ABSTRACT
Dysthymic disorder, as defined in DSM III, refers to a neurotic type of chronic depressive mood, short of depressive illness. The sufferer overreacts to normal and other stresses, and complains of inability to enjoy anything: ‘nothing interests me’. Despite his own low self-esteem
he is demanding and critical of others, often blaming them for his dissatisfaction. Patients of this type are difficult to treat since they ‘do not feel up to’ co-operating with manoeuvres which might be expected to result in an improvement. They try the easy options: more cigarettes and alcohol, more food, anxiolytics (anti-anxiety medicines), holidays and health farms: none is effective. Because the term has only recently come into use, the prevalence of dysthymic disorder is not known: it is probably somewhat more frequent in women (Reus 1984). The familiar ‘difficult’ and continually disgruntled husbands and fathers come into the category. Their families live round their moods in reflected misery. Medication is usually unhelpful, while individual sessions are exhausting to the psychotherapist, yielding little result. Nevertheless, it is worthwhile if the patient can be led to express verbally his halfrepressed resentments towards key figures in his life. Group therapy helps these men to interact more honestly with other people, and find self-respect and respect for them.
