March 14, 2010

Depression v. Nervous Breakdown

There have some good articles lately on the indeterminacy of psychiatric definitions, such as "depression:" John Derbyshire's The Anatomy of Melancholy at Alternative Right, Louis Menand's Head Case: Can psychiatry be a science? at The New Yorker, Jonathan Lehrer's Depression's Upside in the NY Times Magazine, and Ethan Watters' The Americanization of Mental Illness in the NYT Mag.

One of the conundrums is that psychiatric terms change over the generations. For example, terms such as "depression" and "Post-Traumatic Stress Disorder" have largely replaced "nervous breakdown" in popular usage. Robert Heinlein sci-fi stories from the middle of the 20th Century frequently feature spaceship captains who suffer "nervous breakdowns" from the strain of command. (Heinlein was a naval officer for seven years, so his space travel stories are really sea stories.)

And, yet, Wikipedia says:
The terms "nervous breakdown" and "mental breakdown" have not been formally defined through a diagnostic system such as the DSM-IV or ICD-9, and are nearly absent from current scientific literature regarding mental illness. ... The closest DSM-IV diagnostic category to nervous breakdown is Adjustment Disorder with Mixed Anxiety and Depressed Mood (Acute).

But few people talk about ADMADM(A) these days. But everybody worried about "nervous breakdowns" in 1942, when Americans didn't exactly have time for things that weren't important.

Moreover, Heinlein's captains weren't suffering Post-Traumatic Stress Disorder because their stress is over the upcoming or current trauma, not necessarily past ones.

And different terms have have somewhat different connotations. Which term you use will tend to influence your thinking.

I noticed this when I was reading up on the Civil War and got to the formidable Gen. William Tecumseh Sherman's psychological collapse in late 1861, in-between his strong performances at the battles of First Bull Run in 1861 and Shiloh in 1862. While organizing behind the lines for the next year's campaigns, he had to be relieved of command so he could recuperate at home. Sherman later joked, "Grant stood by me when I was crazy, and I stood by him when he was drunk, and now we stand by each other."

The Wikipedia page on Sherman uses the old-fashioned term "nervous breakdown" and blames "the concerns of command." In contrast, James M. McPherson's Battle Cry of Freedom sometimes uses the more modern term "depression," and at one point suggests that Sherman was depressed by his vision of the logic of Total War.

Or was he suffering Post-Traumatic Stress Disorder over Bull Run?

I certainly don't know enough about Sherman to offer a diagnosis. I just want to point out that you can see how the customary terminology of your time and place would tend to channel your descriptions and explanations.

Similarly, other countries have mental illnesses we don't exactly have, such as running amok in Malaysia (in the 19th Century, every village had to have a long pole with a lasso on the end for snagging the inevitable amok runners).

On the other hand, the power of American culture seems to allow us to infect other cultures with American mental illnesses, such as anorexia. USA! USA!

My published articles are archived at iSteve.com -- Steve Sailer

37 comments:

dearieme said...

Whatever happened to "shell-shocked"?

Black Sea said...

Arguably, a nervous breakdown is a heaithy repsonse to the carnage of modern warfare. Or is this notion conditioned by all those episodes of M*A*S*H* that I watched growing up?

Actually, I do think sustained warfare has the capacity to drive most people at least temporarily nuts. My father was in the Second World War, and like a lot of troops at the war's end, was given the opportunity to tour a concentration camp (this was meant to be motivating, I suppose). He declined on the grounds that he had already seen enough about what people were capable of doing to each other, but perhaps he was afraid that it would be too much.

Anonymous said...

Great post. Increasingly, "mental illness" around the world is becoming "Americanized" - http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html

John Seiler said...

Whatever his mental state, Sherman was a mass-murderer who encouraged his troops to burn, kill, rape, and loot their way through the South, violating the Christian precepts of Just War theory involving civilians. His troops were especially brutal in raping every black woman they could get their hands on.

After the war, he then went on to do the same to the Plains Indians.

Grant and Lincoln also bear responsibility for the atrocities.

(In case you're wondering, I'm a Yankee and don't sympathize with the South. But facts are facts.)

Steve Sailer said...

Thanks, I'll add the link.

bgc said...

My guess is that what is currently called 'brief psychotic disorder' was responsible for some of these nervous breakdowns

http://emedicine.medscape.com/article/294416-overview

This is fairly common - I used to see at least one a month of these in an acute admissions psychiatric ward - sometimes even several per week.

One factor they miss out in the above description is that the psychotic breakdown is often preceded by several days without sleep - common in combat conditions.

