Extreme Fear

Getting a grip on the brain's alarm system

The Nervous Breakdown: A Myth?

What we talk about when we talk about breakdowns

When I was a junior in high school my Spanish teacher started behaving very strangely. She became increasingly agitated and defensive, and the class, sensing her emotional frailty, responded as a pack of rabid adolescents predictably would: we relentlessly back-talked and baited her, which I'm sure did nothing to ease her predicament.

It all came to a head one day when she passed around a blank sheet of paper and asked that we sign it, to show that we had attended the class. Later, another faculty member asked me if I would share my thoughts on the petition we had signed. "What petition?" I answered. Apparently, she had attached a statement to our signatures that said something to the effect of, "We, the undersigned, hereby state our unequivocal support and appreciation for our beloved teacher..."

She was promptly fired, and we never saw her again. Asked what had happened, we were told simply: "She had a nervous breakdown."

Nervous breakdown. We all know what it means, in a vague sort of way: one day you're more or less fine, then the pressure gets too much, and then, boom, off the rails. We all know someone who's had one, or had one ourselves. But what does the phenomenon correlate to in modern psychological terminology?

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Not much, it turns out, as I have learned from a delightful article by Gordon Parker in the American Journal of Psychiatry called "The Mechanics of a 'Breakdown'." Parker writes, "The term does not exist in DSM-IV or ICD-10-or in their predecessors. It has no scientific definition and has never been part of the mental health professional's lexicon."

He traces the origin of the phrase to the late 19th century, then delves into the (surprising substantial) literature examining what people seem to mean when they refer to a "nervous breakdown." Parker finds that the phrase broadly correlates to what clinicians would call "adjustment disorder," a broad diagnosis applied to patients who suffer emotional or behavioral symptoms in the wake of identifiable stress. What's consistent in the use of the word "breakdown" is that it refers to an acute condition -- something that comes upon a person at an identifiable moment, and does not persist indefinitely.

Parker himself suggests that the idea of a "breakdown" is similar to the effects of melancholia, a severe form of depression often characterized by anergia, or overwhelming listlessness:

I continue to be struck by how often those with melancholia describe a physical state of "mechanical failure." Their descriptors include "an inability to get out of bed to wash" and feeling as if "walking through thick sand weighed down by a dozen wet blankets."

Parker notes that, in his experience as a clinician, his patients are using the term less and less, as the broader public becomes familiar with official psychological lingo and is increasingly confident in using it for self-diagnosis. I imagine the internet has been a huge help in this regard -- nowadays a word like "nervous breakdown" could only be used by newbies who haven't bothered to google their way to a DSM classification.

My two cents: people have been having a hard time understanding just how the brain works, and how its functioning can go wrong for thousands of years (at least). As our theories change, so does the language we use to describe the dysfunctions that we encounter. Yes, lay terminology is woefully imprecise -- but then, can professional psychologists really throw stones? When the new DSM is issued, many categories that were previously deemed respectable will henceforth be consigned to the dustbin of history. If the term "nervous breakdown" turns out to be vague, then so too, unfortunately, is much official terminology.

 

Jeff Wise is a New York-based science writer and author of Extreme Fear: The Science of Your Mind in Danger.

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