In 1996 the Wall Street Journal noted, “The nervous breakdown, the affliction that has been a staple of American life and literature for more than a century, has been wiped out by the combined forces of psychiatry, pharmacology and managed care. But people keep breaking down anyway.” Indeed they do keep breaking down. Kitty Dukakis, wife of former presidential candidate Michael Dukakis, remembered lying in bed doing nothing. “I couldn’t get up and get dressed, but I couldn’t sleep either.” What was the matter with Kitty Dukakis and millions of sufferers like her? Depressed? What does psychiatry think? In psychiatry there are a few distinct, sharply defined diseases that would be difficult to miss, such as melancholia and catatonia. These tend to be psychotic illnesses, involving loss of contact with reality in the form of delusions and hallucinations, though not always. Then there is the great mass of nonpsychotic ill-defined illnesses whose labels are constantly changing and that are very common. Today these are called depression, oft en anxiety, and panic as well. These are all behavioral diagnoses, suggesting that the main problem is in the mind rather than the brain and body. Yet there is a tradition, now almost lost, of viewing psychiatric symptoms as a result of body processes, and it has always been convenient to speak of these as “nervous” diseases, even though much more of the body than the physical nerves may be involved. Writing in 1972, English psychiatrist Richard Hunter directed attention toward the body as a whole. “Many diseases are ushered in by a lowering of vitality which patients appreciate as irritability and depression. The mind is the most sensitive indicator of the state of the body. An abnormal mental state is equivalent to a physical sign of something going wrong in the brain.” The term symptom cluster is popular today, but that is jargonish, so let us call these patients “nervous.” Their distinguishing characteristic is that they do not have the “C” word, as Eli Robins at Washington University in St. Louis used to call it, meaning that they are not “crazy.”
Psychiatry and Neuroscience
