Weak nerves in China: Neurasthenia-depression controversy as a window on psychiatric nosology
Although shenjing shuairuo (SJSR) has remained a salient clinical and cultural concept in China since the first decade of the twentieth century, in 1980 neurasthenia was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. This roughly coincided with the opening of China after Nixon’s famous visit, and for the first time in many years, Western academics were welcomed back into China to research and collaborate. Several publications arising from one such collaboration sparked what has become known as the neurasthenia-depression controversy and initiated a paradigm in cultural psychiatry termed the new cross-cultural psychiatry (NCCP). Almost without exception, research on SJSR has cited and relied upon the perspective and interpretation of writers situated within the paradigm of NCCP. Unfortunately, there has been no effort in the literature to make a comprehensive criticism of the predominant views of SJSR as they have been propagated over the past 40 years through NCCP writings. In this dissertation, I undertake this effort by first addressing the origins of neurasthenia in the West and then making a study of how SJSR came to be a salient category in China. After establishing this background, I attempt a comprehensive exegesis of the hegemonic efforts of Western psychiatry to frame SJSR within the NCCP and the responses of Chinese scholars to those efforts. In addition, I develop an explanation for how psychiatric distress can vary across cultures. I argue that culturally salient categories are conformed to consciously or unconsciously through a process of belief and expectation, and that codified experiences can be translated from the mind to the body and back again. I maintain that neurasthenia arose as a diagnostic category in the context of a long historical discourse of “nerves” and “nervousness,” but that SJSR became a salient conceptual category in the absence of any such historical discourse. As such, it became a temporally, geographically, and culturally specific mode of manifesting human distress and inner perturbation. SJSR will continue to defy attempts at reductionistic redefinition under the influence of American psychiatry, as it (and categories like it) serves an important function in capturing certain forms of human experience.
cultural psychiatry, neurasthenia, shenjing shuairuo
University of Illinois - Urbana-Champaign
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University of Illinois at Urbana-Champaign