Dysthymia

Dysthymia is a kind or quality of depression that masquerades in many individuals as a fairly decent life, generally speaking.  Dysthymic, you may not think you are depressed.  The world, even the entire universe, is a constricted rainbow of pastels that drain to greys.  You enjoy watching a rabbit sitting on the grass outside your window.  You may “like” your job, enjoy a morning cup of coffee; you might even “love” to type, or love washing the dishes (as an old family friend, a ‘50s housewife, did), but really love nothing.  Ambition may feel like a gauche notion to you: Why run?  And why run uphill through the course of your life?  Pushing the self, though possible to do, will feel lousy, like utter meaninglessness.  The world is – not action, but a tableau.

Dysthymic depression is the 22-year-old new employee who already feels “same shit, different day,” an emotionalized attitude (term borrowed from V. Axline, Play Therapy) which is a transmutation of loss, pain, time and thought fused together.  There may be a feeling of floating or wandering, but of floating above and wandering away from a deep and drastic place you need to be.  In college forty-four years ago and blind to myself, I found my mind visited by the odd idea that I needed a tragedy to wake me up.  It will be some complex feeling too delicate or protean to name sadness, though its verdict is always the same: There is an emptiness there.

Here are some ways dysthymic depression has shown itself to me over the years:

*  I suggested to my client that he has suffered a gentle, insidious repression leading to a mild dysthymia, the active consequence of which has been the evaporating of his interest in college and his life-long interest in marine biology.

*  . . . problem intrinsic to the marriage: His dysthymic sense of ‘lowered expectations.’  That is, he has always felt he must ‘settle’: ‘This is the best I can get.’ 

*  Client’s dysthymic nature may for now be attributed to his parents’ benign failure of empathy – a failure to acknowledge and ‘allow’ his real self by virtue of idealizing him, seeing not him but their ideal.

*  All jobs ‘start to seem like dead-ends.’  Family history revealed causal themes of client’s dysthymic character: alienation, suppression and under-stimulation.  His was not a family that talked about feelings.  ‘My whole life was insipid and gray until high school.’  Earlier, he had ‘no hobbies, didn’t do anything.  My parents left me to my lonesome.’ 

 

*  Teenager has such a well grounded and complacent dysthymic depression that nothing short of a middle-aged existential crisis is likely to question it.  He talked about his roots of emotional inertness.  ‘I never tried to get anything from my parents,’ he said, ‘materially or emotionally.’

*  My example demonstrated both the dysthymic constricting of one’s world of interests and the effective ‘delusionality’ that could lead the client to ‘love,’ or believe she loves, typing.  A different analogy had to do with the enjoyment of nature or ‘beauty.’  Client said that ‘I cut myself off from beauty; I'll stay inside.  I’m lackluster.  But I can appreciate the beauty.’  And, ‘I’m not ambitious.’

  

*  ‘Sometimes I wish the little things in life were more important to me.’  ‘I wish I could be more connected to the world, though I feel being disconnected is more comfortable.’  And, ‘I’m not capable of caring the way other people are.’

*  . . . provisional diagnosis of dysthymia, which client endorsed in the feeling – ‘Is this all there is?’

*  ‘My whole life I've been cheerless, with an underlying blah feeling.  Overwhelmed, like you never get to have enough fun.’

*  She endorsed a constricted emotional spectrum; said that she ‘doesn’t need to take vacations, see new places.’  Interestingly, she has the gut feeling that ‘people who seem overly happy must be on medications.'

*  The dysthymic detachment is severe.  He feels disconnected from his child self: When he thinks of his child self, it doesn’t feel like ‘him.’  He gets the uncanny feeling that photographs of him as a little boy – then with blond, curly hair (he is now a straight brown) may not be him.

What can make a depression that seems a blue-grey fog, not a heavy anchor, and can fool you into thinking that pastels are the entire rainbow?  “I’m not depressed, just the same old same old.”  This question goes to the meaning of depression itself and the dialectic of depression, feeling and identity.

