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Sehee admits to feeling unattractive. She tells her psychiatrist that she hyper-fixates on her looks and worries constantly that other people perceive her as ugly. She notes that women often tell her she’s pretty, but that this upsets her because she feels that it puts too much focus on her face. She also observes that men seldom tell her she’s pretty, and this reinforces her notion that she is unattractive. Even though her new partner tells her that she is his ideal woman, she cannot shake the suspicion that he is lying to her. She also admits that she judges other people for being unattractive, too, and that she dislikes both her self-criticism and her easy judgment of the people around her. Sehee wonders if she might be fixated on her appearance because, if she is to be totally honest, she likes attention.
The psychiatrist suggests she has some, but not all, symptoms of histrionic personality disorder, in which she exaggerates aspects of herself to get attention from the people around her. They further discuss her fixation on her appearance, and the psychiatrist notes that she has so far hidden this aspect of herself from them. The psychiatrist explains that Sehee must apply the idea of three-dimensional, nuanced thinking to her fixation with her appearance as well. She is often neither the most beautiful nor the least attractive person in the room, and she must accept that. She must also realize that physical attraction is individualized and nuanced, and that just because one person doesn’t find her attractive does not mean she is inherently “ugly.”
Sehee acknowledges that she should love herself regardless of her appearance. She knows that, because of her family and society in general, she has been taught to only value beauty and thinness. She is worthy no matter what she looks like, and she hopes to obsess less about her appearance going forward.
Sehee takes an online self-esteem quiz and receives a low score. The score is higher than the last time she took the quiz, but she is still unhappy with the results. She wishes that she felt better about herself, but struggles because her anxiety often manifests as hostility. This, in turn, makes her feel like a “bad” person in spite of the fact that she is actually quite empathetic. She wishes that there were not such a gulf between how she feels and how she acts.
Sehee’s therapist asks her how she has been doing. She tells them that she shared her worries about her appearance with her new romantic partner, and he told her that if she felt too much pressure, she didn’t have to meet his friends. She also allowed him to read some of her writing aloud, but struggled with feelings of inadequacy as she listened.
She does feel that she made progress in her daily interactions with her coworker, however: One of her coworkers came to her with a problem to discuss, as they often do, but Sehee was not in the right frame of mind to listen empathetically. Rather than lashing out and then feeling like a “bad” person for being unkind, she changed her inner monologue: She told herself that it wouldn’t cost her anything to listen, and the fact that this colleague felt so comfortable with Sehee was a sign of how empathetic she is.
They move on to an in-depth discussion of self-esteem. Sehee wishes that self-esteem weren’t so important, and her psychiatrist urges her to reframe her thinking about it. They explain that self-esteem is actually important, but it doesn’t have to scare her. For people with healthy self-esteem, both compliments and criticism are easy to hear. They do not interpret a compliment as potentially back-handed, and they do not feel the sting of criticism so harshly. They know who they are and do not put so much stock in other people’s opinions.
The psychiatrist notes that if Sehee can increase her self-esteem, it will not seem like such a worrisome concept to her: Self-esteem can actually help minimize many of her most upsetting symptoms. The psychiatrist also notes that life is difficult with people who manage their low self-esteem by “puffing” themselves up, purposely acting much more confident than they are. For these individuals, developing healthy self-esteem involves “deflating” their assumed personality and starting over. This is just as difficult as the process Sehee must undergo.
Sehee then shares that she would like to drink less alcohol. She and the psychiatrist discuss her drinking and decide that she is not physically dependent on alcohol and doesn’t merit treatment. Sehee adds that she does not want to stop drinking, but just confine her drinking to the weekends. The psychiatrist explains that, for her, this is just a matter of willpower.
Sehee understands that her black-and-white thinking is the root of much of her unhappiness and is working to change it. She still struggles with this kind of thinking in her romantic relationship. She is also trying to drink less. In spite of her efforts, life lately has still been a struggle. She finds herself wanting to shout at people and then berating herself for her lack of empathy.
Sehee has had a difficult week. She shares with her psychiatrist that her company’s Instagram account, which she used to manage, is now another team’s responsibility. After viewing their first few posts, she was sure that the new team did a better job than she used to. She worries that everyone else thinks so, too.
Sehee tells the psychiatrist that she’s gained weight and feels terrible about herself. She admits that she judges other people for gaining weight or for being overweight, and that this is part of why she is so self-critical. The psychiatrist urges her not to judge others or herself.
They proceed to a discussion of her medication. The psychiatrist doesn’t think it’s working as well as it should, but Sehee doesn’t want to stop taking it. Although she’s struggled lately and often finds herself in tears, she thinks the medication helps her enough to warrant continued use.
Sehee reads a book in which the author argues that the word “suicide” should be changed to “free death” to honor people whose lives are so difficult that they make the decision to die by suicide. She decides to quit her job. She thinks that life is innately changeable and that it might be time for her to do something different.
