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William Styron (1925-2006), well-known author of Sophie's Choice, first experienced major depression at age 60.

His depression worsened over a six-month period, culminating into suicidal impulses. His wife, Rose Styron, was initially unaware of depression and baffled by her husband's withdrawal. She ended up convincing her husband's reluctant doctor to admit her husband to the hospital, where he made a full recovery.  Back in 2001, William and Rose Styron talked about his first episode of depression, described in Darkness Visible, and his second episode of depression.

William Styron

How did the depression first hit you?

When I experienced depression originally in June of 1985, the depression was very gradual; it didn't pounce on me in any immediate way. I was not an alcoholic but I found that alcohol was losing its magical effect and that I had revulsion for it. So, I stopped drinking. I think it may have been a withdrawal from alcohol that helped precipitate this depression. I thought that instead of suffering from depression I was suffering from alcohol withdrawal. The entire summer, I began to feel an encroaching anxiety and sense of dislocation, a sense of unhappiness, a mysterious feeling that all was not right in my world. I felt fragile. All of these new ominous experiences began to focus itself in an emotional turmoil that is almost indistinguishable from physical pain. Every day I would wake, after usually a very troubled sleep with a sense of despair. It got worse and resolved itself into this unfocused pain, which I found almost unbearable. I finally went to a psychiatrist, who in my case was of little help to me. I was put on an antidepressant that didn't work.

The pain grew and grew and I began to experience suicidal thoughts. I realized that life for me was at a desperate impasse. I thought of the garage as a place where I might sit in the car and inhale carbon monoxide. I'd look at the rafters in the attic and think of them as places where I might hang myself. I looked at sharp objects as being implements for my wrist. All of these weird and totally incoherent fears which I had never felt before just overcame me in a panic. This was a very serious time for me because I realized for the first time, that I might take my own life.

In my case, although not necessarily characteristic of others, going to the hospital saved me. One particular night in the fall, following months of this seizure of depression, suicide thoughts were overwhelming me. That night, I lost myself in a kind of psychosis. There was an absolute incoherence in my behavior and my thoughts. I began to get frantic; I was in a state of semi-delirium. My family, my wife Rose, one of my daughters who lives close by and her husband, gathered around to try to pacify me. I realized, as did my family that the only solution for me would be to enter a hospital, which I did the next day. It was the beginning of my recovery.

How was the hospital helpful in your recovery?

My salvation was the hospital. Most people don't want to go to a hospital. But many cases of clinical depression leave one so hopelessly out of joint especially as in my case when antidepressants don't do their work, that hospitals are the logical place to go. Unfortunately now with managed care, people are not allowed to have more than a few days in the hospital. I was in the hospital for seven weeks, which was more than adequate time to find myself cured.

What happened in your second depressive episode last year?
Last year, the summer of 2000, I was once again beset by this illness. It came out of the blue; it struck me while I was in a very vulnerable situation. I was once again hospitalized. This depression was very serious, included suicidal thoughts, and mutated into a strange physical deterioration, which landed me into the intensive care unit of the hospital. But I recovered, and most people do recover from depression. When you are in this ghastly mood disorder, you don't think you're going to recover. The absence of hope is almost universal, which is why so many people end their lives in suicide. If suicide can be averted, as it can in most cases, you recover, almost always and live to tell the tale. So this is by no means a fatal illness.

What advice do you have for others with depression?
I recommend that you get immediate help. Find a reliable, well-recommended therapist. You have to have a solid source of information. Also it is very important to turn to your close relationships with a family member or friend for support.

Rose Styron

How did you know your husband had depression?

The first time I had no idea that Bill had depression. I felt a strangeness come over our relationship and his response to the world. It seemed to me that he would precipitously cancel any plans that might have given us pleasure. He became morose on the daily walks that we took with our dogs. He would abruptly say that he did not wish to see friends or hear his children. Even though he was quite a gourmet, both as a cook and an appreciator of food, he stopped enjoying meals. He used to listen to music every day for long periods and he stopped doing that. His talk, which had been lively and far ranging, always engaging and different, became completely obsessive, self absorbed, monochromatic, and boring to him and to others. It was such a change of behavior. He always had a high temper, given to yelling at whatever or whoever caused the noise or disruption, because he liked peace and quiet. But suddenly he refused to participate and could not enjoy anything.

Neither of us had ever been to a shrink. We really didn't know much about depression or psychiatry, having grown up in a world where silence and keeping one's family counsel was the way that one dealt with anything disturbing. So we didn't share our concerns with our friends, the way we now know we can. Friends kept telling me that his behavior was a sign of alcohol withdrawal and in a month or two he would be fine. But instead, he became more and more hypochondriacal, consulting doctors for every physical ailment one can imagine, none of which materialized. Then, we went off to France for him to receive an award and he behaved in a bizarre manner. It was also a moment of return to the Paris that he loved more than any other city and where we had spent wonderful times before. So his behavior was even more striking.

