Inexact Diagnosis Can Be Socially Useful
The inexact diagnosis is experiencing a resurgence, with doctors in Europe identifying “burnout syndrome” and signs of “vital exhaustion” in patients. A recent paper by Peter Stearns, Ph.D. of George Mason University examines the historic usefulness of an inexact diagnosis such as a “nervous breakdown.”
Traditionally such umbrella terms have concealed a host of mental illnesses, from schizophrenia to social anxiety. According to Dr. Stearns, the vague diagnosis encourages social support while concealing as much of the condition as the patient wishes.
Such imprecise terms also imply that the bout of mental illness is self-limiting, and that another person or even society at large is responsible for the condition. It encourages a view of mental illness as a transitory minor state, much like the stomach flu. The phrase was used to conceal many problems, from a broken heart to drug addiction.
Historically, many famous figures have used the term “nervous breakdown” to indicate a temporary period of mental disability. F. Scott Fitzgerald suffered a “crack-up” that was most likely major depression, perhaps self-medicated with alcohol. Sir Isaac Newton suffered several mental collapses that historians agree were likely bipolar disorder. Young Abe Lincoln’s nervous breakdown was probably major depression with suicidal features, while Tennyson’s was anxiety disorder. Beethoven’s nervous breakdowns were probably psychotic episodes of untreated bipolar disorder.
For women, a “nervous breakdown” provided cover for an inconvenient pregnancy or an unconventional and unacceptable streak of independence.
While the term nervous breakdown does not appear in the DSM-IV or its successor, the DSM V, it is still in popular usage. A recent study showed that 26 percent of Americans identified themselves as having an impending nervous breakdown, compared to 19 percent in 1957.
“It had just enough medial sanction to be useful, but did not depend on medical sanction to be used,” according to Dr. Stearns. The code could cover anything from an unsuccessful suicide attempt to a long vacation in the country. It might be the result of heartbreak or the cause of a bitter divorce. Postpartum depression was often labeled as “nerves” or a nervous breakdown.
Since the early 1800s, stress and the pace of “modern” life have been blamed for many impending breakdowns. Most recently, psychiatrists in a developing nation blamed modern technology for mental illness.
By Joni Holderman, [email protected], contributing reporter for Mental Health News.