This isn't the book review, but my notes and some excerpts from the book which I think I will find useful and anyone who is looking for more information on depression will too. The book review of Darkness Visible by William Styron is done here.

Of the many dreadful manifestations of the disease, both physical and psychological, a sense of self-hatred – or, put less categorically, a failure of self-esteem – is one of the most universally experienced symptoms, and I have suffered more and more from a general feeling of worthlessness as the malady had progressed.

The language fails us when we try to represent depression. And yet, it is our affection of putting everything into words, to give the feeling a tangible form which further aggravates the agony of the inexplicable. The language has thus far always come short in representing many of our deepest expressions and owing to this inability to articulate them into something that can be communicated in words, or a representation of some kind, has led to only one good outcome, against the myriad of troubles – the lone good outcome is creative expression. We have not been able to tell what love is, what altruism is, what kindness is, what feeling in the mind is, a feeling that emanates without touch. But in this search of the perfect line which may describe how we feel, people have piled up mountains of literature.

Despite depression’s eclectic reach, it has been demonstrated with their convincingness that artistic types (especially poets) are particularly vulnerable to the disorder – which, in its grave, clinical manifestation takes up word of 20% of its victims by way of suicide. Just a few of these foreign artists, all modern, make-up a sad but scintillant roll call - Hart Crane, Vincent van Gogh, Virginia Woolf, Arshile Gorky, Cesare Pavese, Romain Gary, Vachel Lindsay, Sylvia Plath, Henry de Montherlant, Mark Rothko, John Berryman, Jack London, Ernest Hemingway, William Inge, Diane Arbus, Tadeusz Borowski, Paul Celan, Annie Sexton, Sergei Esenin, Vladimir Mayakovsky - the list goes on. (The Russian poet Mayakovsky was harshly critical of his great contemporary Esenin’s suicide a few years before, which should stand as a caveat for all those who are judgemental about self-destruction).

It makes me wonder if these men were really creative, or were merely trying to portray the misery of their mind onto a canvas of sorts. Since language is insufficient or at least the common day-to-day languages are, they had to resort to such allegories which could explain what they were feeling. We glorified their misery, we lauded them for being sick albeit creative, we were indifferent to what they were going through and they had no other recourse than self-destruction.

And when they did, we, the society were critical of their actions, paying no heed to the causation while hypocritically wondering “why did he or she do it?” Which “usually leads to speculations, for the most part fallacies themselves. He takes the example of Abbie Hoffman’s death: his reaction to an auto accident he had suffered, the failure of his most recent book, his mother’s serious illness. With Randal Jarrell it was a declining career cruelly epitomized by a vicious book review and his consequent anguish. Primo Levi, it was rumoured, had been burdened by caring for his paralytic mother, which was more owners to his spirit than even his experience at Auschwitz.” Any one of these factors may have been like a thorn in the sides of the three men, and been a torment. I see, letting go as the only answer.

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 towards close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode, although the gloom, “the blues” which people go through occasionally and dissociate with the general hassle of everyday existence of such prevalence that they do give many individuals a hint of the illness in its catastrophic form.

When I started to read about depression, it was with the belief that I possess this quality of being able to feel what others feel if they can only express it in words, that I can relate to them. When the author says the above lines, he makes a certain level of connection with me as I’m captivated by the details, no matter how poor renders or frightening, I have felt the inkling, the tip of what the author might be hinting at. But it is beyond imagination when he says “I had descended far past those familiar, manageable doldrums.” He had been haunted by insomnia owing to this condition and is only heartening to read him state himself to be in “fair spirits” after a very short sleep of few hours under the influence of a minor tranquilizer.

There is a region in the experience of pain with the certainty of alleviation often permits superhuman endurance. We learn to live with pain in varying degrees daily, or over long periods of time, and we’re more often than not mercifully free of it. When we endure severe discomfort of a physical nature of conditioning has taught us childhood to make accommodations to the pain’s demands - to accept it, whether pluckily or whimpering and complaining, according to a personal degree of stoicism, but in any case to accept it… Through the body’s capacity for healing itself, we embrace this eventual respite as the natural reward will receive for having been, temporarily, such good sports and doughty sufferers, such optimistic cheerleaders of life at heart. In depression this faith in deliverance, in ultimate restoration, is absent… It is hopelessness even more than pain that crushes the soul.

