Please stop saying that

"Oh, she's got stress, she won't be back for a while". 

Ok, now wait a minute there - you're saying she's 'got' a very natural and necessary physiological reaction that we need in order to perform? Right. So we'll see her as usual tomorrow then?

"He's already had one nervous breakdown, now he's had another one!" Yeah, I heard he's in a padded cell licking the sweat off the walls in a straight jacket, kicking the potatoes from last night's dinner tray around like the National Lottery balls.

You have to love a good old colloquialism. Unfortunately, the fact that even many GPs don't use the right terminology doesn't do us any favours. 

I've been criticised for saying I don't think 'breakdown' is a useful term. It suggests that you're not in crisis (the more up to date version) unless you're totally lost the plot and are streaking through the town foaming at the mouth. Well, let's see here - my last big one was in 2007, when I was working in a substance misuse service, frontline, crack addicts coming in off the streets and faxes detailing the 30 year criminal history of some of the regulars forced to come in by probation. I'd begun keen and I loved the place, even though I wanted to work with the clients more. Everything was pretty ok, I had my own flat, a car, and a boyfriend. But I had one huge elephant in the room - I'd been addicted to prescription drugs for about 2 years by that point. Finally, after enduring a month of utter hell detoxing on my own with no benzos - bad, bad idea - I was clean. This was the perfect time then for my boyfriend to leave me. I totally lost myself. 

Without the usual crutch of codeine, and its soft cushion of warmth, I nose-dived into oblivion. 

What ingredients do you need to make a good old-fashioned breakdown?

1) Alcohol - check. Maybe 2-3 bottles of wine a night plus any spirit I could find.
2) Cocaine - check. 2 grams minimum.
3) Friends who you didn't really know, but you all did drugs and drank to excess - check
4) Plenty of male attention that tapped into your lack of self-worth and desperation to destroy yourself - check.
5) A stool with your name on it at the end of a bar where drugs were handed out like sherbet - check
6) A job where everyone else there had some level of mental illness - check.

I woke up in bed with strangers in places I didn't know. I gained consciousness whilst running through Whitechapel to escape a man who was chasing me. I cracked my head on the pavement falling down drunk in the road. I showed up at my ex's house, demanded alcohol and then sobbed until I was asked to leave. I was a total car crash. BUT - I still 'functioned'.

I sang in a choir, and during a concert in a cathedral I was in the toilet doing coke off a holy toilet seat. I showed up for work everyday, reeking of booze, still drunk and did drugs off a toilet seat reserved for the abstinent. I'd lost a lot of weight and at work I would only eat peas and gravy. I did another concert in St James's Palace and got so drunk I had to be taken home by a complete stranger, who stayed overnight but left before I woke up still in my clothes and late for work. I went for a night out with friends from work, fell over on the toilet floor and got covered in piss, then took another guy I barely knew home. In the morning I woke up with bruises and my full-length mirror lay smashed on the floor. I have no memory of anything, but that might be my brain's way of protecting me. 

That was definitely 'a breakdown', except it wasn't. I functioned, albeit with considerably less skill than normal. People at work probably thought I was just a bit late and weird about food, I told them I'd had flu when I was detoxing. I did my work, and got good reviews too. If any of them had seen me after 6pm though? They wouldn't have believed I could even show up.

My point is, saying to someone 'I had a nervous breakdown' isn't at all representative of what actually happened to me then. I didn't just stay in bed all day with the curtains closed. I still drove a car and typed emails that weren't just mental rants about pigeons, and the voices in my head. I used a debit card and wrote an entire album in my spare time even - that's more than I've done in the 2 years since giving birth. I was in crisis, of that there was no doubt. 

We all need stress - it makes us perform. But it's not a mental illness, yet doctors still put it on sick notes because it's more socially acceptable than depression or anxiety. The stress bell curve is usually somewhere in any mental health training for a reason, to show that it's a perfectly normal physiological response to certain factors, and because we need it to survive. But if it carries on for a long time and you fall off the end of that curve, that's when you're likely to experience some form of mental aberration. Worrying about whether you've met the criteria for a breakdown is the last thing you need by that point. 

"Oh, well that doesn't sound like a breakdown to me, my brother's girlfriend had one and it was totally different - she didn't leave the house for days! Has the doctor diagnosed stress?" 

Things are moving on, slowly but surely, and it's high time GPs stopped using these terms. Just like asylums, they should be consigned to the pages of history.


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