What Is a ‘Nervous Breakdown,’ Really?

I once worked with someone some years ago who had several times in her life which she described as ‘nervous breakdowns.’ In one of them she described times when she would go catatonic: she would go to her room, wrap herself in a blanket, and remain motionless and expressionless for hours. From what I know of what was happening in her family and marriage at the time, it’s no wonder that she felt overwhelmed and unable to cope. I was reminded of her experience through my recent reading through a biographical account of F. Scott and Zelda Fitzgerald by an English professor, and it’s noteworthy that Zelda was institutionalized several times when she became delusional and dysfunctional, and sometimes these are called mental breakdowns.

Unfortunately, the term ‘nervous breakdown’ or ‘mental breakdown’ really isn’t a term of clinical psychology or psychiatry. It’s more a popular term and colloquial description, and it seems to have its roots back into the earlier half of the 20th century, when the term ‘nerves’ was used to describe ‘anxiety’. It isn’t used that much any more; panic attack nowadays is used much more accurately of some of these incidents. In other words, ‘nervous breakdown’ is not a professional diagnosis from either a qualified psychiatrist or psychologist, and probably has not been anything close to one for many years. It’s been for a long time a sign of amateur psychobabble and of amateur misdiagnosis. In the case of Zelda Fitzgerald, I think that the historical record might be well enriched by a forensic analysis by a professional psychiatrist in the light of more contemporary diagnoses and treatment.

Here are some online sources, some from professional psychologists and psychiatrists, which describe more of what people have meant by the term:

It’s valuable for pastors and Christian leaders to read over these descriptions, since it can help them to avoid jumping to wrong conclusions about what people are going through in their lives. Deep and overwhelming panic, hurt, disappointment and grief can often provoke a strong outward reaction in the people who are experiencing those emotions, and pastors and Christian leaders are often the closest person to be able to minister to those people. For instance, in some communities, someone experiencing the grief at the loss of a loved one may break out in loud crying and wailing. Most of the people going forward do not become dysfunctional in their lives nor do they show signs of delusions, mania, or catatonia, and are not living afterwards ‘on the verge of a nervous breakdown,’ as the cliché goes. They may live in sadness for a while, and may need to make some significant adjustments, but they may not need any kind of medication and certainly not need to be institutionalized, since their reaction is necessarily not the sign of something organically wrong with that person. I personally would not even call it ‘mental illness.’ Rather, I would call it a sign of deep psychological injury, along with those who are seeking to change the terminology to distinguish between organically based mental illnesses such as some forms of schizophrenia, developmental and character disorders such as narcissism, and psychological injury such as post traumatic stress disorder. These outward signs of psychic pain would thus correspond to the same signs of crying and screaming as when someone receives a very painful physical injury.

Usually in the Christian community, when someone tries to market a psychological condition such as depression or burnout, that person points to the dejected Elijah sitting under the broom tree (I Kings 19:4). Rather, the most perfect, sane and sinless person who ever lived once went through a brief period of extraordinarily deep sorrow and distress – measured in an hour or two — and prayed himself through it. That person was Jesus, and he went through this kind of great torment in the Garden of Gethsemane. This is how he described his emotional experience: “My soul is extremely sorrowful, even unto death” (Mark 14:34). And this is how his praying is described: “And while he was in agony he prayed fervently, and it happened that his sweat became like drops of blood which fell upon the ground” (Luke 22:44). I would never, ever, though, apply this term of ‘nervous breakdown’ to the experience of Jesus in the Garden of Gethsemane, because that term also has implications from the past that for someone experiencing a ‘nervous breakdown’ the next step is an institution, and I would never want to put anything close to that implication on Jesus. Rather, I think that we miss the reality of how deep that experience was for Jesus, because throughout the trial and crucifixion we see the same sane, calm, compassionate and truthful Jesus that we see throughout the gospels. But even more, for anyone going through  deep waters, the truth is that Jesus understands what you’re going through, and he is able to help you more than anyone else: “ . . . [he] in the days of his earthly life offered prayers and supplications with strong cries and tears to him who was able to save him from death, and he was heard because of his reverent submission . . .  for we do not have a high priest who is unable to sympathize with our weaknesses, but who was tried in every way like us – apart from sin. Therefore let us approach the throne of grace with boldness, so that we may receive mercy and that we may find grace in times of our need . . .  since he is able to save to the uttermost those who come to God through him, since he always lives to intercede for them” (Hebrews 5:8, 4:15-16, 7:25).

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