He explains the progression of depression, “my acceptance of the illness followed several months of denial during which, at first, I had described the Molise and restlessness and sudden fits of anxiety to withdrawal from alcohol.” He explains his reluctance to seek medical help by claiming that he had been compelled, by himself, into becoming an autodidact in medicine, and had a better than average amateur was knowledge about medical matters. Further, he states ”as an incipient depressive, I had always subconsciously rejected or ignored the proper knowledge; it cut too close to the psychic bone, and assured it aside as an unwelcome addition to my store of information”. Depression, it seems is like every circuit inside our brain failing at the same time – all hell breaking loose. For it is my observation, of self and of people I’ve known fairly closely, we all go through the many stages which if occur together might lead us down this spiral. It is only until we know that we’re in that we’re wise and try to pull out. I for one, remember writing this post back in 2012 when I had one such spell, and I ascribe the writing of the post as my turning point. It would be narcissistic to claim such, but that post has been my beacon of light since then.

General unawareness, as I’ve noticed is a cause of much misery for people and partly (I think) the unappealing name of this debilitating malaise is the reason of this general unawareness. So when someone tells you that they’ve been diagnosed with, say Parkinson’s disease, you immediately open up all the medical resources at your disposal (Wikipedia being one of the most frequented resource for autodidacts of medicine), and find how the disease takes its course – the motor cells in the brain start to give up, then memory begins to fade, and slowly, and steadily as the disease eats up the brain, the sufferer gradually goes down under; such treacherous course, isn’t it? You are more tolerant with the patient when they repeat the questions due to loss of short term memory or attention span, you treat them like a child, because you know that such is the course of the disease, and the patient is now like an infant, frail and fragile. But when someone tells you that they’re suffering from depression, you think it is a common thing. I’ve heard many of my friends say, when they’re depressed, that they are suffering from depression, and earlier I used to not take it seriously, thinking that they have no idea what depression might be like, but now I stop and reconsider, what if it is true. Each misery is different, and unfortunately, not even the most creative geniuses have had the power of language to express how they felt. We shoot down the claim as ‘we all go through it, we all have bad days’. It is insulting, apathetic, humiliating.

It is like “the situation of the walking wounded. For in virtually any other serious sickness, a patient felt similar devastation could be lying flat in bed, possibly sedated and hooked up to the tubes and wires of life support systems, but at the very least in a poster of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honourably attained. However, the sufferer from depression has no option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguished devouring his brain, present a face approximating the one that is associated with ordinary events and companionship.”

A phenomena that a number of people have noted while in deep depression is the sense of being accompanied by a second self - a wraithlike observer who, not sharing the dementia of his double, is able to watch dispassionate curiosity as his companion struggles against the oncoming disaster, or decides to embrace it.” Which is again, quite something that I think I know, closely.

“The grey drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immediately identifiable thing, like that of a broken limb… Comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this caldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion.”

He makes a beautiful analogy in describing what he felt when he first consulted a mental therapist. “Guilt ridden, distraught, miserably depressed, the adulterous Emma (in Madame Bovary) - heading towards eventual suicide - stumbling late tries to prod the abbe into helping her find a way out of her misery. But the priest, a simple soul and none too bright, can only pluck at his stained cassock, distractedly shout at his acolytes, and offer Christian platitudes. Emma goes on her quietly frantic way, beyond comfort of God or man.” He portrays his desperation and how even the psychiatrists don’t understand by the way the therapist, one of the brightest from Yale warns him that taking the medicine that he was prescribing might cause loss of libido or impotency. The pain with medications is that there is no certain medicine, it is hit and try – and each takes at least a few weeks to have any effect if at all. If it doesn’t, a gap of two weeks has to pass without any medication before switching to the new medicine to let out the previous one from the system completely so that the two may not react. This is mercilessly painless and makes the person more hopeless.

