Bring Back the Nervous Breakdown

This article was published online on February 8, 2021.

April 1935 was a nervous month. Unemployment in America stood at 20 percent. A potential polio vaccine was failing trials. The term Dust Bowl made its first appearance in newsprint. A thousand-mile storm carried away much of Oklahoma. And Fortune magazine introduced its readers to “The ‘Nervous Breakdown.’ ”

Soon reprinted as an 85-page book, the article cited experts “whose names loom largest in the fields of mental hygiene.” The takeaway? The nervous breakdown was deemed to be “as widespread as the common cold and the chiefest source of misery in the modern world.” Anyone could be susceptible; it could be precipitated by nearly anything, and it prevented one “from carrying on the business of normal living.” Resolution of the breakdown entailed a time-out, ideally at one of the deluxe sanitariums profiled a few pages in.

Right now—I think we can all agree—Americans are once again living in a nervous time. Pandemic. Wildfires. Indefinite homeschooling. Postelection political chaos. TikTok. Feelings of impending collapse have arguably never rested on firmer empirical ground. But today we no longer have recourse to the culturally sanctioned respite that the nervous breakdown once afforded. No longer can we take six weeks at the Hartford Retreat, one of the healing getaways described in Fortune—all long since closed or transmuted into psychiatric facilities that require a formal mental-health diagnosis for admission. No restorative caesura is forthcoming for us. The nervous breakdown is gone.

For 80 years or so, proclaiming that you were having a nervous breakdown was a legitimized way of declaring a sort of temporary emotional bankruptcy in the face of modern life’s stresses. John D. Rockefeller Jr., Jane Addams, and Max Weber all had acknowledged “breakdowns,” and reemerged to do their best work. Provided you had the means—a rather big proviso—announcing a nervous breakdown gave you license to withdraw, claiming an excess of industry or sensitivity or some other virtue. And crucially, it focused the cause of distress on the outside world and its unmeetable demands. You weren’t crazy; the world was. As a 1947 headline in the New York Herald Tribune put it: “Modern World Viewed as Too Much for Man.”

The term nervous breakdown first appeared in a 1901 medical treatise for physicians. “It is a disease of the whole civilized world,” its author wrote. This disquisition built on the work of a Gilded Age doctor, George Miller Beard, who posited that we all had a set amount of nerve force, which could be depleted, like a battery, by the stress of modern life. Beard had argued that an epidemic of nervous disease had been unleashed by technology and the press, which accelerated everything. “The chief and primary cause of this … very rapid increase of nervousness is modern civilization,” he wrote in American Nervousness in 1881.

This idea of the nervous breakdown as a natural response to modern life gained currency through the go-go 1920s, and then achieved cultural ubiquity with the economic collapse of the 1930s. “Is a nervous breakdown a sign of weakness?” asked a 1934 book titled Nervous Breakdown.

Famous cases illustrated this. Rockefeller’s best-remembered achievements—the national parks, the art museums, Rockefeller Center—came after his breakdown in 1904, which sent him to the south of France for six months’ relief from strain. Weber wrote The Protestant Ethic and the Spirit of Capitalism while prostrated by an excess of the very work ethos he described. (He recovered and resumed teaching just in time to die of the 1918 pandemic flu.)

But by the mid-1960s, when the Rolling Stones recorded “19th Nervous Breakdown,” the concept was getting pushed to the margins by the rise of mass-market, prescription-driven psychiatry (presaged by another Stones single, “Mother’s Little Helper”). The developing field had little use for an affliction that could be treated without the assistance of physicians. Diseases like major depressive disorder, generalized anxiety disorder, and obsessive-compulsive disorder—diagnosed and treated by specialized doctors dispensing specialized drugs—replaced the nervous-breakdown catchall.

This did quite a bit of good: Many people with psychological ailments gained access to medical treatments that could be effective. But something important was lost.

“The very general and ill-defined characteristics of the nervous breakdown were its benefits,” Peter Stearns, a social and cultural historian of the nervous breakdown at George Mason University, told me. “It played a function we’ve at least partially lost. You didn’t have to visit a psychiatrist or a psychologist to qualify for a nervous breakdown. You didn’t need a specific cause. You were allowed to step away from normalcy. The breakdown also signaled a temporary loss of functioning, like a car breaking down. It may be in the shop, sometimes recurrently, but it didn’t signal an inherited or permanent state such as terms like bipolar or ADHD might signal today.”

The nervous breakdown was not a medical condition, but a sociological one. It implicated a physical problem—your “nerves”—not a mental one. And it was a onetime event, not a permanent condition. It provided sanction for a pause and reset that could put you back on track. But as psychology eclipsed sociology in the late 20th century, it turned us inward to our personal moods and thoughts—and away from the shared economic and social circumstances that produced them.

“The psychiatric approach tends to say that you have a specific problem that other people don’t have, and we’re here to fix your problem independent of what’s happening to everyone else,” Stearns noted. The effect is atomizing even in normal times. Today, “everyone is so isolated that you have even less sense than usual as to what the collective mood is. So we may need something like the nervous breakdown—something that is less medically precise but encapsulates the way people are encountering the moment.”

From the January/February 2014 issue: Surviving anxiety

But in a society reflexively suspicious of rest, getting a restorative break tends to require a formal mental-health diagnosis. Otherwise, you risk getting called a slacker. That’s what happened to Alexandria Ocasio-Cortez a couple of years ago when she announced she was taking a few days off for “self-care” after a grueling election. “Congresswoman-elect Alexandria Ocasio-Cortez hasn’t yet started her new job,” Fox News blared, “but she’s already taking a break.”

