“She’s had a nervous breakdown!”
Half-whispers, hushed tones, and pained looks communicated what, to a child, seemed a vast, strange, and unknowable thing.
To my young mind, what had happened to “the woman at number 36” who had suffered this “nervous breakdown” must have been horrific indeed.
I had no idea what a nervous breakdown was or what the symptoms were, but I sensed it was some mysterious, terrifying, even evil thing. Maybe I, at seven, would have a nervous breakdown! Or perhaps my parents would.
Imagination has a way of amplifying what it doesn’t understand. Fantasy can lend a kind of supernatural horror to mis- or half-understood phenomena. And yet many adults don’t understand quite what a nervous breakdown is either. And there’s a good reason for that.
No clinical diagnosis
We can, perhaps, best understand what a nervous breakdown is by understanding what it is not. The term isn’t a clinical one. It’s not listed in the ‘bible’ of psychiatric diagnosis, the Diagnostic Statistical Manual (DSM).
It’s not a psychotic episode in someone with a pre-existing psychotic illness such as schizophrenia, or a depressive episode in someone with a longstanding diagnosis of depression or bipolar disorder. Nor is it an aspect of a personality disorder such as avoidant personality disorder, histrionic personality disorder, or adjustment disorder (an excessive emotional response to changing events). It is more likely to be a result of simply a huge buildup of stress over time, although certainly changing events can be the “straw that breaks the camel’s back”.
A nervous breakdown may be more severe than, say, ‘burnout‘ (another metaphorical description). But at what point does burnout become breakdown?
So what is a nervous breakdown?
To me, a nervous breakdown is what happens when someone without a pre-existing psychiatric diagnosis, or at least not one that is relevant (which might be hard to distinguish), reaches a crisis point. It’s what happens when their capacity to cope with their situation, or feel that they can, is exhausted.
It involves, to use a third metaphor, a kind of personal grinding to a halt, a collapse of energy and confidence that leaves the person temporarily unable to function in day-to-day life. They may stop washing, dressing, or even getting out of bed.
They might feel intense sensations of depression and anxiety and be utterly unable to fend for themselves or meet even basic demands. This tends to be primarily led by excessive external demands rather than inherent aspects of personality or mental health, and might be totally out of character.
The stress and fatigue caused by burnout might lead to the more severe psychological aspects of a nervous breakdown, such as suicidal ideation, catatonia, inability to move or communicate, feelings of excessive restlessness, or even a psychotic break in which reality itself becomes severely distorted. Just to muddy the waters even more, a nervous breakdown may be a manifestation of a hitherto undiagnosed mental disorder, especially in a young person.
A nervous breakdown – an intense mental deterioration – may last days to weeks, depending partly on how well supported the person is by family and friends and how quickly they can receive effective treatment.
What’s more, a person may experience a nervous breakdown just once in their life without ever suffering other psychological problems – although certainly a loss of confidence and trust in one’s own resilience may ensue, which can mean that some people become more vulnerable to ‘breaking down’ again.
So if we are called upon to help a client who seems to have ‘broken down’ in this way, how might we help ‘mend’ them?
Step 1: Reassure
Oftentimes when people ‘crack’ under the strain, they may have been feeling very alone with everything. Simply by listening – if they are ready to talk, that is – we can help reassure them that what they have been experiencing, a kind of nervous exhaustion and then collapse, is entirely normal. I sometimes half-jokingly say to clients that after what they’ve been through if they hadn’t reacted the way they did there would be something seriously amiss with them!
So we can listen and reassure. Once we’ve done this, the client may be ready for the next step.
Step 2: Encourage
We can also provide further reassurance in the form of encouragement. Sally, a client whom I saw in her home, as she felt unable to “face the world” yet, told me she felt she was “broken”.
This is an offshoot of the nervous breakdown metaphor. After reminding her that a nervous breakdown – a term she and her friends had also used – was in fact a metaphor, I went on to assert that what was ‘broken’ could be not only mended, but ‘reinforced’ and strengthened.
So how do we ‘mend what is broken’? Well, we need to start by encouraging completion of the most basic human needs of all.
Step 3: Help them prioritize their body’s needs
Invariably, clients report having started to neglect their body’s needs in the leadup to their nervous breakdown.
Clients often stop sleeping (or do virtually nothing but sleep). They may lose their appetite or eat excessively, they may move constantly or barely move at all. In fact, they may ricochet between all these different states of being.
A buildup of the stress hormone cortisol in the bloodstream can play havoc with appetite, sleep, and motivation to move.1 So we can help our clients first prioritize their very basic bodily needs.
During your sessions, help them calm down and visualize engaging once again in behaviours which will lower stress and therefore the effects of stress. Devise a plan for eating and small episodes of exercise. Even if, as was the case with one client, that means simply walking around the apartment three times and doing two push-ups every morning! This particular client had previously been a fitness fanatic and somewhat of a perfectionist, so after I asked him to do two push-ups a day he soon reported he had been doing 20!
