Medicine
Darkness Visible illustrates the controversies at the heart of treating depression. On the one hand, many of those afflicted do not want to be treated with drugs, believing that the root of their illness is not necessarily in their bodies but either in the world in which they live or in their spirit or mind. People in this camp often seek psychotherapy for treatment. On the other hand, a large part of the medical community itself staunchly defends the use of pharmaceuticals, arguing that depression is a result of faulty brain chemistry and that drugs are the most effective form of treatment for sufferers. Styron himself weighs both of these positions, writing:

The intense and sometimes comically strident factionalism that exists in present-day psychiatry—the schism between the believers in psychotherapy and the adherents of pharmacology—resembles the medical quarrels of the eighteenth century (to bleed or not to bleed) and almost defines in itself the inexplicable nature of depression and the difficulty of its treatment.

Styron never resolves the conflict for himself, partaking of both psychotherapy and antidepressants at various points. Although he ‘‘conquers’’ the disease by the end of his story, his claim that ‘‘the disease of depression remains a great mystery’’ remains his final word on depression. Depression, for Styron, is as much an affliction of the soul as it is of the brain, and he compares those who have endured the ‘‘despair beyond despair’’ to poets who have trudged up from hell into the daylight of emotional health.

Meaning
In a way, Darkness Visible is a meditation on loss and meaning. When his depression hits, he writes that he feels his ‘‘mind dissolving’’ and that his brain is full of ‘‘anarchic disconnections.’’ He loses his voice, his sexual desire, his physical energy, his ability to work, to communicate, to love. He has even lost the capacity to dream. All of the elements that conventionally define human behavior and identity are compromised. He describes himself as existing in a trance, unable to participate in the world in any meaningful way. The relentless whittling away of his world leads Styron at one point to contemplate suicide, the ultimate loss of self. Styron reflects on the relation between suicide and depression, making connections between the deaths of friends and acquaintances and their own struggles with depression or mood disorders. Such reflection, however, at least in retrospect, strengthens his conviction that many of these deaths could have been prevented if the victims (for example, Abbie Hoffman, Primo Levi, Albert Camus) had sought treatment for their depression. Meaning, Styron suggests, comes from the very act of surviving, of human courage in the face of a possibly meaningless universe. And cultivating meaning is more an act of human will than anything else. Styron recoups a degree of his own losses during his recovery from his writing about the disease. In the act of attempting to understand the experience of his depression, he reflects on the loss of his own mother during his childhood and speculates that his inability to mourn her death adequately may have contributed to his illness as an adult.