Neurasthenia: a paradigm of social psychopathology in a transitional society

A particular social aspect of an illness is reflected in an emphasis on those symptoms that the society considers socially detrimental and/or destabilizing. Thus, in the work- and production-oriented society, chronic fatigue, which affects one's productivity and ability to work, becomes a hallmark of neurasthenia or neurasthenia-like syndrome. In a society based on rigid social structures and severely limited possibilities for social change, excessive irritability and outbursts of anger are perceived as a greater threat to the stability of the existing social order, and therefore they come to dominate the concept of neurasthenia. In Yugoslavia, neurasthenia has been primarily conceived of as a manifestation of an accumulated social frustration and anger; neurasthenia has then been constructed as a mental disorder because anger was expressed in a way that the society considered inappropriate, maladaptive, and pathological. A far-reaching, underlying purpose of this conceptualization of neurasthenia has been a preservation of the social status quo. While neurasthenia as a distinct mental disorder remains controversial, its dependence on the social context cannot be denied. Although the designation of neurasthenia so often seems provisional, because it symbolizes limitations and failures of our diagnostic and nosological systems, it serves a definite social purpose, which varies from time to time, and from one culture to another.