Darkness Visible William Styron is an award-winning literary author whose most famous book is ironically not one of his novels, but his memoir entitled Darkness Visible. Darkness Visible: A Memoir of Madness details the inner journey through the hell of depression. The book is a far cry from the dry, detached, and cold clinical accounts of depression in scholarly literature. A Memoir of Madness reads like a poetic narrative, but details many of the scientific underpinnings of depression. Styron researched his condition, and fuses an understanding of the clinical condition with the more important knowledge of what it is like to suffer from depression.

Styron never set out to publish a book about depression. He simply started lecturing on the subject and published an article about depression in the magazine Vanity Fair. The book is an extended version of the Vanity Fair article. The book begins with an anecdote in which Styron travels to Paris to accept a literary prize. It was on this trip that Styron became fully aware of his depressive state. He describes his pervasive self-hatred, his sense of helplessness and hopelessness, and his "dank joylessness," (Styron, 1990, p. 5).

One of the cornerstones of Darkness Visible is Styron's repeated assertion that the term depression has been overused and misused in common vernacular, and because of this, the true extent of the disease is often overlooked. The term depression is, in Styron's (1990) words, "a noun with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground…a true wimp of a word for such a major illness," (p. 37). Although minor bouts of depression are relatively common, clinical depression is not about daily doldrums. Depression can be a serious and life-threatening illness, as it has been for Styron, who underwent severe suicidal ideation. The medications prescribed for his depression often did more harm than good, testimony to the limitations of clinical psychology and psychiatry. Styron also points out that like him, writers throughout history have grappled with depression. Styron's (1990) claims also that "artistic types (especially poets) are particularly vulnerable to the disorder," and that women are more susceptible than men statistically, but ultimately, it is a "democratic" illness that affects millions of people indiscriminately (p. 35).

There is no known cure for depression, and as Styron points out, the disease is persistent and difficult to treat. It certainly does not go away overnight. Styron's symptoms of depression are classic, reflecting official descriptions of the disease as they are documented in the bible of the psychiatric world: the Diagnostic and Statistical Manual (DSM). For example, Styron complains of various sleep-related disturbances and in some cases, an "inability to sleep," (p. 18). He is also quick to point out that depression will impact different sufferers in different ways, with some being unable to get out of bed in the morning and others, like him, feeling progressively worse as the day goes on. Styron's analysis corresponds with recent research showing that different symptoms manifest differently in different people (Fried, Nesse, Zivin, Guille & San, 2014). Moreover, sleep is viewed as an escape or respite from the despair of waking cognitions. Without sleep, notes Styron, there was no relief from the feelings of anxiety and despair. In spite of his professional and personal achievements, Styron felt unworthy and undeserving. Low self-esteem is one of the hallmarks of clinical depression. Styron also felt unable to laugh and in some cases, even unable to speak. He found himself occasionally walking around as if in a "trance" state (Styron, 1990, p. 17). His appetite, even in the midst of great food, was often completely lost. Styron goes on to the describe the specific manifestations of depression in his life, distinguishing major depression from bipolar disorder, speculating about the causes of depression including genetics, and referring to his periods of hospitalization.

Styron's descriptions of his symptoms correspond well with those outlined in clinical literature. With regards to low self-esteem and self-hatred, core themes in Darkness Visible, an ample amount of research highlights the link between low self-esteem and depression. Interestingly, research does reveal that, "depression can be prevented, or reduced, by interventions that improve self-esteem, (Orth & Robbins, 2013).

Moreover, one of Styron's express purposes in writing about his depression was to communicate with others like him to also suffer. He notes, "I had apparently underestimated the number of people for whom the subject had been taboo, a matter of...

34). As soon as he started to speak about depression, Styron (1990) found, "the overwhelming reaction made me feel that inadvertently I had helped unlock a closet from which many souls were eager to come out and proclaim that they, too, had experienced the feelings I had described," (p. 34). Research has shown that stigma is a significant barrier to recovery, and that it exacerbates one of the core issues related to depression: self-esteem (Link, et al., 2001). Pharmacological interventions, often touted as panaceas, often do more harm than good. When Styron (1990) published Darkness Visible, he was administered drugs in the benzodiazepine family, like Halcion, which essentially act as tranquilizers (p. 49). Benzodiazepine drugs create dependence, and long-term use can actually exacerbate depressive symptoms (Leggett, et al., 2014). Yet in spite of their side effects, benzodiazepine family drugs are remain within the arsenal of elder care treatment options (Leggett, et al., 2014). Styron briefly abused the prescription drugs offered to him, including Halcion but also sleep aids. He admits that he had become addicted to the drugs.
Although Styron (1990) does not cite his source, the author claims that twenty percent of persons suffering from depression end up committing suicide. Research does show that the link between depression and suicide is so close, that it is nearly impossible to consider suicide without considering depression. As many as 90% of people who kill themselves had been diagnosed clinical depression or a related mental disorder ("Recognize the Warning Signs of Depression," n.d.). And whereas more women than men seek treatment for depression itself, far more men commit suicide vs. their female counterparts -- 79% of suicides in the United States are males ("Recognize the Warning Signs of Depression," n.d.). Alcohol and/or substance abuse problems are also connected with depression; Styron (1990) had quit drinking prior to his engagement in France to accept the literary award and it is highly likely that without the crutch of self-medication alcohol provided, the true depths of despair bubbled to the surface. Substance abuse is often a symptom of underlying depressive conditions ("Recognize the Warning Signs of Depression," n.d.). Styron (1990) claimed that alcohol was "the magical conduit to fantasy and euphoria," but also the " means to calm the anxiety and incipient dread that I had hidden away for so long somewhere in the dungeons of my spirit," (p. 40). Clinical experts would agree that Styron (1990) quitting drinking was good for him. Recent research goes beyond speculation about the link between depression and alcohol abuse, to show that there is indeed a causal relationship. The direction of that causal relationship is surprising: alcohol abuse can cause depression, just as much as having depression might cause someone to drink. Boden & Fergusson (2011) found "a causal linkage between alcohol use disorders and major depression, such that increasing involvement with alcohol increases risk of depression," (p. 906). Interestingly, though, Styron (1990) did not quit drinking because it was making him depressed, but because he no longer enjoyed alcohol. His physical tolerance for alcohol diminished as he grew older, and he ceased enjoying the "magical conduit" drinking had become. When he quit, his demons came to the surface with a rage.

Clinical depression is a serious and life-threatening illness. In Darkness Visible, Styron describes depression and its many manifestations in a sobering way. The disease is misunderstood, according to Styron. Depression is an overused term and not one that does justice to the depth of suffering felt by those with the condition. Because of misunderstanding of depression and overall stigma associated with mental illness, many people with depression suffer in silence. Some of the misunderstanding about depression is similar to general misunderstandings about mental illnesses in general. For example, Styron (1990) notes that some people may confuse depression with bipolar disorder. Unipolar depression is, as Styron points out, not to be confused with bipolar disorder, in which the individual swings from a pole of intense euphoria to deepest despair. Styron discusses important relationships between depression and self-esteem, depression and substance abuse, and depression and suicide.

The book Darkness Visible also achieves what psychiatric and psychological research cannot do: admit their own limitations. Through his searching literary voice, Styron shows the ways in which psychiatric research, and research in counseling psychology, are limited. Therapy may address the needs of persons with mild depression or who are in the early stages of the disease. At later stages, though, counseling proved useless to Styron: "its usefulness at the advanced stage I was in has to be…