Descriptions of depression from literature

I particularly recommended (passages from) three books:

1. An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison

2. John Stuart Mill, Autobiography, 1873

3. Darkness Visible (A memoir of madness) William Styron

These descriptions are brilliant, eloquent, and moving and will surely give many of my medical colleagues, and others of course, who do not seem to understand depression, a useful insight. Kay Jamison is an eminent psychologist who worked with Fred Goodwin and was also co-author of one of the famous American textbooks of psychiatry which has such a good description of the illness that on reading it I immediately knew that whoever had written it had first-hand experience of it..

Kay Redfield Jamison

In its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state. . . Life is bloodless, pulseless, and yet present enough to allow a suffocating horror and pain. All bearings are lost; all things are dark and drained of feeling. The slippage into futility is first gradual, then utter. Thought, which is as pervasively affected by depression as mood, is morbid, confused, and stuporous. It is also vacillating, ruminative, indecisive, and self-castigating. The body is bone-weary; there is no will; nothing is that is not an effort, and nothing at all seems worth it. Sleep is fragmented, elusive, or all-consuming. Like an unstable, gas, an irritable exhaustion seeps into every crevice of thought and action.

John Stuart Mill

The John Stuart Mill quotation is an older, but excellent, description of depressive illness. Those not used to this style of prose may benefit from reading it several times in order to appreciate its nicety and precision. It was written in the days when peoples’ attention-span was capable of dealing with sentences of more than a dozen words and with more than one sub-clause. The second sentence is 8 lines and 82 words, not a sentence length one encounters much nowadays. Such sentences have been made ‘non-PC’ because they cannot be assimilated by those with challenged reading skills and they score unfavourably on the Flesch–Kincaid readability test. The lowest common denominator rules.

John Stuart Mill, Autobiography, 1873

I was in a dull state of nerves, unsusceptible to enjoyment or pleasurable excitement; one of those moods when what is pleasure at other times, becomes insipid or indifferent. In this frame of mind it occurred to me to put the question directly to myself: Suppose that all your objects in life were realized; that all the changes in institutions and opinions which you are looking forward to, could be completely effected at this very instant: would this be a great joy and happiness to you? And an irrepressible self-consciousness distinctly answered, No! At this my heart sank within me: the whole foundation on which my life was constructed fell down. All my happiness was to have been found in the continual pursuit of this end. The end had ceased to charm, and how could there ever again be any interest in the means? I seemed to have nothing left to live for.

In vain I sought relief from my favourite books; those memorials of past nobleness and greatness from which I had always hitherto drawn strength and animation. I read them now without feeling, or with the accustomed feeling minus all its charm; and I became persuaded, that my love of mankind, and of excellence for its own sake, had worn itself out. I sought no comfort by speaking to others of what I felt. I felt, too, that mine was not an interesting, or in any way respectable distress. There was nothing in it to attract sympathy. Advice, if I had known where to seek it, would have been most precious. The words of Macbeth to the physician often occurred to my thoughts. But there was no one on whom I could build the faintest hope of such assistance.

These were the thoughts which mingled with the dry heavy dejection of the melancholy winter of I867. During this time I was not incapable of my usual occupations. I went on with them mechanically, by the mere force of habit. I had been so drilled in a certain sort of mental exercise, that I could still carry it on when all the spirit had gone out of it. I even composed and spoke several speeches at the debating society, how, or with what degree of success, I know not. Of four years continual speaking at that society, this is the only year of which I remember next to nothing. Two lines of Coleridge, in whom alone of all writers I have found a true description of what I felt, were often in my thoughts, not at this time (for I had never read them), but in a later period of the same mental malady:

Work without hope draws nectar in a sieve,
And hope without an object cannot live

In all probability my case was by no means so peculiar as I fancied it, and I doubt not that many others have passed through a similar state; … I frequently asked myself, if I could, or if I was bound to go on living, when life must be passed in this manner. I generally answered to myself, that I did not think I could possibly bear it beyond a year. When, however, not more than half that duration of time had elapsed, a small ray of light broke in upon my gloom …

