PSYCH 101: Dysthymic Disorder

I don't like labeling people. My preference is for using labels, or diagnoses (that I'll be discussing in Psych 101), to describe collections of behaviors and/or thinking (and feeling) patterns, and/or ways of relating to people, that interfere with ones pursuit of a happy life. My way of thinking about this helps guide my Cognitive-Behavioral treatment approach. In Psych 101 I won't focus so much on the origins of the bad habits/patterns, though I am very familiar with them. My focus will be explaining the diagnosis, as defined in the Diagnostic and Statistical Manual (DSM-IV-TR), and offer some suggestions about treatment, the way I would do it.



"Dysthymic Disorder [is described as] a chronically depressed mood that occurs for most of the day more days than not for at least two years. In children the mood may be irritable, instead of depressed" for at least a year. I describe it as a mild depression (as opposed to a major depression), and it can influence sleep, appetite, energy level, self-esteem, cause poor concentration, difficulty making decisions, feelings of hopelessness and helplessness, negativity, pessimism, and self-isolation. Sounds pretty bad. It feels bad too.



Treatment can be successful without the use of medication, though I often suggest the use of St. John's Wort (a tea/herb) along with counseling. Recovery from Dysthymic Disorder can be difficult because it requires changing certain thinking, feeling, and behavior patterns at a time that the person is feeling low energy and motivation, feelings of helplessness and pessimism. And, as you know, habits are hard to break. You have to push yourself. Take a small step to start, and be persistent. It helps to have a support system, even though you don't want to be around people. Socialize, exercise, find other activities that distract you from the depressed thoughts and feelings. Learn to balance the negative thinking with positive thoughts and optimism. Often the feelings are triggered by unresolved grief. Explore that possibility, and commit to resolving those feelings of loss (and associated anger, guilt, and sadness) by talking and/or writing about them. The biggest culprit, I think, of triggering the depression is an overload of stress. Examine the sources of stress in your life, and control it better. You know my feeling about this. If happiness is not a part of your life you have got to fix that. If you suffer from Dysthymic Disorder, try some of the things I suggest here (also see my MENTAL NOTES blog of March 4, 2007, "Curing Depression...").

Fix Your Self-Esteem

Self-esteem, simply put, is how you feel about yourself. It is a general sense of who you are as a person, though often people base that "general sense" of themselves on a specific aspect of who they are. For example, self-esteem may be based on who they are as a mate, a parent, a worker, or an athlete. So for them, being good or bad at one of these roles, dictates a high or low self-esteem. In reality though, it goes deeper than that. The self-esteem we've developed growing up, influences how we perceive our effectiveness in the roles that we choose. A good example is how some of our successful entertainers, who seem bent on self-destruction, pretty obviously don't love themselves in spite of their talents. Apparently, they have low self-esteem. Aside from those extreme examples, I think most of us have self-esteem issues in certain aspects of our lives. The problem is allowing that to negatively influence our view of ourselves. I mean, if we don't feel good about who we are we tend to perform less effectively. We may also tend to accept unacceptable treatment in relationships (for example, from our partner, boss, coworkers, or even our children). The biggest influence on the self-esteem that we develop occurs in childhood, in our families, in our relationships with our parents and other important people in our lives.

So, how do you fix it without going back in time? And how do we make sure our kids learn to feel good about themselves, and develop high self-esteem?

1. Identify and acknowledge the things that you do well. Focus more on your strengths than your limitations.

2. Develop specific skills that you can feel confident and good about. In a recent article in Oprah's Magazine (January, 2008; we have a copy in the office if you want to come in to read it), they call it "self-mastery." I agree with their suggestion that increasing your level of self-mastery should be the goal, and is the answer to improving how you feel about yourself, raising your self-esteem.

3. Don't let one thing define you. And we often choose the one thing we may have difficulty with, and give it a lot more emotional attention than it deserves. For example, a man who is an incredible employee, husband, carpenter, son, brother and friend (to name a few), makes a parenting mistake and that reinforces any and all of the negative images the guy has of himself. Maybe because he didn't have a father, and always wanted to be the perfect parent when he grew up. Well now that you're grown you can give up that childhood fantasy, and settle for just being a good father (or husband, manager, etc.).

