Doctor of Clinical Psychology
Doctor of Clinical Psychology
Perpetua Neo, DClinPsy, is a psychologist and executive coach who received her clinical psychology doctorate from University College London. She has been featured in Elle, Forbes, Business Insider, and elsewhere.
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September 26, 2023
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One of the saddest things we do to hurt ourselves is thinking our suffering is not serious enough to warrant attention. We’ve been conditioned to think that unless we have a full-blown crisis, tick every symptom box, or have a compelling tragedy, our sufferings are not worthy enough.
And if we seem to have a good life on the surface, we think that makes our pain less valid—and then we say, “I’m not that depressed compared to someone who can’t get out of bed.”
But all this means is we’re telling ourselves we aren’t good enough to qualify for empathy from ourselves. We suffer, and we cheapen it by pretending, or talking ourselves out of it. And this is especially true when it comes to dysthymia, AKA Persistent Depressive Disorder.
Here’s something I’ve learned the hard way: Pain is pain, and mental health challenges are mental health challenges. Every bit of the good life that you have—the one that offers you respite from your pain—you worked towards it. So let’s stop devaluing the effect of dysthymia on our lives.
What is dysthymia?
“Dysthymia” is currently known as Persistent Depressive Disorder in the Diagnostic and Statistical Manual (DSM-V). It is more persistent and less severe than depression, meaning that the individual experiencing dysthymia must have had it for at least two years, but without the same intensity of depressive symptoms…but that doesn’t tell us much.
In some people, this manifests as anxious dysthymia, where they experience restlessness and low self-esteem. Those who have anergic dysthymia, meanwhile, tend to be unable to experience pleasure, and feel sluggish.
To be depressed isn’t about feeling sad. Sadness is an emotion we can feel and register. In contrast, to be depressed is to be numb. And the longer we carry numbness for, the heavier it feels, and the deeper it becomes etched into how we see ourselves.
We call ourselves “depressed people,” and this makes it hard to imagine a life free from its clutches. Plus, who we would be if we weren’t depressed, because we’re so used to living that way?
Why dysthymia is so misunderstood
People who are productive perfectionists—otherwise known as type A personalities—tend towards dysthymia1. This is often their “dirty little secret,” because they look like they have it all. Someone getting promoted at work or jetting off to exotic locations can’t possibly be having that much trouble if they always deliver, right? So we think.
This is why calling dysthymia “low grade depression” cheapens it, because some people have become so well-adapted to looking like they’re functioning well, when they’re actually fight tooth-and-nail to keep up that façade. There’s often an increasingly complex and perilous house of cards stacked up as well, from lifestyle expenses, to up-keeping loved ones, to the shame of being outed. But keeping up appearances gets increasingly exhausting over time, and the longer this goes on, the bigger the chasm between appearances and reality, which makes it harder to maintain and simultaneously more urgent to maintain.
Sometimes the numbness from striving and achieving non-stop, but wondering if we can sustain it before the house of cards falls, can contribute to dysthymia. At other times, it is an all-enveloping grief as priorities change, and we realize we’ve been chasing the wrong things. We mourn the time and energy lost that can never be reclaimed, and wonder how to start over again.
For others, it’s hitting a plateau in their very accomplished lives. Will they simply have to maintain at this level, feeling increasingly tired, lest it becomes a downhill ride from here? We’re torn between gratitude for the material conditions and tangible blessings in life, and the realization that it cannot go on forever, or is not enough to sustain one’s future.
This really isn’t about someone believing they’re a special snowflake where the usual solutions to heal and evolve don’t apply—because Type As have always been proactive—but rather being unable to see how they can do it. Because they don’t believe they have the strength anymore. They feel depleted, a shadow of themselves, or that they’ve lost their nerve.
Common symptoms of dysthymia
According to the DSM-V, these are common symptoms of dysthymia:
- Intense sadness or hopelessness
- Feelings of inadequacy or low self-esteem
- Lack of interest in usual activities
- Lack of energy, changes in sleeping patterns
- Changes in appetite
- Difficulty functioning at work or school
- Difficulty concentrating or memory problems
- Withdrawal from friends and family
What to do about it
Meet the belief that you shouldn’t feel depressed with kindness
What ideas fuel the perspective that you shouldn’t be depressed? Common ones include, “What do I have in my life to feel depressed about?” or “I should be better already,” and even, “Others are suffering more than me.”
To be human is to experience some level of suffering and challenges in life, even if there isn’t some big trauma or tragedy that caused it. In fact, you could even reframe that not having that big trauma or tragedy is one less thing to worry about. And, having things to be thankful for in life does not invalidate your suffering; This isn’t a race to the bottom.
Consider what about the future weighs you down
What makes you feel fearful and/or empty? Common ones include worrying that money or accomplishments or promotions will stop happening. Or, what if your health, energy, or skills are not enough to support the next level of development you are expected to rise to?
These are, in essence, markers of imposter syndrome, which anyone looking to grow will inevitably experience. So acknowledge that you want to be there at the next level, and then ask yourself how you can close the gap. Because with internal and external resources, most puzzles are solvable.
Examine the mindsets that erode your belief in your ability to grow, heal, or get things done
These mindsets might include, “If you are that good, why do you feel this way?” or “If you are that good, why haven’t you sorted this issue out yet?” You might even feel you’re a burden—a belief many perfectionists hold.
Being aware of these means that you can choose not to listen to them when they pop up, nor get upset with yourself when they do.
