A post from 11/12/11 updated.
' 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, 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 prescence, 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 resposible for 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 rhythyms of the English and therefore was unaware of the semantic damage he had inflicted by offering 'depression'' as a descriptive noun for such a terrible 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 - even the uninformed layman might display sympathy 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 vaque spinelessness, but we still seem destined to be saddled with 'depression' until a better, sturdier name is created.
The depression that engulfed me was not of the manic type- the one accompanied by euphoric highs - which would have most probably presented itself earlier in my life. I was sixty when the illness struck for the first time, in the 'unpilor' form, which leads straight down. I shall never learn what caused my depression, as no one will ever learn about their own. To be able to do so will likely for ever prove to be an impossibility,so able complex are the intingled factors of abnormal chemistry, behaviour and genetics. Plainly, multiple components are involved - perhaps three or four, most probably more, in fathomless permutations. That is why the greatest fallacy about suicide lies in the belief that there is a single immediate answer - or perhaps combined answers - as to why the deed was done.
The inevitable question 'Why did he (or she) do it? usually leads to odd speculations, for the most part fallacies themselves. Reasons were quickly advanced for 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 Randall Jarrell it was a declining career cruelly epitomised 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 onerous to his spirit than even his experience at Auschwitz. Any one of these factors may have lodged like a thorn in the sides of the three men, and been a torment. Such aggravations may be crucial and cannot be ignored. But most people quietly endure the equivelent of injuries, declining careers, nasty book reviews, family illnesses. A vast majority of the survivors of Auschwitz have borne up fairly well. Bloody and bowed by the outrages of life, most human beings still stagger on down the road, unscathed by real depression. To discover why some people plunge into the downward spiral of depression, one must search beyond the manifest crisis - and then still fail to come up with anything beyond wise conjecture.
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. Like a great many American writers, whose sometime lethal addiction to alcohol has become so legendary as to provide in itself a stream of studies and books, I use alcohol as the magical conduit to fantasy and euphoria, and the the enhancement of the imagination. There is no need either to rue or apologise for my use of this soothing, often sublime agent, which had contributed greatly to my writing;although I never sat down a line while under its influence, I did use it - often in conjuntion with music - as a means to let my mind concieve visions that the unaltered, sober brain has no assess to. Alcohol was an invaluable senior partner of my intellect, besides being a friend whose manifestations 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.
The trouble was at the beginning of this paticular summer, that I was betrayed. It struck me quite suddenly, almost overnight; I could no longer drink. It was as if my body had risen up in protest, along with my mind, and had conspired to reject this daily mood bath which it had so long welcomed, and, who knows? perhaps even come to need. Many drinkers have experiencd this intolerance as they have grown older. I suspect that the crisis was atleast partly metabolic - the liver rebelling, as if to say, 'No more, no more' - but at any rate I discovered that alcohol in miniscule amounts, even a mothful of wine, caused me nausea, a desperate and unpleasant wooziness, a sinking sensation, and ultimately a distinct revulsion. The comforting friend had abandoned me not gradually and reluctantly as a true friend might do, but like a shot - and I was left high and certainly dry, and unhelmed.
Neither by will nor by choice had I become an absteiner; the situation was puzzling to me, but it was also traumatic, and I date the onset of my depressive mood from the begining of this deprivation. Logically, one would be overjoyed that the body had so summarily dismissed a substance that was undermining its health; it was as if my system had generated a form of Antabuse, which should have allowed me to happily go my way, satisfied that a trick of nature had shut me off from a harmful dependence. But, instead, I began to experience a vaquely troubling malaise, a sense of something having gone cockeyed in the domestic universe I'd done so long, so comfortably. While depression is by no means unknown when people stop drinking, it is usually on a scale that is not menacing. But it should be kept in mind how idiosyncratic the faces of depression can be.