These recommendations work for your kids too. Don't give them empty praise, suggesting that they're good at everything. Give them realistic praise and encouragement for things that they do well. Also, you can help them find things that they can learn to do well. And work hard at finding good things about your child to praise them for. Now, if you can't find at least a few good things about yourself or your child, come in for a session.

Easier - Than - It - Looks Recipe: Tilapia Parmesan

My wife and I enjoy cooking. So we thought that we would share some of our favorite recipes, as well as ask you to share some of your favorites. If they pass the taste test, and the EASINESS test, I would be more than happy to print it so that our other bloggers can enjoy them. The only thing is that we don't eat meat (yes, that does include chicken and turkey. We always get asked that). We do eat a lot of fish, and soy products. And generally prefer low fat, low carb and whole grains, trying to watch those pounds and inches (I've lost 25 lbs. in the past 2 years). Though we definitely enjoy the occasional dessert (especially the high fat, high carb ones). And one of us REALLY enjoys chocolate, but I promised I wouldn't mention her name. So do send us your favorite recipes to my e-mail address, TheFreelsGroup@bellsouth.net . Also maybe a little story about where you got it ("little" story).

Now this one we got while visiting my parents last summer in South Jersey when my Dad got sick. He's much better now. We met my daughters there, and went for dinner after visiting him and my Mom. I ordered the Flounder Parmesan at this Italian restaurant/Pizza shop. Dee-lish-us! I've never written a recipe before, but the Mrs. encouraged me to try. It came out OK. See what you think.

Tilapia Parmesan

Ingredients

1. 1 lb. of tilapia (serves 2) - other fish fillet can be substituted

2. 1 cup of shredded mozzarella cheese (more or less to taste)

3. 2 cups of marinara sauce

4. olive oil, or other cooking oil

5. bread crumbs

6. 1 egg

7. marinate (optional): Use your favorite spices to marinade if you choose to. For this dish I use worcestershire sauce, lemon juice, Old Bay seasoning, oregano, garlic

Directions:

Put the cooking oil in a frying pan (a few teaspoonfuls of oil should be sufficient, though you may add more while it cooks if needed) using moderate heat. Stir an egg in a bowl. Dip the fish in the egg mix, which also helps the breading stick to the fish. Coat the fish with the bread crumbs. Cook the fish in the frying pan for 10 to 15 minutes on each side, until the fish is cooked completely (it should be white inside). Reduce the heat. While in the frying pan, coat the fish with the marinara sauce. Cover it with the shredded cheese. Cover the pan for a few minutes allowing the dish to simmer until the cheese melts. Voila!! You can add more sauce and/or cheese to the completed dish, depending on your taste.

Try it and let us now what you think. Also send me one of your favorites (to my e-mail address). Remember to aim for easier-than-it-looks, meatless (though we sometimes just substitute fish, or soy for the meat in a recipe), and healthy (e.g. we substitute brown rice for white, whole wheat breads and pastas, etc.). But of course, you can go nuts with the desserts.

Our Christmas 2007 Vacation....

I advocate as much vacationing as you can stand. Unfortunately, that ends up being not that much for most of us. These are some photos I thought I'd share from our vacation this past week.

Our first stop (after the shopping was done) was Monkey Jungle. This Gorilla, named King, is pictured here chillin'. The main goal of my vacation, to chill out.

We had a great Christmas. Though I'm still getting used to the hot weather during the holiday season. I'm fine though without the snow and the cold.

Driving to the West Coast (of Florida) to enjoy some relaxation, and birthday celebration.

A swim. We also saw some dolphins!

Beautiful west coast sunset.

And Happy Birthday to me.....

HAVE A HAPPY, HEALTHY, AND

PROSPEROUS NEW YEAR!

'Twas The Night After Christmas (Part 2)

You can feel good. Your changes have begun.

Remember though, you've only started, the war is not yet won.

Take a day at a time. Stay committed and motivated.

