The fear-panic of driving on a high bridge, the mania to check fifty times whether you have locked your doors … So many manifestations that can evoke psychasthenia: a syndrome characterized by anxiety, obsession , doubt, as well as inhibitions and phobias. It was described for the first time by Pierre Janet, at the beginning of the XNUMXth century: this former high school teacher turned doctor had the ambition in particular to distinguish psychology from his philosophical past, and to add to it “The method of natural sciences”. Today, psychasthenia is more frequently referred to as obsessive neurosis.

Impotence to act and tendency to introspection. Mental rumination, doubts, scruples, anxious thoroughness, extreme concern for precision. Or, sadness, morning asthenia: so many manifestations of psychasthenia, a syndrome classified by the World Health Organization (WHO) in the category “other specified neurotic disorders”.

In an article published in the California and Western Medicine from 1925, and describing several cases of patients, Thomas Orbison recalled the definition of psychasthenia: it is characterized by hyper or hypo-irritability, as well as by excessive or exaggerated responses even to normal daily stimuli, and even more to stimuli involving the emotional sphere. Its main symptoms are phobias, feelings of inadequacy, anxiety and fear in general.

Currently, the term psychasthenia is frequently replaced by that of “obsessive neurosis”, and groups different pathological states or personalities, such as a poorly structured phobo-obsessive syndrome, a personality type or borderline state, or even schizoidy.

Pierre Janet (1859-1947), a high school teacher in Le Havre who then became a doctor, believed from the start of the XNUMXth century that psychiatry was wrong in “inventing” a disease by symptom: phobia, anxiety, depression, cyclothymia, etc. For him, “It is a personality who is sick as a whole”. Thus, according to him, it is certainly necessary to treat the symptom, but above all the individual.

He considered that the mental pathologies had been too subdivided, and estimated that apart from the psychoses, one distinguished only two sets: the psychasthenia and the hysteria. Both being weakenings of the ego, characterized by obsessions, or “fixed ideas”. One of his books, written in 1903, Obsessions and psychasthenia, described in particular a feeling of incompleteness in the intellectual and emotional sphere, in patients with psychasthenia.

We can however make a criticism of the vision of the Norman doctor, in the sense that he, radical, believed that “The treatment of psychasthenia would be really more effective starting before birth” : this meant that people with bad nervous heredity should, according to him, not marry or have children!

A psychasthenic patient is often described as “nervous”, worrying about trivial matters, or frequently depressed for seemingly trivial reasons. He is also constantly in doubt when faced with alternatives, even if the eventual decision is unimportant. Tics are sometimes associated with this syndrome, such as grimaces, head movements …

For Pierre Janet, the cause of psychasthenia was the weakening of conscious control, linked to the loss of high intellectual functions. Subsequently, other works in psychology, in particular those of the English Mac Douglas and the Austrian Sigmund Freud, questioned this intellectualist vision, and recognized the cognitive aspects of the mind involved in psychasthenia. Dr. Gibson estimated in 1926 that feelings of guilt developed in childhood and adolescence, or the inadequate development of ego feelings, could be caused by unfavorable educational or environmental conditions.

A recent study, dating from 2016, also highlights the environmental character involved in psychasthenia: thus, children exposed to trauma during their infancy, before the age of five, prove, for example, later, more affected by psychasthenia – but also, by schizophrenia, social introversion, etc. – only children who have suffered trauma later in childhood. A study that confirms the influence of multiple factors occurring during early childhood, on the formation and personality traits in adulthood.

“We have to do with the patient, as we find him”, wrote Purves Stewart, in 1907. For him, the treatment of psychasthenia should be moral, that is to say psychotherapeutic, in order to teach the patient to fight his obsessions and his phobias. The treatment also had to be physical: with, in particular, correct nutrition, massages, cold baths, as well as physical exercise, the beneficial effects for the patient were real. In addition, the doctor should, according to him, “To encourage the patient”.

Similarly, the method called in English “Training Camp Method”, based on physical training as well as individual and team sports, especially in competition, had been proven at the beginning of the twentieth century, demonstrating a redemption of this syndrome. psychasthenia in many patients.

Even today, psychotherapeutic approaches are still the major remedy. But at a time when, moreover, the consumption of anxiolytics is more important than ever, perhaps these methods of the time, which involved much more than today physical activity and sport in the care psychasthenia and mental health in general, should they be more updated …