ABSTRACT
When neurasthenia was removed from the DSM-III, Japan followed the US example, but discussion of neurasthenia (shenjing shuairuo 神經衰弱/神经衰弱) did not cease in professional or lay venues in China. A controversy has resulted regarding the validity of the disease category: is neurasthenia a mood disorder, an anxiety disorder, somatization 軀體化, or a distinct category? This chapter discusses the concepts that have framed this controversy. Concepts from anthropology and cultural psychiatry, including human behavioral breakdown, idioms of distress, and cultural symptom pools, have aided investigations of psychiatric phenomena by taking account of disparate local contexts without resorting to crude equivalencies. This chapter advocates a weak cultural relativism that maintains the ontological reality of psychiatric conditions and recognizes that such conditions are pathoplastic. Two questions guide the inquiry into the neurasthenia–depression debate undertaken in this book: what are we talking about when we make reference to shenjing shuairuo? How is its meaning contested by interested parties? The methodology for this inquiry is a broadly textual one, exploring literary and historical sources in English, Chinese, and Japanese. This approach overcomes one of the chief deficits of extant cross-cultural psychiatry studies, their synchronic perspective.
