On the Verge of a Nervous Breakdown

Women on the Verge of a Nervous Breakdown was the title of Pedro Almodovar’s brilliant 1988 film and is also the theme of this post: that is, women (and men) coming to a point in their lives when their ways of understanding and making meaning no longer make sense. They are in pain. They want to feel better. They don’t want to fall apart. No one wants to have a breakdown right?

As a clinician, what is there to do with all of this? Many therapists refer to nervous breakdowns as “the modern mental health crisis.” I would call this very painful activity a postmodern crisis. What I mean by that is it is a crisis that demands we take a long deep look at the conceptions and methodologies we are using as mental health professionals. How we go about working with people in distress is full of modernist notions of curing the “individual” rather than a focus on human relationality. We are not alone. We are in relationship to many people in our lives. In place of the usual focus of the past as determining the present, I am interested in people experiencing their inherent sociality and creativity. It can be in many ways an opportunity to transform how one has learned to do one’s emotionality. That, in fact, is my interest in all of this.

There is a long history of therapeutic responses to “breakdowns.” From Freud onward through R.D. Laing’s “Journey Through Madness,” and many other therapists who now practice humanistic approaches. Many therapists have chosen to get out from under the institution of psychiatric labels and many have contributed to an exploration of the psychological and emotional potential of the breakdown. Can we organize the breakdown to become a breakthrough? Can this be a moment of growth for the individual (and perhaps the therapist)? For the group? How might that happen?

I spoke to this topic a few years ago at the Taos Institute’s conference in Norway. My presentation was entitled Therapy Interrupted. Yes, I was saying that we need to interrupt traditional psychiatric notions of how we think about the issues of breakdowns in favor of mining the creativity of the therapist and patient. How we practice has everything to do with the potential for helping clients grow and develop their way through a crisis. I met many therapists who are trained as social constructionists and are fellow travelers in their passion for humane and positive responses to emotional pain. In many conversations with colleagues advancing all sorts of collaborative, social-cultural practices, I continue to be intrigued by the social/developmental potential of the activity of “breakdown” for the groups I lead.

This is something that I’m grappling with now in my social therapy groups and in the supervisory sessions I lead with therapists from the U.S. and abroad. It’s a big issue. Our clients are in pain. They want to feel better. They want to have more meaning in their lives, more intimacy. They want to develop their emotional capacities in relationship to themselves and others. They are trying not to fall apart. They want to avoid a “breakdown” at all costs. (After all, who wants to move closer to someone who’s “losing their mind?”) And yet sometimes they do.

Patients “on the edge” often have a hard time saying to anyone, including their therapy groups, that they’re in trouble. They’re scared that if they or others use the “breakdown” language to refer to what they’re experiencing that it means that they are “really (certifiably) crazy.” “Right?” “No, not right,” I say. “In fact, this may be an opening for all of us.”

We’ll see. It depends on what you and we do with it. It could transform how you see who you are, including the possibilities all around you. I’m moving in to organize the group to make demands on the person-in-crisis, counter to the prevailing notions that they’re too fragile to handle it. How we do that matters. I want us to move closer, socializing the fact that it can be scary to step closer to madness (including our own). And that means organizing the group to make demands that the person take a look at (be curious about) where they are, how they got there, and what’s producing their breakdown. Are they open to being impacted? Where are they locating themselves? Can they use what’s going on to learn new ways of being with others?

My patients who are struggling emotionally are often doing everything under the sun to avoid talking about their loneliness, their failures, their growth and how their social therapy group passionately wants to touch and be touched by them. I have chosen not to use the lexicon of clinical descriptors or casual explanations as to why they feel what they are feeling, because I think it’s hurtful to do so. I am interested in not being put off by the craziness of who we all are.

I’m willing to be lost together with clients who are in severe emotional crisis and work like crazy to organize the group to struggle with their own fears of madness to get close enough to be of real help. My groups set the stage for me to say to the person in crisis, “I want you to let me help you create the conditions where you can make use of all the people around you in your life, starting with the people in this room.”

I’ve been doing therapy for 34 years, and throughout I’ve loved the process of being off-book (and off-DSM), of being compassionate and demanding, and curious with patients who are in crisis. It’s a continuous search for method: i.e., figuring out how to use everything (the fear, psychosis, vulnerability, etc.) to create the collective social activity of breakdowns becoming breakthroughs.

I very much look forward to your thoughts, comments and questions, so please let me hear from you.

And for those in the NYC area, I will be hosting a forum on this very topic on Friday evening Feb. 19, in Brooklyn. I’d love for you to join the conversation.