Nervous Breakdown In 20th-Century American Culture

Journal of Social History, Spring, 2000 by Megan Barke, Rebecca Fribush, Peter N. Stearns

Nervous breakdown became a widely-used notion by which Americans explained certain symptoms or anticipatory fears to themselves and through which they sought support from family and acquaintances. It worked, in these functional terms of legitimizing key definitions of distress. Flexible vagueness made it a valid catchall. It described new worries and larger reactions to changing behavioral standards. The focus on collapse and on personal rather than professional responsibility made sense in the medical context that prevailed for several decades after 1900. In this complex setting, the concept authorized and guided widespread self-diagnosis as well as reactions to the woes of others.

Transitions

Conventional wisdom argues that the validity of nervous breakdown began to decline by the late 1960s, and indeed there were signs of major change. Further, many of the causes that had sustained the concept began to shift, so explanation is not obscure. Indeed, the factors prompting a reduced reliance on nervous breakdown confirm some of the reasons for its popularity in the first place.

There were two major symptoms of change, suggesting a reduction in the salience of nervous breakdown in the popular American lexicon. First, the rate of articles and books declined; it became hard, in browsing a bookstore or thumbing through magazines, to come upon descriptions of nervous breakdown or advice on how to avoid or overcome it. As we will see, references did persist, mainly in recurrent first-person accounts of the experience. But popularizers themselves clearly concluded that a once-vibrant market had dwindled. Frank Caprio's book was the last of the genre.

At the same time, popular disease preferences clearly shifted as well, in two directions. First, the concept of stress gained ground. The term had persisted independently in the 1920s and 1930s, as well as being incorporated into common versions of nervous breakdown. But from the 1950s onward it stood more triumphantly on its own. Widely-publicized theories of stress by Hans Selye (whose book, The Stress of Life, emerged in 1956 but who inspired popularized articles from the late 1 940s onward) set the process in motion. The stress emphasis, popularized also in studies of type A personalities and through other terms such as burn-out, related to the growing attention paid to high blood pressure and cardiac disorders. Here, clearly, was a new twist on the old interest in noting the psychic and somatic costs of the pace of modern life. ("High blood pressure is primarily a disease of stepped-up living and urbanization," one Time magazine account trumpeted, claiming among other things, with complete inaccuracy, t hat southern Blacks were exempt from the problem.) [29]

Along with stress came growing attention to depression, here from the 1970s onward. Just as stress took over nervous breakdown's role in reflecting the pressures of modem living, so depression picked up other features, such as a predominant emphasis on women and a sense of inability to function. Taken together, stress and depression reduced breakdown's utility as a catchall category, for problems that the concept had once, however uncomfortably, united were now broken into two more clearly separate categories. Stress took over the idea of outside factors, depression the focus on internal states. Here in turn was both cause and concomitant of the declining place of nervous breakdown in the psychological self-help literature. [30]