Nervous Breakdown In 20th-Century American Culture

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

Popular beliefs about psychic functioning were becoming somewhat more precise. Further, a prefereence for models of organic deterioration, in the case of depression, increasingly rivaled the implications, in nervous breakdown, that an individual could regain control after some kind of pause.

Several factors combined in this transition, from the 1960s onward, while also accounting for the new focus on stress and (a bit later) depression. The impact of World War II, and then the Cold War and Vietnam, was crucial. Experts increasingly urged that the psychological effects of wartime trauma on men could not be talked away as cowardice or even the outcropping of some previous psychological deficiency. Stress happened, with often horrendous results. While disputes lingered in World War II, the widely-publicized pressures on troops in Korea and then Vietnam capped a process of growing understanding. Correspondingly, it became appropriate for soldiers to express their own recognition of the problem (like the Gulf War pilots who openly discussed their fear) and for commanders, as well as military doctors, to recommend appropriate mental preparation. Expert terminology might still vary, but stress captured growing public recognition of the issue, designating psychologically demanding situations that did no t require elaborate definition. Expert studies spilled over into the families of servicemen, also subject to stress. And the climate of the postwar decades, filled with job opportunities but also increasingly recognized pressures of corporate and commuter life, further bolstered the utility of the stress concept. The work ethic did not erode (a feminist- and male liberationist-inspired 1970s attempt to attack "workaholics" did not ultimately succeed), but the kind of ready endorsement of effort that had characterized the 1920s began to yield to greater ambivalence. [31]

Nervous breakdown could of course have handled the idea of pressure from war and work, but we have seen that on the whole the focus in the breakdown concept had shifted toward internal factors rather than external provocation. So the context was ripe for newly-emphasized terms like stress and depression, that would better capture the problems experts and the public both recognized as dominant.

By the 1950s also, a new series of drugs began to attack some of the crucial symptoms often attached to the breakdown idea. (Nervous breakdown performed its greatest service in the decades between two different drug regimes.) Widely-prescribed tranquilizers began to give doctors new weapons and new appeal; Miltown (Meprobamate) was the first "minor" tranquilizer available for anxiety. Antidepressant drugs soon followed. With housewives the principal patient population, the potential impact of psychotropic medications on nervous breakdown would be obvious. First, the need for a disease that would emphasize self-help and adjustment of personal framework, as opposed to consultation of medical professionals, was diminished. Second, the utility of a concept that stressed sudden collapse, after previous mental health, was also altered. People who judged themselves "on the verge" could now delay or attenuate symptoms by prescription drugs. They might still suffer--drugs indeed might mask problems that would later t urn into fullblown depression--but the notion of crisis was reduced. Whether this helped spur the public acceptance of depression, which was based more on an understanding of gradual process, of erosion rather than breakdown, must remain speculative at this point. But prior reliance on the idea of a collapse of functioning was clearly affected. [32]