London - Oprah Winfrey reportedly had one, Paul McCartney has revealed he narrowly avoided one, and Britain’s football referees claim they are at huge risk of suffering them.
Suddenly, everyone is talking about having ‘nervous breakdowns’. The term has long been discarded by mainstream medicine and replaced by the word ‘depression’. But the nervous breakdown seems to be fast coming back into vogue. So, why?
Last month, Winfrey talked about her experience.
The 59-year-old television personality and actress explained that last year she was filming for the movie The Butler, and trying to improve the profile of her ‘struggling TV network’, the Oprah Winfrey Network.
Her symptoms began with ‘just sort of speeding and a kind of numbness and going from one thing to the next thing to the next thing. I realised that if I didn’t calm down, I was going to be in serious trouble,’ she told US television show Access Hollywood.
As Winfrey described it, at one point she was reading a script and had to ‘[close] my eyes in between each page because there was too much stimulation for my brain. I had reached a point where I couldn’t take in any more’.
Meanwhile, Sir Paul McCartney has revealed in a new biography how his first wife Linda saved him from a nervous breakdown that was sparked by the disintegration of the Beatles. He often had sleepless nights, ‘spent shaking with anxiety’, writes biographer Tom Doyle.
Elsewhere, Mark Halsey, a former Premier League referee, has voiced his fear that some football officials may take their own lives without help to deal with the job’s pressures.
‘It will not be long before a referee has a nervous breakdown,’ he warns in his new book, Added Time.
The revival of the term ‘nervous breakdown’ is not just about fashionable phraseology. It is also emblematic of a shift in thinking about these diseases.
Some scientists believe there are crucial differences between nervous breakdowns and depression, but that everyone is currently given the same ‘depressed’ label. This can result in people being put on powerful antidepressants that won’t work for them and which can cause serious side-effects.
The term ‘nervous breakdown’ first became popular in the late 1800s, when a full understanding of the nervous system emerged, explains Dr Trevor Turner, a consultant psychiatrist at the East London Foundation Trust.
‘A breakdown also has a mechanical drama, and it is probably no coincidence that this was at the same time as the advent of the motor car, which was always breaking down.’
‘Nervous breakdown was a way to give a physical explanation - a more acceptable alternative to the idea of mentally cracking up,’ says Dr Turner. ‘It got people over the stigma and gave a physical explanation.
‘Currently, our vogue word for this broad, vague condition is “depression”, though it may soon be eclipsed by the new vogue for “nervous breakdowns”.’
Just a quarter of a century ago, it was very rare to be diagnosed with ‘depression’ - it was thought evidence of weak character. Instead, people with a broad spectrum of depressive symptoms were often diagnosed with ‘a nervous condition’.
In the Fifties, this label was often given to women with postnatal depression. Treatment frequently involved stays in mental hospitals and electro-shock therapy (ECT).
While the stigma surrounding depression is slowly lifting, the term itself implies something very passive. The renewed popularity of ‘nervous breakdown’ as a term may reflect the nature of our highly stressed times.
Last month, even President Barack Obama was rumoured to have suffered one, thanks to the combined strains of dealing with the Syrian crisis, the UN and US budgetary problems.
The internet buzzed with rumours after a news source called the National Report alleged, without proof, that the President had suffered a mental collapse in Washington and had to be sedated.
If there is a desire not to be seen as ‘depressed’, there may also be good clinical reasons for ditching the word. Some leading experts argue that it is inaccurate and unhelpful.
‘Depression is a very broad concept, it covers everything from Monday morning blues to serious bipolar disorder,’ argues Dr Cosmo Hallstrom, a consultant psychiatrist and fellow of the Royal College of Psychiatrists.
‘Depression is normally associated with loss or unhappiness,’ he says, adding that many cases of breakdowns are in fact caused by severe anxiety, as opposed to sadness.
‘I believe anxiety is distinct from depression and is not really dealt with. In the NHS there is little acceptance of it and no treatment.’
Edward Shorter, a historian of psychiatry at the University of Toronto, agrees. ‘Depression is a real illness, but there are different kinds.
‘It covers both melancholia [i.e., sadness] and non-melancholia, two different diseases,’ he says. ‘It’s like trying to lump measles and TB together under one diagnosis on the basis that they are both contagious.’
In his recent book How Everyone Became Depressed: The Rise And Fall Of The Nervous Breakdown, Dr Shorter argues that only one in five patients currently diagnosed with depression actually has clinical sadness - melancholia.
This can respond to treatment with Prozac-type drugs - called selective serotonin reuptake inhibitors (SSRIs), which raise the level of a ‘feelgood’ chemical, serotonin, in the brain - but most patients won’t benefit from a prescription.
‘Melancholia patients have a characteristic physical slump, which can be seen in their posture and body language,’ says Dr Shorter. ‘There are also biological markers. This is the type of depression that can respond to appropriate drug treatments, such as antidepressants.’
The concern is that the other four-fifths of patients end up on drugs that won’t help them. These are linked to potential side-effects, including nausea, reduced libido, increased risk of suicide in some patients, particularly those under 25, and increased risk of bleeding.
For these patients, exercise therapy and psychological support are significantly more effective, argues Dr Shorter.
‘But drugs are overdone instead. It’s a great shame. If you put people with non-melancholic depression on Prozac, they get all the side-effects and none of the benefits.’
This is backed by research from Irving Kirsch, a professor of psychology at Hull University. In 2008, he studied drug manufacturers’ trial results for four common SSRI antidepressants, concluding that Prozac-class drugs probably have a real clinical benefit only for the 20 per cent of patients with severe depression.
So what of the remaining 80 per cent of patients currently diagnosed with depression? What is actually wrong with them, and how can it be alleviated?
Dr Shorter believes their problems are caused by a mixture of conditions that feature chronic mood problems - best described accurately by the old, unfashionable diagnostic labels.
‘That old-fashioned term is nervous disorder. The problem is primarily a disorder of anxiety and tiredness,’ he says.
The symptoms can include more than mood changes. ‘Such patients have lots of somatic [or mind-body] symptoms, too, such as vague physical pains.’
Another potential alternative label to nervous breakdown might be ‘mixed anxiety depression’, a term that was banished from the US psychiatrists’ ‘bible’, the Diagnostic And Statistical Manual Of Mental Disorders, in 1980.
Dr Shorter believes the only way ahead is to ‘go back to ground zero with our diagnoses’. He adds: ‘We need to come up with proper psychiatric diseases that correspond to what people really do have.’ So, names for conditions that describe the distress a person feels.
Now, in these anxious, highly pressured times, the idea of being pushed so hard the nervous system starts to break down seems to make sense - which means we might hear a lot more about ‘nervous breakdowns’. - Daily Mail