ON DEPRESSION
Notes from William Styron’s “Darkness Visible”

For the thing which
I greatly feared is come upon me,
and that which I was afraid of
is come unto me.
I was not in safety, neither
had I rest, neither was I quiet;
Yet trouble came.
–Job
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.
I had come to a point where I was monitoring each phase of my deteriorating condition.
Throughout much of my life I have been compelled, perhaps unwisely, to become an autodidact in medicine, and have accumulated a better-than-average amateur’s knowledge about medical matters and so it came as an astonishment to me that I was close to a total ignoramus about depression, which can be as serious a medical affair as diabetes or cancer. Most likely, as an incipient depressive, I had always subconsciously rejected or ignored the proper knowledge; it cut too close to the psychic bone, and I shoved it aside as an unwelcome addition to my store of information.
For myself, the pain is most closely connected to drowning or suffocation—but even those images are off the mark. William James, who battles depression for many years, gave up the search for an adequate portrayal, implying its near-impossibility when he wrote in The Varieties of Religious Experience: “It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life.” (“positive”…think “the test results are positive”).
The weather of depression is unmodulated, its light a brownout.

One of the century’s most famous intellectual pronouncements comes at the beginning of The Myth of Sisyphus: “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.” Albert Camus
The difference now was in the sure understanding that tomorrow, when the pain descended once more, or the tomorrow after that—certainly on some not-too-distant tomorrow—I would be forced to judge that life was not worth living and thereby answer, for myself at least, the fundamental question of philosophy.
To many of us who knew Abbie Hoffman even slightly, as I did, his death in the spring of 1989 was a sorrowful happening. Just past the age of fifty, he had been too young and apparently too vital for such an ending; a feeling of chagrin and dreadfulness attends the news of anyone’s suicide, and Abbie’s death seemed to me especially cruel. /// Abbie’s brother appeared on television, grief-ravaged and distraught; one could not help feeling compassion as he sought to deflect the idea of suicide, insisting that Abbie, after all, had always been careless with pills and would never have left his family bereft. However, the coroner confirmed that Hoffman had taken the equivalent of 150 phenobarbitals. It’s quite natural that the people closest to suicide victims so frequently and feverishly hasten to disclaim the truth; the sense of application, of personal guilt—the idea that one might have prevented the act if one had taken certain precautions, had somehow behaved differently—is perhaps inevitable. Even so, the sufferer—whether he has actually killed himself or attempted to do so, or merely expressed threats—is often, through denial on the parts of others, unjustly made to appear a wrongdoer.