Once the person has been sedated and had a few night's sleep, there is typically a complete and usually permanent recovery.

Vincent said...

Recently I asked myself: where have all the anorexic young women gone? Do this blog's readers know?

Ten years ago there were plenty of these young women, not least in hospitals. Now, the sort of females who then would've been skeletonic-and-proud-of-it-because-it's-all-the-fault-of-capitalism are now obese-and-proud-of-it-because-it's-all-the-fault-of-capitalism. Anorexia now seems soooooooooooo 1990s.

(Hey, anyone remember that hip 1980s malady, Chronic Fatigue Syndrome? I haven't encountered a single alleged sufferer from it since Duran Duran dropped off the charts and Reagan left the White House. But a quarter-century ago, it was everywhere.)

J Mann said...

I've always thought that was the only way to understand Hamlet - that a Shakespearean audience would accept that the shock of meeting his father's ghost could easily drive Hamlet crazy, and that he would gradually recover.

Anonymous said...

It's no secret that psychiatry is not an exact science (it's probably not even a science at all). The Diagnostic & Statistical Manual is subject to all sorts of political pressures. A few years ago many psychiatrists wanted to add a category for those who continually seek out abusive relationships, but feminists screamed bloody murder--not because they believed such a condition didn't exist, but because they didn't want psychiatry to reinforce patriarchal oppressive norms or whatnot. The DSM editors knuckled under and dropped the category.

Anonymous said...

"Similarly, other countries have mental illnesses we don't exactly have, such as running amok in Malaysia"

My dad, a psychologist, told me that back in the 1960s one Ontario town was reporting a bizarre number of rare mental illnesses, including running amok. It turned out that the standard reporting form used numerical codes. When more than one code applied, the clerk was averaging them.

Anonymous said...

Then there's Eldrick with his "sex addiction" mental illness....

Paul Mendez said...

"Nervous breakdowns" seem not to have been reserved for times of war. Judging from biographies, it was obviously perfectly OK for creative people a couple of generations ago to take to their beds for a month or suddenly go on vacation in some primitive spot for a year when the going got tough.

Anonymous said...

There is another and even more stereotyped form of stress induced madness. You were especially subject to this form of psychic failure if you were a coloratura soprano.

A lot of the plots of early ottocento operas turned on the "Mad Scene". Typically the heroine would receive a shock - usually involving the tenor. This would push her over the edge and result in her singing a lot of high fast notes. In Lucia when she thinks the tenor has abandoned her she murders her other lover and kills herself, but in I Puritani the heroine only goes crazy for a couple acts. When the tenor comes back to her in the last act she snaps right out of it.

By the end of the century this kind of tenor induced madness had dissipated. Tosca and Turandot were made of sterner stuff. They killed those men who crossed them with nary a second thought.

The Western Confucian said...

You are right that "other countries have mental illnesses we don't exactly have."

Here in Korea, there is a disease called hwatbyeong, literally "anger disease." In the rigid ueber-Confucian hierarchy, people have to suck up to each and every "senior," which means anyone one year older. The stress causes some people to lose it and walk around the streets screaming at the world.

Jim O'Sullivan said...

As George Carlin famously noted, "shell shock" became "combat fatigue" became "operational exhaustion" became PTSD. It's all a matter of bullshit language at this point in history. We don't really know what goes on inside our skulls yet.

Ronduck said...

USA! USA!

I've seen that on a few right-wing websites recently and its getting annoying.

Guts Strongman said...

In the 19th century--and still today in many parts of the world, e.g. China--all manner of mental ailments were subsumed under the category of "neurasthenia." Studies have failed to demonstrate an exact correspondence between neurasthenia and any of the DSM's diagnostic categories. Perhaps Szaz is at least partially correct: diagnostic categories help to define the contours of mental maladies.

gcochran said...

"General Joseph E. Johnston, the Confederate officer who had commanded the resistance to Sherman's troops in Georgia and the Carolinas, served as a pallbearer in New York City. It was a bitterly cold day and a friend of Johnston, fearing that the general might become ill, asked him to put on his hat. Johnston famously replied: "If I were in [Sherman's] place, and he were standing in mine, he would not put on his hat." Johnston did catch a serious cold and died one month later of pneumonia. "


Sherman was a softie, compared to the Napoleon, the British, or pretty much anyone in 20th century warfare. He was also highly competent, which in itself makes him alien to modern America.

Anonymous said...

