Image: The nervous breakdown
Hulton Archive  /  Getty Images file
Nervous breakdowns garnered a certain cachet in the '50s and '60s, since celebrities and movie stars like Frances Farmer and Judy Garland were often described as having nervous breakdowns, even when their problems might have more accurately been described as alcoholism or prescription drug abuse.
By By Roni Caryn Rabin
msnbc.com contributor
updated 4/14/2008 8:32:09 AM ET 2008-04-14T12:32:09

When Joe Livernois was a child, his father sometimes spent days racing around giddily and talking non-stop — then he'd crash, become severely depressed, withdraw into his room and spend most of his time sleeping.

If anyone talked about his father’s increasingly erratic behavior, they said he was “having a nervous breakdown,” said Livernois, now a 54-year-old editor at the Monterey (Calif.) Herald, who recently wrote a series of columns about his father.

"‘Nervous breakdown’ was the malady everybody was suffering at the time. I guess it was a polite way of saying, ‘Your father’s just not right,'" he said. "There wasn’t a lot of knowledge, and this was the 1950s, 1960s, the Eisenhower-Kennedy era, when a whole lot of stuff got swept under the rug.”

These days, Livernois’ dad would probably be diagnosed as bipolar, he says. The huge advances in psychiatry made over the last few decades, combined with a new cultural ethos that encourages straight talk about subjects that were once taboo, has helped bring mental illness out of the shadows. Therapists today are often central characters in movie and TV shows. Diagnoses like “obsessive-compulsive,” "bipolar" and "schizophrenia" have found their way into the mainstream vernacular.

But old-fashioned ”nervous breakdowns”? Hardly anyone mentions those anymore.

“I haven’t heard that term in years,” said Mike Fitzpatrick, executive director of the National Alliance on Mental Illness, a national advocacy organization based in Arlington, Va. “’It’s from another era.”

The term — a vague catch-all phrase that could mean anything from a psychotic episode to having a bad day — is not a medical term, doctors say, but it was a popular one that was gentle, non-specific and therefore non-threatening, and could serve as a cover.

It may have even garnered a certain cache, since celebrities and movie stars like Frances Farmer and Judy Garland were often described as having nervous breakdowns, even when their problems might have more accurately been described as alcoholism or prescription drug abuse. In the 1961 Academy Award-winning movie, “Splendor in the Grass,”  Natalie Wood plays a lovesick young woman from a small town in Kansas who is institutionalized after being abandoned by her boyfriend, a wealthy Yale student played by Warren Beatty, and having a breakdown.

“The world has changed dramatically in the last 50 years or so, in terms of our understanding of mental disorders,” said Dr. Darrel A. Regier, director of the American Psychiatric Association’s division of research. “When I was a kid, there were references to relatives or neighbors, who had a ‘nervous breakdown’ and had to go to a hospital, and dropped out for a period of time, and nobody would really be very specific about what the nature of the illness was.”

Treatments varied from the "rest cure," isolation and preventing all stimulation in the 19th century (described by Charlotte Perkins Gilman in her 1891 short story “The Yellow Wallpaper”) to hydrotherapy, electric shock treatments, insulin treatment and lobotomy in the 20th century. Patients who were hospitalized often faced long-term commitments.

“People are no longer just disappearing from the community in the same way that they did when that term was coined and was in use,” Regier said. “The major emphasis now with the mentally ill is on recovery.”

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'It was a fig leaf'
In past decades, the suggestion that someone had a disorder of the nerves or nervous system was an attempt to place mental illness in the same category as a physical ailment, like a stomach disorder, said Edward Shorter, a professor of the history of medicine at the University of Toronto, who wrote the book “A History of Psychiatry: From the Era of the Asylum to the Age of Prozac.”

“It was a fig leaf,” Shorter said. “It suggested this was a non-inherited, non-genetic and more acceptable condition than mental illness — which was believed to be genetic and inherited.”

Psychiatrists emphasize that the term “nervous breakdown” is utterly meaningless from a medical, clinical point of view. If patients today use it to describe a crisis they went through or when giving a family history, clinicians press for more detailed information.

