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Sedation

The doctor usually prescribes sedatives at this stage, and there is no doubt that the patient may need them. But with a layman’s distrust of such ‘dope’, his family is probably urging him to ‘Throw the wretched stuff down the sink,’ adding, ‘It is only helping to depress you,’ and ‘That doctor will make an addict out of you yet.’ The sufferer becomes further confused because at the back of his mind he too is afraid of that. Part of a doctor’s problem is to convince the patient – and what is just as important, the patient’s family – that such sedation is not only not harmful but, as a temporary measure, may be very necessary, and that it will not make an addict of him if carefully supervised. Usually, when cured, the last thing these people want to see is one of those wretched capsules or a dose of that pink mixture.

Life is so contrary, it can put so many unexpected obstacles in the way of recovery. In the words of one woman, ‘You would never believe the number of spanners that get thrown into the works’.

For example, it is possible that, just as the doctor is winning his battle over the taking of sedatives, someone chooses that moment to take an overdose of barbiturates and the newspapers will be vociferous on the dangers of taking such drugs. The patient, who probably hasn’t looked at a paper for weeks, somehow never fails to see the report or hear about it, and so the doctor’s battle begins again.

And yet, however sedated this person may be, fear usually finds its way through such sedation. Sedation only softens the blow, but it does do that, and so plays in important part in recovery, as will be discussed later.

Collapse

Finally the day may come when, yielding to some extra burden of fear, the sufferer gives up what he thinks is his last ounce of strength, and ‘collapses’, while the alarmed family stand round helplessly. The words heard murmured in the hall, ‘Doctor, he has collapsed,’ close a chapter for him and act as chains to bind him to the bed. If he could not find his way out of breakdown while on his two feet he wonders how he will find it now that he has collapsed. The fight seems too great, the journey too uphill, so he may spend weeks, even months, on his back, or be taken promptly to hospital for shock treatment.

The Constant Pattern of Fear

No doubt you have recognized some of yourself in this person and it may be a revelation to find that the basis of your mysterious symptoms is, like his, fear.

Whether breakdown be mild or severe, the basic cause is fear. Conflict, sorrow, guilt or disgrace may start a breakdown, but it is not long before fear takes command. Even great sorrow at the loss of a loved one is mixed with fear, the fear of facing the future alone. Sexual problems are most likely to cause breakdown when accompanied by fear or guilt. Guilt opens the door to fear. Anxiety, worry, dread are only variants of fear in different guises.

It could be argued that strain, as distinct from fear, may cause breakdown in certain situations. For example, there is much prolonged strain for a middle-aged woman tending an old, sick parent. However, while she copes from day to day, does not look too far ahead and does not think it too important that she is literally chained to her duties, she can sustain months, years, of such strain. She may ‘bend’ and need help from time to time, but she will not ‘break’.

I once commented on the ability of one woman to carry on for so long in such a situation and was told by her brother, ‘Yes, it is a great strain on Ada, but Ada never did think of herself.’ That was the key to Ada’s endurance. Had Ada listened to her sympathizing friends, begun to feel sorry for herself and come to dread the future, she would have sown the seeds of a nervous breakdown.

Strain may cause severe headaches (Ada had migraine) and physical exhaustion, but unless accompanied by fear it will not cause the incapacity known as nervous breakdown. When work threatens to become beyond our physical strength and our responsibilities demand that we keep going, fear usually comes into the picture and any ensuing breakdown is caused not by the exhaustion, as so many believe, but by the fears it brings.

Afraid to Admit Fear

Sometimes it is difficult for a person to admit even to himself that he is afraid. One woman insisted that it was the ‘stomach shakes’, not fear, that caused her nervousness. So I avoided the word ‘fear’ when talking to her and tried to convince her that it was ‘tension’ causing her stomach shakes. Her stomach had ‘shaken’ for six months; she had eaten and slept little and looked the wreck she felt, and yet when she finally accepted that the shakes depended on the excretion of adrenalin through tension, she was able to relax and lose them within a month. However, she continued to insist that she had not been afraid of them.

