William Styron's memoir, "Darkness Visible," is an expanded and revised version of a lecture he gave here in April 1989 at an Annual Symposium on Mood Disorders sponsored by the Depression and Related Affective Disorders Association (DRADA) and the Department of Psychiatry of the Johns Hopkins University School of Medicine.
Like the other 400 members of that audience, I was moved by Mr. Styron's description of his gradual descent into the despair of clinical depression and by his wit in protesting the name "depression" and in recounting his "surrender" to occupational therapy in the hospital.
In describing his clinical depression he speaks for many others. However, every patient's experience is different.
Mr. Styron couldn't tolerate the first antidepressant medication he was prescribed. He also felt he was dangerously and excessively tranquilized. Finally, he feels it was hospitalization and good nursing care (much of which had come from his wife, Rose, and friend Art Buchwald prior to hospitalization) that kept him out of harm's way and facilitated his recovery.
Four other patients have spoken about their depressive illnesses at the Annual Mood Disorders Symposium. In 1986, a school counselor, who suffered episodic depressions that were undiagnosed for 20 years, attributed her recovery to accurate diagnosis and a tricyclic antidepressant drug.
In 1987, a dentist with manic-depressive disorder (or bipolar disorder), thanked the caring staff at the National Institutes of Mental Health, his medication, carbamazepine, and his wife for getting him well.
In 1988, Norman Endler, Ph.D., a prominent professor of psychology from Toronto, claimed that electroconvulsive therapy (sometimes misnamed electroshock therapy) was key to his recovery and was also grateful that his doctor had kept him out of the hospital.
In 1990, Artie Houston, who founded the National Hemophilia Society and who was president of the National Depressive and Manic Depressive Association, said lithium was behind her successful treatment.
The moral of four stories (or 4,000) is that there are several generally effective treatments for clinical depression and manic depressive illness. All these treatments engender gratitude and loyalty, but none of them is fully understood. The prudent application of any therapy requires careful diagnosis (a point missed in Mr. Styron's commentary), although this alone does not guarantee rapid relief.
Mr. Styron's treatment was asylum and tincture of time. For most patients with severe depression, this would be too slow, too expensive and too painful, since 80 percent of these patients respond favorably to medications and brief outpatient psychotherapy. Sadly, fewer than 30 percent of seriously depressed patients are both diagnosed and treated for this condition.
We still don't know why antidepressants work so well for the majority of seriously depressed people and why they fail in 20 percent of patients. But then we still don't understand exactly how aspirin works either.
Now that we understand clinical depression and manic-depressive disorder as diseases, research is focused on understand-ing the genetic and brain mechanisms underlying them. We believe the research someday will produce diagnostic tests and curative treatments. This is especially important for the 20 percent of patients who remain depressed despite treatment with otherwise effective antidepressant therapies.
In the meantime, let us be Rose Styrons and Art Buchwalds for our depressed colleagues and family members: to help them seek professional help and to help them keep going until recovery arrives, which it does even when it is least expected.