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Two Types of Breakdown

Most breakdowns are of two main types. One is relatively straightforward and its victim is mainly concerned with the distressing sensations brought by his sensitized nerves. In such people, nerves may be suddenly sensitized by the stress of some shock, such as an exhausting surgical operation, a severe haemorrhage, an accident, a difficult confinement; or, sensitization may come more gradually following a debilitating illness, anaemia, or too strenuous dieting. This person is often happy in his domestic life and work; indeed, he may have no great problem other than his inability, because of breakdown, to cope with his normal responsibilities.

The second type of breakdown is begun by some overwhelming problem, conflict, sorrow, guilt or disgrace. The stress of prolonged, fearful introspection gradually sensitizes nerves to react more and more intensely to the anxious introspection, until bewilderment and fear of the strange feelings sensitization brings, even of the strange thoughts it may bring, become as much part of the suffering as the original problem, conflict, sorrow, guilt or disgrace. Indeed, it may eventually be the main concern.

CHAPTER 4 The Simpler Form of Nervous Illness

People suffering from the first type of breakdown (anxiety neurosis), complain of some, or all, of the following symptoms of sensitized involuntary nerves: sleeplessness, depression, fatigue, churning stomach, indigestion, racing heart, banging heart, shaking heart, palpitations, ‘missed’ heart-beats, a sharp knife-like pain under the heart, a sore feeling around the heart, sweating hands, ‘pins and needles’ in the hands and feet, a choking feeling in the throat, an inability to take a deep breath, a tight feeling across the chest, ‘ants’ or ‘worms’ crawling under the skin, a tight band of pain around the head, giddiness, and strange tricks of vision such as the apparent movement of inanimate objects. Nausea, vomiting, occasional diarrhoea, and frequent desire to pass urine may be added to the picture.

The following is a typical list brought to the doctor by such a patient. This was brought by a young mother. It is printed exactly as she wrote it:

All tied up.

Headaches.

Tired and weary.

Palpitations.

Dreadful.

Nervous.

Sharp pain under the heart.

No interest.

Restless.

My heart beats like lead.

I have a heavy lump of dough in my stomach.

Heart-shakes.

Sufferers from these symptoms are easily upset by little things. They are quite certain that there is something seriously wrong with them and cannot believe that anyone else could have had such a distressing experience. Many feel convinced that they have a brain tumour (at least something ‘deep seated’) or that they are on the verge of madness. Their one wish is to be, as quickly as possible, the person they used to be before this ‘horrible thing’ happened to them. They are often not aware that their symptoms are nervous in origin and follow a well-recognized pattern shared by numerous sufferers like themselves, the pattern of continuous fear and tension.

I shall describe in detail the development of such a breakdown before discussing cure, because bewilderment at what is happening and fear of what may happen next are often the main factors prolonging illness.

The Beginnings: Palpitations

Many healthy people are precipitated into this type of nervous breakdown by the fear induced by some sudden, alarming, yet harmless bodily sensation such as their first unexpected attack of palpitations. Even a healthy heart may palpitate when anaemic, fatigued or under stress. Such an attack can be frightening to a highly strung temperament, especially if it comes at night and there is no one to turn to for comfort and reassurance. The heart races wildly and the sufferer is sure it will burst. He usually lies still, afraid to move for fear of further damaging himself. So fear arises. It is only natural to be alarmed by sudden, unexpected, uncomfortable happenings in our body, particularly in the region of our heart.

Fear – Adrenalin – Fear Cycle

Fear causes an additional outpouring of adrenalin, so that a heart already stirred to palpitations becomes further excited, beats even more quickly and the attack lasts longer. The sufferer may panic, thinking he is about to die. His hands sweat, his face burns, his fingers tingle with ‘pins and needles’, while he waits for he knows not what.

The attack eventually stops – it always does – and all may be well for a while. However, having had one frightening experience, he dreads another and for days remains tense and anxious, from time to time feeling his pulse. If the palpitations do not return he settles down, loses himself in his work and forgets the incident. If, however, he has a second attack, he really is concerned. Apparently the wretched thing has come to stay!

Not only is he afraid of palpitating, but he is also in a state of tension wondering what further alarming experience his body may have in store for him. It is not long before tension, releasing more and more adrenalin, makes his stomach churn, his hands sweat and his heart constantly beat quickly. He becomes even more afraid, and still more adrenalin is released. In other words, he becomes caught in the fear – adrenalin – fear cycle.

Tension Through Fear

At this stage the sufferer consults a doctor, who usually succeeds in reassuring him and banishing his fear. However, he may not be sufficiently reassured and may be unfortunate enough to be put to bed and advised to ‘take things carefully’ and to ‘be sure not to overdo it’. When so advised the average person, particularly if young and not yet protected by the philosophy of age, lies in bed brooding over his ‘bad’ heart, afraid to move for fear of straining it further. This patient was already in a state of nervous tension worrying about the palpitations. Can you imagine his tension now? Perhaps you have experienced it?

On the other hand, should the doctor, in an effort to reassure, make too light of the palpitations, the patient may stay in bed of his own volition, convinced that the doctor is witholding the worst and has not told him all. If he remains tensed and afraid he is certain to have further attacks, and the more frequently they come the more he hugs the couch. The more he rests, the more time he has to brood and the more tense and apprehensive he becomes. His finger is continually hovering above his pulse, and in response to this anxiety his heart constantly beats quicker than it should, although not as fast as when palpitating. Actually he thinks it is beating faster than it is, because he is conscious of every beat. To him it is thumping, banging, racing. One ingenious woman arranged her pillows end to end, so that she could lay her ear on the crack between them – in this way she thought she heard less thumping.

