Nervous breakdown

What is a nervous breakdown?

Nervous breakdown is an old term dating back to the 19th century, when many mental disorders were attributed to failure of the nervous system. It reflects a rather mechanical view of how humans function, which arose as factories became more common. During the 19th century, as the role of electrical impulses in the nervous system was being mapped, it wasn't difficult for people to see it as an electrical machine that could break down.

At the same time, people moved from the countryside to town, which brought its own problems, including cramped living spaces, poor working and living conditions and widespread disease - perfect conditions for the development of what we know call stress-related disorders.

Psychiatrists, however, used the term neurasthenia, which literally means 'lack of nerve strength'.

Both the general population and psychiatrists seemed to accept the difference between what were later termed 'psychotic' and 'neurotic' disorders:

• Psychotic disorders included symptoms such as hearing voices and were stigmatised and viewed as 'lunatics', possibly violent and usually incurable. It was at this time that many of the old asylums were built to hide such people from society.
• 'Neurotics', or those suffering from nervous breakdowns, were more associated with anxiety and low mood, and were seen as curable if given time to recover.
• Mental health professionals still recognise the differences between these two types of mental health condition, but see the divide as much less clear.

This divide was supported when soldiers returning from the First World War came back with 'shell shock', many of whom wouldn't have suffered from mental health problems if they hadn't experienced the trauma of the trenches. Today we recognise that many of them were suffering from post-traumatic stress disorder (PTSD).

Interestingly, shell shock was a diagnosis of men returning from the trenches, whereas neurasthenia was predominantly seen as a condition of women. This is obviously not the case, as both conditions affect men and women.

Stress-vulnerability model

Stress has a role to play in both psychotic and neurotic disorders. One of the most useful perspectives comes from studies into the causes of psychosis. This is called the stress-vulnerability model.

The stress-vulnerability model recognises that anyone can develop a mental health problem if put under enough stress. However, the amount of stress that leads to mental health problems differs from person to person. Someone with high vulnerability to the effects of stress (who is further along the 'vulnerability' line in the graph) will cross over into the 'mental health problem' area at lower amounts of stress (lower down the 'stress' line on the graph). Similarly someone with low vulnerability will cross over the line only when they experience higher amounts of stress.

Just where each person's limit is set is determined by a number of factors. Genetics may have a role, but so does our personal history and our ability to deal with issues. Similarly, what counts as stress can differ from person to person: one person's overwhelming problem could be another's exciting challenge. The meaning of the source of the stress is also important and how it's interpreted can again depend on a number of factors, including personal history and ability to solve problems.

It's important to recognise that some stress is a good thing; it makes us more alert and engaged with life. Just as too much stress can cause burn-out, so too little can lead to what some occupational psychologists call 'rust-out'.

The amount of stress we experience also varies - we all have periods that are more stressful than others. Sometimes we can predict and prepare for them and sometimes they come out of the blue. Similarly, our vulnerability to stress may vary over time - youth may make us more resilient or experience may make us less likely to see certain situations as stressful.

This makes the stress-vulnerability model a flexible way of looking at your life balance and helping you to avoid becoming overwhelmed.

It can be useful to list the sources of stress in your life and rate them from 1 (hardly any stress at all) to 10 (completely overwhelming), so you can assess your own current stress score. It can also be useful to identify other activities that might help raise your vulnerability so you can keep yourself in good mental health.

Related video