Mental health

The DO Book Club, July 2023: ‘Darkness Visible: A Memoir of Madness’

William Styron’s book reminds physicians that understanding depression and its effects on patients, families and others is still in need of illumination.


Pulling oneself up by the bootstraps is entrenched in the American lexicon: opportunity is abundant and arduous work will provide success. While that may be fundamentally true, what William Styron writes in “Darkness Visible: A Memoir of Madness” is a compelling account of his experience of reaching the pinnacle of recognition and success and his spiral into a deep depression.

Styron, an acclaimed writer, authored several well-known novels, including “Sophie’s Choice.” “Darkness Visible” is very well-written. While it requires a deeper read to ascertain overarching points, if a reader dives deeper, the book, published in 1990, is enriched with layers of complex thoughts on this disease. He challenged the bootstrapping lexicon by providing a patient-centric description of his depressive abyss.  Styron’s book reminds physicians that understanding depression and its effects on patients, families and others is still in need of illumination.

Learning about the affliction

Initially, depression was associated with demonic perception. Even though the clinical term “depression” is attributed to Swiss-born psychiatrist Adolf Meyer, and biochemical, psychoanalytic and behavioral explanations have advanced, Styron powerfully describes depression as “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.” (p. 7)

“Darkness Visible” is a personal account into Styron’s struggles to understand, explain and examine what depression is, and why he has been affected.

I have yet to find any other book that singularly portrays and outlines the individual characteristics of a person afflicted by this common illness and the plight for individuals who succumb to melancholia. Styron is clear in his textualization of depression; he makes readers aware that we are all subject to its mysterious clutches. He also stresses that despite the American lexicon, “it remains incomprehensible to those who have not experienced it in its extreme modes.” (p. 7).

Asking, “why me?”

The book opens with a quote from the book of Job: “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.” (p. 1) Job, found in the Ketuvim section of the Hebrew bible, probes the physical, emotional, psychological and spiritual depths of suffering.

Styron suffers from his depression; his struggle is one that neither he nor others could see or immediately discern. 

Like so many others, acceptance of his illness followed months of denial and analysis into the “why” and “what” of depression. His accounts throughout the book show his despair and the zombie-like behavior, despite attempts to maintain a “rosy view.” Even when receiving a humanism award in Paris, he felt “engulfed by a toxic and unnamable ride that obliterated any enjoyable response to the living world.” (p. 16)

The book describes the poignant, indescribable pain from which people who have depression suffer and the general incomprehension that some experience, due to their inability to imagine a form of torment that Styron describes as “drowning and suffocation.” Styron tries to understand his own depression and its depths – examining the world that he knows well, including contemporary literary figures and poets, focusing on those who succumbed to suicide.

A message of survival

Styron is an exceptional, diverse writer who uses the insights of others to unwind and decipher his feelings about depression. Author Albert Camus’ writing was exceptionally important to Styron’s understanding of his own affliction as Camus wrote of the serious philosophical problem outlined in “The Myth of Sisyphus”—judging whether life is or is not worth living. Styron includes accounts of other writers as well, all who died by suicide, while processing his guilt and self-condemnation. Through the work of others, Styron comes to an austere message: “in the absence of hope, one can muster and must still struggle to survive.” (p. 24)

Styron’s short memoir is important and should be required reading for all health care workers. So much of the book is a search for meaning in a world that seems to be more complex and demanding than ever. In a previous issue of The DO, editor-in-chief Vania Manipod, DO, elegantly reported the need for raising awareness of depressed physicians, aligning with Styron’s proclamations that sometimes depression is something we can’t understand, see or control. Styron’s memoir can yield self-insight and insight into our patients.

Physicians, whom others might see as “having it all,” can be afflicted with an illness that is bound by loss, lack and lassitude. Many factors surround suicide and depression among physicians, including the constant pressure, lack of support staff, corporate medical processes, paperwork, battling insurance companies, issues of reimbursement and a culture of medicine that does not allow for open dialogue and clinician well-being.

Taking a step back toward enlightenment

Styron was not shy in describing his descent into madness and the lack of the medical field’s ability to help without introducing a pharmaceutical barrage of chemicals. Styron is poignant in recounting his encounters with mental health professionals—there is a visceral feeling of searching for meaning. There is even wit and humor in his encounters—the institutionalized sitcom of group therapy and the organized infantilism of art therapy. (pp. 73-75).

There is little I didn’t like about this short but intensely detailed book. Like Styron’s depression and descent, the title sets the stage; I did not see it until the end. Styron comes to an enlightenment that allows him to find hope by breaking away from the religious and medical dogma that surrounds this malady.

He preaches to those who suffer from depression and calls them to endure and not succumb to suicide. Styron writes “for those who have dwelt in depression’s dark wood and known its inexplicable agony…the restoration to health has the capacity for serenity and joy.” (p. 84)

It was enlightening as a reader to see that he found solace, support and a needed separation from the world in order to be re-introduced into society. Styron’s account of his admission for suicidal ideation is compelling. The ending of “Darkness Visible” is as powerful as the beginning.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA. If you are struggling, please don’t hesitate to reach out to the Physician Support Line at 1 (888) 409-0141. You can also call the National Suicide Prevention Lifeline by dialing 988.

Related reading:

The DO Book Club, June 2023: “Long Walk out of the Woods: A Physician’s Story of Addiction, Depression, Hope and Recovery”

The DO Book Club, May 2023: “Endurance,” “Practicing from the Heart” and “Uncaring”

One comment

  1. Alicia Bucko. DO

    Great review. Thank you for your insight. So nice to see a book evaluation that will inspire all of us to be more aware.

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