Old Name, Same Game
What's in a name? In the olden days they called it vapors, melancholia, neurasthenia, neuralgic disease, nervous prostration. Indeed, the medical profession originally thought that it was a disease of the peripheral nerves – only later deciding that perhaps it was a disease of the mind. What's the difference? We all know one when we see one: it's a crack-up.
Today's nomenclature includes any of a number of clinical diagnoses found in the DSM-IV (psychiatric classification system): psychotic break, schizophrenic episode, manic break, post-traumatic stress disorder, panic attack and (most commonly) major depressive episode. Although the mental health profession doesn't use the term at all, the ordinary folk call it a nervous breakdown.
What Is It?
A nervous breakdown, officially a symptom of one of the psychiatric diagnoses listed above, includes some sort of disintegration of personality – usually temporary. It's as if the "circuits are overloaded." When associated with stress, it has been described as a "snapping under extreme pressure." (Interestingly, surveys show that one third of Americans have felt on the verge of a nervous breakdown at some point in their lives.)
A breakdown can manifest as an inability to function (to fulfill obligations at work or home or school). It may involve severe weakness, exhaustion or even catatonic posturing (inability to move). In breakdowns of the depressive type, there may be uncontrollable crying, loss of pleasure in all activities, dramatic weight loss or weight gain, sleep disruption or extreme sleepiness, confusion, disorientation, extreme feelings of worthlessness, guilt and despair.
In breakdowns involving psychosis, there will be a loss of contact with reality that can take many forms:
· having visions, hearing voices or feeling sensations that have no basis in fact (i.e. feeling like there is something crawling on the skin when there isn't; hearing someone say something when there is no one present)
· obsessing about doing something harmful (i.e. in post-partum psychosis, having thoughts of harming one's baby)
· feelings of being victimized or persecuted by others (when this isn't happening)
· feelings of extreme guilt or excessive grandiosity or unwarranted intense jealousy
· strange speech patterns (not comprehensible because it is strangely organized and presented)
· strange behaviours (bizarre behaviour such as odd body movements or disrobing in public)
In breakdowns that are actually bi-polar (manic) episodes, there may be racy behaviour, lack of sleep with high energy, very poor judgment resulting in excessive spending and socially inappropriate behaviours, increased talkativeness, and exaggerated self-esteem.
In breakdowns that are manifestations of some sort of anxiety disorder, there may be panic attacks and incapacitating fears that affect daytime performance (perhaps interfering with ability to work, study or run a home) and disrupting night time sleep patterns.
The common factor in all types of nervous breakdowns is that the sufferer steps out of his/her normal, functional lifestyle and into a place of emotional chaos that erodes normal functioning.
Who Gets A Nervous Breakdown?
Some people have a nervous breakdown after exposure to extreme or unremitting overwhelming stress. They may have been "normal" beforehand. For example, a young man may come back from battle with a nervous breakdown (post-traumatic stress disorder), whereas he entered the battle "normal." Similarly, a woman may have functioned normally until she was violently assaulted. Or, a woman may have been perfectly normal until she gave birth, after which she experienced some type of post-partum depression. Theoretically, anybody could have a nervous breakdown.
Some people have breakdowns that were "waiting to happen." These are disintegrations that result from genetically based disorders such as schizophrenia or bi-polar depression. The genetic sensitivity, combined with life stress, can result in a "breakdown." Breakdowns that are episodes of major depression also stem from a combination of inborn and environmental factors (for example, having a family history of depression and then experiencing serious loss, frustration or failure in one's own life).
How Are Nervous Breakdowns Treated?
Appropriate types of psychotropic medications, therapeutic interventions and rest are used to treat breakdowns. Normally people are restored to previous levels of functioning (or even better, depending on the type of breakdown); in some cases of mental illness, healthy functioning is never completely restored. In the vast majority of breakdowns, however, proper treatment leads to recovery and prevention of further collapse.
For example, an episode of major depression ("a nervous breakdown"), can bring a person to psychotherapy for the first time. Psychotherapy (which may or may not require the addition of medication, depending on the severity of symptoms), can help the person come "back to himself" and it can also help him learn powerful ways of monitoring stress levels in the future, so as to prevent further breakdowns. In addition, psychotherapy may help him to achieve a higher level of functioning (mentally, emotionally and spiritually) than he ever had before. In other words, a nervous breakdown can actually be a gift! Indeed, many people have experienced a breakdown as a pivotal turning point in their lives, a situation that forced them to take stock, dismantle harmful mental, physical and emotional habits and revamp their lifestyles. Like many crises, the nervous breakdown can be an opportunity for growth. Nonetheless, most of us would prefer not to have one.
Preventing Nervous Breakdowns
In many cases, a total collapse can be prevented by responding promptly to early symptoms. Don't wait until you crack up – seek professional psychological help when feeling very stressed or when mood is dropping and not picking up quickly. Self-management can include taking a break from work, taking alternative remedies and treatments (see your naturopath, herbalist or homeopath); exercising more, allowing more time for sleep, increasing actual fun and laughter, doing some deep relaxation or meditation daily, improving food choices and de-stressing your lifestyle wherever possible. Take care of yourself! Not all breakdowns can be prevented, but many can. Increase your chance of staying physically and mentally healthy by being proactive in your approach.