Wessely, S · Psychological medicine · 1990 · DOI
This paper compares ME/CFS with an older condition called neurasthenia that was common in the late 1800s and early 1900s. Both illnesses share similar symptoms of extreme fatigue and were popular diagnoses when people believed they were caused by physical (not mental) problems and affected successful, hardworking people. The author argues that understanding ME/CFS requires looking at both brain biology and social factors, not just one or the other.
This historical analysis is important for ME/CFS patients and researchers because it demonstrates how medical understanding of unexplained chronic fatigue has evolved, and cautions against oversimplifying the condition into either purely physical or purely psychiatric categories. It highlights how social context, medical paradigms, and patient demographics shape disease recognition and treatment approaches, which remains relevant to current debates about ME/CFS validation and management.
This paper does not provide empirical evidence about the biological causes of ME/CFS, nor does it establish diagnostic criteria or natural history of the disease. As a historical and philosophical analysis rather than a clinical study, it cannot prove causation for any specific mechanism of ME/CFS or neurasthenia. The comparison to neurasthenia does not determine whether ME/CFS is fundamentally similar to or different from that historical diagnosis.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Wessely, S (1990). Old wine in new bottles: neurasthenia and 'ME'.. Psychological medicine. https://doi.org/10.1017/s0033291700013210
BibTeX
@article{mecfsatlas-wessely-1990-old-wine,
author = {Wessely, S},
title = {Old wine in new bottles: neurasthenia and 'ME'.},
journal = {Psychological medicine},
year = {1990},
doi = {10.1017/s0033291700013210},
note = {PubMed: 2181519},
url = {https://www.mecfsatlas.com/evidence/wessely-1990-old-wine},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/wessely-1990-old-wine
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