He dismisses all the claims made by books which promised speedy recovery and over the night cures of depression. The helplessness of the sufferer is in the anguish and in the wait that things will get better. Comparing to other physical clinical conditions he says “we expect some kind of treatment and eventual amelioration, but pills or physical therapy or diet or surgery, with a logical progression from the initial relief of symptoms to final cure.” He validly points at the futility of quarrels among medical factions which he compares to the medical quarrels of the 18th-century – to bleed or not to bleed – which in itself almost “defines the inexplicable nature of depression and the difficulty of its treatment.

His case was a little inverted than the often quoted depression in a way that others usually feel worse in the morning and tend to get better as the day progresses. His brain storm offered few hours of reprieve in the morning and then by mid-afternoon, he started to sense the onset of “gloom crowding in on me, a sense of dread in the alienation and, above all, stifling anxiety.”

As the disease progressed it started to produce some of its “most famous and sinister hallmarks: confusion, failure of mental focus and lapse of memory. At a later stage my entire mind would be dominated by anarchic disconnections; as I said, there was no something that resembled bifurcations of mood: lucidity of sorts in the early hours of the day, gathering work in the afternoon and evening.

Each day as his mind began to descend into the dark dungeons his “brain had begun to endure its familiar siege: panic and dislocation, and the sense that my thought process were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world”. “I was feeling in my mind a sensation close to, at indescribably different from, acute pain… It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life.” Soon this positive and active anguish would cloud his mind like in trance and “one of the most unendurable facts of such an interlude was the inability to sleep”.

The sense of worthlessness creeps in people suffering from depression as is often quoted. For me, I haven’t quite felt that but once, in a rather off mood which had continued for days, I have had thoughts of burning all my money stash. There was no thought of being worthy or worthless I just felt like doing it, I felt it was all worthless, pointless. Thanks to plastic money, I didn’t have any stashes to burn.

The author as he was sliding down into depression lost all interests, he even failed to force the laughter and had almost total failure of speech. He says he sounded like a 90-year-old. The author had derived much inspiration from the works and personality of Albert Camus, reading whom, he received the “stab of recognition that proceeds from reading the work of a writer who has wedded moral passion to a style of great beauty and whose unblinking vision is capable of frightening the soul to its marrow.” It was Albert’s portrayal of Meusault in “the stranger” that had propelled William to write “The Confessions of Nat Turner” which later won him the Pulitzer Prize. William reflects upon the foreboding sense of ghastly depressiveness that Albert’s writings induce. He is sceptic if the car accident was orchestrated by Camus himself or was really an accident. From all the cases that he has known, and quite surprisingly he has known far too many, it is evident that depressed people show symptoms of despondency well before the storm. Another major symptom is “a disruption of the circadian cycle - the metabolic and glandular rhythms that are central to our workday life… This is why brutal insomnia so often occurs and is most likely why each spaced pattern of distress exhibits fairly predictable alternating periods of intensity and relief”. But even this relief isn’t actual relief, it was like the change from a torrential downpour to a steady shower.

The author explains his descent as a gradual but subtle change. “It was not really alarming at first, since the change was subtle, but I did notice that my surroundings to call a different tone at certain times: the shadows of nightfall seemed more somber, my mornings were less buoyant, walks in the woods became less zestful, and there was a moment during working hours in the late afternoon a kind of panic and anxiety overtook me, just for a few minutes, accompanied by a visceral queasiness – such as seizure was at least slightly alarming, after all. As I sat down these recollections, I realized that it should have been plain to me that I was already in the grip of the beginning of a mood disorder, but I was ignorant of such a condition at that time.

I felt a kind of numbness, and enervation, but more particularly an odd fragility – as if my body had actually become frail, hypersensitive and somehow disjointed and clumsy, lacking normal coordination. And soon I was in the throes of a pervasive hypochondria. Nothing felt quite right with my corporeal self; there were pitches and pains, sometimes intermittent, often seemingly constant that seemed to pre-sage all sorts of dire infirmities.”

Yet again the author tugs at, and I cannot help but notice, the depth of experience that the past authors and literary figures seem to have possessed when they wrote what they wrote. The more references I read about those authors and poets, the more I am compelled to read them, to sequester out all the feelings and know about them. He doesn’t quote Charles Dickens, but in this book and in the previous one, ‘The Depths’, by Jonathan Rottenberg, I was constantly reminded of the poor Doctor. Emily Dickinson, Sylvia Plath, Chaucer, Dante, authors from archaic to contemporary, everyone is painful, everyone is painfully beautiful.

