What Does It Mean to Have a Nervous Breakdown?
The “nervous breakdown” is getting media attention this month. Recent retrospective accounts of the Apollo 11 moon landing have mentioned astronaut Buzz Aldrin’s “nervous breakdown” in the aftermath of his return to Earth. Last week, a former head of MI6 — the famed British intelligence service — told the BBC that his nation was undergoing a “political nervous breakdown” as it continues to grapple with Brexit.
Most people get the gist of what a nervous breakdown is. But the condition’s borders have always been ill-defined. Even calling a nervous breakdown a “condition” is a bit of an overreach. “The term has been around forever — it was used when I was a kid — but I don’t think it’s ever been a formal diagnosis,” says Michelle Newman, a psychologist and director of the Laboratory for Anxiety and Depression Research at Penn State University.
Newman says the concept of the nervous breakdown exists in a kind of gray area. It does not have accepted diagnostic criteria, and the term isn’t used by psychologists or psychiatrists. (It’s also completely distinct from a “psychotic break,” which refers to the kind of psychotic episodes associated with conditions like schizophrenia. Symptoms can include delusional thoughts, hallucinations, and paranoia.) But non-doctors often use “nervous breakdown” to describe a person who has disconnected in some way from their normal life due to a buildup of stress or anxiety. “I also think it’s used by the media as a catchall to describe a celebrity who’s sort of lost it or become dysfunctional as a result of some [undisclosed] issue, whether it’s anxiety or depression or psychosis,” she says.
While a nervous breakdown is not a diagnosable condition, it does have some defining characteristics, according to experts. The most common one is that a person experiences some lapse in their ability to function as they normally do, which can cause them to bail out of their usual work, social, or family obligations. “Someone is overwhelmed with something — stress or anxiety or depression — to the point that it interferes with their day-to-day living,” says Craig Sawchuk, a professor of psychology at the Mayo Clinic.
Sawchuk mentions behaviors like skipping work for one or more days, “disengaging” from friends and family, and/or shutting oneself up at home as commonly associated with a nervous breakdown. Basically, a person reaches a point where they require an unplanned time-out from their life.
The other common components of a nervous breakdown, Sawchuk says, are a mix of emotional, cognitive, and physical symptoms. Emotional symptoms could include feelings of intense stress, anxiety, fear, irritability, guilt, or some combination. “Cognitive symptoms are things like racing thoughts, not being able to focus, experiencing worry or rumination, or a tendency to think or expect the worst,” he says.
There may also be “raw” physical symptoms that are related to the classic fight-or-flight sympathetic nervous system responses. “So a pounding heart, shortness of breath, or feeling tense to the point of light-headedness,” he says.
Many of these symptoms may sound similar to a panic attack, which is a diagnosable condition. And Sawchuk says there’s definitely some overlap between panic attacks and nervous breakdowns. “A panic attack could be layered on top of a nervous breakdown,” he says. “But one way of perhaps differentiating the two is that, with a panic attack, the experience is very brief and very intense, whereas a nervous breakdown is more persistent or continuous.”
A panic attack typically comes on and peaks within 10 minutes — after which it starts to subside, says Newman. “People will say, ‘I’ve been having a panic attack for the last three days,’ but that’s not a panic attack,” she says.
Just as the definition of a nervous breakdown is hazy, its causes are also hard to pin down. But Sawchuk says life events or challenges that are uncontrollable and unpredictable are the ones he associates with a “vulnerability” for a nervous breakdown. “These would be major life events like a disease diagnosis, or the sudden loss of someone close to you, or the sudden loss of a job,” he says. He also mentions a lack of financial or social resources, a past history of mental health problems, or chronic stress and anxiety as risk factors for a nervous breakdown.
“But reality is always in the eye of the beholder,” he says. A person may have none of the vulnerabilities he mentions, but they could still suffer a nervous breakdown if their perception of reality and its challenges becomes overwhelming.
What should someone do if they experience a nervous breakdown — or if they think they’re headed for one? Sawchuk says if a person’s symptoms are at a “low level of intensity,” mental health apps that teach relaxation techniques — such as mindfulness training — are low-cost and effective options. Exercising, eating a proper diet, getting enough sleep, and spending time with friends can also help slow or reverse the buildup of symptoms that can lead to a nervous breakdown.
“If people are somehow impaired by their symptoms” — meaning their life is being harmed by what they’re dealing with — “the next level of treatment could be some combination of psychotherapy with or without pharmacotherapy,” he says.
The details of what makes therapy effective in a breakdown scenario depend entirely on a person’s experiences and symptoms. But Sawchuk says cognitive behavioral therapy can help people manage anxiety and stress in the “here and now,” and that drugs like antidepressants could also be useful. If someone’s nervous breakdown is severe, he says some form of inpatient or outpatient rehab could be helpful.
In the end, the best way to think about a nervous breakdown may be as a confined event, rather than as an ongoing issue or disorder. For any number of reasons, someone “just loses it,” Newman says, and that causes distress or interference in their life.