“It would be like saying someone had a fever, instead of diagnosing different types of infections,” said Myrna Weissman, a professor of psychiatry and epidemiology at Columbia University College of Physicians and Surgeons who studies women and depression. “It’s useful to know someone has a fever, but just as we know so much more about what causes fever, we in psychiatry have a much more sophisticated understanding of the different diagnostic categories.”

In 1952, only 106 types of mental disorders were listed in the  Diagnostic and Statistical Manual of Mental Disorders, or the “DSM,” the American Psychiatric Association’s book classifying mental illnesses. But the fourth and current edition of lists 297 — nearly three times as many.

Treatments have improved over the decades as well. The advent of antipsychotic medications has meant that seriously ill patients can often return to community life as long as they continue treatment and have support systems in place, Regier said.

Since the 1950s, the number of institutionalized patients in the United States has dropped from 550,000 to fewer than 30,000 patients, Regier said. Patients themselves have changed too. Now people are much more educated about medical conditions and aggressive in seeking information. In the age of tell-all TV shows and support groups, people don’t shy away from calling things by their real names.

Still, code words haven’t disappeared completely. One favorite euphemism used today, particularly regarding celebrities, is “exhaustion.” In recent years, Ashlee Simpson, Amy Winehouse, rapper Eminem, Colin Farrell and Lindsay Lohan have all been reported to be suffering from “exhaustion,” in many cases before checking themselves into rehabilitation centers to treat substance abuse.

Named by pop culture
The term “nervous breakdown” seems to have originated in popular culture, said Dr. Jonathan Metzl, an associate professor of psychiatry and women’s studies at University of Michigan in Ann Arbor.

“We use the term medicalization a lot now to talk about how disease concepts, like anxiety, depression and stress, come from medicine and trickle down to society,” he said. “But with ‘nervous breakdown’ the process was reversed — it was defined by popular culture.”

If anything, he said, “Medicine and psychiatry did everything they could to clamp down on it.”

During World War II, Dr. William C. Menninger, who served as chief psychiatric consultant for the Surgeon General of the U.S. Army, developed the concept of “the breaking point,” which was originally applied to soldiers in combat but was later extended to the strains of modern life, Regier said.

“We know that under enough pressure, continued over a long period of time, anyone can be overwhelmed, and bend. All of us have a breaking point,” Menninger wrote in a 1959 paper.

Though many tend to associate nervous breakdowns with women of the 1950s and 1960s who were trapped in very narrow societal roles as mothers and housewives — Betty Friedan’s 1963 book “The Feminine Mystique” talked about the “problem that has no name” that plagued women who were unfulfilled as homemakers — it was men who were seen as most vulnerable to stress earlier in the century, said Dr. Laura Hirshbein, an assistant professor of psychiatry at University of Michigan who studies the history of medicine and psychiatry.

“Men were definitely seen as very susceptible to nervous breakdowns — historians of masculinity describe the switch in men’s work from the late 19th century, when they were in small businesses, with bosses they knew and communities where they felt in control, to the 20th century, when they worked as bureaucrats in large organizations,” Hirshbein said. “It was very stressful for them.”

A pill to calm the nerves
In the 1950s, the new antianxiety medication Milltown was developed and marketed to both men and women, to calm women’s nerves and to ease work pressures for men, Metzl said.
“The idea was that modern society was moving too fast for our fragile psyches.”

Many of the same stresses remain today, it’s just that we’re more specific in what we call our response to them. What used to be blamed on nerves and nervous breakdowns is now often recognized as anxiety or depression and stress is often cited as the culprit.

“Depression is now a socially accepted diagnosis,” Shorter said. “Now everyone’s depressed.”

Roni Caryn Rabin is a health writer who lives in New York City. She has written for The New York Times, The Washington Post, Newsday and Real Simple magazine, among other publications, and is author of the book, "Six Parts Love: A Family's Battle with Lou Gehrig's Disease." She teaches journalism at the Columbia University Graduate School of Journalism.

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