Run an objective audit of your resources
This isn’t simply about the relationships and material resources you have, but rather extends to your internal resources, especially how you’ve grown. Most of us hold onto a much younger version of ourselves—one who looks like a hot mess. So when you say you cannot create or sustain your future, which version of yourself are you hanging this on, and how old is that self?
Remember, younger-you did their very best in terms of what they had; Hindsight is always 20-20. Then, I invite you to reflect on all the ways you have become stronger and a better human being. You can ask your loved ones for their input, and consider all the objective markers that testify to your resources.
Consider what perfectionism has been shielding you from
My friend and clinical psychologist Karen Pooh, DClinPsy says that in the journey to address dysthymia, the key lies in understanding the perfectionist within us.
She offers that cultivating a compassionate self-dialogue with our inner self-critic can be healing. For instance, asking what fears perfectionism is trying to shield us from, such as guarding against the fear of negative judgement or rejection, provides insight to how this becomes a vicious cycle that consumes us.
Reflect on what changes within you contribute to your numbness
Perhaps, your priorities have changed, and being unused to it, you have doubts about your future. In this case, what are the biggest fears or concerns, and what new ways of being or thinking have you been fighting? Or maybe, the fuel you used to run on no longer matters.
Many of my Type A clients have historically been fueled by earning impressive amounts of money, winning someone’s love or approval, or wanting to prove someone wrong. And when they have reached that goal, the blank canvas of What’s Next can feel bleak, rather than exciting.
Others who feel they have lost their courage for living also dismiss their old bravery as if their old self ran on a delusional or impulsive motivation. Being cautious and older, bravado no longer applies.
Here’s the deal: You don’t need to denigrate the priorities that got you to where you are today, even if you think they are silly, small-minded or unspiritual. You do not need to suddenly become zen and pretend that accomplishments don’t matter to you, because if that is what your life has always revolved around and you’re fighting it because you think it’s wrong, then you’re adding to your own suffering. In essence, perhaps it’s useful to make peace with what got you here.
Make peace with the time you think you’ve lost
It can feel as though dysthymia has robbed you of life force and slowed you down. Consider what things you gained in the process that you weren’t setting out to achieve, or that you worked on as a side project or distraction. Because a gain is a gain—never mind the original motivation behind them.
Enjoy the view from the plateau
My favorite reflection here would be, if your younger self could see you now, what would they be immensely surprised by? Which wildest dreams have you fulfilled for them? And then what extra bonuses are you enjoying that they wouldn’t even have dared to dream of?
I am reminded of the saying, “Remember that what you have today is what you once prayed fervently for.” Fears about the future aside, objectively, how would you rate your life right now, as it is?
Pooh advocates thinking about designing our lives intentionally around values. She says, “Values serve as guiding principles that imbue life with significance and direction.”
You can ask yourself, “Beyond the glittering facade of my accomplishments, what kind of person do I authentically aspire to become?” or, “What facets of life hold the utmost importance for me? What do I hope people will remember about me, and what legacy do I wish to leave behind?”
This way, we can identify concrete steps towards meeting these values, which may include courage, flexibility, sensuality, and discipline. Then, ask yourself, how would you know that you are there? For instance, what would your life look like across different departments, and how would you live differently?
What are the things that preoccupy you the most, and how can we solve them? What are the things that weigh your life down the most—for instance, tasks, expenses and relationships—that you can take a step back or delete? And what needless sufferings have you been tolerating your whole life, that you can let go of?
This might include beliefs like, “If I shine too brightly, I am betraying my family,” or, “If I don’t solve others’ problems, then I am not a good person.”
Another way of thinking about this is reframing what your new life is centered around. What would you maximize and what would you minimize? For instance, if someone is prioritizing their health, then they might maximize sleep and minimize saying yes out of a sense of obligation.
Lastly, how can you commit to taking care of yourself especially when things are tough? Because as you take on a new lifestyle, you discard old ways of thinking, being, and seeing the world, and that can be painful and awkward. Some days may be harder than others, and some days you may lose your faith in the process.
What are the very basic things you need to do to keep yourself mentally healthy? For many people, this might include protocols like getting morning sunlight, deep breathing three breaths to reset when stressed, taking a ten minute walk, hydrating, and eating sufficiently well. Keep showing up for yourself.
What is dysthymia called now?
Dysthymia is called Persistent Depressive Disorder, according to the DSM-V.
What are the two types of dysthymia?
Anxious dysthymia is when people experience restlessness and low self-esteem. Those who have anergic dysthymia tend to be unable to experience pleasure, and feel sluggish.
Can people with dysthymia ever be happy?
Yes, pursuing a meaningful life, and training oneself to be grateful and not pay attention to the irrelevant depressive thought patterns help.
Who is prone to dysthymia?
People who identify as Type A and/or perfectionist personalities, suffering from chronic physical or mental health challenges, or undergoing life changes like ageing and bereavement, tend to be prone to dysthymia. Dysthymia also runs in families.
Growth is a beautiful thing, but it can also be trying. Some days you have to keep going on, breath by breath, and step by step. When things feel challenging, zooming out helps us see how far we have come. We say a silent prayer of thanks to ourselves for showing up for us. That helps.
And as we grow, we shed things that no longer matter, or perhaps have never quite mattered apart from felt like expectations placed squarely upon our shoulders. There is no need to deny or denigrate our history and our story, but rather use our resources to get us towards the life we wish to live.
Because life is precious—and maybe, consider that in spite of what everyone says, you don’t need to live your best life. That means you don’t need to prove that you are ticking all the boxes, if they add little value or aren’t aligned with who you are.