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A Dance with Madness
on December 2, 2004
William Styron is perhaps best known for his bestselling novel, Sophie's Choice, which was converted to screenplay and released as an Academy award-winning motion picture starring Meryl Streep. Many critics acknowledged Styron's seemingly natural ability to evoke a sense of bitter, submerged despair through subtle understatement. The reviewers who lauded his work had no way of predicting that Styron would eventually become afflicted with a more personal misery, a depression so severe it would drive him to suicidal obsession.
Styron's harrowing struggle with clinical depression is the subject of his non-fiction bestseller, Darkness Visible: A Memoir of Madness (Vintage Books, 1992). In a mercifully brief 84 pages, Styron eloquently demonstrates how the most brutal and debilitating stages of psychotic depression often hurl patients into an existential nightmare from which the only perceived escape is death (and according to Styron, this misperception constitutes one common, potentially lethal distortion of thought in depressed patients).
Darkness Visible opens with a pointed epigraph from the book of Job. This reflects Styron's perception that like Job's trials, depressed patients are beset by something inexplicable and powerful that threatens to destroy the fruits of their life and labor, the relationships they hold dear, and their very understanding of spirituality. Like Job, depressed patients struggle to find cosmological meaning in their suffering. And like Job, depressed patients who petition God to provide this meaning for them may only receive partial answers or worse yet, a silence that reverberates from an expansive, ominous void.
For people who have never experienced the devastating depths of major clinical depression, it may be difficult to empathize with the life and death struggle these patients wage from within the depths of their spirits. Well-meaning friends and family members may mistakenly attempt to encourage the depressed patient by offering preachy platitudes and pleas that lack depth of perception and compassion, such as, "Life is hard sometimes, you can't let it get you down," or "It can't be as bad as you think," or "Pull yourself up by your bootstraps," or "Everybody gets the blues from time to time." These mistaken "helpers" often confuse clinical depression for situational depression (which is less debilitating, usually temporary, and often explicable through environmental factors, such as the recent death of a loved one). For professional caregivers and loved ones who may be struggling with their own responses to a patient's depression, Darkness Visible provides invaluable personal insights, and therefore plays a significant role in dismantling those experiential barriers that allow the "healthy" to separate themselves from the "sick."
Depression is an insidious disease. It gradually robs patients of their ability to experience pleasure. The insidious disease launches an attack on biochemical, cognitive, and emotive aspects of being. Depression may even manifest as a spiritual crisis, as it deteriorates a patient's ability to experience meaning in life. Styron conveys this quality of depression through dreamlike trains of thought reminiscent of Franz Kafka's fiction.
The disease invades the delicate, temporal realm of the empirical and sensual. The subjective lens of the depressed patient distorts shades of vivid color, fading them to washed-out grays and browns. Sensitivity to touch is often drastically reduced, and many depressed patients describe a sensation of feeling like they are enmeshed in gauze, mummified, unable to touch the world, others, or even themselves. Styron describes an associated sense of "drowning" or "suffocation."
Interpretation of sensation is another factor in depression. A warm home is perceived as a cold prison. The softness of a comfortable bed is experienced as the earthen padding of a silent, beckoning grave. And in William Styron's case, an internationally prestigious award ceremony may become an arduous exercise in endurance.
Depression assaults the emotive experiences of patients, as joyous and even celebratory events are transformed into harrowing exercises in futile endurance. In the opening of Darkness Visible, Styron describes his journey to Paris, where he was scheduled to receive a much-coveted award for his lifetime literary achievements. Despite the immense prestige and recognition, Styron was unable to enjoy the experience, and nearly collapsed in exhaustion and stupor before the conclusion of the ceremony. Worse yet, Styron is befuddled by the inexplicable nature of his gloom. He can find no demonstrable cause for his catastrophic reaction to this pinnacle event.
Depression is a psychiatric disease with social implications. When a patient goes through a sustained period of depression, well-loved friends and family members can become alien and suspect. This is compounded by the frustration of loved ones who genuinely wish for the depression to cease and for life to resume as "normal." These loved ones may add insult to injury by offering emotional encouragement that lacks empathetic understanding. When a loved one tells a depressed patient to "get over it", the effect is similar to a situation in which a gym coach screams the words, "Walk it off, sissy!" to his lead athlete, who happens to be nursing a compound fracture.
Styron makes no pretense of being a qualified physician, but he does recommend that clinically depressed patients exercise caution when utilizing pharmaceutical remedies. He focuses his concern on Halcion, a benzodiazepine that has been correlated with anxiety, amnesia, delusions, hostility, and suicidal ideations. Styron adds his name to the list of critics who claim that Halcion may exacerbate depressive symptoms in some patients, essentially reducing the therapeutic process to a cynical game of psychiatric Russian Roulette in which the only guaranteed winners are the pharmaceutical companies and their stockholders.
While medication can provide short-term relief from depressive symptoms, it should never be administered without careful oversight from a qualified physician. Many of the modern serotonin-oriented remedies for depression cause a plethora of eclectic side effects ranging from blurred vision and nausea to lethargy and sexual side effects (as if lack of ability to achieve orgasm would not in and of itself become a depressing factor). Additionally, pharmaceutical therapies should most often be supplemented with psychological therapy. Medications can provide symptomatic relief for qualified patients, but drugs cannot teach those patients the cognitive, emotional, and social coping skills necessary to prevent a relapse of depression.
Darkness Visible sheds light upon its dreary subject, but all is not gloom. Styron actually manages to convey a comedic sense of irony through his prose. This irony is subtle, attitudinal, submerged in his account and descriptions. This attitude is betrayed when he lists the names of several writers (Virginia Woolf, Albert Camus, Sylvia Plath, etc.) who have suffered from depression, himself numbering among them, as if to recount the roster of a truly elite group - melancholic writers - of which Styron is proud to be a member. By surviving to write this book, Styron is an active participant in shaping and extracting his own meaning from the experience of depression.
Depression is a disease that can produce the bittersweet fruit of lasting fellowship among those familiar with the hidden blessings of wisdom resulting from living through madness and despair. This esoteric, intimate knowledge can only be obtained by wrestling with "the dark beast within" and by working out one's own salvation (with fear and trembling, no less). Depressed readers who peruse Darkness Visible may find a valuable sense of community (in fact, the book could very well serve as a valuable therapeutic supplement for specific patients in recovery). And readers who have been fortunate enough to skirt the yawning abyss of depression will find themselves one step closer to dancing, though ever so briefly, with the specter of madness.
On a personal note... I struggled with clinical depression thirteen years ago, culminating in a suicide attempt and subsequent hospitalization. I can attest that Darkness Visible is the deepest, most subjectively accurate description of this disease that I have ever read. Though the subject matter and style of the book are gloomy, I feel an extraordinary sense of optimism in the experience of completing this book. It's as if the articulation and elucidation exercised by Styron has managed to demystify, and thus disempower, the darkness he sheds light upon.