It was not really alarming at first, since the change was subtle, but I did notice that my surroundings took on a different tone at certain times: the shadows of nightfall seemed more sombre, my mornings were less buoyant, walks in the woods became less zetful, and there was a moment during my working hours in the late afternoon when a kind of panic and anxiety overtook me, just for a few minutes, accompanied by a visceral queasiness - such a seizure was at least alarming, after all. As I set down these recollections, I realise that it should have been plain to me that I ws already in the grip of the beginning of a mood disorder, but I was ignorant of such a condition at the time.
When I reflected on the curious alteration of my consciousness - and I was baffled enough from time to time to do so - I assumed that it all had to do somehow with my enforced withdrawal from alcohol. And, of course, to a certain extent this was true. But it is my conviction now that alcohol played a perverse trick on me when we said farewell to each other: although, as everyone should know, it is a major depressent, it had never truly depressed me during my drinking career, acting instead as a shield against anxiety. Suddenly vanished, the great ally which for so long had kept my demons at bay was no longer there to prevent those demons from beginning to swarm through the subconscious, and I was emotionally naked, vulnerable as I had never been before. Doubtless depression had hovered near me for years, waiting to swoop down. Now I was in the first stage- premonitory, like a flicker of sheet lightning barely percieved depression's black tempest.
I was on Martha's Vineyard, where I've spent a good part of each year since the sixties, during that exceptionally beautiful summer. But I had begun to respond indifferenty to the islands pleasures. I felt a kind of numbness, a reservation, but more particularly 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 corpereal self; there were twitches and pains, sometimes intermittent, often seemingly constant that seemed to presage all sorts of dire infirmities. (Given these signs, one can understand how, as far back as the seventeenth century - in the notes of contemporary physicians, and in the perceptions of John Dryden and others - a connection is made between melancholia and hypochondria; the worlds are often interchangeable, and were so used until the nineteenth century by writers as various as Walter Scott and the Brontes, who also linked melancholy to a preoccupation with bodily ills.) It is easy to see how this condition is part of the psyche's apparatus of defence: inwilling 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.
In my case , the overall effect was immensely disturbing, augmenting the anxiety that was by now never quite absent from my waking hours and fuelling still another strange behaviour pattern - a fidgety restlessness that kept me on the move, somewhat to the perplexity of my family and friends. Once, in late summer, on an airplane trip to New York, I made the reckless mistake of downing a scotch and soda - my first alchol in months - which promptly sent me into a tailspin, causing me such a horrified sense of disease and interior doom that the very next day I rushed to a Manhattan intern, who inaugurated a long series of tests. Normally I would have been satisfied, indeed elated, when 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 gain began the rythmic daily erosion of my mood - anxiety, agitation, unfocused dread.
By now I had moved back to my house in Connecticut. It was October, and one of the unforgettable features of tihis stage of my disorder was the way in which my own farmhouse, my beloved home for thirty years, took on for me at that point when my spirits regularly sank to their nadir an almost palpable quality of ominousness. The fading evening light - akin to that famous 'slant of light' of Emily Dickinson's, which spoke to her of death, of chill extinction - had none of its familiar autumnal loveliness, but ensnared me in a suffocating gloom. I wondered how this friendly place teeming with such memories of (again in her words ) 'Lads and Girls', of laughter and ability and Sighing,/ And Frocks and Curls', could almost perceptively seem so hostile and forbidding. Physically, I ws not alone. As always Rose was present and listened with unflagging patience to my complaints. But I felt an immense and aching solitude. I could no longer concentrate during those afternoon hours, which for years had been my working time, and the act of writing itself, becomming more and more difficult and exhausting, stalled, then finally ceased.
William Styron's house in Connecticut.
