Diagnosed with Dysthymia


Diagnosed with Dysthymia


your avatar   Jason, 46-year-old man

I've been diagnosed with Dysthymia and have had 3 acute anxiety attacks in the past. One caused me to leave work midday. Another prompted me to quit the Peace Corps. Since then, I've been on Fluoxetine 20mg daily. That has stopped the acute symptoms, but what about the persistent ones? I still avoid using people's names in case I use the wrong one. I still worry that the current mortgage-finance crisis might leave me homeless if I don't work as many hours as I can (even though my financial advisor tells me everything is fine). I still hesitate to ask for a date because I feel I have nothing to offer. Are these feelings normal? If not, is more medication the answer?


    Bob Rich, Ph.D.

Dear Jason,

To answer your last question first, how can medication fix your thoughts? They are a kind of a crutch. When you have a broken leg, crutches are a great help. They allow you to move around while you're healing. But they don't heal the break. The healing has to be done by your body. In the same way, medications help you to exist while you're struggling with emotional issues, but they can't fix them. The fixing has to be done by you.

Suppose you meet a new person called John, and accidentally call him Jim. Is that so terrible? How would you react if someone called you Jasper instead of Jason? Would you forgive the other person, punch him in the face, or refuse to talk to him ever again?

You might consider doing a little experiment. Go somewhere you don't know anyone, and meet only strangers you'll never meet again. Introduce yourself to somebody you don't find threatening, and then deliberately call that person the wrong name. Then apologize. Observe the person's reaction. Do this a few times, with different people, at different places.

In advance, before doing this experiment, what is your expectation of the outcome? Assess it like this:

a) What is the best possible outcome, and how likely is that on a 10 point scale (10 certain, 0 can't happen).
b) What is the worst possible outcome, and how likely is that?
c) What is the most likely outcome?

Your second example of a problem situation: if you don't earn every cent you can, you might end up homeless. You have external evidence here: your accountant has told you that your financial situation is OK. Well, you still worry about money. You didn't ask to worry about money, the thoughts just came. You know these thoughts are unrealistic, but they still keep coming.

If you didn't ask for these worries, they are not your doing. They're just there. But they are nothing more than words in your head. They are not true or false, they just are. All you can do is accept them.

When you worry about a worry, you give it power. It feeds on your attention. If you just allow them to happen if they happen, and have them there as background without paying any attention, then they will just starve away after awhile. And if they don't, they can't cause any harm unless you blow them up in importance. Say to yourself: "Oh, here is that out-in-the-streets story again. Hello story - won't I make a good bum if you ever come true."

Finally, what do you think you need to offer to a woman? You might have a number of female friends who are safely married, older than you are, or for other reasons, not potential-mate material. Talk to them about this feeling that you won't ask for a date because you have nothing to offer. Ask them, what does a woman expect from a guy she might date? I think you'll be surprised at the answer.

Jason, I'd like to finish with the motto of the wonderful Toastmasters organization: "Feel the fear and do it anyway."


This question was answered by Dr. Bob Rich. Dr. Rich has 30+ years of experience as a psychotherapist. Dr. Rich is also a writer and a "mudsmith". Bob is now retired from psychological practice, but still works with people as a counselor.For more information visit: http://anxietyanddepression-help.com


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