Trajectories of neurasthenia: negotiating nature and culture within medical practices

The aim of this project is to study the history of neurasthenia in the Norwegian context, from 1880 and up to the present day. Neurasthenia was used as a diagnostic label in the USA from ca 1869 and onwards, and in Europe from ca 1880. The exact cause was not known, but neurasthenia was assumed to be a weakness of the nervous system. This weakness was in turn thought to be caused by several possible factors, such as poor diet, infectious diseases, mental and physical traumas, as well as overexertion of various kinds. There were many possible symptoms of neurasthenia; fatigue and pain were among the most common. The use and understanding of neurasthenia as a diagnostic concept has changed through the years, and also varies between different cultures and countries. Neurasthenia has also "belonged to" several different clinical specialities through the years, such as internal medicine, psychiatry and neurology. The substudies of this project address the introduction of the concept of neurasthenia to Norwegian medicine in the 1880s, the etiological theories and common treatments of neurasthenia in various clinical settings in Norway ca 1880-1920, and the major changes of the Norwegian medical understanding and use of the concept from 1880 and up until today. In addition - since it has been claimed that neurasthenia was a "predecessor" for several conditions known to us today by other names, such as burnout syndrome, chronic fatigue syndrome, and others - the project also includes an analysis of how the historical understanding of neurasthenia is used in the contemporary debate about these diagnoses.

The overall task of the present project is to perform historical analyses of the concept and practice of neurasthenia in Norway, from 1880 up to present day. Neurasthenia, meaning nerve weakness, was a widely used diagnostic label in the Western world dur ing the decades around 1900. A study of the historical concept of neurasthenia in Norway will be useful in the sense that past enactments of neurasthenia constitute important cultural prerequisites for the current knowledge and debate on myalgic encephalo myelitis/chronic fatigue syndrome (ME/CFS). ME/CFS is a poorly understood condition, and a significant challenge to society. The diagnosis is controversial and contested in medical circles, and the ongoing Norwegian public debate about the aetiology and t reatment of the syndrome is characterized by polarization, confusion and strong personal opinions. The present project will therefore be of relevance and use for contemporary society, as it will bring clarity to some of the most debated issues regarding M E/CFS. The project consists of three sub-studies:1) a historical analysis of practices of neurasthenia in its 'golden age' 1880-1920 2) a historical analysis of the medical concept of neurasthenia in Norway from 1880 to the present, and 3) a study of how the historical neurasthenia concept is mobilised in the current debate about ME/CFS, nationally and internationally. Of central importance to the current debates is a cultural understanding, common to almost all participants, of a fundamental barrier bet ween the biological and the psychological, between somatic and psychic causality, between nature and culture. Hence, in all three studies, the relationship between nature and culture in the discourse on neurasthenia will be a recurrent theme. Case records from hospital wards, reports from medical officers and medical journals and textbooks will serve as primary sources, as well as media of different kinds.