This got me thinking that maybe we need to bring back the nervous breakdown, to protect the nation’s collective reserve of nerve force at a time when it’s stretched so thin. What would the modern version of a culturally accepted, nervous-breakdown-precipitated time-out look like?

A century ago, the famous Battle Creek Sanitarium in Michigan marketed itself as a “Temple of Health.” Under a canopy of glass and hanging ferns, bathed in sunlight and the super-fresh air provided by elaborate ducts, patients—the diseased and the nervous; distinctions blurred—engaged in quiet conversation or opulent repose. In one building was the gymnasium, flanked on either side by the hydrotherapy wings. Other rooms housed vibrating chairs and therapeutic light baths. Outside, naturalist talks. And in the dining room, staff serenading diners with the Chewing Song. (The sanitarium’s superintendent, John Harvey Kellogg, believed that each bite of food should be chewed no fewer than 40 times; to aid digestion, he had invented a special breakfast cereal, cornflakes.)

Sanitariums like Battle Creek became places to restore whatever ailed the body or spirit. To be sure, quackery abounded: Kellogg believed in spinal douches and eugenics. But with the right combination of relaxation, engagement, and yogurt enemas, you could leave feeling like Rockefeller, who came for a stay in 1922.

Sometimes, the treatments even worked. “People responded to the fact that something was being done for them,” Edward Shorter, a medical historian and the author of How Everyone Became Depressed: The Rise and Fall of the Nervous Breakdown, told me. “The placebo is a very powerful treatment.” And the experience of communal recuperation prevented the social isolation of private seclusion.

But the cost of a sanitarium stay in the 1930s could run as high as $3,000 a week in today’s dollars, putting it outside the reach of the comfortably middle class. That would still be true today. And even if we could somehow eliminate the financial hurdles, we’d be faced with the cultural ones that Weber traced to Ben Franklin—time is money, idleness is sloth, and all that. Anything that smacked of, say, government-subsidized spa days, no matter how healthful those might be, would be considered un-American.

So rather than the nervous breakdown writ large, we could introduce a more modestly scaled version of it: a series of buffers, firebreaks, or (to use a bankruptcy metaphor) bridge loans to stave off the full Chapter 11 scenario. The French lent us reculer pour mieux sauter—literally “to withdraw in order to make a better jump.” We could slip something more muscularly American, like power break or power-up, into our national lexicon. “Boss, I need a power-up” isn’t an admission of weakness; it’s a simple statement of fact. Achieving widespread cultural acceptance of the practice may take less time than you’d expect—consider how swiftly paternity leave traversed the gap from unheard-of to expected.

The mini-break could insinuate itself into American life in bite-size increments. When I asked an intensive-care nurse what a power break might look like for her, she said it could be small. A two-minute “debrief” after a death in the unit—a moment to stop, reflect, and connect with the constant and familiar—would go a long way in helping someone regroup before they have to lurch to the next crisis. Though the psychic needs of an ICU nurse are particular, the basic concept is generalizable.

Adam Waytz, a management professor at Northwestern, says that to be effective, breaks should entail true disconnection from work—which is to say we need to be able to slip off our electronic leashes. Both France and Spain have made “the right to disconnect” from after-hours work communication an actual legal right. Daimler, the German auto manufacturer, may have gone the furthest of any company toward establishing full mental-bankruptcy protection for its workers: When Daimler employees take time off, they can opt to have their incoming emails deleted on arrival, with senders getting politely notified that their message has been destroyed and that if they need something urgently, they can contact an alternate person. “The idea,” Daimler has said, “is to give people a break and let them rest. Then they can come back to work with a fresh spirit.”

Existing bits of U.S. legislation could augment efforts like this by private companies. For instance, an expiring provision of the Families First Coronavirus Response Act that reimburses employers for up to 12 weeks’ paid leave if an employee’s kid’s school closes could be a starting point for building broader availability of paid time off for family crises or restorative breaks.

From the May 2020 issue: What happened to American childhood?

Nervous breakdowns, as F. Scott Fitzgerald wrote of his own in his 1936 essay “The Crack-Up,” are “not a matter of levity.” He’d found himself “like a man overdrawing at his bank”—“I began to realize that for two years my life had been a drawing on resources that I did not possess, that I had been mortgaging myself physically and spiritually up to the hilt.” At that point, Fitzgerald was well into terminal alcoholic decline, and on his way to an early death.

The past year has made clear the tremendous emotional and social damage that accumulates when whole populations get pushed beyond easily endurable limits. Alcohol consumption is up; drug overdoses are up; reports of anxiety and depression are up. Even once this pandemic wanes, its psychic effects will linger. The previous century’s flu pandemic lasted until 1920, but a spike in suicides was seen the following year, in 1921. Which is why, individually and collectively, we would be wise to do better than remain bundles of never-ending nervousness, too frayed to provide much solace or support for anyone, waiting for the psychiatric-industrial complex to handle America’s growing mental-health crisis, and doing little or nothing to head it off.

Better a more economically feasible and culturally acceptable nervous breakdown now than something worse later on.

This article appears in the March 2021 print edition with the headline “Bring Back the Nervous Breakdown.”