Classic Text No. 76: 'Asthenia' by A. Dechambre (1865)

Abstract

The word asthenia has been used to name descriptive and explanatory concepts, hypothetical functional states, symptoms, syndromes and diseases; and on occasions it has been considered a synonym of adynamia, aboulia, feeling of fatigue, weakness, and lack of energy; for a time it was even the official antonym of `sthenia'. Because at its core it refers to the (hypothetical) want of some driving element, asthenia has from the start been parasitical upon foundational concepts such as `force' and `energy'. For example, following the popularization of Newton's concept of force, asthenia was redefined as a failure in vital impetus (the biological version of the Newtonian idea).This alliance of asthenia with vitalism lasted up to the middle of the 19th century, by which time the new concept of energy had come to the fore and asthenia was dutifully redefined as a lack of `physiological' or `psychological' energy. The 1850s also witnessed the arrival in medicine and psychiatry of the belief that subjective experiences are epistemologically informative. Soon enough asthenia was to become a new name for general (reported) feelings of tiredness, fatigue or aboulia and ceased to be defined on the basis of interactions between hypothetical stimuli and individual diathesis as it had been in the work of Hippocrates, Boissier de Sauvages, John Brown and others. However, defining asthenia on the basis of subjective experiences caused a blurring of boundaries which invited the construction of new `clinical disorders' such as neurasthenia, psychasthenia and the `pathologies of energy'. This medicalization of tiredness culminated in the emergence of the notorious `chronic fatigue syndrome' (CFS) which contained many of the conceptual vices of the past. The epistemology and social role of CFS will not be understood until the history of the concept of asthenia from which it directly derives is adequately studied.