“Neurasthenia and Shenjing Shuairuo in Chinese Culture”

 

-I read an article based on the culture-bound syndrome of Shenjing Shuairuo, or Neurasthenia in western cultures. This article, by Lee and Wong, discussed how this once commonly diagnosed disease, had now made it on the DSM-IV list of “culture-bound syndromes” for its modern day prevalence in Chinese cultures. Neurasthenia was first coined in the United States in 1869, and was described as a disease with fatigue, headaches, anxiety, depression, and neuralgia. During the Victorian era this disease was commonly diagnosed in western countries, particularly the United States and Great Britain. As we progressed in the 20th century, the patients that were once diagnosed as having neurasthenia, were now typically diagnosed with more specific psychological or psycho-somatic diseases that better fit their actual symptoms. But the 20th century also saw the increase use of neurasthenia as a diagnosis for an array of symptoms in Asian countries, but mostly Chinese populations. The Chinese coined their own name for neurasthenia, “Shenjing Shuairuo” and described the symptoms based on principles of traditional Chinese medicine.

-The Chinese description of this illness was a “disharmony and imbalance of the qi (vital organs)”. The breakdown of the name “shenjing shuairuo” further describes the illness; “shenjing” means nerves or spirit, “shua” meaning degenerate, and “ruo” meaning weak. In China and in areas of high Chinese populations, the diagnosis of neurasthenia is often given to someone suffering from mental stress, depression, and anxiety. It is thought that using the diagnosis of neurasthenia or shenjing shuairuo in Chinese society because it is a very common term and diagnosis used between biomedical doctors and a lay person. This diagnosis is often used to prevent stigmatizing the patient, who may have actually schizophrenia or depression, and since this term is widely used and accepted, the person is much more likely to stay active in society and feel comfortable seeking and receiving psychiatric treatment.

-The articles I read made it clear that in Chinese society, the cultural prevalence of diagnosing a patient with shenjing shuairuo is in every sector or the culture- popular, folk, and professional. The articles stated that people in China were very quick and accepting of self-diagnosing themselves with this syndrome, and that traditional and biomedical practitioners both used this diagnosis rather frequently. They did state, however, that the professional sector doctors may do it more so patients don’t experience the stigma of mental disease, rather than clear-cut diagnosis.

References:

1-Lee, S., & Wong, K. C. (1995). Rethinking neurasthenia: The illness concepts of shenjing shuairuo among Chinese undergraduates in Hong Kong. Culture, medicine, and psychiatry, 19(1), 91-111. Retrieved from http://www.springerlink.com.proxy2.cl.msu.edu/content/j537g3k711631861/fulltext.pdf

2-Starcevic, V. (1999). Neurasthenia: cross-cultural and conceptual issues in relation to chronic fatigue syndrome. General hospital psychiatry, 21(4), 249-255. Retrieved from http://ac.els-cdn.com/S0163834399000122/1-s2.0-S0163834399000122-main.pdf?_tid=83ce0582fbfc74acb1b97bb51a0b5773&acdnat=1343003336_40df3f9e79b8806bc8b2f5665ee64f7e

1 thought on ““Neurasthenia and Shenjing Shuairuo in Chinese Culture”

  1. Although arguments could be made in either direction, I do not think neurasthenia should be regarded as a culture-bound syndrome based on what I have learned about this condition in my Culture, Health, and Illness course. Within the professional sector of Western biomedicine, a diagnosis of neurasthenia can be converted into clinical depression by adding mental symptoms such as dysphoric mood and anhedonia. Since depression is a worldwide phenomenon surpassing specific cultures, it should not be considered a CBS since it is not “a locality-specific pattern of aberrant behavior and troubling experience,” as defined in lecture. This sentiment was echoed in Arthur Kleinman’s 1980s research, where he found that neurasthenia symptoms (fatigue, malaise, nervousness, sleep and appetite disturbance, pain, dizziness, gastrointestinal upset) resembled the organic symptoms of depression. Of 100 patients in China diagnosed with neurasthenia, Kleinman diagnosed 93 as suffering from depression according to DSM ethnomedical categories (87 of which were major depressive disorder).

    His conclusion was that the suppressed expression of emotion, the structure of Chinese language, stigmatization of mental illness, and cultural valuation of family unity, harmony, and privacy precluded diagnosis of depression. Moreover, employment institutions in China prioritized industrial development at the expense of family coherence such that physical, not mental illness was required in order to take work leave such that neurasthenia was favored for time off. My opinion that neurasthenia is not a CBS is further justified by Kleinman’s observation that 82% of the 93 identified reported symptom reduction after using tricyclic antidepressants. Importantly, when prompted, a significant proportion of the original sample of ‘neurasthenia’ patients admitted sadness but only when asked directly.

    This suggests that neurasthenia is compatible with Western constructs and that instead of being a culturally-specific pattern of illness experience, a diagnosis of neurasthenia was more amenable to prevailing socioeconomic and sociopolitical conditions within the cultural context of China. This is supported by evidence that depression is more frequently diagnosed in China now that there is more economic security and prosperity, more access to Western medical paradigms, and more willingness to acknowledge mental illness due to circulation of Western psychiatric thinking. Central to this transition is that the government wanted to prevent the drain on resources by making more accurate diagnoses, which would enhance work efficiency and decrease sick leave.

    The advantage of acknowledging neurasthenia as the universal phenomena of depression, instead of as a CBS, is that accurate diagnosis will facilitate administration of proper drugs indicated to alleviate symptoms. In addition to increasing work productivity and providing relief to afflicted populations, classification as depression will lessen the taboo of mental illness as it is perceived as more prevalent and treatable. The disadvantage of not classifying neurasthenia as a CBS is that it is extruded from the culturally encapsulated framework of Traditional Chinese Medicine in which locals understand it. As you mentioned, “since this term [neurasthenia] is widely used and accepted, the person is much more likely to stay active in society and feel comfortable seeking and receiving psychiatric treatment”. Those who suspect depression may be reluctant to seek treatment and be branded with stigmatizing labels, and the idioms and explanatory models through which the Chinese articulate their symptoms may erode. Communication between patient and practitioner may also be impeded if they move from describing the ailment in terms of a Qi imbalance to a neurotransmitter irregularity.

    References

    Kleinman, Arthur. The Social Origins of Disease and Distress: Depression, Neurasthenia, and Pain in Modern China. Yale University Press, 1988.

    Pugh, Judy. Culture, Health, and Illness. Michigan State University. McDonel Hall, East Lansing. 3 April 2012.

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