What's a nervous breakdown?

Health and medicine explained.
March 31 2006 11:38 AM

What's a Nervous Breakdown?

Hint: Italy's wacky Silvio Berlusconi isn't having one.

Italian Prime Minister Silvio Berlusconi 
Click on image to expand.
Italian Prime Minister Silvio Berlusconi

When I think "nervous breakdown," I think The Scream. Edvard Munch did a fine job of putting words to his 1893 painting. "I was walking along a path with two friends," he wrote. "The sun was setting—suddenly the sky turned blood red—I paused, feeling exhausted, and leaned on the fence—there was blood and tongues of fire above the blue-black fjord and the city—my friends walked on, and I stood there trembling with anxiety—and I sensed an infinite scream passing through nature." The quote captures distress coupled with great fatigue, to the point of utter loss of control.

Last week, Italian businessman Diego Della Valle, chairman of the upscale shoemaker Tod's, said that Prime Minister Silvio Berlusconi was "on the verge of a nervous breakdown." Della Valle had been a supporter of the Italian premier, but in the middle of a speech, Berlusconi singled the shoemaker out for a public scolding.

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A week earlier, Berlusconi had walked off the set in the middle of a TV interview because he didn't like the line of questioning. This outburst came shortly after he declared himself "the Jesus Christ of politics" and pledged himself to two and a half months of "absolute sexual abstinence" until his re-election campaign culminates when Italians go to the polls on April 9 and 10.

Della Valle's nervous breakdown remark got traction when BBC World News repeated it in an analysis of the upcoming election. So, are Berlusconi's outbursts evidence that he's having a nervous breakdown? Exactly the opposite.

The Oxford English Dictionary says that "nervous breakdown" is "a vague term for any severe or incapacitating emotional disorder." Psychologists and psychiatrists don't use it as a diagnosis. The catchall phrase owes its existence to the late-19th-century view that snapping under pressure, and then becoming severely depressed, results from physical rather than mental failure. The problem was thought to be exhaustion, and the cure rest as well as the care of a good physician. Though most doctors have never been comfortable with the phrase, some have used it on occasion: "Nervous breakdown" first appeared in a medical context in 1901 and became part of the popular lexicon by the 1920s, writes historian Megan Barke.

When people talk of their own nervous breakdowns, "they point to a precipitant—increasing problems with their marriage, divorce, family events, work or school pressures," says Ralph Swindle Jr., a clinical psychologist who published an article on the subject in American Psychologist in 2000. A person having a nervous breakdown often responds to pressure with behavior that's entirely out of character. Someone who is usually dependable can disappear without warning. Author Agatha Christie went AWOL for 11 days in 1926 after her mother died and her husband confessed he had cheated on her; she later claimed amnesia to be the cause of her upset. Actress Margot Kidder snapped after a disabling car wreck, bankruptcy, and a bout with drug addiction. She went missing in 1996 and was found three days later, "disheveled, dazed and fearful" near a Hollywood studio. (Today she uses her renown to advocate for mental health care.)

ABC News recently repeated speculation that Dave Chappelle's disappearance, in the wake of his $50 million Comedy Central deal, may have resulted from a nervous breakdown. But Chappelle said he'd made a conscious decision in the face of great stress to go on an unscheduled vacation. "The healthiest thing for me to do was to remove myself from the situation," he told ABC. Exactly. Chappelle apparently had the means to indulge in a fantasy lots of us have had: taking off, without a trace, to a faraway place.

Berlusconi's antic behavior also makes a kind of sense, in that it's of a piece with his reputation. He is a powerful man who is used to getting his own way and doing whatever he pleases. Berlusconi has been in public office since 1994 (with the exception of a break from 1995 and 1996) *, and he has a net worth estimated at $11 billion, making him Italy's richest man. He owns the hugely popular AC Milan soccer club, controls Italy's three biggest private TV stations, and sits atop a political party, Forza Italy, of his own creation. He often dives headfirst into controversy; in 2003, he praised Benito Mussolini for being a great statesman, saying that the World War II dictator "never killed anyone." Before and during his term as prime minister, he has been charged with perjury, corruption, false accounting, embezzlement, tax fraud, and judicial bribery. (He has been found guilty more than once, but the convictions haven't stuck.) And he's entirely comfortable sporting the Steve Van Zandt look—one opponent said he wears a bandana "like a 70-year-old woman wears a miniskirt."

The landscape Munch painted in The Scream is in suburban Oslo, near a mental hospital where his manic-depressive sister Laura Catherine was interned. Fifteen years after he made the iconic painting, Munch had his own break. Severely depressed and drinking heavily, he suffered an anxiety attack that led to hospitalization and electroshock treatment. He recovered and returned to painting. But his life-as-art episode reminds us that for every Berlusconi, for whom living on the edge is simply living, there are millions more who mean it when they tell friends and spouses and office mates that they're a step away from the brink.

Correction, April 3, 2006:The article originally failed to note that Berlusconi's time in public office was interrupted by a break in 1995 and 1996 and that between 1996 and 2001, he was a member of parliament and opposition leader, not premier.( Return to the corrected sentence.)

Jeff Merron is a staff writer and columnist at ESPN.com.