When I was young the term ‘nervous breakdown’ was still very much in use. It was really a general term used to explain things that weren’t physical in nature but that somehow conveyed the person was unable to cope, or more crudely had, "gone mad." These days although we talk more about stress-related disorders the notion of the nervous breakdown still exists.
In reality nerves don’t break down at all and neither has there ever been a formal diagnosis of nervous breakdown. Even so, people still talk about “their nerves” as a focus for stress or anxiety. So why is the idea of our nerves so compelling and where did it all start?
Medical historians point to the 19th century as a key period in the development of ideas about the mind and body. It was a time when the medical profession embraced mental disorders as sickness and the body was often likened to a machine. Mental disorders were often considered to result from some weakness or failure of the nervous system. Dr. George Beard used the term neurasthenia in 1829 to describe symptoms such as fatigue, dizziness, depression and anxiety, which he attributed to depleted reserves of energy in the nervous system. It was thought that the condition arose when people, particularly women, had taken on more than they could cope with but that following a resulting illness the person would normally recover.
Neurasthenia became a popular idea and its causes were considered to relate to rapid industrialization, poor and cramped housing conditions and disease. The most common treatment was rest and fresh air. Beard and others went on to experiment with a variety of electrical ‘treatments’, some of which were taken up by the private clinics and sanatoriums of the day. The diagnosis of neurasthenia remained popular into the 20th century, its use gradually fading into the 1920s as greater inroads into medicine and psychiatry were being made.
Perhaps its not so surprising that we hang on to the idea of nerves to explain stress-related disorders. We all know what people mean when they say they are “nervous” or perhaps have a “nervous condition”. These terms have found their way into our everyday language much in the way that engineering terms like breaking point, stress and tension are used to describe certain psychological processes. We also know that while nerves don’t break down, the action of medication for the treatment of anxiety or stress is specifically designed to have some effect on the neurotransmitters.
A few decades ago the idea of the nervous breakdown was something that often made people – well, nervous. As with so many mental health issues it was a dark, mysterious, feared, embarrassing and misunderstood concept. These days I’d like to feel we’ve made a few positive inroads into mental health issues and things slowly but surely are starting to improve.