On nervous breakdowns

Chances are, if you've been agoraphobic, depressed, or anxious for any significant portion of your life, you've experienced something approximating the classic nervous breakdown -- a feeling of being overwhelmed by life and a capitulation to and admission that you are helpless to overcome the pain it brings.

On the Verge of 'Vital Exhaustion?' is a New York Times piece from Sunday, May 31. It traces the history of the concept of the nervous breakdown:

This is the latest umbrella term for the kind of emotional collapses that have plagued humanity for ages, stemming at times from severe mental difficulties and more often from mild ones. There have been plenty of others. In the early decades of the 20th century, many people simply referred to a crackup, including “The Crack-Up,” F. Scott Fitzgerald’s 1936 collection of essays describing his own. And before that there was neurasthenia, a widely diagnosed and undefined nerve affliction causing just about any symptom people cared to add.

Yet medical historians say that, for versatility and descriptive power, it may be hard to improve upon the “nervous breakdown.” Coined around 1900, the phrase peaked in usage during the middle of the 20th century and echoes still.

It also looks at evolving attitudes towards sufferers of nervous breakdowns:

A nervous breakdown was no small thing in the 1950s or ’60s, at least by the time a person arrived at a doctor’s office. Psychiatrists today say that, most often, it was code for an episode of severe depression — or psychosis, the delusions that often signal schizophrenia.

“I don’t remember people who got that label ever using it as their own complaint — it was very much stigmatized,” said Dr. Nada L. Stotland, a former president of the American Psychiatric Association and a professor at Rush Medical College in Chicago, who began practicing in the 1960s. “Whether it was ‘nervous exhaustion’ or ‘nervous breakdown,’ anything that sounded psychiatric was stigmatized at that time. It was shameful, humiliating.”

Famous people who've had nervous breakdowns include Beach Boy Brian Wilson (upon hearing the Beatles' Sgt. Pepper's Lonely Hearts Club Band), comedian Richard Pryor (onstage in Las Vegas in 1969), Enron CEO Jeffrey Skilling (as evidence of his company's greed, arrogance, and disregard for the law came to public light), writer Joan Didion (who wrote about hers in The White Album) ... the list goes on.

Special bonus (!): an autobiographical depiction of a nervous breakdown (at least, I think that's what it was)....

Whoosh. The automatic door closed behind me, and I stood there in front of the Walgreens. In my chest I sensed the emotion beginning to gallop, a dark, unsettled feeling; if I didn’t seize the reins, I knew, that feeling would only grow. In my mind I saw the Asian man at the pharmacy counter, handing me my bank card and saying, “Sorry, insufficient funds.” 

Around me, the neighborhood went about its midday business. A pretty Latina mom walked by pushing a stroller and talking on a cellphone. A couple of teenaged boys in baggy jeans and oversized white t-shirts; a lady cop, strolling her beat. All of them walking right past me, inches away, without even noticing me. I might as well have been a ghost.

It had been 16 years since my first panic attack. I’d had thousands more since then. Without my pills, I knew, I faced the danger of yet another debilitating cycle of panic. Because of panic, I was 40 years old but unable to keep a steady job. Because of panic, I was almost $60,000 in debt. Each night when I brushed my teeth my gums bled, but I couldn’t afford to visit a dentist. I couldn’t afford health insurance, either, and even if I had been able to, my pre-existing condition made me an unacceptable risk to insurers. And because of panic, I’d lost every woman I’d ever loved, and more than a few important friendships.

I really, really didn’t want to start having panic attacks again. I’d long since stopped believing panic signaled imminent death, yet the attacks remained searing, unbearable; each and every time, they left me feeling like I’d been the victim of physical violence. I was tired of fighting them off, of trying to soften my shoulders and breathe slowly and evenly into the depths of my belly, of telling myself this will pass, this is only temporary. I was tired of the knowledge that even as I endured one panic attack, there was always another waiting to strike.

Twenty years earlier, if you’d told me this was where I’d end up, I’d have laughed right in your face. I was popular. I'd gone to an Ivy League school. I had a fancy job on Wall Street. I was good in front of an audience. Girls liked me. The future seemed bright.

Too often since then, though, I’d been seized by sudden, inexplicable terror. In banks, department stores, supermarkets, bodegas, fast food restaurants, airports, subway stations, elevators, taxicabs, movie theaters, night clubs, art museums, auto dealerships, jury-selection waiting rooms, Las Vegas casinos, and multi-level parking structures; on ski lifts, commuter railroads, crosstown buses, suspension bridges, fishing boats, downtown sidewalks, and alpine hiking trails. And that’s just the short list.

I’d been transformed in the process.

The January sun shone down on Mission Street, penetrating and merciless. Something had to change, I knew; if it didn't, I'd end up killing myself or caked in dirt and living under a highway overpass, all my worldly possessions stored in a shopping cart. I'd missed so much, lost so much, failed in so many ways.

The weight of memory pressed down on me, and right there on Mission Street, all 6'5" and 250 pounds of me, I began to weep.