What is a nervous breakdown?
"Nervous breakdown" is neither a medical term nor does
it have a precise definition in popular usage. Generally it refers
to any state of sustained emotional distress that is severe enough
to disrupt normal functioning for several days or more. Like many
other words and phrases, "nervous breakdown" whatever
the person using the term chooses it to mean. It is ironic, therefore,
that a very common fear is . . . having a nervous breakdown! Even
though nobody knows for sure what a nervous breakdown is, the prospect
of having one is a sinister and frightening one because it suggests
a complete loss of control and perhaps even insanity.
Am I going crazy?
A surprisingly common concern and question. Many people are so
afraid that they are going crazy that they don't dare to ask or
bring the subject up for fear that others will find out the terrible
truth about them! The majority of people have probably been seriously
afraid of losing their minds at one time or another, typically in
adolescence and young adulthood. Because the topic is seldom raised
or discussed people do not realize how common, in fact almost universal
this fear actually is. Secrecy and shame, as always, make matters
worse and cause more anxiety and suffering.
The fear of insanity is so common that it might even be thought
of as a normal part of development for many people. Just as with
other developmental phenomena, people "outgrow" it after
The presence of significant depression or anxiety or both is frequently
associated with a fear of losing one's mind. Depression and anxiety
alter the usual "feel" of the mind - and by introducing
new and unpleasant emotions and thoughts, cause the individual to
fear that he is losing control over his mind. It is this feeling
and fear of loss of control that is usually misinterpreted as the
approach of insanity. This of course causes still more anxiety and
dread, especially when, as often happens, the individual is too
frightened to discuss his fears with anyone. Thus people with obsessive-compulsive
disorder or even with scattered obsessive-compulsive symptoms(rituals
and repetitive or peculiar or frightening thoughts) quite commonly
dread losing their minds.
What do my dreams mean?
This is a controversial area in which the answer you get largely
depends on who you ask. Some scientists today insist that dreams
are merely the random or background noise of the mind during sleep
and mean nothing at all. But almost everyone knows from direct experience
of their own dreams that at least some of the time dreams are complex
and personally meaningful, if often obscure creations. Freudian
dream analysis relies upon the dreamer's own connections and associations
to his dream to unravel its contents. There is no real evidence
that dreams can be reliably interpreted "by the book,"
i.e. by consulting a manual of symbols or common dreams. The meaning,
if any of a dream seems to be highly specific for the dreamer.
What is "normal"?
People often wonder and sometimes ask if they are normal. The difficulty
here is that, strange as it may seem, the mental health professions
have never established or concurred in a definition of normalcy.
There is reasonable though not complete agreement today concerning
various abnormal states of mind and behavior - but any discussion
of normalcy itself quickly becomes controversial. Perhaps the best
that can be said for the moment is that normalcy is the absence
of abnormalcy! A far more productive line of inquiry, therefore,
is to ask whether one is happy and healthy, not whether he is normal.
Freud's definition of good mental health -the ability to love and
to work- is perhaps as good as any.
What is the difference between a psychiatrist and
Psychiatry is a specialty of medicine like surgery, internal medicine
or pediatrics. All psychiatrists have therefore graduated from medical
school and are M.D.s before taking additional training(usually three
years or more) in the specialty of psychiatry. Psychologists have
obtained the Doctor of Philosophy or PhD degree from a university
and have not received but have not received the medical training
of a physician.
Do I have to take this medication for the rest
of my life?
Although experience shows that some types of chronic or recurrent
depression and other conditions do best with longer rather than
shorter treatment, no one really knows for sure in an individual
case whether medication will be required indefinitely. New medications
and treatments are constantly being developed that will almost certainly
transform our approach to psychiatric disorders in the next few
decades. The important thing is to maintain good communication with
the prescribing physician and to make decisions about length of
medication use after thorough discussion. A not uncommon scenario
is relapse of depression or other symptoms when medication is discontinued
prematurely and without medical guidance.
Is this medication addicting?
Medication itself is never addicting because addiction is a clinical
syndrome characterized by pathological salience(the substance is
abnormally important to the individual and becomes a life-dominating
obsession), drug seeking behavior, dishonesty, excess and continued
consumption despite negative consequences. Addiction, in other words,
consists of a complex interaction between the individual and the
substance. For reasons that are still unknown but which probably
have to do with both heredity and environment, only certain individuals
are vulnerable to the syndrome of addiction.