Is it possible to explain the disappearance of this woman’s symptoms in any other way than that she had lost her fear of them? I asked her for an explanation and she said, ‘I disliked them. I lost my dislike of them.’ She had disliked them so much that she had let them dominate her life for six months. Surely the difference between such strong dislike and fear is only one of degree? At least we have to admit that strong dislike of physical sensations is so close to fear that it can cause the same nervous reactions.

Camouflage your fear as intense dislike if it makes you feel happier. This is of no importance, as long as you understand that the physical reactions in your body to intense dislike and fear are so similar that any difference is negligible.

The Single Pattern

The breakdown described in this chapter was not complicated by a particular problem. It was caused by no more than fear of the very feelings that fear itself had aroused, and as such is the commonest and most straightforward form of breakdown we know. If yours is this type of breakdown, it is a step towards cure to see your various symptoms as part of a single pattern coming from a single cause, fear. These symptoms are not peculiar to you, but are well known to many like you. And yet, however distressing they may be, I assure you that every unwelcome sensation can be banished and you can regain peace of mind and body.

CHAPTER 5 How to Cure the Simpler Form of Nervous Illness

If you have this type of breakdown you will notice that, as already mentioned, you have certain symptoms as a fairly constant background to your day, while others come from time to time. For example, the churning stomach, sweating hands and rapidly beating heart are more or less always with you, while fear-spasms, palpitations, ‘missed’ heartbeats, pains around the heart, trembling turns, breathlessness, giddiness and vomiting come in attacks, at intervals. The constant symptoms are those of sustained fear, hence their chronicity, while the different recurring attacks are the result of varying intensity in sustained fear, hence their periodicity.

The treatment of all symptoms depends on a few simple rules. When you first read them you may think, ‘This is too simple for me. It will take something more drastic to cure me.’ In spite of this, you will need to be shown how to apply this simple treatment and may often have to re-read instructions.

The principle of treatment can be summarized as:

Facing.

Accepting.

Floating.

Letting time pass.

There is nothing mysterious or surprising about this treatment, and yet it is enlightening to see how many people sink deeper into their breakdown by doing the exact opposite.

Let us look again briefly at the person described in the last chapter, the person afraid of the physical feelings aroused by fear, and see if we can pinpoint his own treatment of his breakdown.

First, he became unduly alarmed by his symptoms, examining each as it appeared, ‘listening in’ in apprehension. He tried to free himself of the unwelcome feelings by tensing himself to meet them or by pushing them away, agitatedly seeking occupation to force forgetfulness. In other words, by fighting or running away.

Also, he was bewildered because he could not find cure overnight. He kept looking back and worrying because so much time was passing and he was not yet cured, as if this thing were an evil spirit which could be exorcized if only he, or the doctor, knew the trick. He was impatient with time.

Briefly, he spent his time:

Running away, not facing.

Fighting, not accepting.

Arresting and ‘listening in’, not floating past.

Being impatient with time, not letting time pass.

Now let us consider how you can cure yourself by facing, accepting, floating and letting time pass.

We will first consider cure of the constant symptoms and then of the recurring attacks.

CHAPTER 6 Cure of the More Constant Symptoms

First, look at yourself and notice how you are sitting in your chair. I have no doubt that you are tensely shrinking from the feelings within you and yet, at the same time, are ready to ‘listen in’ in apprehension? I want you to do the exact opposite. I want you to sit as comfortably as you can, relax to the best of your ability by letting your arms and legs sag into the chair as if charged with lead, and take slow, deep breaths through your partly opened mouth. Now examine and do not shrink from the sensations that have been upsetting you. I want you to examine each carefully, to analyse and describe it aloud to yourself. For example, you may say, ‘My hands sweat, they tremble and feel sore …’ This may sound a little silly and you may smile. So much the better.

