The keynote of neurasthenia is increased liability to fatigue.  The tired feeling that comes on with a minimum of exertion, worse on arising than on going to bed, is its distinguishing mark.  Sleep, which should remove the fatigue of the day, does not; the victim takes half of his day to get going; and at night, when he should have the delicious drowsiness of bedtime, he is wide-awake and disinclined to go to bed or sleep.  This fatigue enters into all functions of the mind and body.  Fatigue of mind brings about lack of concentration, an inattention; and this brings about an inefficiency that worries the patient beyond words as portending a mental breakdown.  Fatigue of purpose brings a listlessness of effort, a shirking of the strenuous, the more distressing because the victim is often enough an idealist with over-lofty purposes.  Fatigue of mood is marked by depression of a mild kind, a liability to worry, an unenthusiasm for those one loves or for the things formerly held dearest.  And finally the fatigue is often marked by a lack of control over the emotional expression, so that anger blazes forth more easily over trifles, and the tears come upon even a slight vexation. To be neurasthenic is to magnify the pins and pricks of life into calamities, and to be the victim of an abnormal state that is neither health nor disease.

The more purely physical symptoms constitute almost everything imaginable.

1.  Pains and aches of all kinds stand out prominently; headache, backache, pains in the shoulders and arms, pains in the feet and legs, pains that flit here and there, dull weary pains, disagreeable feelings rather than true pains.  These pains are frequently related to disagreeable experiences and thoughts, but it is probable that fatigue plays the principal part in evoking them.

2.  Changes in the appetite, in the condition of the stomach and bowels, are prominent.  Loss of appetite is complained of, or more often a capricious appetite, vanishing quickly, or else too easily satisfied.  The capriciousness of appetite is undoubtedly emotional, for disagreeable emotions, such as worry, fear, vexation, have long been known as the chief enemies of appetite.

With this change of appetite goes a host of disorders manifested by “belching”, “sour stomach”, “logy feelings”, etc.  What is back of these lay terms is that the tone, movement, and secreting activity of the stomach is impaired in neurasthenia.  When we consider later on the nature of emotion, we shall find these changes to be part of the disorder of emotion.

3.  So, too, there is constipation.  In how far the constipation is primary and in how far it is secondary is a question.  At any rate, once it is established, it interferes with all the functions of the organism by its interference with the mood.