"Society life",
Retirement,

are the commonest exciting causes of neurasthenia; hard brain-work, unless
accompanied by worry, not being injurious.

The disease is more common in men than women (because of the more active
part played by them in the struggle for existence), in cities than in the
country, in mental than in manual workers, in the "idle rich", and in races
which live feverishly, like the Americans. It is rare in old age.

Ambition, the race for "success", the struggle to carry out projects beyond
the reasonable capacity of one man, and the ceaseless work and worry with
little sleep and no real rest which mark life to-day are responsible for
this disease.

Competition has increased in all conditions of life; free course is given
to ambition, individuals impose on their brains a work beyond their
strength; and then comes care and perhaps reverse of fortune; and the
nervous system, under the wear and tear of incessant excitation, at last
becomes exhausted,

The basic symptom is an inability to stand a normal amount of mental or
physical strain, and shows itself in seven marked ways:

1. Muscular Fatigue, which is often most marked in the morning. The
patient rises reluctantly, feeling as if he had not slept, is listless and
"lazy", and can neither work nor play much without getting unduly tired.
This weariness may pass off as the day wears on.