Book Review

Darkness Visible: Depression, Anxiety, Disassociation

A story of personal courage and the deliverance from an unrelenting suffering can have a great effect on the motivation of an audience, particularly those that feel crippled in their anguish and cannot appreciate the hope of any release from the prison they find themselves locked in. Indeed, as William Styron states: “The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.” If one suffers a physical injury, they experience pain and the suffering comes with it, but the elusive and subjective experience of depression is an injury that causes a similar experience of physical pain; the only difference is not knowing where it is coming from. Styron’ short but very powerful memoir Darkness Visible touches on the profound and debilitating experience of depression that almost led him to suicide.

The author of this astonishing memoir begins his personal and heartbreaking decline into depression while at a hotel in Paris, his presence there to accept the prestigious Prix del Duca award for his literary talent. At the time of acceptance, he felt honoured and privileged for the inclusion of his work among many other talented writers. But, it is in France that he begins his tale of the eventual decline into the somber malaise that would almost take his life. “Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self – to the mediating intellect – as to verge close to being beyond description.”[1]

Clearly affected by insomnia, Styron confesses to have taken the drug Halcion to aid him to sleep the night before the award ceremony; however his deteriorating condition was clear months in advance as he monitored his own gradual decline of “malaise and restlessness and sudden fits of anxiety.”[2] His previous and lengthy reliance on alcohol was abruptly put to an end that was once used to assist in managing these feelings of anxiety.[3] His depressive state impacted on his capacity to concentrate and his knowledge of medical conditions did not practically assist him to overcome the feelings of “gloom crowding in on me, a sense of dread and alienation and, above all, stifling anxiety,”[4] that he faced. During the ceremony in his honour, he outrageously declined to stay on to the luncheon organised months in advance for him and the members that selected him because of the illness that led to “confusion, failure of mental focus and lapse of memory,”[5] sieged at certain times later in the afternoon by “panic and dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world.”[6]

But Styron did what many people often fail to do; he sought help, conscious that his mind was dissolving and his distress increasing, he knew that any further denial would lead to a catastrophic result. After the ceremony and other commitments were over, he collapsed onto his hotel bed, entranced by the feeling of “supreme discomfort… a condition of helpless stupor in which cognition was replaced with ‘positive and active anguish’”[7] as well as being afflicted by the inability to sleep, loss of appetite and a decline in the libido. The intensity of his exhaustion gave him the sensation profound misery and self-loathing (what he refers to as depression’ premier badge) that made him “zombie-like”[8] and the storm of madness – or the storm of murk[9] – arrived in time for him to become aware that if this experience of “rare torture”[10] continued it would cost him his life. Death had become a daily presence, where items around them home became instruments to enable this possibility, what he admitted when he chose to visit psychiatrist ‘Dr. Gold’. While Dr. Gold offered consolation, Styron could barely process and describe his ‘desolation’ together with the fact that pharmacology had an impact on his ability to function; while anti-depressants can assist in some serious cases, both psychotherapy and pharmacology did not help.[11]

“The pain is unrelenting and what makes the condition intolerable is the foreknowledge that no remedy will come.”[12] This eventual hopelessness that the pain of this elusive experience will go away left him in such a wretched state that he chose to throw away his life into the garbage, effectively choosing to die. As he prepared for the necessary arrangements that would lead to his end, one fateful night he had an epiphany. There was a joy available to him and he remembered the hope of happiness that was present; he realised that he could not die, he could not kill himself. The next day, he admitted himself to hospital. His final words to those afflicted by the debilitating illness is to see this hope, that “whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair.”[13]

There are a range of depressive disorders from major depression that can be short-term up to very long term dysthymia and the severity of these experiences can differ, although usually the symptoms are disabling enough to interfere with usual activities and can be characterised by a melancholic change of mood that often slows a person down. While the brain regulates our moods, for many uninformed people the idea that depression is caused solely from a chemical imbalance fails to consider a number of other factors that interact with or trigger the onset of the disease. The cause of depression is just as elusive as the experience itself, but there are a number of physical, environmental and cognitive factors that can influence the development in addition to brain chemicals including genetic, health and wellbeing, as well as drug and alcohol abuse and chronic medical conditions.

Depression is a non-communicable disease and the leading cause of disability worldwide.[14] As Styrone himself indicated, it is a disease.[15] In Australia, there are currently three million people living with depression or anxiety, with an estimated 45% experiencing this debilitating mental health condition in their life and only 35% of those three million accessing treatment to support their recovery.[16] Those living with the condition experience difficulties with personal relationships, careers and their general well-being and become more prone to substance abuse as well as an increased risk of health problems. There are risks that can increase “triggers” such as a loss of a job or financial loss[17] or chronic health conditions such as injuries from a car accident or ailments such as osteoporosis or arthritis.[18] At a global level, depression effects more than 300 million people with the second highest cause of death for young people aged 15-29 is suicide, whereby depression is known to lead to suicide and a total of 800,000 people take their own lives each year.[19]

“The madness results from an aberrant biochemical process. It has been established with reasonable certainty (after strong resistance from many psychiatrists, and not all that long ago) that such madness is chemically induced amid the neurotransmitters of the brain, probably as the result of systemic stress, which for unknown reasons causes a depletion of the chemicals norepinephrine and serotonin, and the increase of a hormone, cortisol.”[20] With a number of medical improvements vis-à-vis technology, brain imaging have enabled scientists to access a more clear picture of the effect depression can have on the brain itself. Functional magnetic resonance imaging (fMRI) among other sophisticated and computed techniques continue to show that activities in the brain significantly alter when a person is experiencing depression. A person can be affected by chemical neurotransmitters that transmit messages between neurons of the brain and when low levels of serotonin and norepinephrine – organic chemical/hormone – the primary cause an imbalance between these transmissions impair mood and behaviour.

