Are somatoform disorders changing with time? The case of neurasthenia in China

To examine how sociocultural factors shape the professional classification and transformation of neurasthenia (shenjing shuairuo in the Chinese language) in China.

We review the relevant literature as well as cite our own research experience on the topic.

We identify three main periods of transformation, namely, the prereform period (before 1980) in which neurasthenia encompassed a wide range of anxiety and mood disorders; the reform period (1980s-1995) when the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III) and Kleinman's study in Hunan steadily shaped the Chinese conceptualization of nonpsychotic mental disorders; and the postreform period (after 1995) when neurasthenia has become a rarely used category of subsyndromal depression among Chinese psychiatrists.

The dramatic transformation of neurasthenia in China speaks to the global power of the DSM system of classification, on the one hand, and the latter's failure to engage cultures in the local system of psychiatric practice, on the other. The Chinese story of neurasthenia and the social context in which the disease category is contested, marginalized, and reconstituted as the popular Western disease of depression among Chinese psychiatrists attest to the socially constructed nature of psychiatric classification. The public health implications of this transformation remain unclear.