“I am so sick and tired of being sick and tired. I can’t even talk about it anymore. I go for long periods where life is good and I’m fairly happy. I have a great job as an engineer, a reasonably good relationship with my wife and all of our three kids are in college. How could anybody be unhappy with that set up? But then for no reason at all I go into the dumps. I can’t get up when life is good. It’s always been that way in my life. I’ve never been continuously happy. It’s up and then down. I’ve pretty much tried everything to feel better — 12-Step groups, meditation, yoga, and talk therapy. Nothing helps. I’ve given up on ever being truly happy. I guess I’m just one of those people who isn’t cut out for real happiness. I wish I could believe people when they say they really like me. I don’t know why they would.”
It may seem hard to believe that having a good job, a loving family, and successful children wouldn’t make us completely happy. It’s the American dream. But guess what? It doesn’t. Many apparently accomplished people have problems with chronic, low-grade and often hidden depression. They are not who they appear to be. They look fine on the outside and are often fairly good, likable and responsible people. They just don’t like themselves. Their depression doesn’t usually knock them out; it just causes them to drag through life, withdraw at times, and not be all they are capable of being. Their gloominess takes it toll on loved ones and work peers. Worst of all, they often don’t know why they are like this.
You can imagine what it’s like to be in this man’s shoes. He’s does everything reasonably well and is fairly successful. He has people who love him. Yet he is not happy. In fact he has never been completely happy. Even when others tell him how great he is. Most of his life has been a drag ever since his earliest years. The persistence of this experience sometimes causes him to give up hope and occasionally entertain thoughts of suicide. Afterall, there seems to be no point to his life anyway. He can’t even be happy with having it all. And what causes him the most hopelessness is that he can’t figure out what is bugging him.
People with this difficulty deserve our compassion. There are many people like this. Even famous ones, like perhaps Abraham Lincoln. They are said to have dysthymic depression, a chronic low-grade but often serious depression. About 1.5 percent of American adults are reported to have dysthymia (although this number is likely underestimated) and nearly half of these people have regular severe symptoms. Most recovering addicts have underlying dysthymia. That’s what may prompt them to use in the first place, and puts their continuing sobriety at risk.
The average age of dysthymia onset is 31 years, although it has likely been in their life from an earlier age. Dysthymic people may have never known what it was like to be for-the-most-part happy. Unlike people with Major Depression or Situational Depression, people with Dysthymia can get out of bed and function relatively well. It’s just that life feels persistently empty and anxiety-producing when they do get out the door, and often they would rather just stay under the covers.
It drives people crazy to never be completely well and have no hope for it to change. Women are more prone to this difficulty because they are more apt to worry about what other people think of them than men do. However, men are not immune from Dysthymia. They define themselves in terms of their achievements. Being gloomy and self-critical gets in the way of taking career risks and they often underachieve or are constantly dissatisfied with their success. Men withdraw and brood instead. People with this condition don’t feel in control of their lives and suffer from persistent anxiety and insecurity as well as depression.
The key to understanding this condition is to realize we are all not just our behaviors, contrary to what our American culture would have us believe. We are human beings, not human doings. Each of us needs meaning, a sense of purpose, a feeling that we belong and a reasonably positive view of ourselves to be happy. These latter aspects are lacking in people with dysthymia.
There is help for dysthymia and no one needs to resign himself or herself to being chronically discontent and miserable. Unlike what the drug companies preach, this condition is not just a neurobiological disease, it is a treatable psychological condition that can be helped by a combination of careful, and sometimes lengthy, psychological treatments combined with minimal medication and lifestyle changes. Yet, oddly enough, some people recover from this condition fairly quickly if given specialized treatment. It doesn’t go away on its own.
Causes of chronic depression
The research on what causes Dysthymic Depression is inconclusive. Clearly brain chemistry, genetics, environmental agents (such as personal loss, relationship conflict and an achievement-obsessed culture), and personality traits (like chronic pessimism and perfectionism) all contribute to this disorder. Clearly each person’s experience is unique and hard to generalize from. Yet, if you would allow me to shoot from the hip and give you my understanding of this difficulty based on nearly 40 years of psychological practice I will.
