University of Virginia Historical Collections at the Claude Moore Health Sciences Library

Neurasthenia: Introduction

Image: Gustave Caillebotte. Paris Street, Rainy Day, 1877. Art Institute of Chicago.


In the 1880s, U.S. physicians developed a diagnostic profile for a condition afflicting the leading families of the United States. The best educated, most cultured Americans were suffering from a new, distinctly American condition that was destroying their health. They had migraines, poor digestion, fatigue, depression, and even complete mental collapse in alarming numbers. They suffered from neurasthenia – nervous exhaustion.


The clinical and diagnostic profile for nervous exhaustion (neurasthenia) was first described in 1881 by George Miller Beard, M.D., an early neurologist and graduate of the College of Physicians and Surgeons of New York. Beard based his ideas on a theory of “nervous energy,” that is, the health and capability of the nervous system. If this energy was depleted or abused, the person fell into nervous exhaustion and its debilitating conditions. Beard’s best known books were American Nervousness, With Its Causes and Consequences (1880) and Practical Treatise on Nervous Exhaustion (1884).


Evolution of Neurathesia

This chart from American Nervousness, With Its Causes and Consequences by George M. Beard (1880) illustrates the progression of symptoms that were attributed to neurasthenia.

Beard saw neurasthenia as created by the hectic, fast-paced life in American cities – he even called it “American nervousness.” The nation’s leaders in business, government, and the arts were made ill by the stress and strain of modern life. The only cure was withdrawal from the pressures of urban life, rest, and a simpler, healthy lifestyle.

The diagnosis and treatment for neurasthenia were distinctly American, but the concepts soon became part of standard medicine in Great Britain, France, Germany, the Netherlands (Holland), and eventually in China and Japan.

Also, the condition gradually spread to more and more groups of society, not merely the elite. Neurasthenia was almost a badge of social status. Further, anxious, and depressed patients were reassured that their symptoms were caused by a physical disease (exhausted nerves) and not by psychological weakness.






Neurasthenia is no longer an official diagnostic category in Western medicine (except in psychiatry where it is rarely used outside China and Japan). Instead, modern physicians recognize different conditions, such as clinical depression, fibromyalgia, post-traumatic stress disorder, postpartum depression, and perhaps chronic fatigue syndrome and mononucleosis as being part of what physicians in 1900 called neurasthenia.

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