Multipath Model of Depression
Depression is a serious mental disorder that affects a large percentage of the population, so the study of this disorder is very pertinent especially since reports of people experiencing depression has become more common in recent years. William Styron, the author of the book Darkness Visibleembarks on the brave task of describing in an unprecedented way the struggles he has faced with his depression and the measures he has taken to overcome this adversity and seek treatment.
The biological dimension of depression suggests that depression results from a variety of factors such as reduced levels of certain neurotransmitters like serotonin and dopamine, disturbances in one’s circadian rhythm, a shrinkage of the hippocampus, and a short allele of the 5-HTTLPR gene. In the book, William first describes his feelings of hopelessness accompanied by brutal insomnia that forced him to stay up at night and remain in a state of exhaustion throughout the day. He continues to write that his only escape from his sour mood was the nap he allowed himself after dinner and before midnight. This disruption in circadian rhythm served to only add to his depressive symptoms to the point where his only relief came in the form of naps. William describes depression as a constant siege upon his life so any attempt to put off the siege was welcome, including trying to re-regulate his circadian rhythm.
The psychological dimension of depression suggests that negative thoughts, errors in thinking, learned helplessness, certain attributional styles, and rumination all contribute to the onset or continuance of depressive symptoms. In his book, William expresses to the reader his negative thought patterns and how these thoughts such as, “I was forced to judge that life was not worth living,” contributed to his feelings of learned helplessness. William is also cited several times throughout his book having conversations with other writers and friends who also had brushes with depression. These talks and journaling’s can be seen as a form of co-rumination because each side begins to dwell on their respective thought processes and symptoms when in the throes of depression. Continuing to ruminate about such thoughts has been proven to worsen depressive symptoms because it is often hard to move past these negative cognitions once one has dwelled upon them for some time. However, as William demonstrates simply by having the courage to write this book, sometimes talking about one’s depression can be therapeutic.
The social dimension offers lack of social support, early maltreatment, neglect, and loss as reasons for depression. Throughout the novel, William mentions several friends, work colleagues, family members, and even a spouse. Clearly the author had a good social support system however, this aspect alone does not necessarily get rid of the possibility of depression. Simply because his parents didn’t neglect him doesn’t mean that Williams was immune to developing depression. While social support can help to combat the symptoms of depression at times, it does not provide a cure-all remedy.
The sociocultural dimension cites traditional female gender roles, sexual orientation, and racial or ethnic discrimination as causes for depression. Since William was a straight, white male, none of the above factors pertain to his situation. Even though he probably never experienced any sort of discrimination for these traits, he did feel sociocultural pressures in other ways, such as going to foreign countries in order to gain respect as an American writer while adjusting to their societal norms.
Since the story is written in an autobiographical fashion, I can say with certainty that the book’s portrayal of depression is very accurate. In class, we learned about the causes, treatments, and prevalence of depression and what I’ve learned in the classroom lines up very well with what’s written in the book. William does an excellent job of describing his depressive symptoms and moods throughout the novel in a way that the reader can appreciate and at times even relate to. His eloquent writing style really makes his story come to life and can easily be pictured in the mind of the reader. I enjoyed how rather than just simply stating that he felt sad, the author went into depth to describe all the different emotions that he felt, because it was never just one emotion, it was a mixture. This honesty once again really served to make the story appear genuine and authentic. The author’s raw vulnerability when describing how truly hopeless he felt made this story really applicable to not only those experiencing depression, but those that wish to better understand and help those with the disorder.
Today, Depression is often treated with a combination of antidepressant medication and psycho/behavioral therapies along with other remedy’s such as circadian related treatments, brain stimulation therapies, and exercise. Antidepressants, such as MAOIs, SNRIs, SSRIs, and Tricyclics are all meant to treat the biological factors related to depression. The various therapy types are often used more for the psychological dimension and the social dimension is involved when using interpersonal psychotherapies. Because depression is explained by multiple factors, treatments are used that target all of these dimensions as well. Therapy is essential because medication can only help so much and patients often experience a relapse of depressive symptoms after stopping medication when their treatment plan doesn’t include therapy as well. It is essential to have a combination of both therapy and medications in order to achieve the best results for longer periods of time and to decrease the risk of relapse.
In the book, William briefly touches on the treatments that helped him the most in his own fight with depression. He explains that pills were never really the answer for him and once he stopped drinking alcohol, his depressive symptoms actually worsened. William credits his seven week stay in the hospital as his true saving grace during his treatment. He writes, “This refuge, while hardly an enjoyable place, is a facility where patients still may go when pills fail, as they did in my case, and where one’s treatment might be regarded as a prolonged extension, in different setting, of the therapy that begins in the offices such as Dr. Gold’s.” The stable environment and routine of the hospital setting provided a sense of security and a time of reflection for William that eventually led to the termination of his suicidal thoughts. “For me the real healers were seclusion and time,” writes William. Due to his insomnia, William also praises the hypnotic medication Dalmane as a miracle drug that finally let him sleep and restore his circadian rhythm when all else failed. For William, it was the combination of sleeping medication and a more routine environment that led to his recovery.
After reading this book, I feel as though I definitely understand and empathize better with depression. Before reading, I always pictured depression as simply feelings of intense sadness but the more pages I read, the more I began to understand the feelings and utter hopelessness that accompany this disorder. A quote I particularly liked from the book was when William was commenting on his inability to truly sympathize with his depressed friends before he himself developed the disorder. He wrote “I was an outsider, unable to grasp the essence of the illness.” I was really able to relate to this quote because I do not have depression and to me, depression seems like an “abstract ailment.” It’s a disorder that is hard for the mind to rap around unless you are going through it yourself. After reading William’s story, I have a newfound respect for those who suffer from this disease and I admire the strength that it takes them to seek out treatment and get help. The book also reestablished to me the importance of being connected socially and how companionship can truly be a sort of treatment in itself. For William, it seemed to really help that his friends also had bouts of depression because they could recount their own struggles and give advice to what helped them get through their own adversities.