What Do We Really Mean When We Say Someone Is Having A "Mental Breakdown" ?

Photographed by Alexandra Gavillet.
On this week's episode of This Is Us, we saw Randall crying, trembling, and breathing heavily after undergoing some seriously stressful events. We might be tempted to call this a "mental breakdown" or a "nervous breakdown" (and, indeed, several stories have referred to it as such), but neither of those terms are accurate — nor do they refer to real medical diagnoses.
In general, when we say someone is having a "nervous breakdown," we mean that person is under an extreme amount of stress. She may be acting in ways she doesn't normally act (e.g. making hasty decisions) or be unable to take care of herself in basic ways (e.g. not eating, going to work, or showering). Or she, like Randall, is in the middle of an intense moment of anxiety.
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"The term was frequently used in the past to cover a variety of mental disorders, but it's no longer used by mental health professionals today," writes Daniel K. Hall-Flavin, MD, at the Mayo Clinic. "What some people call a 'nervous breakdown' may indicate an underlying mental health problem that needs attention, such as depression or anxiety."
When you say someone is having a mental breakdown, they might actually be in the midst of a manic or hypomanic episode, which are symptoms of several disorders (e.g. bipolar or schizoaffective disorder).
In other cases — including Randall's — that person might actually be suffering through a panic attack. These are temporary (but terrifying) episodes brought on by a sudden increase in anxiety. If you're having an attack, you might feel like your heart is racing and your body is shaking, and like it's getting harder to breathe. Some people also feel like they can't move or as if their body is numb and detached from reality. And, as Randall experienced earlier on in the season, your vision may be blurred or dimmed.
If you've never had a panic attack before, it's probably a good idea to get medical help because it can feel a lot like some other serious conditions (e.g. a heart attack). But if it's truly a panic attack, you should know that these aren't dangerous beyond, you know, the awfulness of the attack itself.
So, just because a mental breakdown isn't an official diagnosis doesn't mean it's not serious. It can be a symptom of these very real disorders or a sign that you need to find a better way to deal with stress. That's why, even if you don't think you're dealing with clinical anxiety or a manic episode, it's still crucial to talk to a professional if you feel a "nervous breakdown" coming on.
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