Certain medications, including alcohol, induce states of physical
dependence in everyone who ingests them long enough and in sufficient
quantity. Physical dependence means that there may be a withdrawal
syndrome if the intake of the substance is suddenly stopped or drastically
reduced. Physical dependence and withdrawal syndromes are not addiction.
They are easily managed in non-addicts by the gradual reduction
of dosage until the substance is finally discontinued.
Most but not all substances involved in addiction can cause physical
dependence - but physical dependence alone is not addiction.
What is a chemical imbalance?
Although the phrase "chemical imbalance" has no precise
definition it is commonly used to describe a type of depression(major
depression, endogenous depression) that is thought to result at
least in part from deficiencies in certain brain chemicals, called
neurotransmitters. Certain anxiety disorders as well as bipolar
disorder(manic depressive disorder) and schizophrenia also involve
disturbances of normal brain chemistry. Serotonin, norepinephrine,
dopamine and probably many other substances, some known, others
not yet known, play a role in mood regulation. Antidepressants and
other medications work by restoring normal levels of these brain
chemicals. There are no currently useful laboratory tests for such
imbalances. Evidence for the chemical imbalance theory comes from
research. In ordinary clinical practice the diagnosis of a "chemical
imbalance" is made from the patient's history and symptoms
and from his response to treatment.
How do shock treatments work?
Shock treatments or electroconvulsive therapy(ECT) induce an artificial
epileptic seizure by means of a small electric current applied to
the skull. Before the ability of electricity to create a seizure
was discovered various other methods, including intramuscular and
intravenous injections of chemicals known to cause seizures were
used. The ability of spontaneously occurring epileptic seizures
to relieve certain mental illnesses was noted in the last century
and led to a search for a safe and effective way to create seizures
in non-epileptics. It is thus the seizure and not the electricity
or any other means of causing it that is the effective thing in
convulsive therapy. Modern ECT is always done under light anesthesia
and after a powerful fast-acting muscle relaxant has been administered
that totally blocks the visible bodily response to the seizure.
Often the only evidence that a seizure has actually occurred is
the readout on the EEG(brainwave monitor). For more information
on ECT see www.psycom.net/depression.central.ect.html
Will hypnosis help?
Hypnosis is simply a means of focusing attention. It can often
be useful in strengthening motivation for change, e.g. smoking cessation,
weight loss, exercising &etc. There is nothing magical about
it, however. And although it is an intuitively appealing idea that
hypnosis could provide a "short cut" to repressed or forgotten
memories that might prove helpful in therapy, there is no reliable
evidence that this is the case. Trying to access the unconscious
directly by hypnosis is like trying to go someplace without actually
taking the journey. The actual effective and lasting part of most
therapy involves confronting and working through resistances and
repressions, not bypassing them. The journey is actually the destination.
What is a split personality?
There is no category or phenomenon in psychiatry called split personality.
The term is commonly used in popular language to indicate a contradictory
or drastically and dramatically alternating type of behavior of
the"Jekyll and Hyde" type. It is often confused with the
medical illness of schizophrenia because the etymology of the latter(from
the Greek schizein, to split + phren, mind) suggests, misleadingly,
that schizophrenia is a type of split personality. In schizophrenia,
however, the splitting is within one single personality as the individual's
thoughts, feelings and emotions are seriously and confusingly disconnected
from each other in a chaotic and random fashion. Schizophrenic individuals,
far from having split or multiple personalities, actually have a
great struggle maintaining the coherence and integrity of even a
Can people still be sent away or committed to mental
"Snake pit" and long term mental asylum images from old
movies and popular literature still frighten many people but they
no longer represent the way things are. Although individuals who
are obviously mentally ill and dangerous to themselves or others
can be legally detained and evaluated for safety, involuntary treatment(treatment
against the individual's wishes) has become uncommon. There are
all kinds of legal safeguards expressly designed to prevent abuses
of psychiatric treatment - so many, in fact, that it is often difficult
to treat desperately and dangerously ill individuals who do not
recognize the condition they are in. Nor are people hospitalized
for long periods of time any more. The old state mental hospitals
where some patients lived for years, even their entire lives in
some cases, no longer exist. Inpatient treatment today, if it is
provided at all, is typically a matter of days or weeks, not months
or years. Ironically, and unfortunately, the major difficulty patients
today encounter is not getting out of a psychiatric hospital when
they don't need to be there - it is getting in to one when they
urgently require help.
Submit a question.
Questions of broad or general interest will be considered for a
general response in this section. All material on the "Psychiatry
& Wellness" website is intended for general educational
purposes only. We cannot respond to personal and specific questions,
which should be directed to a local mental health professional.
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