The most important universal human need is the need to attach. Scoring it big in the stock market, having career success, having a stable marriage and being wealthy are so much less important. What we really need most is to have a positive forgiving relationship with ourselves, to sincerely feel we matter to others, that our lives have value for a greater good and that we fit in some group of people who love us. Such a need is common to all mammals. As animal research attests, it’s the connecting to ourselves and others that really matters. It’s how our brains are wired. In fact, we are all just glorified monkeys! That’s why doing things in itself doesn’t make us happy and why so many of us love our pets.
People with dysthymia have emotional attachment issues. They have histories of emotional abandonment. Consequently they can’t feel close to others, forgive themselves or allow others to be close to them. Such missing parts undermine their self-confidence. This is why children and adolescents today have high rates of anxiety disorders, social phobias and suicide potential. They are more connected to their cell phones than to people who love them. Often, emotional nurturing by caregivers has been lacking from their earliest years (either too lax, too controlling or nonexistent). They have never been securely emotionally attached and are prone to abandonment fears. They may even lack mentation — the ability to see and reflect on themselves. It’s hard to imagine something more depressing than to have never been securely attached to an adult caregiver.
Consequently dysthymic people are often more wired to things than people. They may even see other people as dangerous. In a defensive posture, they develop a false self in functioning in the world. They pretend to be whole people doing the best they can. Indeed, in my view, attachment disorders and the neurological damage that derives from them are the root cause of Dysthymic Depression.
Overcoming chronic low-grade depression
The good news is that attachment disorders can be overcome. To understand the science behind this claim and learn helpful skills read Feeling Good by David D. Burns, M.D., and A General Theory of Love by Lewis, Amini, Fari and Lannon (Vintage Books, 2000). We can learn to truly love others and allow them to authentically love us over time. Many, but not all, people in 12-Step programs understand this fact of life all too well. Often, this connecting relearning process needs to happen on an individual as well as group basis, just like we learn to attach to our parents before we connect with peers. Breaks in attachment are best repaired in the accepting and challenging relationship with a skilled psychotherapist. That’s the heart of recovery from dysthymia.
Helpers with this training are said to work psychodynamically with clients and will employ a variety of skills, such as cognitive therapy, body and trauma therapy, exposure and desensitization repair, or mentalization training to help learn know and relate to oneself. Couple and group therapy, as well as life management training such as diet and exercise planning, sleep management skills, emotional mindfulness and competency building, as well as cultural and spiritual mindedness are also often utilized. Certainly an initial physical and possible medication management may be needed as well.
Once a finely attuned and accepting relationship with a professional is established where one can assert their needs, they are well on their way to being attached and less prone to being in an overall funk in life. Often seeing the minutia of closeness in the working relationship with a helper is how people learn to overcome depression and have real attachment in life as a whole. In the darkness of exploring life with a helper, people start seeing the light at the end of the tunnel. Eventually they come into the full light of day, while never being alone.
If you find yourself resisting the message of this article, as it sounds all too easy, consider yourself normal. It’s not easy. Healing is a lot more complex and individualized than this one article can explain. However, I do hope you consider my main message: healing chronic depression is a two-person repair and one does not have to have faith in it for it to work. It takes the patience and courage to hear these words.
If you or someone you care for would like to get help from a trusted helper I can recommend Hamm Clinic in St. Paul (Phone: 651-224-0614). This clinic is ethical and professional. Let the intake person know the kind of helper you would like to see. You may have to wait to be seen — it is worth the wait. Otherwise ask for word-of-mouth referrals from trusted friends or 12-Step peers. You are certainly free to call me. Ask questions at your first appointment to see if you are in good hands. Trust your instincts. It’s the working relationship with the helper that makes all the difference in the world. God speed in your quest!
John H. Driggs, LICSW, is a Licensed Clinical Social Worker in private practice in St. Paul and co-author of Intimacy Between Men (Penguin Books, 1990). He can be reached at 651-699-4573.