Memoir Case Study
Clinical depression is a source of health concern that can affect any person. The memoir “Darkness Visible” by William Styron spans through his experience with this condition. The memoir outlines Styron’s live with the condition, diagnosis, challenges, dangers faced and therapy. In his struggle with depression, Styron’s social life had been adversely affected, and he resorted to such as alcohol. His social life had deteriorated to the point of lack of worth for his life. It is such moments of worthlessness that he attempted suicide. Styron explains that the cause of his depression was the death of his mother. During his life, Styron had lived in denial of the condition. His diagnosis started with his acceptance of the condition and subsequently seeking medical attention from his psychiatrist.
Diagnosis
During his life with clinical depression, Styron’s emotions are inconsistent with some instances feeling worthless and unappreciative. He is portrayed to have low self-esteem to the point of doubting his existence. According to American Psychiatric Association (2013), Styron is likely to be suffering from major depressive disorder (MDD). This inference follows from the emotional disturbance that he portrays in the article that results in suicidal ideation. The following sections seek to support this inference by evaluating DSM-5 criterions for MDD.
Black, Grant and American Psychiatric Association (2014) explains that MDD patients show affection withdrawal symptoms. Patients often have a progressive decline of interest in activities they previously enjoyed. For instance, Styron had lost concentration in the afternoon, which was his working time. Moreover, his interest in his wok and social interaction continued to decline with much of his time spending in solitude. Another criterion for MDD patients is that they often experience insomnia. Styron states that he would often have instances of insomnia. Another consideration for MDD patients according to DSM-5 is feeling of being fatigued and worthlessness (American Psychiatric Association, 2013). Styron states that he would often experience moments of restlessness and malaise. Styron’s attempt to commit suicide is an excellent illustration of a case of worthlessness.
According to Black, Grant and American Psychiatric Association (2014), another criterion for MDD is that patients are depressed most of the day. In the memoir, Styron is portrayed as being depressed most of the times. Another essential criterion for DSM-5 is that MDD should have been consistent for about two years. In ascertaining this fact, we consider the fact that Styron experienced his first instance of depression when he was 13 years old. The situation is seen to have progressed until his adulthood. Therefore, Styron has been living with the condition for much of his lifetime. Styron’s personality is shown to favor solitude. In his memoir, he states that he felt immense solitude at some point in his life ( Styron, 2010).
DSM-5 requires exclusion of mania or hypomanic conditions (American Psychiatric Association, 2013). In no instance has Styron been portrayed to exhibit personalities of a maniac or hypomanic. Moreover, it is essential to ascertain that the physiological effects experienced by MDD patients do not result from substance abuse or another medical disorder (Black, Grant & American Psychiatric Association, 2014). Styron had been abusing alcohol for much of his lifetime. However, the physiological influence of alcohol is nullified by his explanation that he used it for enhancing his imagination and induce euphoria and fantasy. In his statement, Styron says that “But my behavior was really the result of the illness…” (2010). Therefore, Styron’s condition was not due to alcohol use. It is also prudent to exclude schizophrenia, schizoaffective and delusional disorders while diagnosing a patient with MDD. Syron does not show instances of abnormality in his thought process. In any case, he used alcohol to induce instances deferring from reality, which he claimed were essential in his work.
In DSM-5, MDD patients are expected to exhibit social impairment and withdrawal from their critical functioning areas. In his memoir, Styron shows lack of appreciation of his work and social withdrawal. Moreover, he experiences difficulty interacting with other individuals in the society and even family friends. “At dinner I was barely able to speak, but the quartet of guests, who were all good friends…” (Styron, 2010).
Alternative Diagnosis
A possible alternative diagnosis in Styron’s situation is Substance-induced depressive disorder. This disorder is exhibited by mood disturbances that are induced by physiological dependence on a drug (American Psychiatric Association, 2013). Styron had been abusing alcohol for a significant part of his life claiming that it enhanced his work. He had abused alcohol for forty years, and it is shown to have affected his behavior.
However, considering the entirety of the memoir, diagnosing Styron with substance-induced depressive disorder fails to explain behavioral abnormalities in some circumstances. For instance, Styron would still experience situations of depression even after he stopped taking alcohol. Moreover, his depressive condition is shown to have started earlier in his life long before he begun using alcohol.
Treatment Plan
Styron is suffering from a severe depressive episode without a psychotic disorder. According to World Health Organization (2015), the code for this disorder is F33.2. It involves low self-esteem with instances of suicidal thought. From the memoir, it is evident that antidepressants helped to alleviate symptoms. However, the continued symptomatic evidence requires an inclusion of psychotherapy (Davidson, 2009; Fochtmann & Gelenberg, 2005). The treatment plan will involve the following interventions;
- Use of antidepressants such as serotonin-specific reuptake inhibitors (SSRIs) that have more efficacy and few side effects compared to other medications (Beevers, 2011).
- Interpersonal psychotherapy (IPT) would be essential in this case. Styron had been suffering from depression mainly due to denial of his condition. Therefore, an IPT would be essential in helping Styron identify and deal with his condition and helps improve medical treatment (Beevers, 2011; Milin, Walker & Chow, 2003).
- According to Seligman (2004), Styron could be encouraged to get involved in physical activities and others that will help improve his confidence and esteem. This treatment plan will help counter suicidal ideations that Styron experienced at some point.
- Behavioral marital therapy would also be effective in the case of Styron (Beevers, 2011). This approach would be essential in eliminating the existing marital discord due to communication distancing in the family.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Ed. Arlington, VA: American Psychiatric Association.
American Psychiatric Association. (2013). Desk reference to the diagnostic criteria from DSM-5. Washington, DC: American Psychiatric Publishing.
Beevers, C. G. (2011). Introduction: Evidence‐Based Practice for Major Depressive Disorder. Treatment of Depression in Adolescents and Adults, 1-19.
Black, D. W., Grant, J. E., & American Psychiatric Association,. (2014). DSM-5 guidebook: The essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition.
Davidson, J. R. (2009). Major depressive disorder treatment guidelines in America and Europe. The Journal of clinical psychiatry, 71, e04-e04.
Fochtmann, L. J., & Gelenberg, A. J. (2005). Guideline watch: practice guideline for the treatment of patients with major depressive disorder. Focus,3(1), 34-42.
Milin, R., Walker, S., & Chow, J. (2003). Major depressive disorder in adolescence: a brief review of the recent treatment literature. Canadian Journal of Psychiatry, 48(9), 600-606.
Seligman, L. (2004). Diagnosis and treatment planning in counseling. Dordrecht: Kluwer Academic/Plenum.
Styron, W. (2010). Darkness visible: A memoir of madness. New York: Open Road Integrated Media.
World Health Organization. (2015). ICD-10 Version: 2015.
