniable fact that there appears to be more or less fashion in regard to some diagnoses, in nomenclature at least, if not in the diseases themselves, and of late years " nervous prostration" has taken rank among ordinary functional disorders.

The general name neurasthenia includes a large variety of nervous symptoms, and while all of the physiological processes of the body are more or less impaired, the symptoms may predominate in one or more mechanisms, as, for instance, that of the circulation, gland secretion, or absorption.

Men who find themselves in business straits or in circumstances of prolonged anxiety feel that they are straining their vital powers, and resort to an increased or excessive use of stimulants, such as alcohol, tobacco, coffee, and various drugs, to excite their overtaxed mental and physical powers into greater activity. By means of this substitution of force, especially with the use of alcohol, they are enabled to work on, and still further excite a debilitated nervous system until finally the limit of endurance is reached, and some slight additional strain reduces them to utter prostration. Not infrequently local functional disorders, such as writer's cramp, neuralgia, etc., give warning that a general neurasthenic condition is imminent, and if this warning be not heeded in time, more serious symptoms inevitably follow.

Neurasthenia reacts on the digestive system, producing malnutrition and a variety of functional disorders, for so dependent is the whole alimentary canal upon a normal vigorous blood supply and nerve regulation that it necessarily suffers profoundly.

General Treatment

The treatment of neurasthenia is fundamentally based upon two absolutely essential conditions: First, complete body rest, with the necessary absence of the original exciting cause of the difficulty, which will enable the impoverished tissues to become regenerated and have the balance of their energy properly retarded; secondly, a nourishing diet, which will supply the material for this energy and tissue metamorphosis. Various tonics, such as strychnine, iron, and arsenic, are of recognised benefit to the nervous system, but the main reliance in all treatment must be placed upon rest and food. The milder cases may be relieved by a change of occupation and the enforcing of strict rules in regard to the hours of sleep, the methods and time of eating and taking exercise, bathing, etc. Many persons with functional nervous disorder have no appetite early in the day, but towards evening can eat a substantial meal, and they should dine late.

Patients who for years have been accustomed to exceedingly active mental work find it almost impossible to endure confinement, absence from social intercourse, and lack of occupation, and in such cases the advantages of dietetic treatment may be enhanced by cheerful surroundings and diversion. As a rule, it is far easier for the fatigued or worried business man or "brain worker" to break off completely his accustomed occupation for a period of several weeks or months, to be spent in travel or at some foreign spa, than it is for him to continue his ordinary occupations in moderation, and take exercise and proper food and sleep in accordance with the rules laid down by the physician.

In many cases of this nature travel affords a certain and fairly prompt relief, but it has the disadvantage that it involves considerable irregularity in the hours of rest, character of diet, etc., as well as the fact that many are deterred from this means of cure by the expense involved. In another class of cases too active travelling is stimulating and fatiguing, and if such people are not made ill at sea nothing gives more benefit than the isolation, invigorating air, and enforced idleness of a sea voyage. For others, in whom the digestive system is comparatively little impaired, camping or living an outdoor life in the woods affords the same advantage. Whatever journey is undertaken, therefore, should be in the direction of rest and moderate diversion without the sight-seeing which is involved in visiting new cities. The physician should not only study carefully the previous habits of the patient, but should consuit his tastes in regard to occupations and amusements. When this is done and his confidence has been thoroughly gained, it is far easier to have the rules for diet which are prescribed carefully adhered to. In still another class of cases of neurasthenia the general nerve breakdown is so sudden and the exhaustion so extreme that absolute rest at home and in bed is imperative.

To this class of cases belong a large number of overworked society women whose lives of constant excitement and mental activity or stimulation, combined with the number of charitable interests or other occupations to which they give much energy, wear them out in time.

The most severe cases of neurasthenia require special treatment, the principles of which are, first, complete rest for body and mind; secondly, systematic feeding; and thirdly, massage. This treatment is applicable to those cases in which the nervous system is so greatly exhausted that the patient suffers continual depression from the least exercise, exertion, or emotional excitement. In some instances insomnia is a predominant and serious symptom; in others the patient is drowsy in the daytime and unable to perform any concentrated mental labour; in others again inanition is the most pronounced feature, and the rapid loss of weight and failure of strength alarms the patient, or the body may even increase in weight, while the muscles become soft and so feeble as scarcely to support the frame. Many cases are complicated with pronounced hysteria, hypochondriasis, or unnatural irritability.

One of the first requisites in treatment is to secure a faithful and intelligent nurse and to isolate the patient from well-meaning but oversympathetic friends whose constant inquiries and suggestions are apt to aggravate existing conditions by focusing the attention of the patient upon them. In general, it is best to allow no one to see the patient excepting the trained nurse, the physician, and perhaps some one trusted member of the family. All business matters and domestic news of an exciting or depressing character should be carefully kept from the patient, and such connection as may be allowed with the outside world should be only of a cheering and encouraging nature.

It is very important that the nurse, who is so constantly with the patient, should be congenial and possessed of the requisite tact and cheerfulness of disposition. Many of these details may seem trivial, but their importance is appreciated after experience, which shows how easily infringement of the rules, such as the untimely reception of exciting news or the visit of an untactful friend, may react upon the digestive system and interrupt the favourable progress of the case for several days. This is particularly true of all hysterical cases. On the other hand, there are some instances in which patients with active minds do decidedly better if mild, pleasurable occupation or entertainment, such as reading aloud, is provided for them, which is carefully limited to prevent fatigue.

It is necessary to explain the general plan of cure and its object to both patient and family in order to secure their cooperation, and this having been done, the treatment which has received the name of "rest cure" should be outlined by definite rules in a most careful and systematic manner. To be of any service, the rest cure should last six weeks or more, and in severe cases it should be explained that this treatment by no means completes the restoration of the normal nerve functions, but is to be regarded as a basis for a further regimen of exercise and outdoor life. While the rules for diet for individual cases must be distinctly laid down, and conscientiously adhered to, there is scarcely any other variety of disease in which the physician is called upon to exercise more tact and discretion, and the success of the treatment will depend very largely upon the extent to which he adapts its provisions to the needs of individual cases. It is comparatively easy to prescribe definite regulations for the treatment of neurasthenia, but practically there is no case which does not present individual peculiarities which require special consideration.