And be patient if you slip up, remember how long you've waited.

The final step to keeping your New Years resolutions

While your breaking bad habits develop some healthy new ones.

Start an exercise regime. Take a 15 minute walk.

Say a few nice things about people, instead of the whiney or gossipy talk.

Find a hobby, travel some, give your kids some extra time.

Join a club. Socialize. Walks on the beach don't cost a dime.

Before you know it, time has passed, and you're starting to feel better.

You're saying to yourself, "I didn't know that I would get here!"

Very important. Please remember, though you've made it to this day,

Relapsing or slipping up, is a part of this, they say.

Don't worry. If you do that, all is not lost my friend.

Choose a new and smaller step, and get started once again.

So you have the steps. Start resoluting. 10 is enough they say.

But you only need 1, and that first step, to get you on your way.

HAVE A HAPPY AND HEALTHY NEW YEAR!

'Twas The Night After Christmas...(Part 1)

It was the night after Christmas or Kwanzaa or Hanukkah. You're thinking you're done,

With the shopping,... the giving, ... the family drama,... and fun.

Now you're looking ahead at the coming New Year,

You're feeling "maybe now's the time to shift my butt into gear."

If I could just break some habits, I think I'd be fine,

I'm sure I can make changes before the start of '09.

Let's look at some reasonable New Year's resolutions;

Not the kind we always don't do, but some manageable solutions.

If you smoke too many cigarettes, or make too many bets;

If you yell at loved ones far too much, or are too easily upset.

Perhaps your problem is shopping more than you really can afford,

Or you're drinking more than you should, because you're usually bored.

Bad habits come in all shapes and sizes. Are your changes overdue?

Start now. Take small steps. '08 could be great for you.

First make a strong personal commitment to what you want to change.

Visualize the better you. Picture yourself without the chains.

Go ahead, imagine a non-smoking you, or less angry you, or less fast food in your day.

See a healthier you, or a more loving you, or someone who's more kind in what they say.

Think, what would my life be like if I had that extra money I spend,

and what your life will be when this bad habit is at an end.

Hold that picture. Next choose a small, but specific change in that unhealthy pattern.

Something that you will do to make it different than it has been.

One less cigarette per day for the first week, maybe two the week after that.

Or one less casino trip next month, or cut a carb or extra fat.

Next, get started with the change, to break a habit takes a while.

But beginning takes a minute. You've begun. Go ahead and smile.

- TO BE CONTINUED -

Forgiveness, ...Easier Said Than Done? (response to comments)

Forgiveness is difficult, sometimes. I see it as being important as a means of helping to repair relationships, though that is not it's only value. The most important benefit of it is to relieve the forgiver of the burden of unnecessary anger and resentment. I say "unnecessary" because the anger no longer serves a healthy purpose for the person. Resentment requires that a person hold on to painful feelings from the past. To relive the betrayal emotionally sometimes years after it has occurred. It then interferes with other aspects of the person's life. For example, rebuilding an important relationship, or being able to trust people in similar but unrelated situations, or even the negative effects of the stress related to the angry baggage. What I wrote about in my Mental Notes ("All You Need Is Love," 9/22/07) referred to the importance of forgiveness in a loving relationship. And in response to the comments, I will focus on how to make it happen. An article that I found explains the process very well ( "How To Forgive Someone And Move On With Life" ). Basically, the author suggests separating the action from the person who did it. That way you can still express compassion for the person without accepting their offending behavior. I am not suggesting (at all) that you forget what happened. But when you focus on the person that you love, it's easier for you to appreciate that they made a mistake, which we all do; or that there may be other factors at play that were not totally under their control. This is also NOT to say that you want to leave yourself open to be mistreated again. But if they acknowledge their mistake, are sorry, and you truly believe that they will work hard not to do it again, then forgiveness can help you both. If it is something that they continue to do, then forgiveness is not likely, and you have to reconsider your involvement in the relationship. I also always suggest that if you are having too much difficulty letting go of anything from the past, then you have to look within. Sometimes the hardest thing to do is to forgive yourself.