Beating the Blues

Most people experience mild depression at some point in their lives; it is normal to do so.  Of course, most people also sprain their ankles at some point in their lives.  A sprained ankle is still painful and is temporarily disabling.  Similarly, the fact that mild depression is a common experience does not make it healthy.  According to Michael Thase and Susan Lang, authors of Beating the Blues, chronic mild depression, known as dysthymia, is a serious health problem.  Their book describes what dysthymia is, how to tell if you suffer from it, and what ways there are to treat the problem.  It is written in relatively simple language, explaining the technical terms it uses, and it is full of boxes and checklists that make it easy to browse.

One of the main themes of the early chapters is that dysthymia is an under-recognized and under-treated condition, so it is not surprising that it isn't very clear exactly what counts as dysthymia.  Indeed, the condition was only officially named in 1980.  Nevertheless, if you have it, then not only will it probably mean you are deeply unhappy, but your chances of developing even more serious mental illness is significantly higher.  The authors state that up to a quarter of all Americans experience some depressive symptoms or mild depression, but even this seems an underestimate.  Who doesn't become somewhat down with changes to sleep and eating patters at some point in their lives?  But the authors don't seem to say in the book exactly how many people qualify as having the medical condition of dysthymia: the book jacket says up to 35 million Americans while the publicity letter from the publisher says up to 17 million Americans. 

Have you experienced the following?  Low self-esteem, sad for no reason, taking little pleasure in formerly pleasurable activities, irritable, lacking motivation, pessimistic, and feeling helpless.  At the same time, have you had poor concentration, short-term memory problems, indecision, worries and morbid thoughts?  Have you started missing deadlines, had changes in eating patterns, your energy levels and sleeping patters?  If so, you may have dysthymia.  Thase and Lang say that people with dysthymia tend to be

·        loyal workers but underachievers

·        hold jobs below their abilities

·        somewhat rigid about changes

·        lacking in coping skills

·        timid and socially withdrawn

·        sleeping too much

·        unmarried or divorced, or in a deadlocked marriage

·        afflicted with other medical problems

·        afflicted with other mental health problems [adapted from page 34]

They go on to explain that there is a range of possible causes of dysthymia, including biology, psychology, and psychosocial. 

When it comes to treating the problem, they take much of their inspiration from five well-known books:

·        Martin Seligman: Learned Optimism

·        Martin Seligman: What You Can Change and What You Can't

·        David Burns: Feeling Good

·        David Burns: The Feeling Good Handbook

·        Daniel Goleman: Emotional Intelligence.

They identify distorted and constructive thinking patterns and patterns of thinking and communication, their recommendations will be familiar to most people who have browsed through self-help books.  They also recommend looking into psychotherapy, and they explain the different kinds available.  Naturally they also summarize the various antidepressant medications that are available.  It is good to see that they also emphasize changing one's diet and getting exercise.  They are somewhat circumspect about alternative therapies and natural remedies, but they do discuss the options available and what evidence there is for the effectiveness of complementary medicine.  While they don't cite any evidence for it, they do suggest it could be helpful to watch as little television as possible. 

The final main section of the book looks at special populations, such as the young, women, men, and the elderly.  The end of the book has lists of many resources available for people looking for help in dealing with dysthymia. 

The information in Beating the Blues will be useful to those who know little about depression and dysthymia and are wondering whether they might suffer from a diagnosable mental disorder.  The information in the book is presented briefly, but it seems in line with what you would find in most mainstream approaches to chronic mild depression.  The authors don't take any explicit strong ideological stand within psychiatry except in their insistence that dysthymia is a treatable condition and that without treatment, sufferers can be at risk for even more disabling conditions.

This book may leave some people uneasy.  So many terms are ill-defined. When for example is a person underachieiving?  When is a marriage deadlocked?  Is there any way to be objective about who has a rigid reaction to changes in life?  Apart from the vagueness of the terms, some might question the fundamental assumption apparently behind the diagnosis of dysthymia that people should be happy and that mild depression is a disorder.  Some might argue instead that life is inherently hard and full of suffering, so depression is a natural state of mind and in fact happiness should be a rare and an unnatural state.  Others would argue that while people can be happy in the right circumstances, modern life in the West is profoundly alienating and the widespread occurrence of mild depression is a powerful sign that we need to change our world rather than try to change ourselves through self-help techniques, personal psychotherapy or medication.

The closest that Beating the Blues comes to addressing these concerns is in its discussion of the aftermath of the September 11 terror attacks.  But what they say is that the attacks put the whole population at greater risk for dysthymia and this gives us all the more reason to use the methods in the book to rid ourselves of our depression.  It is disappointing that the authors don't address the more philosophical and social questions that are raised by the growing treatment of dysthymia, but then in a book aimed at a general readership, it is not too surprising.  In North America, the fundamental assumption is that not only have the right to pursue happiness but that we have a duty to do so. 

Beating the Blues is a solid work of popular psychology and self-help for people who suffer from persistent mild depression.  It contains plenty of useful information.  For a more thoughtful approach to the prevalence of dysthymia in modern society and what this means for our culture, readers will have to look elsewhere.

© 2004 Christian Perring. All rights reserved.

Christian Perring, Ph.D., is Academic Chair of the Arts & Humanities Division and Chair of the Philosophy Department at Dowling College, Long Island. He is also editor of Metapsychology Online Review.  His main research is on philosophical issues in medicine, psychiatry and psychology.