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The regions of the brain that play an important part of regulating mood and ultimately with depression include the amygdala, the thalamus, and the hippocampus all within the limbic system[21] and they are less active or significant reduce in size because of the suppression of the production of new nerve cells in the region[22] and why antidepressants can significantly increase neurotransmitters in the brain. The limbic system “has a major role in producing emotion and motivational behaviour. Rage, fear, sexual response, an intense arousal can be localized to various points in the limbic system.”[23] The amygdala in particular and it is often triggered by highly emotional events (strongly related to fear) including a death of a loved one or a severe car accident, and can affect the thalamus that directs sensory experiences to the cerebral cortex and inputs reactions and how one thinks into proper function. When the amygdala is activated, it initiates the evolutionary ‘flight or fight’ and thus gains immediate access and bypassing the function of the cerebral cortex, which is responsible for sensory, motor and association including learning and decision making. Additionally, the hippocampus within the temporal lobes play a predominant role long-term memory and recollection and the amygdala is can be activated by the experience of fear and a memory of a fearful experience that occurred earlier in life, leading to highly stressful experience that impairs the hippocampus. Thus, as the scans show, those experiencing depression appear to have a smaller hippocampus in size.

The standard reaction and ultimate taboo that renders comments on the subject of mental health concerns to be, “you’ll pull out of it” or “we all have bad days”[24] have only made the subject of depression even more difficult to socially articulate. It could also be why – together with our limited cognitive abilities should the trauma be experienced during childhood – that people often repress trauma that is revived later in life. Depression has been linked to other concerns including anxiety and experiences of disassociation, where feeling of an aching loneliness is accompanied “by a second self – a wraithlike observer who, not sharing the dementia of his double, is able to watch with dispassionate curiosity as his companion struggles against the oncoming disaster, or decides to embrace it.”[25] Disassociation has been termed as: “a mental process of disconnecting from one’s thoughts, feelings, memories or sense of identity.”[26] This includes feeling a sense of depersonalisation with a lack of control of connection to themselves. Styron shows as dissociative disorders and the eventual loss for any sense of self leads is very closely linked to the experiences of both anxiety and depression. “Nothing felt quite right with my corporeal self; there were twitches and pains, sometimes intermittent, often seemingly constant that seemed to presage all sorts of dire infirmities.”[26] A person who experiences conditions like disassociation, which is descriptive of a detachment of the self from one’s own environment is doing so as a defence mechanism to cope with potentially difficult conditions. Anxiety, can be described as an ongoing and distressing feeling as Styrone felt later in the afternoon that interfered with his daily life.

The onset of all these conditions are not fully known, although there are clear indicators such as social and environmental conditions including peer pressure, domestic issues or difficulties at work, traumatic event or experience, health and well-being including a poor diet, drug and alcohol abuse as well as chronic physical ailments, the experience of depression is unique to every individual because our experiences with the external world are different.  For Styrone, his substance abuse, in this case alcohol, was used for over forty years to become the “magical conduit to fantasy and euphoria, and to the enhancement of the imagination”[27] and was a means to “calm the anxiety and incipient dread that I had hidden away for so long.”[28]

In as much as Styron was influenced by the literary genius of Albert Camus, I too have been greatly inspired by this fascinating memoir that describes the rise and fall of a terrible illness, one in which I too have personally experienced. The lack of control, the horrible pain that one cannot describe, and mostly the helplessness was for me pushed to the furthest of reaches when I was taunted by other people who had neither the compassion nor comprehension for how I was feeling. Unlike Styron, I had no help, no support, but circumstances or “the healing process of time”[29] enabled me to eventually recover, however this memoir shows the importance of seeing professionals for help, of the importance of the love of people around you. The subject has for a long time been taboo and indeed, as a worker with refugee and asylum seekers, mental health concerns still remains taboo for many cultures and something I have experienced first-hand with my family and especially my mother. I highly recommend that everyone reads this concise, but accurately clear picture of this terrible illness.

 

 

[1] 5
[2] 6
[3] 39
[4] 9
[5] 12
[6] 14
[7] 15
[8] 16
[9] 46
[10] 48
[11] 55
[12] 61
[13] 85
[14] Australian Bureau of Statistics. (2008). National Survey of Mental Health and Wellbeing: Summary of Results, 2007. Cat. no. (4326.0). Canberra: ABS.
[15] 5
[16] Op. Cit, Australian Bureau of Statistics. (2008).
[17] Price, R.H., Choi, J.N. and Vinokur, A.D. (2002). Links in the chain of adversity following job loss: How financial strain and loss of personal control lead to depression, impaired functioning, and poor health. Journal of Occupational Health Psychology, 7(4), 302-312.
[18] Jacka, F.N., Pasco, J.A., Henry, M.J., Korn, S., Williams, L.J., Motowicz, M.A., Nicholson, G.C., Berk, M. (2007). Depression and bone mineral density in a community sample of men: Geelong Osteoporosis Study. Journal of Men’s Health and Gender. Vol. 4 (3), pp.292-297.
[19] World Health Organisation, Depression: Fact Sheet, February 2017 http://www.who.int/mediacentre/factsheets/fs369/en/
[20] 46
[21] Op. Cit, Australian Bureau of Statistics. (2008).
[22] Ibid.
[23] Dennis Coon, John O. Mitterer, Introduction to Psychology: Gateways to Mind and Behavior, Cengage Learning (2008) 69
[24] 37
[25] 64
[26] 43
[26] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dissociation-and-dissociative-disorders
[27] 39
[28] 40
[29] 32

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