If fear of palpitations has not drawn this person into this type of nervous breakdown, fear of some other upsetting bodily sensation generally has. Perhaps he has had pain in the region of his heart which he, in alarm and ignorance, diagnoses as angina. Perhaps a strenuous, anxious, highly tensed life has given him a constantly churning stomach or ‘shaking’ heart at which he becomes alarmed. Whatever the cause, in answer to his continuous apprehension his adrenalin-releasing nerves become sensitized and gradually burden his day with the new, upsetting sensations described above. He tries to fight or escape, until he too becomes caught in the same fear – adrenalin – fear cycle as the person afraid of the palpitations.
As mentioned, these people have these sensations as a more or less constant background to their day. They may have moments of respite; for example, some on waking feel strangely calm and may be able to lie at peace for an hour or so before the churning starts. Others feel calmest at night. Others know no peace.
Panic
Some people, as well as having this background of disturbing sensations, are swept from time to time by intense waves of panic. Some have a panic spasm every few minutes, and this may continue for hours. It will be appreciated how disturbing these spasms can be when a sufferer is working and trying to appear normal and how he lives in dread of their coming at inappropriate moments. Unfortunately they are most likely to come at such times, as he is then most apprehensive and afraid.
It is possible that the recurring attacks of palpitation have now left him and that he is more concerned with the other manifestations of fear, although it is more usual to find the palpitations continuing and adding to the miserable burden.
This is not a far-fetched story. I have heard it so often that I give it respectful attention. I have known this stage, inadequately treated, to last several years, the patient going from doctor to doctor.
To healthy people this history may sound all too childish and stupid. They think, ‘Why doesn’t he pull up his socks and get on with his work and forget all this nonsense?’ That is exactly what he would like to do. But what we, the healthy ones, do not realize is that by this time the fear felt by such a sufferer is greater than any the average person has known or has paused to imagine. Repeated spasms of panic, when accompanied by exhaustion, not only increase in intensity but need less and less to start them. Dread of having them may bring on a whole sequence. Meeting a stranger, the thought of being left alone, even a slamming door may suffice. Also, in spite of a great desire to pull up his socks and get to work, such frequent, intense spasms of fear seem to paralyse his will to act.
Some years ago, when recuperating from an operation, I stayed with friends who were planning a bush walk. They asked a young man to join us. It was not a long walk, they assured me (but long enough for me, thought I, as I looked at his long legs). To my astonishment this big fellow soon fell behind and we frequently had to wait for him to catch up. At lunch he lay exhausted on the grass. Later he told me his story. For years, since student days, he had had recurring spasms of intense panic, so that his life had become a nightmare. He was not afraid of anything in particular, only the feeling of fear itself, and this had become so intensified and exhausting that even that short walk had been too much.
This man was eventually cured and able to lead a scientific expedition. I mention him because he was no weakling but a clever scientist in a responsible position. With help he recovered quickly, after having suffered for ten years.
Fighting
The sufferer from nervous breakdown is neither fool nor coward, but often a remarkably brave person who fights his breakdown to the best of his ability with commendable although often misdirected courage. He may fight through almost every waking moment, with sweating hands and tensed muscles, agitatedly trying to force forgetfulness of his desperate state by consciously concentrating on other things. Or he may pace the floor of his mind, anxiously searching for a way out of his miserable prison, only to meet one closed door after another.
At night he falls into bed exhausted, to sleep the fretful sleep of nervous agitation, the heavy sleep of nervous exhaustion, the drugged sleep of the barbiturate swallower, or, worse still, to find no sleep in spite of heavy sedation.
At times the early part of the evening may not seem so bad. He may feel almost normal and think he has conquered this ‘thing’ at last, and may go to bed saying, ‘Now, that’s the finish. Tomorrow I will be my old self again,’ only to wake and find the spasms and the churning worse than ever. He cannot understand why, having felt so much better by evening, he should wake the next morning feeling as ill as ever, perhaps even worse. He certainly feels more hopeless, if that be possible. He is either convinced that there is some short quick road to recovery which continually eludes him or that there is not, and never could be, a way back to peace from such suffering as his.
He looks back with longing at the person he used to be, the person who could sit peacefully and enjoy a good book, or happily watch television, and he apprehensively counts the weeks, months, even years, since he was that person. He reasons that if he cannot become himself again by fighting, how else can he? Fighting is his natural defence, the only weapon he knows, so he fights even harder. But the harder he fights, the worse he becomes. Naturally – for fighting means more tension, tension more adrenalin and further stimulation of the adrenalin-releasing nerves, and so the continuation of symptoms. To make matters worse, his friends do not hesitate to advise him to fight it. Even his doctor may say, ‘You’ll have to fight this thing old man. You mustn’t let it get the better of you!’
What has happened to him he cannot understand. He is like a man possessed. He does not realize that there is no devil sitting on his shoulder and that he is simply doing this to himself with fear, fight, and flight from fear.
It is at this stage that he may develop severe headache which he likens to an iron band encircling his head, or to a weight pressing on top of it. He may be giddy, nauseated, have difficulty in expanding his chest to take in a deep breath, feel a heavy soreness around his heart or a sharp pain under it which he sometimes refers to as ‘the dagger’. He may also have recurring ‘funny turns’ such as spells of abnormally slowly beating heart, ‘missed’ heart-beats and weak, trembling turns. He loses interest in everything and in everybody, and mounting tension makes him easily upset by trifles. As one young mother put it, ‘I take it out on the poor kids’.
Sedation
The doctor usually prescribes sedatives at this stage, and there is no doubt that the patient may need them. But with a layman’s distrust of such ‘dope’, his family is probably urging him to ‘Throw the wretched stuff down the sink,’ adding, ‘It is only helping to depress you,’ and ‘That doctor will make an addict out of you yet.’ The sufferer becomes further confused because at the back of his mind he too is afraid of that. Part of a doctor’s problem is to convince the patient – and what is just as important, the patient’s family – that such sedation is not only not harmful but, as a temporary measure, may be very necessary, and that it will not make an addict of him if carefully supervised. Usually, when cured, the last thing these people want to see is one of those wretched capsules or a dose of that pink mixture.
Life is so contrary, it can put so many unexpected obstacles in the way of recovery. In the words of one woman, ‘You would never believe the number of spanners that get thrown into the works’.
For example, it is possible that, just as the doctor is winning his battle over the taking of sedatives, someone chooses that moment to take an overdose of barbiturates and the newspapers will be vociferous on the dangers of taking such drugs. The patient, who probably hasn’t looked at a paper for weeks, somehow never fails to see the report or hear about it, and so the doctor’s battle begins again.
And yet, however sedated this person may be, fear usually finds its way through such sedation. Sedation only softens the blow, but it does do that, and so plays in important part in recovery, as will be discussed later.
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