Neurasthenia: An Old Name for Chronic Lyme Disease
by M.M. Drymon
Lyme disease appears to be an ancient and ubiquitous affliction that humans have been coping with for eons. It can be argued that, using the tools and knowledge available within a historical culture or social paradigm, people labeled and understood Lyme disease as a variety of named afflictions. These may have included the sicknesses associated with witches and witchcraft during the Early Modern Era, rheumatism, the summer sickness, the currently popular fibromyalgia, and neurasthenia- an ill defined disease that was often diagnosed in the late 19th and early 20th centuries.
The core symptoms of neurasthenia were excessive physical and mental fatigue and muscle weakness. Common features included insomnia, depression, fears and irritability, headache, sweating, polyuria, tinnitus and vertigo, photophobia, easy exhaustion at the slightest effort, inability to concentrate, complaint of poor memory, poor sleep, numerous constantly varying aches and pains, and vaso-motor disturbances. This is also a classic description of the myriad of symptoms that can be associated with the third stage or Chronic Lyme patient. Lyme disease, called "the great imitator" because it carries with it such a wide array of symptoms, may have been the cause of many cases of neurasthenia in the past. How did people with neurasthenia fare in the past? The answer is: none too well! They were sometimes subjected to ridicule and ridiculous theories, pushy patent drug promotional campaigns, derision, and the occasion bout of electric shock therapy. So many languished in this time period that they entered the literary world as an American trope-consider Edith Wharton's cranky wife character from her novel Ethan Frome, with vague symptoms, chasing after innumerable doctors, looking for help. Seem familiar?
Neurasthenia first appears in the medical literature in 1869. The term was 'coined' by George Miller Beard to denote a newly appearing condition. Although also found in England and Europe, Americans were supposed to be particularly prone to this affliction, which resulted in it sometimes being called "Americanitis." It was explained as being a result of exhaustion of the central nervous system's energy reserves which was attributed to the stress of modern civilization. Physicians associated neurasthenia with urbanization and the stress suffered as a result of an increasingly competitive business environment. Typically, it was associated with upper class people and professionals with sedentary employment. Women were thought to be more vulnerable because of their weaker nervous systems. Women were thought to be "more prone to break down in this way" especially if they were educated. They "never get over a long and ambitious course of study…" A common treatment was the rest cure, especially for women.
Looking back there have been many attempts to explain the epidemic which appeared in the 1860's and ended in the 1930's. Elaine Showalter presented a feminist thesis for the history of neurasthenia. In her theory, female victims languish fatigued, often incapable of walking, on the chaise-lounges of London and New York as a form of protest against their empty and unfulfilled lives. But a review of statistics from primary sources reveal contradictory and contrasting views on the gender distribution of neurasthenia-finding it about equally distributed between the sexes. Some writers considered it to be a disease of professional and intellectual men, found to be common among clergymen prone to overwork
''Americanitis,'' became the clarion call for a nascent and developing patent medicine industry, which profited handsomely from sales that were accompanied by early advertisement campaigns. The concept of neurasthenia reached a high point and world-wide medical acceptance by the end of the 19th century. Then, sometime after 1930 it virtually disappeared as a diagnosis. In the 1990's, in the middle of the modern Lyme disease epidemic, a new wave of patients were being afflicted and diagnosed with chronic fatigue, fibromyalgia, Gulf War syndrome, and multiple chemical sensitivities-all like Chronic Lyme disease were in many ways similar to the old neurasthenia. Parallel to these developments, increasing importance was attached to clinical descriptions of illnesses which, on account of their similarity to the symptoms of neurasthenia, could be termed modern variants of the same disease.
While the question of causality has not been decisively answered for any of these modern afflictions, Chronic Lyme disease has become mired in a peculiar form of stasis induced by medical politics that denies root cause preferring the psychological "all in your head" explanations. Once again, women seem to have been singled out, correctly or not, as the focus of an odd and peculiar type of attention. As the cyber-prolific Dr. Edward McSweegan lamented, "What is it about white, upper-middle-class, college-educated, middle-aged women that compels them to use a common infectious disease as the vehicle for their emotional and psychological problems?" Could it be because that common infectious disease has caused the problems?
Many modern physicians have depicted patients who continue to experience symptoms after antibiotic treatment for Lyme disease as having the class of disease that became popular in the Post Freud Era: the psychiatric disorder. And indeed, a recent study has shown that as many as one third of all the patients in at least one modern psychiatric hospital may be infected with the Lyme spirochete. When the twentieth century Lyme patient, Polly Murray, was admitted to the mental ward of a Boston hospital, she may have been reluctantly following in the footsteps of many centuries worth of Lyme disease sufferers, including those with neurasthenia.
The decreased prevalence of neurasthenia may be due to this paradigm shift in medicine in which neurasthenic symptoms came to be regarded as caused in the mind. Neurasthenia as a symptom complex never actually disappeared, but was simply re-labeled. There was a 'diagnostic drift' in the evolution of disease categories. The same point is made in an article by Wessely, who provides evidence from primary sources that symptoms of neurasthenia were replaced by psychological symptoms. He also suggests a continuity between neurasthenia and the modern diagnosis of chronic fatigue syndrome or myalgic encephalitis (ME). Chronic Lyme disease can be added to this historic spectrum.
An environmental context also needs to be added to any holistic discussion of Lyme disease and neurasthenia. The rise and fall of neurasthenia in the late 19th and early 20th century appears to follow the level of industrialization, de and re-forestation, and also the amount of interaction between the human population and the forests. The peak of the deforestation in New England occurred between 1800 and 1850. It is estimated that, with the exception of northern Maine and New Hampshire, nearly 80% of forested regions in New England were cleared for agricultural use during this time. But with the move of agricultural hubs to the Midwest and populations into urban areas, between 1885 and 1925, the forest cover grew back, more than doubled, and exceeded 70% growth back by 1952. It has steadily increased ever since. One of the activities enjoyed by upper class urban Americans, who sought to regain contact with the 'healthy' natural world, was "rusticating"-visiting rural and forested areas while on vacation. These activities brought with them an increased risk for Lyme disease infection. During the Great Depression, it appears that there was much less interaction with the forests, and it remained so until a post-war building boom brought the suburbs and their inhabitants back into the forests. Since Lyme disease is part of a complex environmental cycle there are also other factors, like mouse and deer populations that would all play into the pattern of infection.
