In the Dark

A blog piece by Dean Burnett  I read on on the Grauniad website yesterday set me thinking about whether I should post a personal comment in reaction to it. I never know what is the appropriate way to draw the line between the private and the public on In the Dark but since having a blog is clearly an exercise in self-indulgence anyway I thought I’d go ahead and write a piece.

Dean’s piece is about nervous breakdowns, but it’s really about why “nervous breakdown” is not a very good name for what it purports to describe. Regular readers of this blog  (both of them) will know that I went through one last year, and one thing I do remember is the disapproval that the term “nervous breakdown” provoked when I used it during my subsequent course of therapy. Apparently it’s a bit frowned-upon among professionals in the field.

Here is Dean (who is a neuroscientist in his day job) on the subject:

The term nervous breakdown is actually surprisingly old, and stems from a time when both “nervous” and “breakdown” arguably had different meanings to their modern ones. It seems the “breakdown” element refers to a breakdown in the same way that cars or other machines can break down. And nervous just refers to the nervous tissue. So originally it meant a fault or error in the nervous tissue that controls the body. And suddenly my interpretation doesn’t seem so literal.

But this doesn’t mean it’s an invalid term, it’s just more of a rule-of-thumb or generalisation used to refer to what happens when someone becomes psychologically unable to function as normal. In the simplest sense it could be said that, mentally speaking, a nervous breakdown occurs when an individual finds that the number of things that they are able to cope with is lower than the number of things that they have to cope with.

That seems to me to sum up very sensibly why the term is not very useful for an expert: it’s too vague, in that there are so many quite different things that might cause a person to become “psychologically unable to function as normal”. But it also explains quite well why its usage persists in popular language, in that the state of being “”psychologically unable to function as normal” is not as uncommon you might think. Anyway, if someone says they’ve had a nervous breakdown it gives at least a general idea of what they’ve experienced, although the specifics vary widely from individual to individual.

I hope you’ll bear with me if I illustrate this with some personal observations in the light of my own experiences.

I’ve suffered from a form of panic disorder for many years. Actually even that term has a very broad definition, so that different individuals experience different forms of panic attacks and they can also take very different forms for the same individual. For me, a “typical” panic episode begins with a fairly generalized feeling of apprehension or dread. Sometimes that’s as far as it goes. However, more often, there follows a period of increasingly heightened awareness of things moving  in my peripheral vision that I can’t keep track of. This leads to a sense of being surrounded by threats of various kinds and panic ensues. Usually, at that point, I run.

A typical panic episode lasts only a few minutes, but that’s not the end of it. For a considerable period (hours) afterwards I find myself in a state of hypervigilance during which I’m such a bundle of nerves that the slightest sound or movement can trigger a repeat.

I tend to think of these episodes as being a bit like earthquakes. The milder ones happen fairly frequently, but they’re quite easy to cope with. I have altered my behaviour to avoid places likely to trigger them (see below) and to be aware of appropriate exit strategies. The more severe episodes are much harder to deal with, though, and when one starts there’s nothing I can do apart from try to find somewhere that feels safe, wait for it to pass and then just get through the aftermath, hoping for no aftershocks.

In Dean’s piece he writes about the different stressors that can trigger a breakdown. In my case it was a bit more complicated than that.  Thinking about the milder attacks I find it very difficult to identify specific triggers – they seem to occur more-or-less randomly. However,  I can cope with this low-level “noise” pretty well. I’ve had plenty of time to get used to it, at least.  The more severe attacks seem more likely to be triggered by specific places, especially if they’re crowded with people moving around – although I don’t always have a problem in places like that. To give an example, crossing the main concourse at Victoria Station is, for me, like descending into the abyss; I simply can’t do it, and have to go outside the station to get between the trains and the underground station. Paddington Station, on the other hand, is fine. Weird.

I think the probability of one of these episodes is also influenced by background levels of stress arising from other independent things. Anyway, last year I got into a state in which I was experiencing multiple episodes per day. I couldn’t sleep or eat for over a week, and couldn’t leave the house for fear of experiencing another major problem. I think “nervous breakdown” is a pretty apt description for that period, but my breakdown was caused not by a new problem, but the amplification of an old problem to completely intolerable levels.

The reason for writing about the anatomy of my breakdown in this context is twofold. One part is just to reinforce Dean’s point that a “nervous breakdown” can be triggered by many different circumstances and conditions. Mine is probably an unusual example, but I think everybody else’s  is too.

The other reason is to confess how frustrating it is to be a physicist who has experienced a thing like that. It seems natural that having experienced such an episode I should want or need to try to make sense of it, but I’ve struggled to do that. The way we’re used to thinking about things in physics is to make simple models that capture the relatively simple cause-and-effect relationships between relatively few variables, usually based on the objective analysis of data controlled experiments and/or systematic observations.   This all involves trying to break down a phenomenon into its component parts so as to look at their separate action and thus establish the simple rules (if there are any) that govern the overall behaviour.

The trouble with this analytic approach is that the human brain and its interactions with the external world are far too complicated and non-linear to be approached in the simple-minded way we physicists usually do things. Even if you accept that the brain is basically a collection of atoms communicating with each other using electrical impulses, that doesn’t mean that it’s useful to try to describe its action using atomic physics and electromagnetic theory.

On top of all that, there’s the issue that neuroscience is a subject I know very little about at a technical level. There’s only room in my feeble little brain for my own specialism, so I lack the knowledge needed even to understand the literature.

So although I got over my breakdown, it has left me with a huge number of questions I don’t even know how to begin to answer. What is happening in my brain when a panic episode begins? What is going on with my peripheral vision when it goes awry like it does? Why do some particular places  or circumstances trigger an attack but other, apparently similar, ones don’t?

I don’t suppose anyone out to answer these questions, but if any neuroscientists out there happen to read this piece I would be grateful if they could recommend appropriate literature, as long as it’s simple enough for an astrophysicist to read…