Our perhaps understandable modern need to dull the sooth-tooth edges of so many of the afflicions we are heir to has led us to banish the harsh old fashioned words: madhouse, asylum, insanity, melancholia, lunatic, madness. But never let it be doubted that depression, in its extreme form, is madness. The madness results from an abherrrant 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 cause a depletion of the chemicals norepinephrine and srontonin, and the increase of a hormone, cortsol. With all its upheaval in the brain tissues, the alternate drenching and deprivation, it is no wonder that the mind begins to feel aggrieved, stricke, and the muddied thought processes register the distress of an organ in convulsion. 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 antithesis of violence. It is a storm indeed. but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero. Ultimately, the body is affected and feels sapped, drained.
That fall as the disorder gradually took full possession of my system, I began to concieve that my mind itself was like one of those outmoded small- town telephone exchanges, being gradually inudated by floodwaters: one by one, the normal circuits began to drown, causing some of the functions of the body and nearly all those pf instinct and intellect slowly to disconnect.
There is a well-known checklist of some of these functions and their failures. Mine conked out fairly close to schedule, many of them following the pattern of depressive seizures. I particularly remember the lamentable near dissapearance of my voice. It underwent a strange transformation, becomming at times quite faint, wheezy and spasmodic - a friend observed later that it was the voice of a ninety-year old. The libido also made an early exit, as it does in most major illnesses - it is the superfluous need of a body in beleagured emergency. Many people lose all appetite; mine was relatively normal, but I found myself eating only for substistence: food, like everything else within the scope of sensation, was utterly without saviour. Most distressing of all the instinctual disruptions was that of sleep, along with a complete absence of dreams.
Exhaustion combined with sleepnessness 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 Haleion - a matter which deserves particular notice. For some time now many experts in psycho-pharnology have warned that the benzodiazpine family of tranquilliszers, 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, an insouciant doctor had prescribed Ativan as a bedtime aid, telling me airily that I could take it casually as apirin. The Physicians' Desk Reference, the pharmeacological bible, reveals that the medicine I had been ingesting was (a) three times the normally prescribed strength, (b) not advisable as a medication for more than a month or so, and (c) to beused with special caution by people of my age. At the time of which I am speaking I was no longer taking Ativian but had become addicted to Halcion and was consuming large doses. It seems reasonable to think that this was still another contributary factor to the trouble that had come upon me. Certainly , it should be a caution to others.
What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the grey drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immedately identifiable pain, like that of a broken limb. It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resembe the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this cauldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion.'
Reprinted from :-
Darkness Visible - William Styron ( Cape 1991).
.William Styron, who first descended into clinical depression at the age of sixty, described himself as "one who had suffered from the malady in extremis, yet inspiringly returned to tell the tale about mans ability to endure in extreme circumstances, I personally am very grateful that he did. Styron was one of the lucky ones , thousands of us are still unfortunate to live with this condition from day to day, some of us sadly do not have the means to survive, and tell our stories.
Remember a lot of people with mental health problems never actually seek professional help. Sometimes when sought the help is not what is needed. Even though William Styron's book helped demystify the subject,with his vivid account of his descent into clinical depression, there is still serious stigma attached.This book has helped me though, when I too have been suffering and would strongly recommend it. The complex wrestling of the human soul is often difficult to avoid, life for some of us can be overwhelming. Personally speaking when my melancholy calls ,it often arrives uninvited.
Attracts some like a magnet. But as seasons flow, new tactics emerge , sometimes they work, every small step is because you are living. Every day one of survival. It forces us to look, join the dots, life as one big balancing act. Find the means to veer away from the darkness within. Even though episodes can return, the waves can be broken, peaked and moved over.
Remember there is nothing to be ashamed off . Courage lies within all of us, beyond the confines of despair, as Styron reminds me, our greatest hope lies in the passage of time and " the passing of the storm.... Mysterious in its coming, mysterious in its going, the affliction runs its course, and one finds peace." After a bout recently, I am one of the lucky ones, have at least a few caring listening ears, I will continue to avoid the dodgems though, try and keep on surviving !
More on William Styron here.
http://en.wikipedia.org/wiki/William_Styron
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