He’s particularly insightful when he says “it is easy to see how this condition is part of the psyche’s apparatus of defense: unwilling to accept its own gathering deterioration, the mind announces to its indwelling consciousness that it is the body with its perhaps correctable defects - not the precious and irreplaceable mind - that is going haywire.” Even after seeking medical attention initially, he couldn’t feel good, “after three weeks of high-tech and extremely expensive evaluation, the doctor pronounced me totally fit; and I was happy, for a day or two, until there once again began the rhythmic daily evolution of my mood - anxiety, agitation, unfocused dread”. Even in the physical presence of his unflagging and ever patient wife, he felt an immense and aching solitude.

His reaction to the flight of birds while he was in the woods, that of fear, helplessness and shivering, are the nuances of low mood were attention to threats is exaggerated and deeply focused. He says that it is, “in its extreme form, madness - but only turned inwards. Sometimes, though not very often, such a disturbed mind will turn to violent thoughts regarding others but with their minds turned agonizingly inward, people with depression are usually dangerous only to themselves. The madness of depression is, generally speaking, the anti-thesis of violence.”

Many people lose all appetite; mine was a relatively normal, but I found myself eating only for subsistence: food, like everything else within the scope of sensation, was utterly without savor. Most distressing of all the instinctual disruptions was that of sleep, along with the complete absence of dreams”. I have lost dreams, I attributed that to the use of the alarm clock, and stopped using it. Somehow, it was immediate reprieve. I slowed down, I understood that it is my life and not even my job for its routine has the right to mess with it. Besides, if am not up to the mark, if am not totally healthy, how can I ever do justice to my job, and to myself? That one single correction, might have been one, in many corrections, which though quite logical, we often neglect in our greed to chase dreams (which unfortunately, is important too). What would you do if you could not even dream of your dreams?

And yet he expresses hope, since psychiatrically has done something if anything at all - use of lithium to stabilize moods in manic depression is a great medical achievement.

One psychological element has been established beyond reasonable doubt, and that is the concept of loss. Loss in all of its manifestations is the touchstone of depression - in the progress of the disease and, most likely, and its origin… I felt loss at every hand. The loss of self-esteem is a celebrated symptom, and my own sense of self had all but disappeared, along with any self-reliance… One dreads the loss of all things, all people close and dear. There is an acute fear of abandonment. Being alone in the house, even for a moment, cosmic exquisite pain and trepidation… One develops fierce attachments. Ludicrous things - my reading glasses, handkerchief, a certain writing instrument - became the objects of my demented possessiveness. Each momentary misplacement filled me with a frenzied dismay, each item being the tactile reminder of the world to be obliterated… I had now reached that face of the disorder where all sense of hope had vanished, along with the idea of a futurity; my brain, in thrall to its outlaw hormones, had become less an organ of thought than an instrument registering, minute by minute, varying degrees of its own suffering. The mornings themselves were becoming bad now as I wandered about lethargic, following my synthetic sleep, but afternoons were still the worst, beginning at about 3 o’clock, then I’d feel the horror, like some poisonous fog bank, roll in upon my mind, forcing me into bed. That I would live for as long as six hours, stuporous and virtually paralysed, gazing at the ceiling and watch for the moment of the evening when, mysteriously, the crucifixion would ease up just enough to allow me to force down some food and then, like an automated, seeking an hour or two of sleep again.

When he tried to write his suicide note, he found that “there was something almost comically offensive in the pomposity of such a comment as ‘sometime now I have sensed in my work a growing psychosis that is doubtless a reflection of the psychotic strain tainting my life’. Casere, in his parting note wrote simply: ‘no more words. An act. I’ll never write again.’

He attributes his recovery to be “partly the result of sequestration, of safety, of being removed to a world in which the urge to pick up a knife and plunge it into one’s own breast disappears in the newfound knowledge, quickly apparent even to the depressive’s fuzzy brain, that the knife with which he is attempting to cut his dreadful Swiss steak is bendable plastic… For me the real leaders were seclusion and time.