A man comes to therapy and says, “I don’t know what it is.  I have a good life: great wife, kids – I love ’em to death [that phrase always sends chills down my spine] – a good job, the house is nearly paid for.  But I feel empty inside.  It’s like I’m just going through the motions.  Sometimes I feel like an imposter, a child wearing adult’s clothing.”  He may say – as a fair number do – “I don’t know who I am.”

Doesn’t it make sense to see in this “empty inside” both a lack of feeling and a lack of self, and to see that this is depression?  But what makes it grey – dysthymia – for some and black – major depression – for others?  (For the clever uninitiated – “double depression” is a diagnosis of both types combined.)

One idea is that dysthymia is a life that “sneaks up” on a child; or more accurately, seeps in slowly under cover of normalcy.  It is not a terrible capsizing loss that never heals, but a continuum of microscopic pinpricks, as if one could micro-prick a beautiful soap bubble (with its swirling luminescent colors) until eventually it drained to clear.  What wields these pins?  Nice parents who don’t hear you.  Promises by father that, in his neurosis, fade away.  Aloneness in your room, quietly painful, that in time becomes both pain and comfort.  Sarcasm masked as humor, confusing your truth.  Like mine, a mother not loving, but . . . cordial.  Having needs (for fun, as an example) that unmet, weaken to wants that weaken to . . . unnecessary.

A problem in treating the dysthymic disorder is its tendency to become character.  A rape or war trauma will not, typically, be assimilated to become one’s way of living and looking at the world.  It is an alien part that can be targeted, cried and raged at in therapy.  But dysthymic injury, ten million quiet pinpricks, deflates the unaware Self and the world it lives in simultaneously, leaves us and our world and our thoughts smaller.  Our philosophy of life, our attitudinal set, greys accordingly.  It is when we notice – something, maybe some contrast between our self and our birthright of love and joy, or an early loss that feels, in retrospect, quite impossible to have survived – that we may come for help.

Quiddity

Today’s word is quiddity, defined by dictionary.com as “1. the quality that makes a thing what it is; the essential nature of a thing.  2. a trifling nicety of subtle distinction, as in argument.”  And by Merriam-Webster as: “1. Whatever makes something the type that it is: essence.  2. A trifling point: quibble.”

That is, the word means the opposite of itself: the essential nature of a thing, and a subtle distinction.  While Janov (primal therapy) sees dialectic, “the interpenetration of opposites,” throughout human psychology (http://cigognenews.blogspot.com/2010/03/dialectic.html), I also see it in the practice of psychotherapy.  One expression of it: Some of the most critical core truths verge on (a) the effectively irrelevant or (b) the absurdly recondite.  For those who have read beyond Psych 101 or a master’s degree community counseling curriculum – pretty much equivalent – into the real stuff (the quiddities), you will see what I mean.  You might find at random this, from an article by Janov:

“The point about original reduced oxygen experience is that the whole personality seems to ‘shrivel up.’  It is a constriction rather than an expansion.  When she speaks she takes up much less space and air; her words hardly move out of her mouth, and there is an air of fatigue about her.  Is it any wonder that she (or he) is less sexual?  Again, the whole system slows to adapt to reduced oxygen; the system is doing its best to avoid a mismatch between supply and demand (Singer, 1999).  And when there is imprinted low oxygen we might expect slower growth rate.  One way we see this is in neonates born to smoking mothers who are often of smaller stature.  That in itself assumes trauma somewhere during womb-life maturation.  That can foretell of a premature heart attack or cancer later in life.  I think it is more likely to lead to cancer than cardiac problems because of the massive repression or inhibition that goes along with this kind of personality.  Repression of womb life events is nearly always of life-and-death matters; the repression it engenders is massive, and the result can cause serious distortion at a cellular level.  (“Life Before Birth: How Experience in the Womb Can Affect Our Lives Forever,” Arthur Janov, PhD, Journal of Prenatal and Perinatal Psychology and Health, 23(3), Spring 2009.)