From this moment my burden grew lighter. The oppression of the thought that all feeling was dead within me, was gone. I was no longer hopeless: I was not a stock or a stone. I had still, it seemed, some of the material out of which all worth of character, and all capacity for happiness, are made. Relieved from my ever present sense of irremediable wretchedness, I gradually found that the ordinary incidents of life could again give me some pleasure; that I could again find enjoyment, not intense, but sufficient for cheerfulness, in sunshine and sky, in books, in conversation, in public affairs; and that there was, once more, excitement, though of a moderate kind, in exerting myself for my opinions, and for the public good. Thus the cloud gradually drew off, and I again enjoyed life.

William Styron

Edited and excerpted by me, many years ago, from: Darkness Visible (A memoir of madness) William Styron Pan books 1990 (ISBN 0 330 31735 9)

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 zestful, 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 slightly alarming, after all. As I set down these recollections, I realize that it should have been plain to me that I was already in the grip of the beginning of a mood disorder, but I was ignorant of such a condition at that time.

I was on Martha’s Vineyard, where I’ve spent a good part of each year since the 1960s, during that exceptionally beautiful summer. But I had begun to respond indifferently to the island’s pleasures. I felt a kind of numbness, an enervation, but more particularly an 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 corporeal 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 words are often interchangeable, and were so used until the nineteenth century by writers as various as Sir Walter Scott and the Bronte’s, 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 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.

By now I had moved back to my house in Connecticut. It was October, and one of the unforgettable features of this 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 perceptibly seem so hostile and forbidding. Physically, I was 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, becoming more and more difficult and exhausting, stalled, then finally ceased.

There were also dreadful, pouncing seizures of anxiety. One bright day on a walk through the woods with my dog I heard a flock of Canada geese honking high above trees ablaze with foliage; ordinarily a sight and sound that would have exhilarated me, the flight of birds caused me to stop, riveted with fear, and I stood stranded there, helpless, shivering, aware for the first time that I had been stricken by no mere pangs of withdrawal but by a serious illness whose name and actuality I was able finally to acknowledge. Going home, I couldn’t rid my mind of the line of Baudelaire’s, dredged up from the distant past, that for several days had been skittering around at the edge of my consciousness: “I have felt the wind of the wings of madness”.

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.

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 disappearance of my voice. It underwent a strange transformation, becoming 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 be-leaguered emergency. Many people lose all appetite; mine was relatively normal, but I found myself eating only for subsistence: food, like everything else within the scope of sensation, was utterly without savour. Most distressing of all the instinctual disruptions was that of sleep, along with a complete absence of dreams.

Exhaustion combined 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.

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 writhing at the devastation taking place in my mind, and awaiting the dawn, which usually permitted me a feverish, dreamless nap. I’m fairly certain that it was during one of these insomniac trances that there came over me the knowledge weird and shocking revelation, like that of some long-beshrouded metaphysical truth — that this condition would cost me my life if it continued on such a course. This must have been just before my trip to Paris. Death, as I have said, was now a daily presence, blowing over me in cold gusts. I had not conceived precisely how my end would come. In short, I was still keeping the idea of suicide at bay. But plainly the possibility was around the corner, and I would soon meet it face to face.

What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immediately 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 resemble the diabolical discomfort of being imprisoned in a fiercely over-heated room. And because no breeze stirs this caldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion.

I have to add a brief note about Styron’s case, which was treated by psychotherapy for some considerable time by some blinkered and misguided American Freudian acolyte — indeed it was a miracle he did not succeeded in killing himself before he was made better in a few weeks by phenelzine. I remember hearing an account of his ‘treatment’ in a radio program and I experienced a sense of shame and rage that my colleagues could be so blinkered and incompetent. Sadly, that is the awful legacy of Freud, who created the school of zealots who implemented his bizarre ideas with a rigid fanaticism bordering on lunacy (cf Osteroff) that can only be compared to the extremism of religious zealots. Unfortunately, like people who believe in a flat Earth, such Freudian-type analysts still lurk in the dark corners of the profession.