John Seiler
When I was in school, I was not taught this about Sherman's men in the south. Were my textbooks written by damn Yankees?

Seriously, please provide a few brief, historically accurate references.

Anonymous said...

I'm not sure there's such a thing as "American culture". Leaving aside the usual chest thumping about how great we are, I have trouble pinning down exactly what this society is about. Perhaps it's just an ex-colony with a bunch of surplus people dumped into it, everybody doing their own thing. Culture of one sort or another may erupt in various locales, but throughout the country seems to be too much to ask for.

Whiskey said...

Oh please Seiler. Sherman's march to the sea killed almost no one. He engaged almost no enemy troops, and lost few himself. Sherman in fact compared the Confederacy to an eggshell. Hard on the outside, but brittle and defenseless inside.

Sherman's total losses during the march to the Sea were about 500 men, most of those outriders / scouts captured by Confederate cavalry. He killed about 5,000 of th enemy in several small engagements. Grant, who butchered the Confederates (and his own men) in straight up frontal assaults, could kill 5,000 of the enemy in five minutes. Sherman's slight losses and slight engagements with the enemy are a matter of record, well documented by both sides.

Sherman's point was to destroy the infrastructure of the South's war-making economy. First he burned warehouses and public buildings. Later, he simply destroyed rail-roads, it was more efficient. And Sherman NEVER stayed to fight pitched battles. His entire strategy was to keep moving. If he stayed more than two days in one spot he calculated he would leave his troops unable to forage for food and they'd starve.

Sherman was NOT a mass-murderer, in fact his horror at Shiloh convinced him that only an end-run not straight up assault would end the war.

JeremiahJohnbalaya said...

(not an endorsement, just happened to have read) US defense expert P.W. Singer from the Brookings Institution talks to SPIEGEL ONLINE about the stresses that drone pilots are subjected to and the risk of emotional exhaustion and burnout. The whole experience of war is being changed by the new technology, he argues.

Dahinda said...

Here is a nervous breakdown reference from a recent incedent:
http://en.wikipedia.org/wiki/Jeffrey_Skilling

Anonymous said...

Hans Eysenck's later work contained a lot of very informed commentary regarding the pitfalls and imprecisions of mental health
diagnoses. The process has been
badly corrupted by several influences. One is the scientific shortfalls in the DSM manuals. One is "juggling" diagnoses to accommodate insurance payment requirements. Another is just the penchant for making "quickie" psychiatric diagnoses that would be much more accurate if made attendant to sound psychological questionnaire results.

Anonymous said...

Chris Brand's writings ( find a
"samizdat" copy of his depublished
" The 'g' Factor" that in 1996 was actually recalled from retail stores by his publisher ) are a treasure trove of information and concepts. He notes at various points the social science indications of how overwhelmingly left-liberal the known political affiliations and sentiments of mental health workers are. There are notable exceptions, but the central tendency is a "profession"
that is very asymmetrical from the general population, in both UK and US. The leftie passions within the "profession" color all manner of issues, incluiding this one of diagnosis. Brand's QUOTES (see online_) have relevant sections. His book presumably can be downloaded from "IQ and PC" but had only about three dozen conventional copies of the UK February 1996 publication that ever got across the pond. The general political perversity of the "mental health profession" in America is a barrier to realism in many respects, including that of confronting the evolutionary bases for troubling differences along lines of race, gender, and social class.

Justthisguy said...

Ah, Steve, it's not "sci-fi", it's SF. Also, it was not a civil war, it was a War Between the States, as the term was used in the Federalist Papers. Oh, and it's not Bull Run, it's First Manassas. You California people really do have less culture than pasteurized yogurt, and deserve your Mexicans.

David said...

Here's a song to play in the background while contemplating Sherman et al.

http://www.youtube.com/watch?v=uFgBNU_Ewdk

ricpic said...

I've had a couple of mental breakdowns in my life. The interesting thing is that I went on functioning through the several months of each breakdown. Functioning poorly and feeling all the time like a shattered glass but somehow going on. And then I came out of the breakdowns. Time. Time was the doctor and as far as I'm concerned the only doctor that ever works.

Okinawan Irishman said...

I always thought a nervous breakdown signified a dramatic collapse of mental/social/physical function, while depression referred to a long running malaise. The former is when you snap, the latter when you deal with the aftermath, or begin the build up.

Lucinda said...

