10.04.2009

Dysthymia

Dysthymia and cyclothymia: historical

origins and contemporary development

by

Brieger P, Marneros A

Psychiatric Hospital,

Martin Luther University,

Halle-Wittenberg, Germany.

peter.brieger@medizin.uni-halle.de

J Affect Disord 1997 Sep; 45(3):117-26

ABSTRACT

The aim of this article is to review and put in their historical context today’s data, methodologies and concepts concerning subaffective disorders. The historic roots of dysthymic and cyclothymic disorders–part of the subaffective spectrum–are essentially Greek, but the first use of the word ‘dysthymia’ in psychiatry was by C.F. Flemming in 1844. E. Hecker introduced the term ‘cyclothymia’ in 1877. K.L. Kahlbaum (1882) further developed the concepts of hyperthymia, cyclothymia and dysthymia–with possible subthreshold symptomatology–in 1882. After Kraepelin’s rubric of ‘manic-depressive insanity’, the term ‘dysthymia’ was widely forgotten, and ‘cyclothymia’ became ill defined. Nowadays the latter term is used in three, partially contradictory, senses: (1) a synonym for bipolar disorder (K. Schneider), (2) a temperament (E. Kretschmer) and (3) a subaffective disorder (DSM-IV, ICD-10). A renaissance of subaffective disorders began with the development of DSM-III. Therapeutically important research has focused on dysthymic disorder and its relationship to major depressive disorder, while cyclothymic disorder is relatively neglected; nonetheless, operationalized as a subaffective dimension or temperament, cyclothymia appears to be a likely precursor or ingredient of the construct of bipolar II disorder.

via Dysthymia.

What shape might the life of a person who has significant anhedonia, who does not recognize or respond to reward, take? Mine seems to have become an exercise in pain avoidance. I recall so many times closing my eyes and seeing myself as a bumper car that bounces off pain. It makes life so random, hitting pain at various angles and ricocheting who knows where, just to repeat that time and again. And then of course I try to avoid the avoidance by avoiding anything I associate with pain. But it doesn’t stop there I go into meta- mode avoid the avoidance I’m avoiding to avoid the pain. After while there are really only two things in the world, avoidance and pain. That doesn’t sound very good and it’s pretty much as bad as it sounds. No direction, lots of anxiety, hyper alert and every decision, appears to me to be some kind of blow, just choices between ways to lose. Sometimes I feel that beat up just by the process of living.
I could buy a house then I’d have a house. If I don’t buy a house I have to continue to live and have my business in rented space. Rented space can be abandoned in a snap. Houses, in any kind of intelligent escape need to be sold and that takes time. Anything that takes time isn’t a proper escape – and I have no idea what I would escape from but I’ve done it many times. Maybe I’m just escaping from feeling trapped.
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