For nearly two and a half years now, with only a brief break late in 2018, I have been in therapy. Although I’ve never asked in all this time to be given my “diagnosis,” I know for insurance purposes I have to have one.
I suspect it’s dysthymia, which is also called persistent depressive disorder.
When most people think of depression, they likely think of major depressive disorder - potentially more severe, but acute; diagnosed with symptoms lasting weeks. Persistent depressive disorder, as its name implies is chronic, with “low-level” symptoms lasting years.
Sometimes, due to an acute stressor, persistent and major can occur simultaneously leading to “double depression.”
I dislike all of these labels (as you might have guessed from my liberal use of quotation marks).
I don’t think of myself as having a disorder since I’ve had the “symptoms” nearly all my life. They are part of me - part of how I move through the world - and I don’t know any other way.
It goes something like this.
Over a few days, something feels like it’s building; it’s like a storm you can sense and smell. I don’t always know how bad the storm will be. Sometimes, it looks fearfully dark on the horizon but ends up mostly missing me as it moves through and I weather it with relative ease. It can also go the other way though, and take me by surprise with its intensity.
The worst of it usually lasts no more than a day or so and afterward, I’m left tired and shaken, but thanks to therapy, I’m able to rebound over only a few more days. And also thanks to therapy, I am capable of a more robust rebound than I was before and I’m less likely to express my distress as anger toward others.
To sum it up, the “good” times are much better and the “bad” times aren’t as bad.
I’m not particularly fond of the bad times, of course. The hardest part for me is loss of interest in things I like to do. I don’t feel much like reading or writing or hiking, although, sometimes I do force the issue out of impatience, ironically prolonging the whole thing.
When a therapy session happens to coincide with the low point of an “episode” my therapist always asks what I can do to get myself through it and my answer - much as I wish we could mix it up a bit sometimes - is always the same: time, rest, and reflection. To which she will always add a call for a healthy dose of self-compassion.
That’s it. There’s no magic involved; no quick-fix. You just have to be kind and let it ride.
And this is likely how it will always be for me. I won’t ever be “cured.”
This doesn’t mean that I shrug my shoulders and say oh well, however. I continue to put in time and effort to learn and grow - just as anyone would with something they feel is holding them back - so that the good times keep getting better and lasting longer, and the bad times become fewer and less troublesome.
I think of it as training rather than treatment.
I see my therapist as a coach whose job is to help correct my bad form so I can be more successful in the race. And with her expertise and my dedication and practice, I will continue to improve. But at times, say when I’m tired or stressed, I may still default to old habits and not perform as well as I am able.
The best thing then for me, is not to have others better understand my “condition,” but to have these rhythms of my life not called a condition at all.
All of this is why the campaign to “reduce the stigma of mental illness” makes me so uncomfortable. While certainly well-meaning in its intent, I think it unwittingly undermines itself by singling out illness in the first place. By dividing people into sick and well.
I am not an illness.
Everyone struggles on a continuum; some of us just sit at the lower end.
I would rather see a culture where we are just more comfortable with the experience and expression of our emotional lives. One where struggle isn’t seen as something to fix - which can feel dismissive and unhelpful - but as the normal part of life it is. Perhaps then we can truly believe - and not just simply say - that the ability to experience it well is a strength.
Trust me, it is much, much harder to sit with these episodes and patiently let them happen than it is to attempt to suppress them, distract with work, or numb with substances. It requires a great deal of strength and courage and persistence.
And while I often lament in these times how I wish I was “normal,” when I’m feeling better I am usually able to see them with perspective. To see that they can be used to build all the things I admire - strength, courage, persistence, patience, kindness - and to fortify them.
In other words, I may not ever wish for them, but I can accept them.
Which is a damn sight better than fearing them or feeling ashamed I think we can agree.
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