They are four women who have never met: a nurse in Chicago, a literary agent in New York City, a restaurant owner in Montgomery, Alabama, and a writer in Los Angeles. But for each of them, there came a moment when they realized: This can’t be normal.
“I walked into a psychiatrist’s office, and he said, ‘You suffer from depression.’ Nobody had ever told me that before. I thought, Oh, my God, I’m seeing the world through a different lens,” says Beth Vesel, 43, a literary agent and happily married mother of a 5-year-old boy. Up until that point, Vesel had felt there was simply something wrong with her personality, some character flaw.
“It’s like you’re walking around with a leg that’s half an inch shorter than the other, and everybody tells you, ‘The problem is your back,’ or ‘It’s your neck.’ And then somebody says, ‘Your leg is half an inch shorter, but we can construct a special shoe,'” she says.
Low-grade depression (dysthymia) is one of the most common ailments on the planet and one of the least likely to be diagnosed. Like its cousin, clinical depression, low-grade depression hits women roughly twice as often as men (though some researchers believe mood disorders in men are underreported because of social stigmas). Clinical depression is a kind of mental hurricane: Symptoms include debilitating insomnia, weight loss, anxiety or a mental fog so dense that people forget what they’ve read as soon as they’ve read it. The pain is so awful that suicide can seem an acceptable solution.
Low-grade depression is more like a year of drizzly weather. It is, by definition, chronic. A diagnosis requires the presence of symptoms on more days than not for a period of at least two years, which is what makes it so hard to pin down. Any given day might be okay, even happy. Yet in the general run of days, there are more gray ones than not, more unhappiness than joy. Most people afflicted with this kind of chronic malaise instinctively blame themselves: They would rather believe they can solve the problem—if they could just find the right job or the right man or lose weight—than admit they have a psychiatric disorder.
That’s not to say that the problems a depressed person fixates on don’t exist. But a healthy person might take action, or simply look around for a fun distraction. A person with low-grade depression broods and gets stuck. Caught in that drizzly mental weather, she doesn’t seek shelter or buy an umbrella; she goes on slogging through puddles.
Someone You Know Has It
Approximately one adult in six will be affected by some form of depression in his or her lifetime—a rate that varies only slightly among various ethnic groups and cultures. Low-grade depression is less common, affecting 3 to 6 percent of the adult population. Even so, the two-to-one gender disparity means that between four million and eight million American women will suffer from an insidious, low-grade mental illness, most of them receiving no help.
Fewer than half the people with clinical depression ever seek medical advice, fewer than that get appropriate help, and people with low-grade depression fare worst of all. They think, “Hey, nobody said life is a party. If I’m still showing up at work, I must be okay.”
Yet the damage chronic low-grade depression inflicts can be even more devastating than a single episode of severe clinical depression. “Being 80 percent of yourself for two years is worse than being 20 percent of yourself for two months,” says Frederick K. Goodwin, M.D., former director of the National Institute of Mental Health and now a professor of psychiatry at George Washington University.
Susan G. Kornstein, M.D., associate professor of psychiatry at Virginia Commonwealth University, notes, “Someone with an acute major depressive episode is much more likely to get help because there’s an obvious change. But low-grade depression causes greater impairment to patients’ overall functioning in their work and social lives because it goes on for so long. These people go unrecognized, even by health care professionals.”
That is, they do unless somehow something gives them a glimmer that life can be much better—or unless they sink into clinical depression, says Jane Ferber, M.D., an assistant clinical professor of psychiatry at Columbia University. In that sense, a major life crisis can turn out to be a blessing: It forces people to acknowledge that they have been existing in a gray zone of subhealth.
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