Sehee admits to feeling “completely drained” (143). She cannot find the energy to work or interact with her co-workers. She feels jealous, anxious, and resentful. She is no longer sure that she is a good person. She tells her psychiatrist that she has had a terrible week. She informed her boss that she was quitting and was honest that she wanted to do so for mental health reasons. Her supervisor was sympathetic and assured Sehee that they would talk about changing her role when she was ready to return to work. She has been binge-eating and feels depressed about the resulting weight gain.
She wants to write a book and start a business, but she needs a vacation first. Although her relationship with her romantic partner has been going well, Sehee has decided to travel alone. She’ll visit the temples at Gyeongju, hoping that the peaceful place will help her to feel better. She admits that she feels she has hit rock bottom. The psychiatrist pushes back against this claim, noting that she is just having a particularly difficult time but that it is a phase. They decide to adjust her medication.
There is a repetitive quality to the writing and narration at this point in the memoir. Sehee and her psychiatrist work through a series of problems that they have already discussed in depth and detail during more than one session. This repetition speaks to the cyclical nature of depression, the difficulty of its treatment, and to The Non-Linear Nature of the Therapeutic Process. Sehee once again hyper-fixates on her appearances. Although she shares more of her experiences of body dysmorphia and self-criticism with the psychiatrist, and they further diagnose her with some symptoms of histrionic personality disorder, much of the material they discuss is not new.
Sehee once again feels unattractive and worries that she has gained weight, in part from the binge-eating that is a side effect of both her broader depressive condition and the lack of ease she feels in social situations. Sehee also admits, again, that part of her struggle to move past self-judgement and increase her low self-esteem is her habit of judging other people for qualities she dislikes in herself. Of other women’s appearances, she notes: “I judge them, because my own face gets judged a lot” (102). She and the psychiatrist have already established this thought and behavioral pattern as damaging, but Sehee returns to it because she is trapped in yet another depressive cycle.
That Sehee’s transcripts during these sessions resemble those of some of her very first meetings emphasizes for the reader the difficulty that patients living with dysthymia have trying to make progress. Sehee’s essays further evidence this struggle. In them, she directly names her cognitive distortions and limiting beliefs as well as the action steps she is taking to address them. Still, she notes, progress includes moments of serious regression, and she cannot always put her psychiatrist’s wisdom into practice.
The Impact of Long-Term Depression on Personal and Professional Lives remains another key thematic focal point as Sehee describes the way that depression continues to shape her relationships both at home and at work. She feels that her new romantic relationship is happier and healthier than many she had in the past, but notes her discomfort with meeting her new partner’s friends. When she communicates this anxiety to her partner, they explain that she does not have to socialize with their friends if it would cause her to feel “on display.” This feels, for both Sehee and the psychiatrist, like a moment of progress, and she is able to reflect on how open, clear communication helps her to maintain romantic bonds. Nevertheless, she also notes her extreme anxiety at sharing her writing with her partner, and it is evident from the genuine distress she feels at having been vulnerable that her habit of self-judgement and hyper-observation causes her to be emotionally removed from relationships.
Sehee describes a similarly complex experience in a work relationship. She relates a story in which a coworker sought her out for emotional support during a moment in which Sehee herself felt emotionally drained. Here, however, she does describe more growth and a better outcome, demonstrating that she is better equipped at noticing problematic thought patterns and addressing them. Rather than responding emotionally, she reflects on why this coworker sought her out and realizes that her own emotional state is impacting her ability to be open and empathetic. Since she has noted in the past how upset she becomes when she lacks empathy or lashes out, this new response shows Sehee how much progress she’s made and becomes a rubric for future interactions.
The psychiatrist helps Sehee to reframe her frustration around the importance of self-esteem, reflecting Therapy as Collaborative Self-Authorship. Sehee would like to ignore self-esteem entirely, but the psychiatrist challenges that goal. They explain to Sehee that self-esteem can actually be a powerful tool. Gaining self-confidence and a more sound sense of self can help Sehee to feel less dependent on external validation and help her to remain more present in her relationships going forward. Sehee demonstrates her increased ability to self-reflect in her response to the psychiatrist, although based on past progress, they both realize it is likely that she will experience more moments of regression in this area.
The collaborative nature of the patient-therapist relationship also impacts the discussion that Sehee and her psychiatrist have about the idea of “rock bottom.” Sehee feels that she cannot sink to further emotional depths, but as she and the psychiatrist discuss the actual recent events of her life, it becomes apparent that there is actually quite a bit of room for achievement and growth. Sehee wants to quit her job, is interested in new creative projects, and feels secure enough in her relationship to take a vacation on her own. She seems, at this point in her therapy, poised to take important steps on the way to managing her depression.



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