My nervous breakdown, not yours

Because we're all entitled to at least one nervous breakdown. It can't be, Let me tell you about my nervous breakdown, and someone else chimes in with a story about their own.

What is fascinating, in our tolerant, (almost) anything goes culture, is that there is still shame in having one at all. But there is, probably because mental illness can be debilitating and burdensome, so much so that when we are in the middle of a nervous breakdown, people fear the temporary debilitated and burdensome as symptomatic of something more permanent. But it usually isn't.

Not that a nervous breakdown isn't mental illness; it is. And we're all predisposed, vulnerable to something, under the right circumstances, some biological fever or another. What manifests to whom, and how-- that is the question.*

And another dissertation question of the week: Is the stigma we associate with mental illness due to  unfamiliarity, fear, helplessness, or a combination of all of the above? Or is it about anger, having to shoulder all the work. Somebody has to get the kids to school.

Somewhere in the Stuff That Makes Us Sick section of this blog, we talk about how there is no designation, nervous breakdown, in the Diagnostic and Statistical Manual of Mental Disorders. The DSM defines episodes of depression, all kinds, mania, too, and an entire nosology of dreadful symptoms associated with anxiety. But the syntax nervous breakdown is nowhere to be found.

It is most familiar to the generation that relates (really relates) to Mad Men (the TV show). In the fifties you had to have one to get attention for feeling mentally ill.

We omit it because it is defined by better differentiated disorders.  Yet, that perfect storm of anxiety, panic, blinding fear, and catatonia, an inability to communicate well, a feeling of shutting down, symptoms of several Axis I disorders all rolled into one isn't close to feeling healthy.

And it happens to many, if not most of us, and for some people, it happens at the worst of times, the beginning of a new job, the birth of a baby, making a wedding, graduating high school, college, moving away or moving toward.  Certain diagnoses are more likely to manifest at certain ages.

There's never a good time, is there?

If it is ubiquitous, and symptomatic of some type of mental illness or a combination of disorders, then perhaps the stigma about the nervous breakdown isn't about misunderstanding or unfamiliarity, rather it is born of a sense of dire helplessness in the face of the collapse of another. Not knowing what to do, wanting to help and not knowing how, we displace our anxiety, judge, blame the victim. And the victim isn't doing much around the house, is the truth, which can make us very, very mad.

Caregivers who come to the rescue will need therapy themselves if the fever of their partner, friend, or family member doesn't resolve soon enough, or keeps recurring. They deserve more than the tee shirt, I'm Working on Surviving His (Her), My Mom's, My Kid's Nervous Breakdown.   But a tee shirt is a nice gesture.  The one who crashes gets to wear Lost It

So many opportunities to lose it in a lifetime.  There's little chance of coasting without being affected, if only temporarily, little chance of not hurting to the max emotionally.  No longer grounded, sanity is penciled onto the loss list,  if only temporarily. (I have my patients write one, everybody has to grieve, tee shirts aside.) Here's a short summary of family developmental steps that threaten ours.**

(a) Pregnancy

By far one of the most pathological conditions known to man, hormones shifting, bodies changing. Yet people make comments about size and weight gain, comparisons to animals (whales, mainly). It is one thing for me to describe my pregnancy as capable of filling out a hula hoop, quite another if you do.

A woman carrying a child needs nothing but love, as those of us who have survived it know. Carrying alone is justification to kvetch, we don't need much advice or personal solutions to the inevitable problems. There's enough information on the Internet to reinforce our insecurities. Ask benign questions, smile at pregnant people. That's all they need.  The looming fear of parenthood will go away, if only temporarily.

(b) Better out than in, owning an infant

Babies cry so much, and sometimes they're sick, and their sleep schedules are unpredictable.  Their insecurities (I'm so small, hasn't anyone noticed? Why did they leave me alone in this crib?  It's freezing in hear and they don't care.  Life has changed for the worse!)

