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Nervous Breakdowns - Research News
The nervous breakdown, the mysterious affliction that has been a staple of American life and literature for more than a century, has been wiped out by the combined forces of psychiatry, pharmacology and managed care.

But people keep breaking down anyway. Margot Kidder, Philip Roth, William Styron, Kitty Dukakis, Mike Wallace, Bobby Fischer, Betty Ford, Joan Rivers, just to name some of the famous -- all experienced a wrenching break from this world, a kind of living death. "The mind begins to feel aggrieved, stricken, and the muddied thought processes register the distress of an organ in convulsion. . . . It is a storm indeed, but a storm of murk," wrote William Styron about his experience. Kitty Dukakis recalled lying in bed doing nothing: "I couldn't get up and get dressed, but I couldn't sleep either."

Indeed, perhaps the only symptom of this condition that has remained constant over the years is mental and physical exhaustion, a feeling that an overloaded machine has finally blown. "You don't shave. You don't shower, you don't brush your teeth. You don't care," the actor Rod Steiger said about his experience.

Most psychiatrists sniff at the term nervous breakdown, considering it to be as inexact and unscientific as its predecessors: the vapors, neurasthenia, spinal irritation, neuralgic disease, nervous prostration. "Patients preferred the idea of a physical illness, an illness of the nervous system, to a psychological illness," says Edward Shorter, professor of the history of medicine at the University of Toronto. "That way it wasn't inherited. It was a little fig leaf that psychiatrists used for about 100 years to get patients to come to them." With the Freudian revolution, psychiatrists began to realize that nervous breakdowns and other mental disorders were diseases of the mind, not of the spine and peripheral nerves.

Yet among the general public, the term nervous breakdown is still widely used and understood to mean snapping under extreme pressure. In a 1995 survey by Prevention magazine on the subject of stress, 13% of the respondents said they were "two steps ahead of a nervous breakdown." And in a new movie called "Losing Chase," a wife and mother played by Helen Mirren returns home after a lengthy recuperation from a nervous breakdown. So profound is her enervation that she struggles even to tap the ash from her cigarette.

Over the years, psychiatry has gradually subdivided the term into more precise diagnostic categories. Today, nervous breakdowns may be acute psychotic breaks or schizophrenic episodes, as when people suddenly become convinced that aliens have planted listening devices in their teeth, or manic breaks. Or they may be panic attacks, the hot new malady that is quickly replacing depression as the mental illness du jour. But the current diagnosis that most closely resembles the traditional nervous breakdown is "Major Depressive Episode," in which, according to the Diagnostic and Statistical Manual of Mental Disorders, a person may experience "loss of interest or pleasure in nearly all activities" and "sustained fatigue without physical exertion." (The first DSM, published in 1952, called nervous breakdowns "psychophysiologic nervous system reactions.") Peter Kramer, a professor of psychiatry at Brown University and author of "Listening to Prozac," laments the "hyperdiagnostic" phase the field is now going through. "Maybe it's just something like having the circuits overload, and it doesn't matter how you get there," he says.

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