Nervous breakdown: Causes, symptoms and treatment

A nervous breakdown is not a medical term. Still, it has been used over time to effectively describe the feeling of not coping with stress or mental health issues such as anxiety or depression, to the extent that life becomes emotionally and physically overwhelming. Experiencing stress and anxiety in response to life's pressures is common, but when they build up to a level that impacts daily life, this may be described as a nervous breakdown.

The term 'nervous breakdown' may date from the 1700s, centuries before the Rolling Stones sang in 1966 about their '19th Nervous Breakdown.' It may have originated to keep people out of asylums. Labelling symptoms as the result of nervous sensitivity or disorder gave a physiological cause, avoiding the stigma and prejudice of mental illness.

However, the historical symptoms of a nervous breakdown, or 'nervous collapse' and 'nervous exhaustion,' map to those we now associate with depression: lack of joy or enjoyment in life, despair, and loss of confidence. Perhaps the critical word to focus on is 'breakdown' because it describes what may feel like 'breaking' in response to overwhelming internal or external demands. Anxiety and stress become too much, affect daily life, and prevent you from functioning as usual.

What may cause a nervous breakdown?

A nervous breakdown can be caused by extreme stress resulting from a single event or life stressors such as trauma or divorce. Mental health conditions often play an underlying role, such as anxiety, depression, or post-traumatic stress disorder (PTSD). Factors that make people more vulnerable to a nervous breakdown, causing a build-up of stress, include:

Social stresses

• a lack of social support
• unemployment
• homelessness

Interpersonal stressors

• relationship problems within couples, families, or the workplace

Internal factors

• depleted coping skills
• decreasing resilience
• an inability to 'soothe' or find peace

How is a nervous breakdown treated?

Treatment depends on the individual, addressing underlying causes and issues, and may include medicines, psychotherapy, and community support programs.

The following is a fictional example:
 
Jake came to therapy at the age of 47, having become emotionally overwhelmed at work. He had noticed that his mood had felt low for a while, creeping from a grey feeling of not enjoying or engaging in anything much to noting that his heart raced on the way to work and that he often found himself unable to think in meetings. Jake considered himself successful and lucky, having worked hard for years, creating a thriving engineering business.
 
Jake's mood started to change when his mother was diagnosed with dementia. As the oldest of three, he took over problem-solving as usual, finding a care home and selling her home. He also had to respond to issues at work: there had been two industrial accidents, leading to investigations. Jake felt responsible. Responding to the investigations took time, and Jake gave up playing golf and going to the gym as he had no time. Home also felt overwhelming. He adored his wife and two teenage daughters but wanted time alone. His wife worried that one of the daughters had lost weight and was too preoccupied with dieting.

Jake felt that he couldn't cope with any more worries. He made mistakes at work. Driving home late from work one night, he lost concentration and ran into the back of a car at a red light. He found that he couldn't get out of the car and felt frozen, unable to speak. The other car's driver called for help, fearing that Jake had been injured and was taken to the hospital. Jake had no injuries, and his wife collected him, noticing that he was silent, and became very concerned when Jake went straight to bed and was unresponsive the following day, turning his back to her.
 
When Jake's psychotherapist met him, it felt as though Jake had given up. Over time, what emerged was the immense pressure that Jake placed himself under. Raised by a single mother, he had taken on responsibilities from a young age, looking after his two younger siblings and comforting his mother when she came in late from work. Jake had been described as 'parentified,' taking on a role reversal of caring for his parent. The cost to Jake came from shouldering responsibilities beyond his capacity to understand what he was compelled to do, cognitively and emotionally.
 
After weeks of talking therapy, Jake's psychotherapist suggested EMDR (eye movement desensitisation and reprocessing). He had noted that Jake often conveyed negative beliefs, such as 'It is all my responsibility' and 'I am a failure.' EMDR involves processing memories using what is called 'bilateral movements,' provided by eye movements, sounds, or tapping. As memory is recalled during 'sets' of bilateral movements, processing allows the memory to be reprocessed, untangling it from beliefs that cause discomfort. The memory loses intensity and becomes accessible to new experiences and learning, rather than causing the event to be re-experienced, triggering anxiety and intense emotions.
 
Starting with a target memory, Jake described looking after his siblings after school at age eight. It was a hot day, and his siblings were irritable, so he gave them lots of sweets to be quiet. His sister, age six, had sugary, sticky hands from the sweets. She swiped at a persistent wasp until it stung her. Jake was comforting her, trying to stop her screams, but something was wrong. He noticed that her lips looked swollen, and her crying sounded strange. Jake froze; it was his fault. His brother ran for a neighbour. Jake recalled flashing blue lights, chaos, and shouting. After his mother collected the children from the hospital, Jake was told that his sister had nearly died, and he noted his mother's red eyes, pale face, and tight lips. His mother was silent on the way home, and Jake's mind created a narrative to make sense of his confusion: a belief that 'it is my fault' persisted and pervaded his life after that point.
 
After each set, different memories and beliefs emerged, with the therapist asking, 'What did you notice?' Jake processed many memories. He realised that the successes in his life had only brought a momentary reprieve from anxiety. Jake noted different emotions emerging alongside memories: sadness, loss, loneliness, and anger. Finally, towards the end of the session, Jake quietly said, 'It is not my fault. I was just a child.' The therapist worked with Jake to instil the opposite cognition, a positive 'I did my best.'
 
Jake continued therapy for a few months, noting a shift. Without the foundational belief of 'it's all my fault,' Jake felt under less pressure and more at peace. Life was not perfect: his daughter still struggled with an eating disorder, and business pressures emerged from time to time. Jake felt freer; he controlled what he could and increasingly enjoyed day-to-day life. He felt that he could cope again. Without the immense pressure and burden of negative beliefs created in childhood, in response to events he did not have the maturity to process, Jake no longer felt overwhelmed or 'broken.'