He chronicles “the leaden and poisonous mood” (Styron, 1990) that occupies most of his days. He reflects his diminished interest and pleasure towards “exceptionally island’s pleasure”, his “beloved home”, writing and other activities that he used to enjoy. He wonders how his friendly place seemed so hostile and forbidding. As a writer it felt helpless and painful to him when he found out “the writing becomes more difficult and exhausting, finally ceased” because depression has made him unable to concentrate.
Styron’s statement of “two or three hours of sleep I was able to get at night” indicated that he suffered from insomnia and the everyday sleepless was “a rare torture” to him. It was clear that his insomnia evolved from middle insomnia to severe insomnia just right before his hospitalization (Andreasen & Black, 2011). Styron also stated his slowed psychomotor functions that manifested in “slowed-down responses, near paralysis, psychic energy throttled back close to zero”.
Styron further describes his mental illness severity as “reached the phase of the disorder where all sense of hope had vanished, along with the idea of a futurity”. While these particular descriptions depict Styron’s hopelessness and despair, he also proposed a question “Why wasn’t I in a hospital” which implies his later voluntary hospitalization and improvement in his illness. In addition, Styron constantly thinks about death and suicide evidenced by “Death, was now a daily presence”. His house has also become a place that was filled with possibilities of committing suicide.
These core symptoms in Styron’s case defined major depression and has presented for more than two weeks (American Psychiatric Association, 2000). Styron stated by himself that there was no manic episode occurs. And there were no evidence for a Mixed Episode. Although it was clear that client’s alcohol abuse history and his overuse of sleep medication play roles in his depression client’s depression are not due to the direct physiological effects of the substances or any general medical condition (American Psychiatric Association, 2000).
It is interesting to address that client’s symptoms are not better accounted for by Bereavement but the unresolved grief Styron had toward his mother can be consider a major factor that contributed to his depression. The childhood trauma and the unresolved grief will be discussed later in this essay. In Styron’s case his depression began gradually during the six to eight month time frame. “Styron is on point in his astute description of milder dysthymic states that evolve into physiologically engaged forms of sever, endogenous depressions” (England, Ganzer, Foster, & Tosone, 2006).
Based on client’s current situation it is reasonable to give Styron “moderate” with current GAF score of 65. Styron stayed in hospital for nearly seven weeks and discharged with an improvement in his illness and his functions. All of his statements of “I began to get well, gradually but steadily” “the fantasies of self destruction disappeared” “suicidal notions dwindled then disappeared” “had first dream in many months” indicated that he was in the process of Partial recovery. Not only he started to feel “peace” in his mind but also he was able to attend hospital group activities.
Styron has high adaptive level of defensive functions at current state. The understanding of the causes of depression has evolved over centuries. While Styron was detecting his “forgotten or buried events” that underlay his depression it will be important to look into his case through the biopsychosocial lens. From biopsychosocial model perspective the three major factors which all play a role in causing depression are biological, psychological and social factors. There are three aspects that contribute to Styron’s biological factor: genetic, alcohol use and medication.
Based on Styron’s memory, his father, a shipyard engineer, suffered from clinical depression. When Styron was a young boy he have witnessed his father’s depression and hospitalization. Recent genetic research supports earlier studies reporting family links in depression (Pittenger & Duman, 2008). If one or both of child’s parents have a vulnerability to depression, then it can be transmitted to the child. Therefore Styron’s father’s depression can be viewed as a risk factor to Styron’s later depression.
In the narrative of Styron, he stated his dependence on alcohol and the overuse of Halcion for his sleeping problem. Excessive alcohol consumption significantly increases the risk of developing major depression (Gottlieb). Similar to alcohol, the increased risk for developing depression in benzodiazepines might be due in part to effects of drugs on neurochemistry, like decreased levels of serotonin and norepinephrine (Pittenger & Duman, 2008). Styron himself acclaims that “more significant factor” (Styron, 1990) to his depression was the death of his mother when he was thirteen.
In order to view psychological factor in Styron’s case Styron’s early mother lost has strong affect on his depression. Attachment theory predicts a relationship between depressive disorder and the early bond between the child and parents. Particularly the experiences of early loss, separation may all lead to insecure internal working models (Ma, 2006). To Styron, the death of his mother has “created nearly irreparable emotional havoc” (Styron, 1990) for him. This huge hole in his life may lead to his insecure and self-worthlessness.
This insecure internal working models manifest through depressed individuals often blaming themselves for negative events and may not taking credit for positive outcomes. Styron reaction towards can be interpreted as he subconsciously felt he was not worthy of the honor (Marowitz, 2009). Regarding Styron’s own insight of “incomplete mourning” (Styron, 1990) he is right about the unsolved grief can keep bring the “insufferable burden of rage, guilt and sorrow”. “The Styrons were a dignified Southern WASP fanily and open displays of grief were tacitly discouraged” (England, Ganzer, Foster, & Tosone, 2006).
Since Styron was stuck in the phase of unresolved grief and using rage, guilt, and sorrow as the fuel for his work he never really learned a correct way to release his negative repeating emotions. Social factor in Styron’s case may be his social isolation during his early life from childhood to adolescent. As an only child in the family Styron’s social support can only come from his depressed father and mother with terminal illness. There was no one to share the burden and loneliness with him. As a pre mature and gifted child Styron went to school’s grade that did not match his developmental stage.