The sufferer by now is really sorry for himself. He loses appetite, loses weight and dreads being alone ‘for fear of having a turn’; at the same time he is afraid to be with people for fear of having one and making a fool of himself. It is not long before he develops most of the sensations of breakdown – the churning stomach, sweating hands, pains around the heart, racing heart, giddy turns, headache – in other words, the full fear-adrenalinfear cycle.

If fear of palpitations has not drawn this person into this type of nervous breakdown, fear of some other upsetting bodily sensation generally has. Perhaps he has had pain in the region of his heart which he, in alarm and ignorance, diagnoses as angina. Perhaps a strenuous, anxious, highly tensed life has given him a constantly churning stomach or ‘shaking’ heart at which he becomes alarmed. Whatever the cause, in answer to his continuous apprehension his adrenalin-releasing nerves become sensitized and gradually burden his day with the new, upsetting sensations described above. He tries to fight or escape, until he too becomes caught in the same fear – adrenalin – fear cycle as the person afraid of the palpitations.

As mentioned, these people have these sensations as a more or less constant background to their day. They may have moments of respite; for example, some on waking feel strangely calm and may be able to lie at peace for an hour or so before the churning starts. Others feel calmest at night. Others know no peace.

Panic

Some people, as well as having this background of disturbing sensations, are swept from time to time by intense waves of panic. Some have a panic spasm every few minutes, and this may continue for hours. It will be appreciated how disturbing these spasms can be when a sufferer is working and trying to appear normal and how he lives in dread of their coming at inappropriate moments. Unfortunately they are most likely to come at such times, as he is then most apprehensive and afraid.

It is possible that the recurring attacks of palpitation have now left him and that he is more concerned with the other manifestations of fear, although it is more usual to find the palpitations continuing and adding to the miserable burden.

This is not a far-fetched story. I have heard it so often that I give it respectful attention. I have known this stage, inadequately treated, to last several years, the patient going from doctor to doctor.

To healthy people this history may sound all too childish and stupid. They think, ‘Why doesn’t he pull up his socks and get on with his work and forget all this nonsense?’ That is exactly what he would like to do. But what we, the healthy ones, do not realize is that by this time the fear felt by such a sufferer is greater than any the average person has known or has paused to imagine. Repeated spasms of panic, when accompanied by exhaustion, not only increase in intensity but need less and less to start them. Dread of having them may bring on a whole sequence. Meeting a stranger, the thought of being left alone, even a slamming door may suffice. Also, in spite of a great desire to pull up his socks and get to work, such frequent, intense spasms of fear seem to paralyse his will to act.

Some years ago, when recuperating from an operation, I stayed with friends who were planning a bush walk. They asked a young man to join us. It was not a long walk, they assured me (but long enough for me, thought I, as I looked at his long legs). To my astonishment this big fellow soon fell behind and we frequently had to wait for him to catch up. At lunch he lay exhausted on the grass. Later he told me his story. For years, since student days, he had had recurring spasms of intense panic, so that his life had become a nightmare. He was not afraid of anything in particular, only the feeling of fear itself, and this had become so intensified and exhausting that even that short walk had been too much.

This man was eventually cured and able to lead a scientific expedition. I mention him because he was no weakling but a clever scientist in a responsible position. With help he recovered quickly, after having suffered for ten years.

Fighting

The sufferer from nervous breakdown is neither fool nor coward, but often a remarkably brave person who fights his breakdown to the best of his ability with commendable although often misdirected courage. He may fight through almost every waking moment, with sweating hands and tensed muscles, agitatedly trying to force forgetfulness of his desperate state by consciously concentrating on other things. Or he may pace the floor of his mind, anxiously searching for a way out of his miserable prison, only to meet one closed door after another.

At night he falls into bed exhausted, to sleep the fretful sleep of nervous agitation, the heavy sleep of nervous exhaustion, the drugged sleep of the barbiturate swallower, or, worse still, to find no sleep in spite of heavy sedation.

At times the early part of the evening may not seem so bad. He may feel almost normal and think he has conquered this ‘thing’ at last, and may go to bed saying, ‘Now, that’s the finish. Tomorrow I will be my old self again,’ only to wake and find the spasms and the churning worse than ever. He cannot understand why, having felt so much better by evening, he should wake the next morning feeling as ill as ever, perhaps even worse. He certainly feels more hopeless, if that be possible. He is either convinced that there is some short quick road to recovery which continually eludes him or that there is not, and never could be, a way back to peace from such suffering as his.

He looks back with longing at the person he used to be, the person who could sit peacefully and enjoy a good book, or happily watch television, and he apprehensively counts the weeks, months, even years, since he was that person. He reasons that if he cannot become himself again by fighting, how else can he? Fighting is his natural defence, the only weapon he knows, so he fights even harder. But the harder he fights, the worse he becomes. Naturally – for fighting means more tension, tension more adrenalin and further stimulation of the adrenalin-releasing nerves, and so the continuation of symptoms. To make matters worse, his friends do not hesitate to advise him to fight it. Even his doctor may say, ‘You’ll have to fight this thing old man. You mustn’t let it get the better of you!’

What has happened to him he cannot understand. He is like a man possessed. He does not realize that there is no devil sitting on his shoulder and that he is simply doing this to himself with fear, fight, and flight from fear.

It is at this stage that he may develop severe headache which he likens to an iron band encircling his head, or to a weight pressing on top of it. He may be giddy, nauseated, have difficulty in expanding his chest to take in a deep breath, feel a heavy soreness around his heart or a sharp pain under it which he sometimes refers to as ‘the dagger’. He may also have recurring ‘funny turns’ such as spells of abnormally slowly beating heart, ‘missed’ heart-beats and weak, trembling turns. He loses interest in everything and in everybody, and mounting tension makes him easily upset by trifles. As one young mother put it, ‘I take it out on the poor kids’.