Depression in dancers: nobody's perfect--but try to tell that to an overachiever.

Imagine a dancer who gives the appearance of "having it all"--talent, prestige, admiration, lots of friends, and best of all, a promising future. Then, imagine this same person laid low by depression. Confusing? You bet! No one is immune to mood disorders, whether a top performer or a straggling dance student. Population estimates indicate that depression afflicts approximately 17 million Americans across the country. And if the recent repeated inquiries to DANCE MAGAZINE about depression are any indication, it's a topic of interest to many right now.

Depression is a real medical illness, like diabetes or ulcers. This means that you can't "snap out of it" like you can from a temporary ease of the blues. Instead, symptoms of depression typically last for two or more weeks due to biochemical changes in the brain, creating feelings of sadness that permeate your life. Worrying and irritability are also common, as are problems with concentration and memory. It may be difficult to think, sleep, dance, or even have sufficient energy to do your daily activities. I know one 18-year-old dance student who had to take a leave of absence from his school when an episode of major depression impaired his performance to such a degree that he constantly overslept, missed dance classes, and forgot ballet combinations. He also experienced minor physical complaints associated with depression, including frequent headaches and digestive problems.

Different types of depression may produce additional symptoms. Dancers in the northern hemisphere who develop seasonal affective disorder (SAD) during the late fall and winter months may crave sweet and starchy foods and gain weight. In contrast, individuals with bipolar disorder report mania in addition to depression, making rash decisions, such as maxing out their bank accounts, when elated. Dancers with the most benign type of mood disorder, known as dysthymia, suffer chronic, low-grade depression over many years, often beginning in childhood or adolescence. While some dancers are disabled by depression, others continue to function with difficulty. Still, clinical depression should never be ignored, since it is involved in more than half of all attempted suicides.

Although depression tends to run in families, factors apart from heredity can trigger an episode. These factors may include illness (such as an underactive thyroid), stressful life events, a decrease in exposure to sunlight, fluctuating hormones (associated with oral contraceptives or premenstrual syndrome), substance abuse, and burnout. Psychological makeup can also lead to depression, especially in high achievers. In fact, countless accomplished people have suffered from depression, including the late co-founder of the New York City Ballet, Lincoln Kirstein. Does this mean that talented people are more vulnerable to feeling down when others feel up? According to Dr. Sidney Blatt, a psychologist specializing in depression at Yale University, the same qualities that create significant achievement can also lead to self destruction, depending on one's perfectionistic tendencies.

So is perfectionism destructive? Yes and no. Like accomplished people throughout history, successful dancers tend to have extremely high standards. In fact, giftedness and perfectionism often go hand in hand. This is positive up to a point because it drives you to constantly push to achieve excellence. It becomes negative if you must avoid failure at all costs. Unfortunately, the dance culture's emphasis on an ideal body and technique may push certain vulnerable dancers over the edge, especially if teachers refuse to make allowances for fatigue, injuries, mistakes, or anatomical flaws. For example, I know one 16-year-old dancer who became seriously depressed after she was ridiculed in class for having "knobby" knees. Over time, her quadriceps muscle developed, making this problem much less noticeable. However, the emotional damage was already done.

Given the relationship between low self-esteem and depression, it is safer (and more productive) for teachers to focus on learning goals, where the dancer's self-worth is not tied to being perfect. Examples include learning new tasks and acquiring information. Taking a positive approach in dance training can also help dancers manage their own perfectionistic tendencies and set more realistic goals.

Not surprisingly, depression often catches dancers off guard, particularly in a culture that prizes stoicism. As a result, dancers and teachers may view certain red flags associated with depression, such as a loss of energy and concentration, as signs of weakness. Likewise, substance abuse, whether it's cigarettes, alcohol, drugs, or food, may represent a futile attempt to self-medicate for depression. Although it's never a good idea to rely on self-diagnosis, you can use a simple self-screening test (see sidebar) developed by the National Mental Health Association to help you determine if you or someone you know is depressed--but this is in no way a substitute for a medical diagnosis. First, check all the symptoms that apply. If they add up to five or more and have lasted for more than two weeks, the next step is to get a diagnosis from a licensed therapist, such as a clinical psychologist, psychiatrist, or social worker--not some amateur who may want to analyze your past lives. The NMHA Resource Center can put you in touch with mental health services in your community (800.969.6642).

The good news is that depression is a highly treatable medical illness. In some cases, psychotherapy is all that is needed, although the length of treatment may be more extensive for negative perfectionism. Antidepressant medication can also be a useful adjunct to therapy--but he aware that using alcohol and illicit drugs along with certain antidepressants can be dangerous. At the very least, remember to set realistic goals and seek out supportive people. And never underestimate the healing power of laughter.

Former New York City Ballet dancer Linda Hamilton, Ph.D., is a lecturer, a psychologist in private practice, and author of Advice for Dancers (Jossey-Bass).