We cut short the visit and came home. It was obvious then that he was in real need of medical help. But, unfortunately we didn't get the right medical help. We found a doctor who identified depression, which in one way was a relief. But, the care was not what it should have been. The doctor was so worried that Bill was well known and that this incident would stigmatize him or cause some kind of public crisis. He kept telling me to keep giving him higher and higher doses of one of several medications and to keep him at home, not to let him out of my sight.

What was the impact of your husband's depression on your family?

It was pretty terrible because we were so baffled the first time. Our emotions ricocheted from feeling sad for him to angry for us. We felt rejected and guilty for whatever we had done that was causing him to reject us. We are a very close family and the kids rallied around all the time, so we had each other to talk to, and that saved us from the impact being too great. We talked over what we saw as his recession from reality. or his delusions, which all had to do with him being a really bad man who was going to ruin all of us if he hadn't already. We wanted to make him feel better and we felt worse because we couldn't. We became progressively more horrified. Each of our children and I had a different take on it. We didn't know that until later, but we each felt personally guilty, rejected, and helpless to him.

How did you persuade your husband to get help?
First we had some help from other friends, who were writers and close friends of ours, who had either been through incredible mood swings themselves since childhood or had friends who had real problems and suicides. They told me I had to get him to a psychiatrist. But, I couldn't persuade the doctor to take him to the hospital. Finally, one dreadful night I called the doctor and told him that I couldn't keep Bill at home any more. It was preposterous. I couldn't keep track of the medicines he was, or was not, taking. I couldn't even go to sleep for five minutes because he might not be here when I woke up. Luckily, we did have a daughter nearby. Once my daughter and I said 'we're going to take you to the hospital in the morning,' there was this tremendous relief. We realized that he wanted to go, too.

How did the hospital help your husband?
Chiefly it was the haven it gave him: he didn't have to worry about not responding to the outside world or to people close to him. He could just give up and be within himself and know that somebody else was going to call the shots. He knew he couldn't commit suicide, because the circumstances were not there for him. Initially it seemed to me that he had gotten much worse. They put him on so much medication that it began to look like 'One Flew over the Cuckoo's Nest.' But that passed quickly and in a few weeks he began to recover.

How was it different in his second depressive episode?

He had been on the lip of a depression for a while. In the spring, he gave excellent speeches and appearances, which were really better than anything he had done in his life. He was writing at the top of his form. But when he came home and didn't have to perform, it would be a very low time for him. I recognized an up and down pattern and it bothered me a lot. It also bothered him.

After he had a bad allergic reaction to one medication, he wanted to try a different treatment. So, he went to the hospital. But, the treatment itself was initially disastrous. It made him go further and further down hill, not only mentally, but also diminishing the physical health he once had. I watched him become depleted, tentative, and finally lose 50 pounds. He refused to eat and had all kinds of psychoses, which changed day by day. The psychoses had a little germ in reality, but then became 99% fantasy. Physically and mentally, he deteriorated at such an alarming rate that it didn't look like he was going to recover.

What has helped you cope with your husband's depression?
My family. I have four wonderful children and an extended family of in-laws, grand children, and a marvelous cadre of friends. I am able to talk and share things with three generations of kin and pals. They have been so wonderful: they make sure that I get away, to get my athletics and travel in. Bill has recovered in this miraculous way that none of the doctors or our close acquaintances and family ever thought he would. So we have renewed faith in the body, the mind, and the world around us.

How hard is it to be the caregiver, and still focus on your career and family?
In this last year, I couldn't focus on anything else. I never wrote a poem. If I went to a meeting, I couldn't focus and certainly couldn't run a meeting. I didn't do any of things I like to do, for or with my children or friends, unless they came and grabbed me. There was only one focus. I think you can't pay attention to other things as much as you want to do. Your mind isn't there. Since doctors are so busy and specialized, I found that I was the one who had to make the connections. I had to tell one doctor what the other doctor prescribed, or what Bill did or did not do an hour ago or a day ago that didn't get recorded or considered. Once Bill miraculously recovered, I went overboard and pursued two careers and traveled too extensively.

You developed a mantra, 'stop, look, listen, hang on', how does this help?

I have a tendency to run when I should be walking and walk when I should be sitting. So for me 'stop' means to stop what I'm doing and focus on Bill and 'look and listen' to Bill. Does he look different? Has his speech slowed or become higher or lower? Has his face become slightly mask-like? These are signs for me. I look to see if he moves differently, if his pattern of activity changes, if his pleasures diminish or something odd becomes heightened. And when I see these signs, I say to myself, 'hang on', let's see what's going to happen next. I don't leave or go to sleep. I hang around. It is important to me, both to track it and make sure it is different tomorrow.

What advice do you have for families?
It is important to observe your spouse or son, daughter, mother, whoever it is, for a long period and try to remember how they were a year, ten, or twenty years before and how they have changed. I recommend keeping a diary, because everybody forgets. It's a diary of adversity and change. You can look back on it and realize that this situation can get better.

You also have to make sure the depressed person really knows that you're on his side. You need to show that you understand what's going on, and that you're not coming at this from some scientific or social perspective. You also have to say what you really believe, even if the person gets even angrier with you, or depressed in the moment. I would advise not to take personally any slights, snapping, or change of plans. The person is so inside his own head and his reaction may not be objective.

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