# What is a "nervous breakdown"?



## David Baxter PhD (Apr 15, 2008)

In search of the good old nervous breakdown: Everyone from actors to housewives used to have them, so what were they?
By Roni Caryn Rabin, MSNBC
Mon., April. 14, 2008

When Joe Livernois was a child, his father sometimes spent days racing around giddily and talking non-stop ? then he'd crash, become severely depressed, withdraw into his room and spend most of his time sleeping.

If anyone talked about his father?s increasingly erratic behavior, they said he was ?having a nervous breakdown,? said Livernois, now a 54-year-old editor at the Monterey (Calif.) Herald, who recently wrote a series of columns about his father. 

"?Nervous breakdown? was the malady everybody was suffering at the time. I guess it was a polite way of saying, ?Your father?s just not right,'" he said. "There wasn?t a lot of knowledge, and this was the 1950s, 1960s, the Eisenhower-Kennedy era, when a whole lot of stuff got swept under the rug.?

These days, Livernois? dad would probably be diagnosed as bipolar, he says. The huge advances in psychiatry made over the last few decades, combined with a new cultural ethos that encourages straight talk about subjects that were once taboo, has helped bring mental illness out of the shadows. Therapists today are often central characters in movie and TV shows. Diagnoses like ?obsessive-compulsive,? "bipolar" and "schizophrenia" have found their way into the mainstream vernacular.

But old-fashioned ?nervous breakdowns?? Hardly anyone mentions those anymore.

?I haven?t heard that term in years,? said Mike Fitzpatrick, executive director of the National Alliance on Mental Illness, a national advocacy organization based in Arlington, Va. ??It?s from another era.?

The term ? a vague catch-all phrase that could mean anything from a psychotic episode to having a bad day ? is not a medical term, doctors say, but it was a popular one that was gentle, non-specific and therefore non-threatening, and could serve as a cover. 

It may have even garnered a certain cache, since celebrities and movie stars like Frances Farmer and Judy Garland were often described as having nervous breakdowns, even when their problems might have more accurately been described as alcoholism or prescription drug abuse. In the 1961 Academy Award-winning movie, _Splendor in the Grass_,  Natalie Wood plays a lovesick young woman from a small town in Kansas who is institutionalized after being abandoned by her boyfriend, a wealthy Yale student played by Warren Beatty, and having a breakdown.

?The world has changed dramatically in the last 50 years or so, in terms of our understanding of mental disorders,? said Dr. Darrel A. Regier, director of the American Psychiatric Association?s division of research. ?When I was a kid, there were references to relatives or neighbors, who had a ?nervous breakdown? and had to go to a hospital, and dropped out for a period of time, and nobody would really be very specific about what the nature of the illness was.?

Treatments varied from the "rest cure," isolation and preventing all stimulation in the 19th century (described by Charlotte Perkins Gilman in her 1891 short story _The Yellow Wallpaper_) to hydrotherapy, electric shock treatments, insulin treatment and lobotomy in the 20th century. Patients who were hospitalized often faced long-term commitments.

?People are no longer just disappearing from the community in the same way that they did when that term was coined and was in use,? Regier said. ?The major emphasis now with the mentally ill is on recovery.?

*'It was a fig leaf'*
In past decades, the suggestion that someone had a disorder of the nerves or nervous system was an attempt to place mental illness in the same category as a physical ailment, like a stomach disorder, said Edward Shorter, a professor of the history of medicine at the University of Toronto, who wrote the book, _A History of Psychiatry: From the Era of the Asylum to the Age of Prozac_.

?It was a fig leaf,? Shorter said. ?It suggested this was a non-inherited, non-genetic and more acceptable condition than mental illness ? which was believed to be genetic and inherited.?

Psychiatrists emphasize that the term ?nervous breakdown? is utterly meaningless from a medical, clinical point of view. If patients today use it to describe a crisis they went through or when giving a family history, clinicians press for more detailed information.

?It would be like saying someone had a fever, instead of diagnosing different types of infections,? said Myrna Weissman, a professor of psychiatry and epidemiology at Columbia University College of Physicians and Surgeons who studies women and depression. ?It?s useful to know someone has a fever, but just as we know so much more about what causes fever, we in psychiatry have a much more sophisticated understanding of the different diagnostic categories.?

In 1952, only 106 types of mental disorders were listed in the  _Diagnostic and Statistical Manual of Mental Disorders_, or the _DSM_, the American Psychiatric Association?s book classifying mental illnesses. But the fourth and current edition of lists 297 ? nearly three times as many.

Treatments have improved over the decades as well. The advent of antipsychotic medications has meant that seriously ill patients can often return to community life as long as they continue treatment and have support systems in place, Regier said.

Since the 1950s, the number of institutionalized patients in the United States has dropped from 550,000 to fewer than 30,000 patients, Regier said. Patients themselves have changed too. Now people are much more educated about medical conditions and aggressive in seeking information. In the age of tell-all TV shows and support groups, people don?t shy away from calling things by their real names.