. . . or this, by Masterson:

“The defensive or libidinal grandiose-self-omnipotent-object relations fused unit of the closet narcissistic disorder consists of an omnipotent-object representation that contains all power, perfection, direction, supplies, and so on.  The grandiose-selfrepresentation is one of being superior, elite, with an affect of feeling perfect, special, unique, adored, admired.  The underlying aggressive object relations fused unit consists of a fused object representation that is harsh, punitive, and attacking and a self-representation of being humiliated, attacked, empty, and linked by the affect of the abandonment depression that is experienced more as the self fragmenting or falling apart than as the loss of the object described by the borderline personality disorder."  ("Psychoanalytic Psychotherapy of the Narcissistic Personality Disorder (Closet): A Developmental Self and Object Relations Approach," James Masterson, MD.)

Another quidditicious state is the proliferation of psycho-wisdom in scholarly, academic, pop and conversational forms.  It is so boundless as to be a kind of runaway inflation: Each “unit” loses value in lived reality and personal discourse; becomes a trifle.  I (discreetly) roll my eyes whenever someone labels a public figure or coworker a “narcissist” or “sociopath,” or their aunt’s husband a “codependent” or an “enabler,” or describes herself as “clinically depressed” or “bipolar” or “ADD” or a “split personality.”  A poignant conversation about your difficult life transforms to instant bathos when the word “abuse” or “trauma” appears.

Fortunately for me, the quiddity dust storms crash to a halt, the sun replaces the clouds, the air is clean and quickened, when the most ‘subtly distinct’ of all things – a 16-year-old client – sits in the chair.  I burn all the books in a pile behind me and by the light, listen to a moving quiddity: an essential loss of self reflected in the most intangible ways.

The young man, always anxious, sees forces not events.  When he feels happy, “everyone else” is miserable.  When he gets high grades in class, “everyone else” does poorly.  World events occur in roles and stereotypes, not because individuals act by their lights.  A cultural movement is by "Caucasians" or Hispanics or "the poor" only, en masse, like oil and water not mixing in a great ocean surge.  An idea read in a book or heard in an advertisement replaces whatever was in his head and becomes what his life is dedicated to, until the next one.

One reason this client is so engaging is that I believe I relate.  When I was a boy, I did not see people as people, but as roles.  Father and mother were just and only that, not individuals alive first and performing second.  A truck driver, who would honk his horn for me when I made the honk gesture, was only and always a truck driver: It was his complete identity; he could never turn into something else.  When I learned that a teacher at my elementary school quit to become a real estate agent, I could not grasp it: She was a teacher – with an emphasis on “is.”

Though I haven’t read all the books, I would chance a guess that none of them has ever explained – in a real existential, neurological, familial, understandable way – what happens in a child’s psyche that causes the exchange of reality for this strange experience.  Explanations are given, I’m sure, but they are useless – terms that try to paint the ocean, homestead the inscrutable, like ego, identity, bonding, cathexis, individuation, “withdrawing object relations part unit” (WORU), undifferentiated unity, depersonalization, derealization, dissociation, and more.

For me, this tinted reality came from disconnection, later transformed to different aberrant traits based in unmet infancy needs and immaturity – putting hexes on other kids, knowing that some aware yet effete god looked down upon me from the sky, knowing my value – and culminated around my client’s age, fifteen-and-a-half, in a shiny porous narcissism anchored to Ayn Rand’s philosophy and attitude of egotism.  In my young client, I “preliminarily saw” a beginning similar to mine, but a psycho-development bathed in more anxiety and fewer encouragements of reality, such as friends possibly.  No one can explain why his feet have never firmly touched the ground, why the grand forces of the world that cow, amaze and convince a toddler, have continued to be his Father into his late teens.

The work I do with him is a quiddity.  He doesn’t sleep anymore, and if one accepts Modrow’s flowchart of psychosis (How To Become a Schizophrenic), the not sleeping could be another missing rung of the downward ladder to schizophrenia.  I try humor – not very successful – and encouragement not to respect the ideas that come from anxiety, which comes from early fear.  The ultimate help may never be possible, as it may be to emotionally face the earliest unmet needs – help from birth panic?, corrective holding and bonding?, to scream in existence pain? – without which we remain waiting.