Their insecurities are contagious, and parents feel a loss of control.  Sleep deprived, reality isn't real, lovers become enemies. Decision-making is compromised.  Life is all about four little words, Is the baby okay? When both parents are up all night no one feels good and self-pity or blaming the other natural.  The best fights begin. Happiest times of our lives, for sure, those moments with the little bundles of joy.

Infancy is relatively short, and if handled graciously, with few preconceived expectations, can be delightful, delicious, and unforgettable in a positive way.  It is obvious we forget how bad it can be because we keep on doing it, some of us, live to repeat the mistake.  Someone's teleological trick.

(c) Parenting toddlers

The diapers, seriously, as babies morph into little people who walk, make us sick, and we feel a sense of failure as the little one, all of three years old, (usually a boy, most girls train sooner) refuses to use the potty.  The pleading cry of infancy has matured to a respectable tantrum.  Things break, fly across the room.  Bites happen.  Parents feel they must be able to control this cub-like behavior, and surely they should, but how?

And if a child is sick, has a disorder of some type, perhaps isn't progressing or begins to slip developmentally, that sense of failure becomes identity without support from friends and family.  Support is of the essence and it isn't always there.  Neighbors run from problem children, hope someone else is picking up the slack.

(d) Having children five and under

Little people, little problems, but no, not really. Children are complicated and because their verbal communication skills aren't perfect yet, hard to read. We send them off to school expecting them to behave, and they look around and find other little people wearing better clothes, with better phones, and better manners, or they are bullied. Their teachers are critical and not always good at what they do.

Under all kinds of pressure and social stress, missing home and picturing Mom or Dad with the new arrival, little people act out, have even better ways, demand, or sulk and hide in their rooms. We don't know how to respond to their nervous breakdowns except to say, Snap out of it or no doughnuts. This usually works.

(e) Having children in latency

Freud named the elementary school years latency, pre-puberty, a stage of development theoretically sexually dormant. Children in his world (who were these children?) settled into academics, worked hard at school. Erickson called the stage Industry.

Now, of course, there is no latency and the age of puberty has dropped, probably due to the sexual stimuli in our world or nature's way of demanding we recreate. The stress doubles as parents return to work, children aren't supervised, homework isn't done and food isn't on the table. Perhaps, by now, the slightly alcoholic tendencies of our twenties manifest as truly alcoholic, and sober partners shoulder a disproportionate amount of stress. Marital conflict warms up. Kids get symptomatic, take the hit for everyone. Good times.

(f) Parenting adolescents

By now we have shown our true colors to our partners and whatever marital issues we have, or what is thought to be a mid-life crisis, is a movie the kids have seen at least once. One of us has abandoned the other emotionally, or physically.

Divorce is imminent or discussed in front of children and friends, anyone who will listen. The stresses of money, keeping up appearances, aging, coping with the ghosts of our own childhood-- all of this crescendos as the children smugly look on and get stoned. Who has the nervous breakdown? Any or all of us.

(g) Launching

The kids are off to college or getting married, traditionally the best time for mental illness to manifest. Oh, wait. Nobody's leaving home anymore. Now the nineteenth nervous breakdown*** is about everyone living in the same house. Nobody's off to college, and if some of them managed to go, the parents are in hock for student loans they will never pay off.

Launching, when it does happen, traditionally tips the relationship system in the family, not always in a good way. The suicidal mom, you know, is a kid-magnet, ruins a perfectly good launch.

Oh, we could go on and should, but that's enough for now. The first thing the therapist is going to tell you, if you are lucky enough to get one, is that you are entitled, or you were entitled, to your nervous breakdown. And we want to know if somebody was there for you, what happened at the time and what happened later. Because frankly, the aftermath is so much more important than the crash.


* Jews thought they had no alcoholic gene until recent history. Our ancestors didn't drink to excess, not only because they were too poor, but you can't learn anything when you're drunk! So there was no such thing, in most families, as drinking for fun. You have a glass to toast to a new baby or a marriage, or to bring in the Sabbath. But now, as a culturally assimilated people, we drink along with everyone else. And what are we finding? Alcohol dependence! Crazy, I know.

