Monday, September 30, 2013


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.


  1. This is spot on to how i've been feeling since about age 15-16. Been trying CBT and meeting psychiatrist today. 15 years of feeling like this sucks. Thank you for the great article. - Jim

  2. Jim – Thanks for the appreciation (though I find it feels worse to hear that someone is suffering dysthymia than it does to be treating someone with it). I complain a lot about all the cognitive therapies (such as CBT), but yet would never assume it won’t work for a person. If you find it helpful, please write back and let me know. You may want to look up Janov’s blog entries (12 total) on depression, starting at -- .

  3. The CBT has helped situationally but the scars seem pretty deep that it feels almost like "shell shock." Psychiatrist is suggesting wellbutrin so hopefully that can kick start some motivation (which is almost non-existant.). It took me 6 months to actually call a professional... -jim

  4. Thank you for this, it is beautifully written. Recently my psychologist told me that my feelings of melancholy could be called dysthymia. I am still thinking about it and wondering what it means to have this label.

    1. Thank you for the appreciation. I received the diagnosis myself a long time ago, when I interviewed to become a group therapy client as part of my counselor education. I was still learning some elements of myself and hardly knew the word "dysthymia." But I had informed the therapist in a matter-of-fact way that I had no hobbies, no friends and no strong emotions. And so I was given the label.

  5. Hi Pessimistic Shrink,

    Its the same anonymous as above. I am back on the site because I have been feeling more melancholy the last few days.

    I have a dilemna. Everything I read about dysthymia says that CBT is the preferred type of psychotherapy for treating it. I have been seeing a psychodynamic therapist for 8-9 months now and I am quite attached to him (which is a whole other can of worms). I don't know how to bring up this question with him and hope to get an honest answer. Would I be better off seeing a CBT therapist? There is something about CBT that I shy away from in any case, on my own. Somehow, I am a person that is easily swayed by others' opinions and in an eagerness to please a CBT therapist, I am afraid I may think I am making changes that are good, but which may not last in the long term.

    1. I wish I knew how long most clients of "cognitive therapists" stay in therapy. I think effective cognitive therapy is both self-sabotaging and self-perpetuating: It uses the intellectualizing and rationalizing defenses to undermine thinking, leaving the client to feel bad but now without an explanation for it. If he "de-catastrophizes" and says, "My life really isn't so bad -- look at all the good things going right in it," yet continues to feel a heavy insecure emptiness (depression and anxiety), what can he do next? Probably continue to learn and say soothing things to himself; that is, have more cognitive therapy.

  6. Your last paragraph -- especially -- is such profound truth. I've never heard it expressed that way before. I knew on some level, I was worse off than people who had suffered a single, specific, and arguably much more serious trauma than mine. But I was never able to articulate why in the way you've done here. I always felt a little guilty for seeing my problems as on par with, or worse than, those of a rape survivor or combat veteran whose life has otherwise been good.

    1. Thank you. Actually, I believe the psyche is so complex that it is analogous to the wave-particle duality of quantum physics, where a discrete phenomenon (a trauma, an emotional injury) is never just itself, but also a subject-object wave of whole family dysfunction. That means most (or all) of us are the compromised result of an ocean of influences, though a single trauma or effect (rape, “parents’ divorce”) may be an easy hook to hang a cause from. I think with a good glance we could see this in ourselves, and it’s certainly obvious in something like Borderline Personality, where living one’s first few years with an immature mother constitutes a lengthy trauma.

  7. Hello!

    Great post. I think for a lot of us, it is spot on. So what is the best way to tackle this? I'm seeing a new psychiatrist next week so I can start taking Remeron again. It really helped with regulating my sleep and stimulating my appetite. I was only on it two months before stopping due to insurance reasons but I did notice a *slight* improvement in my mood in addition to the improvements in sleeping and eating. Is there a medication that is more highly recommended for dysthymia that I can bring up during my appointment ? I have already tried Prozac and Zoloft before sticking with Remeron. I also have an appointment to start CBT with a therapist but after reading this post, what other psychotherapy options should I look into? Thank you in advance for your time!

    1. I’d ask you to look at a later article -- -- for some more ideas about feeling-centered and cognitive-type therapies. I don’t think there is a “brand” of therapy that is geared to dysthymic depression, though Existential therapists would probably assume they are especially qualified. And, the original and still going-strong Primal Therapy ( would have a good shot at disintegrating the dysthymic sheath over deeper pain. (One thing I am completely baffled about is how pretty much the only article out of 125+ that receives comments is the one on Dysthymia.)


Comments are welcome, but I'd suggest you first read "Feeling-centered therapy" and "Ocean and boat" for a basic introduction to my kind of theory and therapy.