What is a nervous breakdown?

Many use the term “nervous breakdown” casually to highlight stress and anxiety – “I nearly had a nervous breakdown when that happened…”. But what happens doing a serious nervous breakdown and what exactly leads up to a nervous breakdown?

A nervous breakdown (also known as a mental breakdown) often occurs after a person has experienced a prolonged period of sustained stress and pressure. Eventually, a state of exhaustion, helplessness and hopelessness takes over.

Signs of a nervous breakdown:

A lack of interest in doing anything

Loss of motivation and enthusiasm

Loss of interest in sex

Loss of interest in food

Feelings of helplessness, powerless and desperation

Feelings of self-loathing and guilt at not being able to cope

Detaching from life, feeling unable to cope

There is no ‘one size fits all’ when it comes to describing a nervous breakdown. There are many wide ranging experiences but one thing in common is that the person feels like giving up, has temporarily lost their ‘fight’ and ceases to be able to cope and function with life as they normally do. Their defenses are down and many describe feeling “broken and at rock bottom”. Research suggests that relationship problems and being a single parent can often trigger a nervous breakdown or at least predispose someone to have a nervous breakdown.

The most common kind of breakdown, according to Dr Philip Timms, a consultant psychiatrist with the South London and Maudsley Trust, is someone developing moderately severe depression, normally over a period of weeks. ‘A person would begin to feel more on edge, find it more difficult to sleep, find themselves thinking more negatively about themselves, feel increasingly hopeless and incompetent about what they’re doing, and then there comes a day when they just can’t face going to work, or getting out of bed, perhaps. A nervous breakdown occurs if a depressive episode is not dealt with – it builds up and it’s part of a process.’

Identifying the early signs can help prevent the eventual build up and nervous breakdown. Be aware of your mood and current coping levels. Do you feel unhappy and exhausted most of the time? Deal with it as it won’t disappear by itself – especially if you have felt this way for 3 months or more. Mild depression, if not dealt with can lead to further anxiety and possibly panic attacks.

A common occurrence is where a person tries to cope for too long, all the while fooling themselves into believing they are fine and coping. Slowly but surely, their performance deteriorates, their anxiety levels and self doubt increase and they begin to introduce unhelpful behaviours to escape the tension and stress – such as shopping too much, eating too much, drinking too much etc Coping in this way makes a person extremely vulnerable to a final trigger – commonly referred to as “the straw that broke the camel’s back”.

Fact from fiction

Mental illness is shrouded in myth. Here is the truth about four commonly held ‘nervous breakdown’ misconceptions:

‘Nervous breakdown’ is a technical term
Oliver James says that the term nervous breakdown is devoid of technical meaning. ‘It is most likely to have come into use in the First World War as a result of treating shell shock. A lot of our understanding and attitudes to mental illness come from medicine in the military.’ Dr David Bell says that the term probably dates back to a time when all psychiatric illness was referred to as nervous disorder: ‘It was thought that all mental-health complaints were neurological in origin.’

Breakdowns are always ‘bad’
Most experts agree that breakdowns are not an entirely negative experience – with the right treatment, they can be turned into a breakthrough. As David Bell says, ‘When someone has spent their whole life functioning in a certain way, breakdown can be an opportunity for change.’ There are also circumstances under which breaking down is an entirely rational response. ‘In fact,’ says David Bell, ‘for some people, not breaking down is a problem.’

A breakdown is most likely to occur where there is a genetic predisposition
Dr Philip Timms says that although ‘depression, like most major mental illnesses, runs in families, genetics doesn’t explain all of it.’ And, according to Dr Massimo Riccio, even psychotic breakdown could happen to anyone: ‘In the general population, there is a 1 per cent lifetime risk of developing schizophrenia.’ Oliver James feels that most nervous breakdowns are caused by ‘a very poor early infancy, resulting in a very weak sense of self, which, if you like, makes for a much weaker foundation stone.’

Breakdowns can’t be prevented
Philip Timms says that in some cases a breakdown could be avoided if we felt able to take a few weeks out before we reached crisis point. ‘It’s about the way we organise our lives, about pacing ourselves. There’s this notion that we’re either fully functional or completely disabled, and people find it hard to deal with the halfway mark.’