**By no means the full list. We have to quit while we're ahead, at about the time the kids start having kids of their own. That softens some of the pain of impending sickness, coping with aging parents and helping our children who have new problems, similar to our very own, that sandwich thing. Hardly worth talking about.

***Ninteenth Nervous Breakdown is an old Rolling Stones song.


Ella said…
Ha! now I feel better about my lost sanity, since I have so much company.
therapydoc said…
Yeah, a lot of words to say, basically that ;)
Smitty said…
How interesting. What I would LIKE to call a nervous breakdown.... and what at least one friend has called their own nervous breakdown.. was called "brief reactive psychosis."

Now we expect these things to become chronic and call them schizophrenia the first time it shows up.

No fair, I say! Creeping diagnosis, instead of understanding that, as you say, we can all be vulnerable.

Now that it is clear I have long periods of complete "normalcy" and recognizable "triggers," the good docs finally tell me this: "Without sleep, anyone can develop psychosis." Would have like them to say that the first time. Then I could have simply admitted I am sensitive to loss of sleep.

Without sleep, allowing drama to operate night and day, we can all experience a breakdown. Duh.
Kerro said…
What about all the reasons to have a nervous breakdown that don't revolve around children? Or wanting them, and not having them, or not wanting them, and having them, or just having them? Surely singleton's without kids are entitled to nervous breakdowns as well? If for no other reason than we *fail* to live up to society's expectations.
therapydoc said…
Smitty, I can't believe I left that out, brief reactive psychosis, or brief psychotic reaction. 100%! Thanks.

Kerro, I so apologize, want to kick myself. I fell into a developmental psychology model, and these are always short-sighted. I'm glad you caught it, thanks so much. Not following the usual developmental path isn't even unusual anymore. Yet deviating from the norm in our society can precipitate a crisis, especially without social support. It can be be painful and stressful in so many ways. Thanks for setting me straight.
Leigh said…
Mine happened when I was 13 - does going thru that awkward phase count?

BTW How many breakdowns are we allowed to have before things start to get abnormal? :P
kerro said…
Thanks Therapydoc, I'm glad that children aren't the "only" reason for a nervous breakdown. Then I'd be certifiably insane, for sure.

Btw, what is "the norm" these days??
Liz said…
what a great post.
Anonymous said…
Well written- total clarity into nervous breakdowns after having children. Also, the sandwich generation struggles is one that needs more attention!!
Hiten said…
Good post. I'm not a parent yet, but this is good flavour of what to expect!
Anonymous said…
Hey Doc. Long time no...I haven't been getting around the blogo~ much lately but am trying to make a comeback. ;-) Just stopped by to say "Hi!"
My sister-in-law used to have those - everyone just said "breakdown" - twice in the 20 yrs. I've known her, don't know how many before that but it wasn't new, and since her daughter grew up and left home about 6 yrs. ago she's been fine. Actually seems happy for a change.
It ain't just mom's over kids though is it? Others for, causes?
therapydoc said…
Absolutely. I even forget the other Rolling Stones song, not sure of the name, but it was about valium, mother's little helper. Now we give kids helpers. There are developmental stressors, causes, at every stage of our lives that could drive us to the brink unless we have people there to support us.
Richard said…
Society places no value on emotional well-being. There's an assumption that coping with life is a skill that we all possess to a perfect degree - barring very exceptional circumstances. There is no concept of essential human downtime. So people have no option but to carry on - sometimes with the help of drink or drugs, outbursts of violence or other forms of discharge.

Until we have the kind of society where ordinary people can afford to take a few months off to rebalance then we'll continue to have nervous breakdowns.
therapydoc said…
Or we learn to take a siesta in the middle of the day, like normal people. A meal, a nap, and back to work. But the nap has to be part of the equation.
Richard said…
Well, yes - I enjoy a good siesta myself! But my experience as a therapist is that not many people get quality time to themselves at the times in life when they need it most. When you're raising children and trying to pay the mortgage the idea of even a siesta is a fantasy!