Demystifying Dysthymia

Journeying with persistent depressive disorder

Mental health entered my life when I was 15. Being the naive vulnerable 15-year-old I was, I fell into the trap of an eating disorder (an old piece on this). Safe to say that it overtook me and consumed the next 4-5 years of my life, in different degrees and phases. I was hit hardest in the first 2 years — was severely underweight and withdrew from everyone around me. It came back in milder phases, some worse than others. It was accompanied by panic attacks, low energy or motivation, and lots of self-isolation. However, my base level of functioning was always higher than the average person (I had days packed to the brim which I went about despite struggling to get out of bed; and thrived academically as well). This meant I spent many years hiding behind a mask. It didn’t help that everyone thought I was fine, which made it easier to convince myself all was well. “Fake it till you make it”, they say. This subsequently affected my ability to acknowledge the issues that needed working on, let alone accept any form of help.

My Relationship With Professional Help

I first crossed paths with professional help a few months after the onset of the eating disorder. I was diagnosed with situational depression and given medication for depression and anxiety. However, it didn’t last long. I saw medication as a form of reliance, which my inner independent self disliked, and was never very good at taking it consistently. I also didn’t get along well with my therapist and hastily concluded Cognitive Behaviour Therapy was fluff. After a few visits, I stopped medication or therapy and insisted on “sorting it out” myself.

I got on pretty decently in the subsequent two to three years. I started running competitively (in hindsight a dangerous move for someone on the fringes of disordered eating), partook in social life, and thrived in school. It never really haunted me the same way and I thought I managed to shake it off.

A year later when I entered university, my depressive episodes came back stronger ever, despite my eating disorder having subsided in intensity. I lost all my curiosity, drive, and passion for life. Most of the time, I just went through the motions, and felt very detached from everyday life. I threw myself into over-exercising again — only to get compliments about my fitness. This “fake it till you make it” thing wasn’t really working out. Even on my Leave of Absence volunteering in a village somewhere in Thailand, there were days I struggled deep down. This was when I knew it wasn’t the “situational depression” I had been diagnosed with when I was 15 — it wasn’t a simple cause-effect relationship between the eating disorder and depression. There was more to it.

In 2022, I had another particularly difficult period — which prompted my return to the clinic. At that point, it had been over 4 years since everything had started and all I really wanted were answers. I explained my whole clinical history to the psychiatrist and laid out my symptoms. She asked the usual DSM-5 questions of whether I was suicidal or self-harmed and realised it was none of those. Also did the usual of trying to uncover any triggers and trace my timeline, only to realise there was little. She acknowledged that mine lay in the high-functioning spectrum. It wasn’t the situational depression I had been told I had. Instead, it’s dysthymia — a persistent depressive disorder that manifests in milder but longer-term symptoms. Oddly enough, I remember feeling this wave of relief — like I had been given a fresh dose of life. With this newfound clarity, I was no longer questioning nor denying myself of anything. Something was going on, and I had to cope with it.

I was still adamant about not taking on therapy, but gave medication another shot. I tried to be consistent because I knew the repercussions of inconsistency. Yet, driven by the desire to be self-sufficient and the discomfort I had with the way modern medicine approaches mental health, I only lasted half a year before stopping medication, once again.

On Healing and Coexisting

Since I refused therapy or medication, I knew I only had myself to rely on. I knew there was a fine line between acknowledging the condition and being a self-defeatist, and didn’t want to fall for the latter trap. I picked up many self-help books and read many online resources. I learnt to unpack toxic traits and unlearn unhealthy beliefs. I learnt to develop healthier relationships with the people around me and reach out when I needed. Much of this entailed embracing the art of vulnerability — because when we’re openly vulnerable with one another, we break down barriers. I spent so many years of my youth with a wall around me that I lost the chance to make real meaningful connections. From someone who dismissed her feelings and feared being seen as “weak”, I sought to discuss the everyday struggles and the issues seen as “taboo”. Because to live a life so highly guarded is to do injustice to the human condition.

“Vulnerability is the core of all emotions and feelings. To feel is to be vulnerable. To believe vulnerability is weakness is to believe that feeling is weakness. To foreclose on our emotional life out of a fear that the costs will be too high is to walk away from the very thing that gives purpose and meaning to life” — Brené Brown

Much of it was also coming to terms with the fact that this was going to be a part of me. As someone who used to wonder if her melancholy and pessimism were innate or causal, the diagnosis was comforting. I didn’t have to find fault in myself for feeling the things I did or doing the things I did. But it also meant I had to develop my toolbox and get attuned to my coping strategies. Moreover, it was learning to be kinder to myself. To rest, and see life beyond achievement and productivity. To stop beating myself up when I fall short of my 100%. To accept it’s impossible to be disciplined consistently. To accept that some days we fall short, and that’s okay.

It was also about acknowledging that some environments were just not for me. It’s learning that I thrive better wherever it’s quiet, and accepting that I get sensory overloads easily. It’s learning that I’m not the social animal I was brought up to believe I was. It’s learning that it’s better to be alone than be around people who don’t understand you. And it’s learning that sometimes, it’s about protecting yourself from external stimuli because the outside world can get too much. This means realising I function best with over 8 hours of sleep, and realising that I shouldn’t have to feel guilty for spending my day at home if I could afford to. And if I can’t achieve either, it probably means I’m overloading my plate with too many things.

More Life

Undoubtedly, this has been a journey of healing, reconciliation, and enlightenment. A journey of developing my trusty toolbox. The decisions I’ve made have been quite different from professional advice and not one I’d advise others on, but it’s probably what has sat most well with me and worked best thus far. I’ve found peace with the fact that the symptoms may never go away and that melancholy, pessimism, and others will remain layers in my soul. And for the times I wonder if it’s nature or nurture, I’ve found peace in the fact that I may never have answers. Some days the world will appear extremely dull and some days it’ll feel like there’s a rock on me. Some days I’ll shift from being hyperproductive to having a breakdown. And some days I’ll feel completely numb or detached. And they’re all okay.

To let the darkness seize control is to be disempowered. To journey is to hold tight to all the colour that remains. To journey is to live a life intentionally with energy and spirit. A life in touch with the mind and body, and a life grounded in the fundamentals of being human — vulnerable.

“To live with courage, purpose, and connection—to be the person whom we long to be—we must again be vulnerable. We must take off the armor, put down the weapons, show up, and let ourselves be seen.” — Brené Brown