So we help build a person up slowly, and can ask them to do less than they are capable of at first. We can also help our clients return to the all-important nourishing sleep.
When the body’s needs are fulfilled, mood stabilizes and motivation returns. You may have to spend quite a bit of time simply helping your client relax and meet their body’s needs.
But our clients also need to be kind to themselves.
Step 4: Help your client be fair to themselves
One man who’d had a breakdown told me how he’d always demanded the absolute best from himself and everyone around him, and now he couldn’t stand it that even walking to the local store felt beyond him. I suggested that perfectionism itself was a trap and that his future life could perhaps be approached with more flexibility.
Expectations need to expand and contract in life as circumstances change. Only when this man learned to give himself a break and feel okay about not being able to live at 100 miles per hour (at least until he was feeling better) could he finally get the worry-free rest his mind and body so badly needed.
If someone has just run their first marathon, it might be unreasonable to try to force them to sprint down to the local store and back. They need to rest! And if your client has had a nervous breakdown, they needn’t expect too much of themselves for a while either, because they too need to rest and recuperate.They too have, in a sense, just run a marathon.
We can remind our clients that they are not workhorses, or machines, or slaves to the clock each day. They have needs, and we can teach them exactly what those needs are and help them build a life better suited to meeting those needs in balance and sustainably in future. We can ask them if they tend to treat themselves and/or inwardly speak to themselves more harshly than they would other people.
We also need to discover what caused the breakdown, not only so we can help them manage their stress better in future but also to help deal with any emotional experiences that may have caused faulty pattern matching for them.
Step 5: Deal with emotional residue
We may need to help our client overcome trauma through a calming and comfortable technique such as the Rewind Technique. We may, in fact almost certainly will, need to effectively reframe damaging perceptions that may have been hurting them. We may need to help them overcome aspects of the past as best we can.
We can do all this more effectively when we use clinical hypnosis both to deeply relax our clients and as a medium for undoing the effects of past conditioning.
But there’s also something we can do on a more behavioural level once the stress hormones have settled down.
Step 6: Set intrinsically satisfying tasks
A build up of worry about stuff that cannot be resolved now or even soon is inherently exhausting for human beings.2 Unresolved worry represents a heavy cognitive and emotional ‘load’ within a person, which they may describe metaphorically as a feeling of being ‘weighed down’, or a ‘burden’ that is ‘too heavy to carry’.
The antidote to this is to rest and relax – but this will work only if your clients begin to either practically solve the issues that have been ‘weighing them down’ and therefore exhausting them, or stop worrying about them so much. So how can we achieve this?
Well, we can work at the behavioural level by setting tasks. Small tasks with a beginning, a middle, and an end are intrinsically satisfying for human beings, meeting, as they do, the universal need for completion. The level of satisfaction people can get from completing paperwork, mowing the grass, or baking a cake can seem out of proportion to the activity itself, simply because completion of a task stimulates dopamine reward pathways in the brain.
Behavioural tasking may seem glib or superficial, but it can have powerful effects for clients. These kinds of activities, simple yet satisfying, can gradually increase action and decrease passive catastrophic rumination. As they do more and worry less, clients gain a genuine sense of lightening their load.
Dividing and conquering problems
When we see all our problems as one big mass, it feels overwhelming. So the best strategy with multiple problems is to divide and conquer. But first things first!
In the short term, your client really needs to ignore their problems altogether – or at least hold them at arm’s length while they recover.
We can reassure them that once they start to feel better again, we can help them divide their problems into one-at-a-time steps and help them either solve them practically and/or feel differently about them.
Finally, we need to know – and, more importantly, they need to know – how things will be different from here on in.
Step 7: Ask what will be different in future
A nervous breakdown is a signal that life as it was being lived just wasn’t working. Now your client, having been forced to stop, has an opportunity to determine what exactly they want to be different in their future.
Maybe they’ll focus more on relationships, or spend more time outdoors; perhaps they’ll renew their interest in lapsed hobbies or find new ones.
As they say, no one reaches the end of their life and wishes they’d spent more time in the office. How does your client want their life to be from here on?
We can help them take the steps to building a new, more emotionally and physically sustaining life.
As for that woman at number 36 all those years ago, I recall seeing her looking happy and strong not all that long after she’d had that breakdown. To my relieved young mind, she’d bounced back, and from then on the term ‘nervous breakdown’ no longer felt so threatening – to me, at least.
Maybe it really is true, at least sometimes, that what doesn’t kill us can make us stronger.
Learn to Relax Anxious Clients Quickly and Deeply
Anxiety is becoming the issue of our era – that and anxiety-driven depression form the majority of most practitioners’ caseloads these days. That’s why knowing how to use your voice and words to relax clients quickly and deeply is so vital. You can learn naturalistic, conversational hypnosis online with Mark. To find out more, read about his Uncommon Hypnotherapy course here.
Read more therapy techniques »