He strongly feels against the carelessness of breezy doctors “who told me that I could, without harm, take as many of the pills as I wished” of Ativan, which might have been an aggravating factor in his depression. “One cringes when thinking about the damage such from risk is prescribing of these potentially dangerous tranquillizers in creating in patients everywhere”. The seclusion, and the news running on TV made him aware that ”the place where I had found refuge was a kinder gentler madhouse than one I had left.” He urges all the sufferers that “if they survive the storm itself, its fury almost always fades and then disappears. Mysterious in its coming, mysterious in it’s going, the affliction runs its course, and one finds peace.

His joy of having his first dream in many months is equally shared by the reader after such a harrowing tale through the darkness. ‘It is of great importance 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. A tough job, this; calling “chin up!” From the safety of the show to a drowning person is tantamount to insult, but it has been shown over and over again that if the encouragement is dogged enough - and the support equally committed and passionate - the endangered one can nearly always be saved… It may require on the part of friends and lovers, family, admirers, and almost religious devotion to persuade the sufferers of life’s words, which is so often in conflict with the sense of their own worthlessness, but such devotion has prevented countless suicides.’

I began to see clearly how depression had clung close the outer edges of my life for many years. Suicide had been a persistent theme in my books... Thus depression, when it finally came to me, was in fact no stranger, not even a visitor totally unannounced; it had been tapping at my door for decades.”

On the other hand, though I am not as much of a writer as any of them, but I’ve found myself utterly incapable of writing about death. Even from the depths of despair, I’ve found my summer, by the end of my written word. I have a light, I’m a light. I’m not depressed, but by my fairly close encounters with it, I’ve come to know a thing or two about it.

The morbid condition proceeded, I have come to believe, from my beginning years - from my father, who battled the gorgon for much of his lifetime, and had been hospitalised in my boyhood after a despondent spiralling downward in that in retrospect I saw greatly resembled mine. The genetic roots of depression seem now to be beyond controversy… The death or disappearance of a parent, especially other, before or during puberty - appears repeatedly in the literature on depression as a trauma sometimes likely to create nearly repairable emotional havoc… “Incomplete mourning” – has, in effect, been unable to achieve the catharsis of grief, and so carries within himself through late years and an sufferable burden of which rage and guilt, and not only dammed up sorrow, are a part, and become the potential seeds of self-destruction. Here, I sense the level of insight that most cultures have developed over the years. Long mourning periods over deaths in many cultures, such as that in Hindu, in Chinese and others (if you know more, please let me know) are an established tradition, something which we, now have come to reject as outdated and dogmatic. Incidentally, depression cases are on the rise with as many as 1 in 7 people (in the developed countries) is known to be suffering from this mood disorder.

Guilt accrues when it is suppressed. It is like smothering coal, which will always surface at some point of time, or many points of time. Letting it out of the system helps. That is why people often challenge everyone to write their deepest secrets somewhere and not keep them in the head. I understand that and with fair sense of urgency, and much contemplation, I’ve often concurred that the best place to keep them is in the open. No one likes to read what is obvious. We are always enthralled by the mysterious, by the clandestine, the esoteric and when we do discover, we find that the folly was in us, that we did not see such an obvious thing. Truth, as a matter of fact is deeply disconcerting because it is too simply, too obvious, too overlooked. It is like the missed decimal place in digits, or the overlooked apostrophe in English. What stops us from writing it there? Because it is so simple and obvious to us that the mere thought of the sham that it might wreak numbs us, “what if they find out, what if, what that?” The leap of faith is what we fail to take, and suffer.

My parents told me that I respond well to calm and loving teaching, whereas my brother responds much better under pressure. I have had bare glimpses of what I would be, how broken I would be if I am unkind to myself. Self-destruction, there’s one root – but since books, and people, and reflection have helped me see that taking pressure of any sort does not work with me. Life has been much better since then. No one in my life has treated me as badly as I’ve treated myself sometimes. A reality check, like a medical check is of utmost importance, and I suspect it is equally important to everybody. Otherwise, we’ll always be on the losing side, no matter how hard we try and no matter how big our laurels claim. ‘Don’t be so hard on yourself’ is what we tell everybody, and yet, it is one of the hardest advices to implement.

Depression - Darkness Visible | Aesthetic Blasphemy