But the stigma of self-inflicted death is for some people a hateful blot that demands erasure at all costs.
Randall Jarrell almost certainly killed himself. He did so not because he was a coward, not out of any moral feebleness, but because he was afflicted with a depression that was so devastating that he could no longer endure the pain of it.
Despite depression’s eclectic reach, it has been demonstrated with fair convincingness that artistic types (especially poets) are particularly vulnerable to the disorder—which, in its graver, clinical manifestation takes upward of twenty percent of its victims by way of suicide. Just a few of these fallen 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 Boroswki, Paul Celan, Anne Sexton, Sergei Esenin, Vladimir Mayakovsky—the list goes on. (Cheri Blum).
When one thinks of these doomed and splendidly creative men and women, one is drawn to contemplate their childhoods, where, to the best of anyone’s knowledge, the seeds of the illness take strong root.
When I was first aware that I had been laid low by the disease, I felt a need, among other things, to register a strong protest against the word “depression.” Depression, as most people know, used to be termed “melancholia,” a word which appears in English as early as the year 1303 and crops up more than once in Chaucer, who in his usage seemed to be aware of its pathological nuances. “Melancholia” would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by 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. It may be that the scientist generally held responsible or its currency in modern times, a Johns Hopkins Medical School faculty member justly venerated—the Swiss-born psychiatrist Adolf Meyer—had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering “depression” as a descriptive noun for such a dreadful and raging disease. Nonetheless, for over seventy-five years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.
As one who has suffered from the malady in extremis yet returned to tell the tale, I would lobby for a truly arresting designation. “Brainstorm,” for instance, has unfortunately been preempted to describe, somewhat jocularly, intellectual inspiration. But something along these lines is needed. Told that someone’s mood disorder has evolved into a storm—a veritable howling tempest in the brain, which is indeed what a clinical depression resembles like nothing else—rather than the standard reaction that “depression” evokes, something akin to “So what?” or “You’ll pull out of it” or “We all have bad days.” The phrase “nervous breakdown” seems to be on its way out, certainly deservedly so, owing to its insinuation of a vague spinelessness, but we still seem to be saddled with “depression” until a better, sturdier name is created.
The storm which swept me into a hospital in December began as a cloud no bigger than a wine goblet the previous June. And the cloud—the manifest crisis—involved alcohol, a substance I had been abusing for forty years. Alcohol was an invaluable senior partner of my intellect, besides being a friend whose ministrations I sought daily—sought also, I now see, as a means to calm the anxiety and incipient dread that I had hidden away for so long somewhere in the dungeons of my spirit.
Soon I was in the throes of pervasive hypochondria. Nothing felt quite right with my corporeal self…. 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.
Exhaustion combines with sleeplessness is a rare torture. The two or three hours of sleep I was able to get at night were always at the behest of the Halcion—a matter which deserves particular notice. For some time now many experts in psychopharmacology have warned that the benzodiazepine family of tranquilizers, of which Halcion is one (Valium and Ativan are others), is capable of depressing mood and even precipitating a major depression. Over two years before my siege (at age 60) an insouciant doctor had prescribed Ativan as a bedtime aid, telling me airily that I could take is as casually as aspirin. The Physicians’ Desk Reference, the pharmacological bible, reveals that the medicine I had been ingesting was (a) three times the normally prescribed strength, (b) not advisable as a medication more than a month or so, and (c) to be used with special caution by people of my age. (gmc: I have been taking Ativan for 20 years. At times, I was taking up to 5, even 7 mgs a day. For the past few years, sans great anxiety, I have managed to allow myself two, one milligram tablets, at night. Although I no longer feel any effect from the Ativan, the several times I have only one, or none, I had wrestled through the night in a fitful sleepless agitation. While I would like to end my toxic relationship with Lorazepam, the research is clear: it takes months to be completely weaned off this poison and the body’s readjustment during this withdrawal is hellish and turbulent. Studies indicate that a successful recovery requires fulltime monitoring by medical professionals. I would like to also note here the untimely death last week of singer Chris Cornell (whom I started streaming about a year ago). Cornell, originally the lead singer for Soundgarden, one of the breakthrough Seattle…to be continued…
At any rate, my few hours of sleep were usually terminated at three or four in the morning, when I stared up into yawning darkness, wondering and writing at the devastation taking place in my mind, and awaiting the dawn, which usually permitted me a feverless, dreamless nap. (Note: This was my pattern for me in recent years, ending when I moved to New Mexico in January, stayed on a combination of Naltrexone and Wellbutrin, and cut out the alcohol/Ativan combination at night…I only took the two Ativan. Previously, I would drink 4 to six ounces of Vodka, eat a day’s worth of eating in two hours, take the 2 Ativan, then fall off to sleep for a few hours. My waking happened around 1 or 1:30 a.m., then I would “wrestle” through the darkness, then, usually as a pre-dawn light began to push the night away, I would drop off into what Styron aptly describes, “awaiting the dawn, which usually permitted me a feverish, dreamless nap.”
The vast metaphor which most faithfully represents this fathomless ordeal, however, is that of Dante, and his all-too-familiar lines still arrest the imagination with their augury of the unknowable, the black struggle to come:

Nel mezzo del cammin di nostra vita
Mi ritrovai per una selva oscura,
Che la diritta via era smarrita.

In the middle of the journey of our life
I found myself in a dark wood,
For I had lost the right path.

One can be sure that these words have been more than once employed to conjure the ravages of melancholia, but their somber foreboding has often overshadowed the last line of the best-known part of that poem, with their evocation of hope.

E quindi uscimmo a riveder le stele.

And so we came forth, and once again beheld the stars.