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Abstract

Darkness Visible A book by William Styron First published 1990
MEDICAL CLASSICS
Darkness Visible
Andrew Moscrop clinical researcher, Department of Primary Health Care, University of Oxford,
Oxford OX1 4UP
Darkness Visible
A book by William Styron
First published 1990
Lyrical eloquence and lucid self examination are not features
of depression. Thought processes, William Styron tells us in
Darkness Visible, become muddied in the “grey drizzle of
horror.” Recounting the story of his mental illness, Styron recalls
his “torpid indifference” to a dinner party arranged by his wife,
at which friends “politely ignore” his “catatonic muteness.”
Depression is “indescribable,” a “despair beyond despair” that
destroys your ability to communicate. Only if it were otherwise
could those experiencing the disease “depict for their friends
and loved ones (even their physicians) some of the actual
dimensions of their torment.”
The best selling, Pulitzer prize winning novelist Styron offers
a literary self portrait of the depression that “took full
possession” of him in 1985. His account follows his initial
avoidance of help—a “reluctance to accept the reality that my
mind was dissolving,” through the psychiatrist’s chair and
prescriptions of benzodiazepines, tetracyclics, and monoamine
oxidase inhibitors, to his eventual admission to hospital,
described as “an orderly and benign detention where one’s only
duty is to try and get well,” and finally to restitution.
Styron’s depression is marked by loss: a loss of appetite, lost
sleep, absent dreams, “the libido also made an early exit,” a loss
of self esteem, and a fear of abandonment by others. “Loss in
all its manifestations is the touchstone of depression—in the
progress of the disease and, most likely in its origins,” Styron
suggests. He perceives the origin of his own disease in the death
of his mother when he was 13. He was “unable to achieve the
catharsis of grief” and his repressed sorrow, rage, and guilt
became “the potential seeds of self destruction.”
Acutely conscious of the literary heritage of self destruction,
Styron reminds us that depression claimed the lives of Virginia
Woolf, Sylvia Plath, and Ernest Hemingway. Styron discovers
an unconscious theme in his own earlier novels. He observes
how, in the minds of several suicidal characters, he had already
“created the landscape of depression.” In addition to his
psychological insights and recognition of the association
between life events and creativity, Styron finds meaning in
physicalist theories of the mind: the “intermingled factors of
abnormal chemistry, behaviour, and genetics.” He argues
emphatically that those “compelled to destroy themselves” are
wholly victims of their disease, citing the author and holocaust
survivor Primo Levi, who fatally threw himself down a staircase
in 1987. They are no more deserving of moralistic reproof than
the victims of terminal cancer.
The darkness here is not interminable. Styron does get better.
The first person narrative implies from the outset that this is a
survivor’s tale, making the story bearable for the reader. Yet
that only compels us to contemplate further how unbearable
Styron’s condition must have been when the darkness seemed
without end. Styron is aware of this effect of his story and,
without lessening its impact or sounding complacent, he
emphasises that “by far the great majority of the people who go
through even the severest depression survive it, and live ever
afterward at least as happily as their unafflicted counterparts.”
Here, then, is an invitation to spend a few hours with someone
who is not depressed, but who has known severe depression; to
strive to comprehend without feeling pressured to intervene.
The author’s only request is that “those who are suffering a
siege, perhaps for the first time, be told—be convinced,
rather—that the illness will run its course and that they will pull
through.”
Competing interests: None declared.
Provenance and peer review: Not commissioned; not externally peer
reviewed.
Cite this as: BMJ 2012;345:e4748
© BMJ Publishing Group Ltd 2012
andrewmoscrop@yahoo.com
For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
BMJ 2012;345:e4748 doi: 10.1136/bmj.e4748 (Published 16 July 2012) Page 1 of 1
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