The Upside of a Mental Breakdown

What if we need to break down in order to rebuild?

by Evan Malmgren

Evan Malmgren is a school bus driver and freelance writer based in Madison, Wisconsin. He is currently working on a book about people trying to live “off the grid” in modern America.

Around this time last year, my inner world was in shambles: I was socially withdrawn, badly addicted to prescription amphetamines, and mired in an abusive relationship that had grown to eclipse much of my life. My outlook had turned bleak, yet I was nonetheless making steady progress towards a range of somewhat arbitrary personal goals: I was teaching a course at The New School, on the verge of closing a book deal, and plugging away at a handful of features that, unfortunately, either stalled out or got killed when it became unavoidably obvious by the early summer that I was losing my grip on reality.

One of the problems with human beings is that we can be too good at pressing ahead when we desperately need to slow down. We can go about habits, cycles, and routines on autopilot for months or decades at a time without examining whether they are truly serving our needs; we can pursue ambitions regardless of their correlations to happiness or personal fulfillment. If we do this for long enough without checking in on ourselves and performing basic maintenance, as I learned the hard way, we run the risk of breaking down in dramatic fashion.

It has become obvious that many, if not most of us, are living close to the edge. The past few years have seen a consistent rise in youth suicides and emergency department visits; a recent Pew survey indicated that around three quarters of parents are worried about their children struggling with anxiety or depression. Last August, Gabbie Hanna went viral with a string of some hundred TikTok clips documenting a manic episode in real time. Celebrities like Kanye West have by now been doing the same in the media for years.

The notion of a “nervous breakdown” originated in a 1901 medical treatise and found widespread use throughout the first half of the 20th century, but fell out of favor with the rise of mass-market psychiatric medicine. The term does not describe a narrow category or lend itself to specific treatment—there is no formal definition or medical diagnosis—but it is nonetheless a helpful catchall for a range of mental and emotional phenomena that push people beyond the brink. Encompassing anything from panic attacks or bouts of depression to manic episodes and all-out psychosis, a breakdown describes a period in which one is suddenly—whether due to a traumatic trigger or seemingly inexplicably—incapable of maintaining the basic functions and expectations around which they had hitherto structured their lives. “The very general and ill-defined characteristics of the nervous breakdown were its benefits,” said social and cultural historian Peter Stearns in an interview with The Atlantic. It can lend the afflicted freedom to work through their experiences in a personal way, or provide a general explanation for their inability to perform at a normal level. “It played a function we’ve at least partially lost.”

Episodic breakdowns are often shocking and inconvenient for people who experience them as well those who are indirectly affected, so today there is typically a knee-jerk reaction to medicalize the problem, treat its particular symptoms, and resume business as usual as quickly as possible. But breakdowns also tend to be preceded by long periods of latent, unaddressed inner turmoil. They are culminations of sickness rather than sudden manifestations. To view breakdowns through a purely psychiatric lens, then, is often to overlook the lessons embedded within them.

Psychoanalysis, by contrast, offers fertile ground for extracting meaning from the form and contents of breakdowns. Sigmund Freud’s Psychopathology of Everyday Life, a foundational text in the genre, examines a slew of unconscious operations in seemingly random or happenstance errors, neuroses, and slips of the tongue. In the case of a breakdown, we can imagine that the murmurs of the unconscious have been dialed up to a degree that can no longer be reasonably waved away.

In Catch Them Before They Fall, British psychoanalyst Christopher Bollas posits that breakdowns serve the unconscious function of confronting the self with the other, and that their embedded potential for radically positive self-transformation is often obscured by blunt measures such as hospitalization, intensive medication, or cognitive behavioral therapy (CBT). He writes that these, “may help relieve the person in the immediate situation,” but ultimately negate meaning: “Discovery of the unconscious reason for the breakdown, and the opportunity for sentient understanding and tolerance of it within a human and therapeutic situation, are denied to the person.” These are instead recoverable by listening to the highly personal language of the breakdown itself. “A breakdown is a paradoxical gestalt,” he writes: “A moment of self-fragmentation is, at the same time, a moment of coming together inside the self. In the end, it is formative more than it is fracturing.”

The process of “recovering” from a breakdown is not necessarily one of recapturing a baseline “before” state, but of synthesizing the episode’s unconscious reasons for being into the practice of daily life. I have personally found this to be a helpful and resonant way of thinking, and one that has been echoed in numerous conversations with others who have gone through similar experiences. Sometimes, we simply cannot get better—either because we are living in denial or otherwise lack the emotional tools to do so—without first falling very, very ill. This point is neatly illustrated in a 2018 video from The School of Life, which suggests likening breakdowns to emotional revolutions: If internal tensions go unaddressed for long enough, the unconscious rises up to overthrow a dysfunctional order. As with any revolution, the best a breakdown can hope to achieve is to set the stage for incremental progress. But this hope is real, and often worth embracing. “When someone has spent their whole life functioning in a certain way,” said psychotherapist David Bell in an interview with The Guardian, “a breakdown can be an opportunity for change.”