Our thinking

Imagine a seven-year-old girl bike riding on a beautiful day, at one with the world, at one with meaning. She brakes and pauses in thought: “What’s the purpose of this? Is this good enough? Isn’t there something useful I should be doing?” Or, channeling Sartre and Shakespeare, “This riding, signifying nothing.” Imagine a thirty-something man playing in a softball game on his company’s team. He catches a fly ball and in a flash of sun and memory is given, in hand, a shard of his lost childhood. He falls suffocated by feeling, thoughts vanquished, his entire life drowning in the fiery rainbow of emotion.

We recognize the zombie absurdity of a child mediating her world through thought. It kills life, putting her in a prison of herself. We dread the absurdity of a grown man living incandescent feeling unmediated by thought. Tears in a hurricane, a blind and backboneless creature. Thinking! It is power and control – distance, yet that touches; lucidity and godlike ownership in and of itself. But how can it be that, if it serves to distance us, protect us from the truth, from our feeling experience?

My work has shown me, almost as if I were watching a scene of horror, the translucent blindness of thought.

A thirty-something young man has known all his life that he wants to be a graphic artist like his father. When finally, a father himself and unemployed, he is admitted to college on financial aid, he finds he can’t open the books, makes other plans and does other things, plays complex fantasy games with his old high school buddies. “I know I want to be a graphic artist,” he says. “Am I just lazy?” My questions to him:

            What do you mean, you “know”?

            What does “lazy” mean?

            Who are you asking?

There is an old Robert Heinlein science fiction story, climax of which had a married couple driving their automobile through a landscape that was being apocalyptically remade by God: He was starting over, they were saved. They looked out the car’s windows and saw a typical day with sun and trees and the familiar scape. But then, against His injunction, the woman rolled down the passenger window and saw the reality: flung in chaos, the churning and chewed-up material of their world. Our thought, for most of us, is the transparent window through which we see deception. We roll down the window to the chaos of feeling. We fall into it, down and down the taproot of our history. In this history are the true feeling-reasons for who we are, what we do. We do something sacred or profane: the cause is the viscera, the volcanic churning deep in our earth.

“I’m a lover,” a man says. It is not true: You are a needer.

“I hate people,” a teenager says. Untrue. You need them and are burnt to near-death by it.

A recent college graduate says: “I’m a very cerebral guy.” He lives with his toxic botch mother, is a servant of his mother and sister. He is enamored of Jungian archetypes. His thinking is vital, and it races like smoke around the rape and humiliation of his soul, the entrapment of his body. Will Jung save him?

An unhappy wife, who finds her husband “unpleasant, irresponsible, immature, cold to me,” says “I love him for loving me the way he does.” What you call love is . . . I don’t know. Feel the feeling. It will be complex: twisting, starving, dying that never stops, touch, insanity, lost youth. These are our feelings, not – as I say in sessions – the “name brand” ones like happy, sad, angry, afraid.

How do thinking and feeling become a paradox? Where thought is blind and primitive feeling is sight? A simple account would be that we feel what we are and think what we want to be. Human beings are gyroscopic: forcibly upright as our roots twist, our foundation tilts. One loses a leg and holds himself up by a prosthetic, doesn’t founder and die. One loses mother’s love that makes life and growth possible and holds himself up by hopeful thought, by redefining need as love, by redefining life as striving. Thinking becomes our new truth, our prosthetic.

Though Sartre believed that we are “condemned to be free,” I think it’s less debatable that we are condemned to be adult, to look at the world and oneself through the window of thought. We cannot return to the child’s union of feeling and experience where we see and smell and touch the flowers and “not have to count them.” But we may, at times, ride our bike on a beautiful day, one with feeling, in silence.

