will be appreciated that there are different grades of ‘nervous’ suffering. Countless people have ‘bad nerves’ and many of them, although distressed, continue at their work and cannot be said to suffer from nervous breakdown. Indeed, while they readily admit to having ‘bad nerves’, they would indignantly refute any suggestion of breakdown. And yet a nervous breakdown is no more than an intensification of their symptoms. Although this book is concerned mainly with the development and treatment of nervous breakdown, almost every symptom complained of by people with ‘bad nerves’ will be found here, and such people will recognize themselves again and again in the patients with breakdown described in the following chapters. The symptoms are the same, it is but their severity that varies. The person with breakdown feels these symptoms so much more intensely.
Where do ‘bad nerves’ end and where does nervous breakdown begin? By nervous breakdown we mean a state in which a person’s ‘nervous’ symptoms are so intense that he copes inadequately with his daily work or does not cope at all. Doctors are asked if people really ‘break’, and if so, how? We are also asked how a nervous breakdown begins and develops.
The Breaking Point
Many people are tricked into breakdown. A sudden or prolonged state of stress may sensitize adrenalin-releasing nerves to produce the symptoms of stress in an exaggerated, alarming way. This state of sensitization is well known to doctors, but so little known to people generally that, when first experienced, it may bewilder and then dupe its victim into becoming afraid of it. If asked to pinpoint the beginning of nervous breakdown, I would say that it is at the moment when a sensitized person becomes afraid of the sensations produced by severe stress and so places himself in a cycle of fear – adrenalin – fear. In response to his fear, more adrenalin is released and his already sensitized body is thus stimulated to produce even more and more intense sensations, which inspire more fear. This is the fear – adrenalin – fear cycle.
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
