A neurotic reaction marked by persistent feelings of mental and physical fatigue, diffuse “nervousness,” and vague aches and pains.The asthenic patient feels that any exertion is too much for him, and finds it difficult to concentrate, make decisions, or carry any job through to completion. Minor problems or difficulties are magnified to major proportions, and any hint of criticism is likely to upset him completely. He spends an unusual amount of time sleeping but invariably awakens unrefreshed and out of sorts. Yet his fatigue and lassitude tend to be selective rather than total, for he may have ample energy for sports, recreation, or other activities that arouse his interest.The asthenic individual is constantly worried about his physical condition. A chronic hypochondriac, he is always complaining about headaches, dizziness, back trouble, weakness, or vague discomfort in his stomach, head, chest, or genitals. In men potency is likely to be impaired, and in women menstruation is usually painful or irregular. Every upset, even the slightest, produces the same degree of distress and concern. Similarly an undue amount of attention is paid to digestion and elimination and to the latest diets, laxatives, vitamins, and pills that are supposed to keep these processes in order.Asthenic reactions are especially common among middle-aged persons, including the “nervous housewives” who feel trapped in their homes. The disorder seems to be most prevalent on the lower socioeconomic levels, and probably accounts for at least 10 per cent of all neurotic disorders.The asthenic syndrome used to be ascribed to physical depletion of the nerve cells due to overwork and emotional burdens. The American psychiatrist George Miller Beard originated the name neurasthenia—literally, “nerve weakness”—but this term is falling into disuse today because the disorder is regarded as a psychological rather than a physical fatigue reaction. See NEURASTHENIA.The dynamics of asthenic reaction are relatively clear since it is so closely related to everyday experience. We all know how readily we become tired and listless when we are disappointed or bored or tom by conflict—and how easy it is to concentrate on the slightest aches and pains at such times. It is not hard, then, to imagine how a person who feels chronically dissatisfied, discouraged, frustrated, or rejected would respond. In such a person the ordinary reactions might well be exaggerated and he would become exhausted instead of merely tired, inert and immobilized instead of merely sluggish, and prey to any number of physical complaints instead of just a few. This is actually what happens to the asthenic individual.The life histories of asthenics may not reveal sufficient reason for their extremereactions, but they usually show that they have experienced a fairly large amount of failure, monotony, lack of affection, sexual dissatisfaction, or social problems. In adult life asthenic wives may actually be trapped in the home and cheated by life (and sometimes by their husbands as well)—up to a point. But more important than these influences—which thousands of other people experience—are their own attitudes and reactions. Instead of “coming up fighting,” they allow themselves to be consumed by resentment or numbed by feelings of hopelessness. Then, perhaps repeating a tendency which originated in childhood, they begin to exaggerate any physical complaints they happen to have, as a response to an unconscious urge to escape from responsibility. If this serves the purpose well and in addition brings them “secondary gains” in the form of attention and sympathy or control over others, the reaction may develop into a confirmed pattern.As this pattern takes hold, the person with asthenic tendencies gradually becomes a chronic complainer and “wet blanket.” Members of his family may try to excuse him because he suffers so much, but eventually they usually lose patience and find it hard to be sympathetic, especially since he may make them feel they are somehow responsible for his troubles. Moreover, it becomes increasingly hard to live with a person who is so lacking in confidence, independence, and ordinary cheerfulness. But any criticisms or suggestions they make fail to do any good since the asthenic is basically an immature individual who finds himself totally inadequate to face up to the problems of life. Instead, he falls back on illness, fatigue, and dependence as a way out.It is not easy to change these personality patterns. The physical complaints are so real that the patient cannot believe that they have a psychological origin. Besides, organic disorders do develop in many cases because of lack of sleep and a generally run-down condition, and since these conditions have to be treated medically the patient feels that all his ailments must be purely physical. In many cases the frustrations of life are also so undeniable that it is hard to convince him that things are not as hopeless as they seem. Moreover, the benefits he derives from the attention and assistance of others make it even more difficult for him to give up his symptoms.In spite of these obstacles it is often possible to treat the asthenic successfully, particularly if the reaction has not become too deeply ingrained. The object of therapy is to help him gain insight into the faulty techniques he has been using, and to grow to a point where he will no longer need to fall back on them. He must also learn to assess his life situation more accurately and become more and more confident that he has the ability to stand up and meet his problems. This is usually a step by step process in which he needs considerable support from the therapist. See HYPOCHONDRIASIS. Illustrative Case: asthenic reaction The following excerpts are taken from an interview with a middle-aged married woman who felt, and with good reason, that her husband was no longer interested in her. Often he failed to come home for several days at a time, and when he was home, he showed little evidence of interest or affection. Although the patient had completed high school, she had no occupational skills and felt completely dependent upon her husband for support and protection. She was self-pitying in her attitude, prone to relating her symptoms almost endlessly, and very demanding in her attitude toward the therapist.PT: I used to talk rather fluently, but now I’m more nervous than I’ve ever been and my tongue seems to catch on my teeth so that I don’t speak plainly. Everything seems such an effort . . . like I had an anchor tied to me or something. I no longer care to play cards or even talk to people any more. . . . Even the simplest things are too much for me. DR: Even the simplest things . . . PT: Ah, hm, I mean, the phone is there and I’m lonesome and yet I don’t even phone. ... I don’t even talk to my neighbor much any more even though I know that I should be with people and I like people, but I’ve gotten so that . . . (long pause) . . . that . . . (sigh) ... I feel too bad to even talk or do anything (voice breaks and tears).I’ve tried so many things to get well, but it’s just awful ... I mean . . . sometimes I can just barely live ... I mean just listen to the radio or read, or eat . . . I mean just like being in a daze or something ... I don’t know ... I just feel so horribly tired and sick.Two months ago I felt better than I had been. I mean I was able . . . well I went to several shows and I actually even went to a dance. Often I would begin to get tired, and I was very frightened that I would break down, but I would go on . . . I mean like some people would go to a battle or to a battlefront (proud tone of voice). But . . . now . . . well I am just so tired and run-down that I can’t evengo to the show ... if I do go ... I have to leave in the middle because I’m not strong enough ... I mean I don’t have enough strength to sit through it. DR: Two months ago you felt better? PT: Well, yes . . . you see my husband’s brother came to visit us . . . and he would talk to me and he had such a way of diverting me and he was very interesting, and you’d be amazed, within a few minutes or a few hours I’d be just different . . . and he took me to several shows and to the dance. I felt so much better and I had a really good time. So I can see it isn’t sleeping or eating. I mean ... I need someone who’d give me something different to think about . . . someone who’d show you some affection . . . enough interest in you so that you would improve. But my husband . . . well, I just can’t understand how he can treat a woman who is ill . . . and trying her best . . . well (tears) ... I have just sort of withdrawn ... he has really made me sick . . . (Coleman, 1964)

Cite this page: N., Sam M.S., "ASTHENIC REACTION (Neurasthenia)," in, November 28, 2018, (accessed September 26, 2022).


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