The shootings

Just to say a few words about the mass shootings in the news.  Experts (psychiatrists, psychologists, sociologists, anthropologists, forensic professionals, profilers, and next Tuesday the taxidermists will pipe in): Please stop saying the same generic pap each and every time, that these men are mentally ill, angry, loners, disenfranchised, sociopaths.  The great majority of the world has some quality of mental illness by virtue of childhood injury; all healthy people have a capacity for anger, and it’s unhealthy people who have lost it; many feel “alone in a crowd”: different or defective or uncomfortable in social settings.  And empathy and conscience – lacking in sociopaths – are traits somewhat rarer than we would all like to admit, are fragile qualities that can easily be snuffed out in children, even in nice homes.  These qualities have to do with bond, a loving link in the earliest needful moments and years of a child’s life.  It doesn’t require abuse to kill or prevent that bond.  Living in an incubator for six weeks following birth might do it; being born in pain – like the eleven-year-old psychopath I treated who had been born in and lived his first six months screaming in crack cocaine withdrawal – might do it.  Living one’s young life without touch will cause such pain – the skin on fire – that protective calluses form, sink down and cover the heart.  PTSD victims sometimes have tactile anesthesia: A nurse I knew who came out of child sexual abuse and group humiliation couldn’t feel the backs of her hands.

What makes a shooter?  Too much pain.  Anger, loneliness, empathy burial or death, numbness (lack of pain) are just symptoms of it.

Casual theory of ADHD

This is my theory of ADHD – “Attention Deficit Hyperactivity Disorder” – as it is diagnosed, and as the symptoms present, in many clients I’ve seen.  These are people who cannot sit still on a feeling.  They squirm physically, they squirm and race and deflect mentally to avoid what will appear beneath the surface when the waters are calmed: emotional truth.  I remember a forty-five-year-old man – one of my strongest efforts and worst cases – who pranced and ran away from all feeling and insight every minute of every session for well over two years.  His parents had been abusive, shaming, cruel – he’d mention this during one or two of his severed-headed, jocular sprints – but he always ran and never faced it.  Now the pain remained underground and, like a planet’s magnetic radioactive core, weakened all structures on the surface, pulled to him a terrible marriage, warped the field in his brain to absurd attitudes and philosophies.  “Life” and “the universe” were to blame for his marriage, for his absence of success.  He raged over lost pennies so often that his children eventually made him invisible, couldn’t listen to him literally to save their lives.  Why couldn’t he ever – ever – still his mind and look within himself?  That would be to see the fire beneath the house – or skyscraper – of cards.  More accurately, it would be to return to childhood, which was the fire.

It can’t be hard to picture a small child sitting in class, fidgety (HD) from tension and spaced or distracted (AD) to avoid the feeling that life is wrong at home.  Next time you see this child, stop the damn world you idiot and listen.  Throw the clocks away, throw your adult crap away, and listen.

Teenagers are difficult

Teenagers may be the most difficult clients to help. While there are therapies for babies (corrective recapitulation of birth trauma: see William R. Emerson’s “birth psychology”) and the very old and dying (existential psychotherapy) – tough sells – I don’t think these populations seek or are brought to therapy that often. Adolescents, on the other hand, regularly come in, though often against their desires. I find that they have a unique defense: an especial aversion to feeling their past which they have just barely escaped. Many children – like the child I was – are too mired in anxiety or traumatic shell shock to, in effect, inhale and exhale time. They are lost in themselves, stuck, and don’t grow through time and experience. The strain of their impossibility won’t be severely felt during Masterson’s “umbrella of dependency” phase – latency; not until the moment when “childishhood” ends at the front door to junior high school. There, the little ballerina is plunged into a war zone, the magical thinking and whining little boy is shoved into the men’s locker room. Defenses are born and try to fill in the cracks but the cracks are too wide and defenses entirely incompetent: grades plummet, girls find young dicks, boys become angry-scared “rebels without a clue,” girls cut, boys form – as fast as a car airbag inflates – a soothing cynical philosophy, all wear black to have an identity.

The teen sits in the chair, and sometimes the most solid part of himself is his breathing: It keeps going while everything else seems to be a question mark in an incomprehensible language. I’ve seen a thirteen-year-old girl who’d been in a heterosexual relationship for four years and who talked like an old grey poet. I’ve seen a fourteen-year-old boy who had a complete nihilistic philosophy. These youngsters are often glib because they have to glide faster than the truth.

I enjoy working with teens. One reason is my nonsense: I like to think that at some place within them they can be re-parented. That is what they need. All of them.