Still, code words haven?t disappeared completely. One favorite euphemism used today, particularly regarding celebrities, is ?exhaustion.? In recent years, Ashlee Simpson, Amy Winehouse, rapper Eminem, Colin Farrell and Lindsay Lohan have all been reported to be suffering from ?exhaustion,? in many cases before checking themselves into rehabilitation centers to treat substance abuse.

*Named by pop culture*
The term ?nervous breakdown? seems to have originated in popular culture, said Dr. Jonathan Metzl, an associate professor of psychiatry and women?s studies at University of Michigan in Ann Arbor.

?We use the term medicalization a lot now to talk about how disease concepts, like anxiety, depression and stress, come from medicine and trickle down to society,? he said. ?But with ?nervous breakdown? the process was reversed ? it was defined by popular culture.?

If anything, he said, ?Medicine and psychiatry did everything they could to clamp down on it.?

During World War II, Dr. William C. Menninger, who served as chief psychiatric consultant for the Surgeon General of the U.S. Army, developed the concept of ?the breaking point,? which was originally applied to soldiers in combat but was later extended to the strains of modern life, Regier said. 

?We know that under enough pressure, continued over a long period of time, anyone can be overwhelmed, and bend. All of us have a breaking point,? Menninger wrote in a 1959 paper.

Though many tend to associate nervous breakdowns with women of the 1950s and 1960s who were trapped in very narrow societal roles as mothers and housewives ? Betty Friedan?s 1963 book _The Feminine Mystique_ talked about the ?problem that has no name? that plagued women who were unfulfilled as homemakers ? it was men who were seen as most vulnerable to stress earlier in the century, said Dr. Laura Hirshbein, an assistant professor of psychiatry at University of Michigan who studies the history of medicine and psychiatry. 

?Men were definitely seen as very susceptible to nervous breakdowns ? historians of masculinity describe the switch in men?s work from the late 19th century, when they were in small businesses, with bosses they knew and communities where they felt in control, to the 20th century, when they worked as bureaucrats in large organizations,? Hirshbein said. ?It was very stressful for them.?

*A pill to calm the nerves*
In the 1950s, the new antianxiety medication Milltown was developed and marketed to both men and women, to calm women?s nerves and to ease work pressures for men, Metzl said. 

?The idea was that modern society was moving too fast for our fragile psyches.?

Many of the same stresses remain today, it?s just that we?re more specific in what we call our response to them. What used to be blamed on nerves and nervous breakdowns is now often recognized as anxiety or depression and stress is often cited as the culprit.

?Depression is now a socially accepted diagnosis,? Shorter said. ?Now everyone?s depressed.?

*Nervous breakdowns in pop culture* 
A number of celebrities famously had reported "nervous breakdowns" including:


Judy Garland
Frances Farmer
Rosemary Clooney
Lana Turner
Marilyn Monroe
Howard Hughes
Vivien Leigh
Rita Hayworth
Patricia Neal
Betty Hutton
Agatha Christie
Poet Anne Sexton
Zelda Fitzgerald, wife of F. Scott Fitzgerald
In 1966, the Rolling Stones released the song _19th Nervous Breakdown_.

Oscar-winning Pedro Almodovar directed the 1989 movie _Women on the Verge of a Nervous Breakdown_.


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## Lana (Apr 15, 2008)

What is an appropriate title for an event where someone has a...well....breakdown?


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## ladylore (Apr 15, 2008)

Great article. 

Lana - I would think psychotic episode. I think but don't quote me on that.


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## David Baxter PhD (Apr 15, 2008)

Some people do still use the term "breakdown" without the "nervous" part. Or "burnout". Or "meltdown".


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## Halo (Apr 15, 2008)

I like the term breakdown or meltdown personally....burnout to me reminds me of someone who is simply overworked and needs time off.

JMO


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## braveheart (Apr 15, 2008)

I've had several 'breakdowns'. But only one really even verged on psychotic. They were mostly PTSD related.


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## ladylore (Apr 15, 2008)

I have a few myself and the last one took months to get over and resemble even a bit of normalcy.


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## Cat Dancer (Apr 15, 2008)

Does one generally know if one is having a nervous breakdown?


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## lallieth (Apr 15, 2008)

My mom still refers to her time in the hospital as a "nervous breakdown" My brother's called their deep depression's as "hitting the bottom"


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## Misha (Apr 15, 2008)

I tend to use the word "crash."


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## ShyLady (Apr 15, 2008)

I like to use nervous breakdown myself. It is deep depression where your nerves can't handle life's problems anymore and you need a break for a while. How you get the break is as different as there are people in the world. I've seen people just stop working for a while to get the break.


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## suewatters1 (Apr 30, 2008)

I feel like I am going through a breakdown. I just today booked 2 weeks off work starting next week. I can't take it anymore. My health issues and how it affects me at work and after working there 24 years I am fed up. I wish I could just stop working. I have aches and pain everyday and when I had enough at work with my pains and I can't stop or they expect me to do more then I can do physically just frustrates me. I am getting worse physically so it makes my mental health worse. I hate the way my life is going when will I ever get a break for god sakes.
Also having ADHD and coming home to house which is in a disaster zone doesn't help. Broke because of my gambling issues and depress because of all the things combine is to much.

Sue


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