Casebook: A Diagnosis of Dysthymia

Sometimes we find a psychiatrist who diagnoses a “mental illness” and this is highly distracting and keeps us from seeing what is staring us in the face.

Harold needed to forget the label given to him and get his life working

It was only at the end of our first session that Harold revealed he had a diagnosis of Dysthymia.  It had been made by a real expert on mental illness, namely his NHS psychiatrist.  As a small detail and despite feeling pretty bad for months and having spent time also seeing an NHS psychologist and a CBT therapist, Harold was still feeling just as rotten.

He had been taking medication for a number of months (of course) but this had not helped and he was ready to quit. So what is Dysthymia?  I googled it and what I found was that it was the name given to an extended period of low mood – not depression you understand but a low mood, chronic and maybe quite mild at times.

Now it was true that at that first session I had found that Harold was not a good trance subject and he found it difficult to connect to emotionally stressful periods in his past.

But Harold wanted to see me again and indeed came regularly for 10 sessions – which is a lot for me. In that first session and the next two we focused on his work as a schools administrator which he found very unsatisfactory. He was also finding it very difficult to develop his career away from administration in ways he felt he wanted to, though in truth he showed no great enthusiasm for any change.

And then in our fourth session it began to emerge how difficult his marriage was and how hard he found it to create the life he felt he and his wife were looking for. So we spent 2/3 more sessions working on that. By this time, his wife had moved out (to find herself) and to his great surprise his mood began to lift. 

What was emerging was that their marriage was over and that this would be good for both of them. And quite quickly, pieces began to move into place for Harold. He met up with a couple of friends he had known for a long time and indeed there was another relationship, long on hold, which began to develop quite naturally.

He also found he was enjoying his work rather more. And then Harold said that he felt he was ok and did not need to see me anymore. He also said at the end that he was not sure why exactly, but I had been the only therapist he had ever seen who he felt he got anything from and who he wanted to see again. And by the end he had junked both the psychologist and psychiatrist.

Looking back it seems pretty clear to me what was going on. It was Harold’s marriage which just could not be made to work and the feelings he had around that – many of them quite disempowering. In other words he was stuck. Forget a crazy diagnosis. I would say that that would be enough to lower anybody’s mood and makes so much more sense than a pointless and meaningless label; however exalted was the person who chose it.


Labels to describe mental problems are not helpful in most cases – as illustrated by the experience of Harold Listen/download