That sounded optimistic

Pessimism and optimism in one – that’s right.  Love, touch, being cared about in our pain or in our happiness (but not in our persona) is a tangible good.  Optimism is physical.  When we feel cared about in our reality, not our façade self, there must either be optimism or a very serious challenge to our negativity.

A new client, let’s say anywhere in his teens to 60’s, sits down.  He looks at me quietly and I see an ocean; or agitatedly and I see a time machine in a time bomb.  He is – we are, too much, a molecular mess held together by defenses.  A baby screams when he’s in pain.  An adult in pain smiles and says “That which doesn’t kill me makes me stronger” or “I was beaten and I turned out all right” or “I love my mother to death, I just can’t stand to be around her” or “My child doesn’t respect me.”  He is clothed in the chainmail of anesthetizing, delusional thoughts.  Here is one of many paradoxes: The real, authentic person is a hysterical, contorted mess, maybe even a 42-year-old baby dying in his crib; the faker is a high-functioning guy with good posture and a philosophy of life.

I look at the ocean and he looks back.  I have never seen any person who knew what was wrong, but sometimes she will come closer to knowing.  She will say, “I don’t know.  I’ve never felt right.”  This is possibly someone more in touch with the hidden parts of her ocean than someone who talks the standard symptoms, or who talks and talks.  Too much talking about things that are feelings rooted in birth and infancy and childhood is a sign of survival: running fast across a field of stratospheric helium balloons lest she stop – and fall.

How does a psychotherapist help?

How does a psychotherapist help people?  What does “help” mean?  Over the past two decades I’ve come to see myself as a helping person.  Occasionally a little narcissism seeps in (before it disappears) and I’m possessed of the absurd feeling that my mere presence in the room – and in attenuated fashion, via email – is healing.  That feeling is absurd, but not completely.

There is the question, What is help?  And the assumption that things go really wrong with people, that they suffer existence damage.  As this blog begins, something of my own existence damage sneaks in.  I notice that in my feeling I am conjuring up a straw man, or straw men and women, who would disrespect me through my way of seeing myself and other people, and this causes me to assert the unimpeachableness of my vision: My approach is right!  Later blog entries will address more of my own, as well as my clients', psycho-existential errors.

People are damaged when childhood injury is not healed.  Adults can of course be damaged, too.  But in a very real and meaningful way, if your roots have been cut and your heart scarred over in childhood, you don’t really become an adult – but that you think you do.

What damages children?  All the various ways that love doesn’t happen.  We need certain kinds of contact – loving eyes and touch, loving words and tone, respect and even valuing of our individuality.  But love is a terribly misused word.  It’s not when you need your child.  It’s not when you see her as your project.  If the air is clear between you and her, that is love.  If instead the air is permeated by you – your pain and pain-filled ideas which can materialize as assumptions and ambitions and your underground continent of triggerable feelings and a “need to be respected” – that’s not love.  I see parenting-by-unconscious-revenge every day.

A good therapist sees the unloved child (within the child, the adolescent and the adult) and offers some strands of love.  This can be wonderful – life-giving – but often it can’t be accepted.  For many people, accepting the therapist’s love would be like living an entire lifetime of sadness, aloneness and poverty then winning the lottery on your deathbed at age 93.  Later on, I’ll talk about why many clients run from the offer of deep visibility (love).

So, on to the pessimism of my title.  I believe that when the roots are injured the tree is damaged.  It may be quite beautifully gnarled and bent, and we appreciate it.  And Edvard Munch can paint The Scream.  What psychotherapists and good friends – all the same – can do is touch as touch was once needed; listen as being heard was once needed; maybe even hold as holding was once needed.  The typical difference between the friend and the counselor is that I can frequently offer to and sometimes touch, hear and hold the past – the child.  And since that’s who we adults still are, well, that’s pretty good.

Pessimistic Shrink!

A new psychology-influenced blog, experimental for now.  This is to see if I want to talk to people, or to myself, about understandings and questions that come out of my work as a psychotherapist, and out of my sixty-plus years.  Probably the first subject I'll get into is -- Why "pessimistic"?