In my case, last summer I spiraled into a full-blown schizoaffective episode. Initially I grew paranoid and began to perceive hidden plots where none existed; eventually I believed that I was experiencing premonitions, telepathically communicating with others, and receiving direct instruction from a higher power. It is hard to say precisely when the episode ended or began—the come-up and come-down were gradual—but the meat of it lasted for roughly one month, during which time I felt compelled to set off on a private pilgrimage that consisted of driving aimlessly around the country, blowing my savings on hotel rooms, and performing strange ritualistic acts like hacking up phlegm, collecting it in water bottles, and depositing it in rivers. At the peak of it I went without sleep for up to days at a time, took long, glassy-eyed walks in the middle of the night, and compulsively signed messages into my temple that I understood to be of otherworldly origin.

It is hard to convey psychosis to someone who has not experienced it, but for those who have experimented with psychedelics: It felt like a weeks-long acid trip. My surroundings took on an immense symbolic significance; to find a penny on the ground meant that whatever I was thinking in that particular moment was a message from God. I felt as though I could see around corners, vicariously experience other people’s emotions, and divine secret meanings hidden in cryptic comments from strangers. My mind raced through media that I had consumed throughout my life, and I saw hidden gestures of divine architecture everywhere. At one point I climbed over the metal fencing that enclosed a generator to lie on the concrete and symbolically “put myself in jail” for past sins; later I traveled to Washington Island in Lake Michigan to be “reborn.”

As this was happening, I was highly resistant to seeking any kind of medical treatment: I believed that everything I was experiencing was real and that others simply would or could not “get it.” As I gradually came to realize that my perceptions were not aligning with reality, however, the episode prompted me to seek treatment with a degree of seriousness that I had not previously accepted as necessary. I have since been diagnosed with bipolar disorder, and have come to understand my breakdown as having been a severe manic episode on a spectrum with less obvious emotional dysregulation that had persisted throughout much of my life. This perspective has helped me see and understand myself in ways that I had previously been incapable of accessing in talk therapy—not to mention relieved me of once-lingering anxieties about how I am perceived by others.

When I tell people the details of my breakdown, they tend to offer some form of sympathy or condolence—an understandable response—but I ultimately feel that it has left me a happier and more self-aware person. It slammed the brakes on a lifestyle that was not serving my wellbeing, kicked the crutches aside, and forced me into a process of challenging growth. In leaving me no recourse but to address my mental hygiene in exhaustive detail, the episode has helped catalyze an ongoing healing journey in innumerable terms—including medication, but by no means constricted to that domain.

At the same time, I have found that the contents of the delusions that I experienced have been helpful to examine on their own terms: As products of my psyche they were, after all, entirely compiled of my own actual memories, experiences and associations. They dredged up traumatic experiences that I had repressed or avoided; pressed me to grapple with how I had structured my life and personal ambitions; made me feel as though I was being pursued by instances in which I had harmed others, around which I had accumulated years of under-examined guilt. My breakdown forced me to confront these things in intimate proximity and, in a way, provided me with a cognitive structure to work through them in the physical world. All of this happened against a backdrop of sudden and significant upheaval in my personal life. But to squarely blame the episode on an external trigger would be akin to overlooking a shoddy foundation in the case of a collapsed building in the wake of an earthquake.

Certain avenues of the schizoaffective episode that I experienced were genuinely terrifying to experience—at one point I could not sleep because I believed that a demon might physically manifest and kill me—but even in these moments I felt a sense of euphoric interconnection with the universe. The feeling of contact with a higher power is a common thread among people who experience mania, and I have often reflected on the fact that what are today framed as psychotic breaks would more likely be understood as spiritual experiences until somewhat recently. Innumerable saints were appointed their status on the grounds of “visions” that might now be dismissed as hallucinatory bouts of madness, after all, and even today there are those who speak openly about astral projection and communing with spirits.

While I may have interpreted the episode as some kind of spiritual awakening as it was unfolding, however, the ordeal was deeply alarming to many who cared about me. Even while I was going through it, I intuitively understood that they would likely think that I was crazy if I explained the details of what was going on inside of my head, so I made a conscious effort to hide as much of it as I could. 

I certainly regret many aspects of how things played out, but I continue to believe that my delusions contained a symbolic kind of “truth”—and that I ultimately learned a valuable string of lessons about myself, my outlook, and my personal history that I likely would not have absorbed through hospitalization or psychiatric means.

In the Freudian construction, psychosis occurs when a subject is eclipsed: Delusional thinking aims to serve an ordering function, but inevitably constructs an “other” with no exteriority—an unconscious presence that appears to originate from beyond the bounds of the self. It is easy to see how this could be interpreted as a divine or metaphysical presence, or at least how it could provide messages of personal significance in symbolic form. While I personally find psychoanalytic vocabularies to be more compelling than religious dogma, there is an abstract quality of truth to either angle of interpretation that is lost when we narrowly medicalize the phenomena of breakdowns.

The process of interpreting and coming to terms with the psychotic break that I experienced last year has been a gradual yet generative one, not to mention profoundly humbling. Perhaps counterintuitively, I have come to feel that it was in some part fueled by a tendency to over-rationalize; to place excessive significance on my own powers of reason and observation. If nothing else, it gave me a heavy-handed shove that I feel has ultimately helped me along a process of positive readjustment.

In general, we do well to listen to breakdowns, and to understand them not just as sudden bouts of sickness but as unconscious, if inarticulate, bids for health. If someone you love seems suddenly “off,” they may be navigating a difficult adjustment that would be hard to grasp from the outside; if you feel that you can no longer keep up with the day-to-day grind, it might be worth investigating whether it is really in your best interest to simply push through it. When we grow out of touch with our inner selves, sometimes business simply cannot be permitted to continue as usual.