Warning signs

In Positive Under Pressure (£6.99, Thorsons), psychotherapist Gael Lindenfield and stress specialist Dr Malcolm Vandenburg identify the early warning signs of immobilising stress.

Physical
Includes bowel-related problems, such as diarrhoea and constipation, back pain, migraines, palpitations, breathing problems, disrupted sleep, loss of libido, impotence and, for women, a disrupted menstrual cycle.

Emotional
Includes worrying all the time, anxiety, feeling overwhelmed, out of control, guilty, confused, trapped and unable to know what to do next.

Behavioural
Includes mood swings, temper loss, preoccupation, inability to tolerate noise, withdrawal from ‘normal’ life (eg, stopping hobbies), inability to stop moving/fidgeting.

Going public

When a celebrity’s private suffering becomes common knowledge.

Stephen Fry walked out of West End play Cell Mates in 1995. ‘I would say now it was a breakdown. I don’t know precisely what it was. I did see doctors, both the ordinary ones and the psychiatric kind. They said it was a cyclothymic bipolar episode or something like that. That’ll do. But one might as well use the language of demonisation. There was a demon of something in me and it took a lot of getting out.’

Joanna Lumley on her 1970 breakdown: ‘I found everything just unbearable. I’d try to go shopping at Safeway or whatever and couldn’t go in, the thought of all the people in there. You’d have to talk to yourself aloud in your head, divide yourself in two and counsel yourself like a friend, so the one you knew would speak in a sensible voice would tell the other one the simplest task they had to do, and the reward would be to go out of the shop and go home.’

Brett Easton Ellis had a breakdown after the success of his novel Less Than Zero . ‘It was a sort of emotional exhaustion,’ he says now. ‘My mom came over, I started seeing a shrink, I got my medicine – kind of regulated myself.’

PJ Harvey had a nervous breakdown after the break up of her first affair in her early twenties. ‘I couldn’t do anything for weeks – little things like having a bath and brushing your teeth, I just didn’t know how to do it. I never want to go back there again.’

Alistair Campbell on his drinking and breakdown in the mid-80s while working on Today newspaper. ‘It was a nightmare recovering, trying to re-build my career, while trying to give up drinking. You learn what your priorities are and who your real friends are – and you can count those on one hand… I get letters from people who say, “I’ve had a nervous breakdown and it’s great that someone talks about it.”‘

Peter Mullan on breaking down during his final year in university: ‘I was working 15 hours a day, every day, for two months. Then something snapped. I started crying and didn’t stop for a week. I had three or four relapses in my twenties. It was very humbling. It was the best and worst thing that ever happened to me. You realise there is a darkness within that you can’t always deal with.’

Spike Milligan: ‘If you’ve been through a breakdown, it’s like having been honed by a very fine Toledo blade.’

Bob Hoskins: ‘When I separated I had a nervous breakdown because walking away from two kids is a horrific thing. I started living in a kind of bubble, a bubble of grief, because I’d lost my family and couldn’t cope… I was having these long sessions with a psychiatrist, then going for a drink with my friend Verity Bargate. She used to say, “You’re telling the psychiatrist all your best plots. You should be doing it on stage.”‘

Seek help if you feel exhausted and at the end of your tether. There is help out there. A combination of drugs and talking therapy is often incrediby effective and can get you back on track.

Mandy X

• The Mental Health Foundation information line is manned Monday to Friday, from 10am-6pm (020 7535 7420). For leaflets providing information about mental-health issues, such as depression, schizophrenia and anxiety, send an A5 sae to The Mental Health Foundation, 20-21 Cornwall Terrace, London NW1 4QL; or go towww.mentalhealth.org.uk.

Call Samaritans on 08457 90 90 90  (24 hours a day/365 days a year) or visit their website.

Visit your GP.

References:

https://www.theguardian.com/theobserver/2000/sep/10/features.magazine37

Photo by Mysi(new stream: www.flickr.com/photos/mysianne)

Author: Mandy Kloppers

Mandy is a qualified therapist who treats depression, anxiety, OCD, PTSD, trauma, and many other types of mental health issues. She provides online therapy around the world for those needing support and also provides relationship counselling.