HEALTH: TALES FROM THE THERAPIST'S COUCH

A man in his eighties, reflecting on his earlier life, describes the turmoil and disorientation of a breakdown that he suffered in his thirties: "I lived as if under great inner pressure. Everything in the world seemed difficult and incomprehensible. I was in a constant state of tension. I plunged down into dark depths, and couldn't fend off a feeling of panic."

People can suffer breakdowns of various intensities, but anyone who has endured the terror of one (or many) will probably identify with his description. A breakdown may emerge from an ongoing depression or merge with one as it unfolds; it can envelop someone slowly or overwhelm them suddenly like a bolt from the blue. It may be difficult to pinpoint what triggered it, it might be a reaction to external stress, or be caused by a blend of an individual's makeup and life events.

I have met and worked with many people who have suffered from what is so crudely known as a "nervous" breakdown. Physically, people tend to experience continual bodily tension and uncontrollable tears. There may be a loss of appetite, the desire to sleep and/or the inability to do so, and difficulty in performing even the most basic everyday functions. "Even going to the corner shop to buy a paper is a nightmare," explained one young man, "because if I speak to anyone I may burst into tears." Emotionally, there is usually a mood of overwhelming sadness, uncontrollable panic and frightening distress.

It is difficult to generalise from what is particular and unique to each individual, but one frequently experienced state is a terrifying loss of self-identity and fear of madness. As one woman put it: "I don't know who I am any more. I've utterly lost my bearings. I feel so lost and at sea." The "I" who was at the helm has gone, as if dissolved, and with this loss of "I" or ego control, the rest of the being spirals into panic. It is the anguished cry of King Lear before he stumbles into the storm, his familiar world turned upside down, his identity, power and certainty broken: "let me not be mad, not mad, sweet heaven."

Whether to a greater or lesser degree, most of us can probably think of moments in our lives when we have lost the sense of who we are or where we are going. It is a theme frequently explored in myths and literature: a dark night, a lost way, death. The outcome is frequently triumphant and transforming: Dante only reaches heaven by struggling though hell and purgatory. In psychotherapeutic writing, descriptions of a breakdown are also invariably enfolded in the optimistic outcome of a breakthrough. You have to get worse, the theory goes, before you get better. Or, to put it another way, the "I" or self that was steering the boat before the sea-storm erupted was in fact a "false" self, which has finally buckled under the strain of living against its true nature.

According to this viewpoint, a breakdown is our instinctive way of self- healing. Like a snake needing to slough off a skin that no longer fits, a breakdown is the body's way of joining in with the psyche to say: enough, these too-familiar trappings don't work any more. If we can endure the chaos and turmoil of things falling apart, we can discover that our lives are often shaped by forces that cannot be controlled, but which can essentially be trusted.

Many people could vouch for the truth of such an optimistic interpretation. The man quoted at the start of this piece went on to talk about his lengthy breakdown as being the most creative thing that had happened to him. He was the analytical psychotherapist CG Jung, and his experiences were written into his autobiography Memories, Dreams, Reflections. I have been moved in my own work by similar experiences of fear and turmoil imperceptibly giving way to a life force that can be trusted.

Yet despite my belief in the validity of this breakdown/ breakthrough pattern, I am a little wary of waving its banner too eagerly. For many people, a breakdown doesn't end in a creative triumph but in a temporary abeyance before the onslaught of more suffering. For many, a breakdown can mean a lifetime on medication, the loss of work and/or the loss of a loving relationship. If the trigger was an external stress (bullying, racism and sexual harassment are often causes of breakdowns) avoidance of repetition can feel impossible.

In his autobiography, Jung talks about how vital the support of his family was during his crisis. He also talks about his professional work as having prevented him from being "driven out of my wits". Many people are not so fortunate in having the anchor of a supportive family or an understanding workplace. If as a culture we were less critical of those who find themselves confused, fragile and needy, it would become possible for more people to make the transition from a state of breakdown to one of breakthrough.

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the clinical material above refers to individual cases

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