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 is released. In other words, he becomes caught in the fear – adrenalin – fear cycle.
Tension Through Fear
At this stage the sufferer consults a doctor, who usually succeeds in reassuring him and banishing his fear. However, he may not be sufficiently reassured and may be unfortunate enough to be put to bed and advised to ‘take things carefully’ and to ‘be sure not to overdo it’. When so advised the average person, particularly if young and not yet protected by the philosophy of age, lies in bed brooding over his ‘bad’ heart, afraid to move for fear of straining it further. This patient was already in a state of nervous tension worrying about the palpitations. Can you imagine his tension now? Perhaps you have experienced it?
On the other hand, should the doctor, in an effort to reassure, make too light of the palpitations, the patient may stay in bed of his own volition, convinced that the doctor is witholding the worst and has not told him all. If he remains tensed and afraid he is certain to have further attacks, and the more frequently they come the more he hugs the couch. The more he rests, the more time he has to brood and the more tense and apprehensive he becomes. His finger is continually hovering above his pulse, and in response to this anxiety his heart constantly beats quicker than it should, although not as fast as when palpitating. Actually he thinks it is beating faster than it is, because he is conscious of every beat. To him it is thumping, banging, racing. One ingenious woman arranged her pillows end to end, so that she could lay her ear on the crack between them – in this way she thought she heard less thumping.
The sufferer by now is really sorry for himself. He loses appetite, loses weight and dreads being alone ‘for fear of having a turn’; at the same time he is afraid to be with people for fear of having one and making a fool of himself. It is not long before he develops most of the sensations of breakdown – the churning stomach,