What about all the women in the Regency and Victorian eras who would succumb to "the vapors"? I always thought it would be a convenient thing to have such an undefinable malady as a "way out" of certain social situations. In my opinion, it may have been a polite euphemism for menstrual cramps, a sort of "get out of the parlor free" card for women. I always imagine a callow youth asking a more mature man what exactly ails the lady, and being told, "Don't ask".

travis said...

For example, terms such as "depression" and "Post-Traumatic Stress Disorder" have largely replaced "nervous breakdown" in popular usage. Robert Heinlein sci-fi stories from the middle of the 20th Century frequently feature spaceship captains who suffer "nervous breakdowns" from the strain of command. (Heinlein was a naval officer for seven years, so his space travel stories are really sea stories.)

I imagine Heinlein's inspiration for all his disturbed captains is Captain Ahab, the personification of a certain kind of American madness (e.g. Sherman, Curtis LeMay, Whiskey).

"The White Whale swam before him as a monomaniac incarnation of all those malicious agencies which some deep men feel eating in them, till they are left living on with half a heart and half a lung.”

Anonymous said...

Steve, there's a pretty good book on the historically contextual nature of mental disorders by the philosopher Ian Hacking:

http://www.amazon.com/Mad-Travelers-Reflections-Transient-Illnesses/dp/0813918235

He spends a lot of it discussing the history of the once-common but now rarely seen "fugue state"; and concludes with nuance: it's not that mental illnesses aren't "real," but they do require certain "ecological niches" (his term) to express themselves.

Relatedly, there's this very interesting piece in the Atlantic from a decade ago, in which the author explores apotemnophila as a "new way to be mad."

Anonymous said...

As regards ricpic's comment: An
amusing historical event is the
carefully and statistically sophisticated presentation made in the early 1950's by Hans Eysenck regarding the presumed efficacy of psychotherapy (then heavily Freudian bent ). After he concluded the presentation at a national conference of psychologists, large numbers of the usually sedate and unctuous therapists were virtually yelling and in one instance challenging Eysenck to fight. What was it all about? Eysenck had presented the data indicating that for the most part spontaneous recovery would account for the presumed efficacy of psychotherapy--i.e, those benignly neglected to allow Dr. Time and Dr. Nature to tend to their recovery, got back to normal just as quickly as those having the intercessions of psychotherapists. Nowadays, the better view is that therapy can be efficacious and sometimes very efficious but if so, the effectivness has arisen from confronting facile assumptions--not from indulging them.

Anonymous said...

Bill Wilson, co-founder of AA,
long after desisting from use of alcohol, suffered a lot from depression. In his later years, he found that use of megavitamins--particularly niacin and B(3)--eliminated, or put into remission, this problem. He attempted to advocate regard to this approach witin AA but suffered a good bit a rebuke from "think-inside-the-box" psychiatrists then having power within AA.

Anonymous said...

Odd behavior is the consequence of a number of causative agents. We recognize the behavior but at this point in time we are uncertain about the causative agents. It is rather like 18th century medicine's classification of diseases as "fevers" when the causes - bacteria, viruses, parasites - were unknown. We see mental illness as a disease when it is just a symptom of a disease that we cannot yet understand. No wonder the terms are so confused.

Rereading Paul Ewald I tentatively suggest that the cause of depression is the Borna virus or maybe Toxoplasma gondii.

Dutch Boy said...

Whiskey's historical analysis is not completely sound. Grant and Sherman were both practitioners of maneuver warfare. Sherman had a wider field of play in Georgia than Grant had in Virginia. The depiction of Grant as a mindless butcher is itself mindless. By 1864the Confederacy had gone over to the strategic defensive with the inherent advantages of same in the era before aircraft and motor vehicles. Even with this disadvantage, Grant's casualty rates during the war were substantially lower than Lee's. As for combat stress, the British army learned in WW II that even the toughest soldiers could stand only a certain amount of time at the front before becoming psychologically impaired and useless for combat. They then instituted unit rotations to forestall this process. The US army had to learn this lesson all over again ("A War of Nerves" by Ben Shephard is a good source for the curious).

David said...

> Eysenck had presented the data indicating that for the most part spontaneous recovery would account for the presumed efficacy of psychotherapy <

Very interesting. It's much like those cancer sufferers who go to Mexico to buy lead bracelets to strap around their ankles or whatever. We hear about the people whom this treatment "cures," but not about the uncured. (We don't often get five-year follow-up stories, either.)

In addition to time, also helpful for mental health are these things among nature's facilitators: sufficient nutrition and sleep, living in a more or less rational cultural niche, regular habits, and good cognitive habits, especially the last. I'm convinced all these take care of many of the less serious cases.