CHURNING STOMACH

Begin with the nervous feeling in your stomach, the so-called churning. This may feel like an uneasy fluttering or may bore steadily like a hot poker passing from your stomach through your back. Do not tensely flinch from it. Go with it. Relax and analyse it. Take a few minutes to do this before reading further.

Now that you have faced and examined it, is it so terrible? If you had arthritis in your wrist, you would be prepared to work with the arthritic pain without becoming too upset. Why regard this churning as something so different from ordinary pain that it can frighten you? Stop regarding it as some monster trying to possess you. Understand that it is but the working of oversensitized adrenalin-releasing nerves and that by constantly shrinking from it you have stimulated an excessive outflow of adrenalin which has further excited your nerves to produce continual churning.

While you examine and analyse this churning a strange thing may happen: you may find your attention wandering from yourself. This ‘thing’ that seemed so terrible while you stayed tense and flinched from it, may fail to hold your attention for long when you see it for what it is – no more than a strange physical feeling of no great medical significance, and causing no real harm.

So, be prepared to accept and live with it for the time being. Accept it as something that will be with you for some time yet – in fact while you recover – but something that will eventually leave you if you are prepared to let time pass and not anxiously watch the churning during its passing.

But do not make the mistake of thinking that it will go as soon as you cease to fear it. Your nervous system is still tired and will take time to heal, just as a broken leg takes time. However, as you improve and are no longer afraid of the churning, and do not try to cure it by controlling it, and are prepared to accept it and work with it present, you will become more interested in other things and will gradually forget to notice whether it is there or not. This is the way to recover. By true acceptance you break the fear – adrenalin – fear cycle, or, in other words, the churning-adrenalin-churning cycle.

True Acceptance

From this discussion you will appreciate that true acceptance is the keystone to your recovery, and before you continue with the examination of your other symptoms we should make sure that we understand its exact meaning.

I find that some patients complain, ‘I have accepted the churning in my stomach, but it is still there. So what am I to do now?’ How could they have accepted it while they still complain about it?

Or, as one old man said, ‘After breakfast the churning starts, I can’t just sit there and churn. If I do, I’m exhausted after an hour, so I have to get up and walk round, so what am I to do?’ I said to him, ‘You haven’t really accepted that churning, have you?’ ‘Oh, yes I have,’ he answered indignantly. ‘I’m not frightened of it any more.’

But he obviously was. He was afraid that after an hour’s churning he would be exhausted, so he sat tensely dreading its arrival, shrinking from it when it came and worrying about the exhaustion to follow. Of course the churning, itself a symptom of tension, must inevitably come while so tensely awaited.

I tried to make him understand that he must be prepared to let his stomach churn and to continue reading his paper without dwelling on the churning. Only by so doing would he be truly accepting. In this way, and only in this way, would he eventually reach the stage when it would no longer matter whether his stomach churned or not. Then, freed from the stimulus of tension and anxiety, his adrenalin-releasing nerves would gradually calm down and the churning would automatically lessen and finally cease.

This man was asked to do no more than change his mood from apprehension to acceptance. The symptoms of this type of breakdown are always a reflection of your mood. However, it is well to remember that it may be some time before your body reacts to the new mood of acceptance and that it may continue for a while to reflect the tense, frightened mood of the preceding weeks, months or years. This is one reason why nervous breakdown can be so bewildering and why this old man was bewildered. He had begun to accept, but when the symptoms did not disappear immediately, he quickly lost heart and became apprehensive again, although trying to convince himself that he was accepting. It takes time for a body to establish acceptance as a mood and for this eventually to bring peace just as it took time for fear to become established as continuous tension and anxiety. That is why ‘letting time pass’ is such an important part of your treatment and why I shall emphasize it again and again. Time is the answer. But there must be that background of true acceptance while waiting for time to pass.