It is so infuriating to hear I Smile Back labelled as an ‘addiction drama’ because that utterly misrepresents this bleak but honest exploration of Depression and mental illness. Yes, New Jersey housewife Laney Brooks has a dependency on alcohol and drugs, but these are a symptom, rather than a cause, of the anguish that she experiences every day. Despite an obvious love for her husband and two children, Laney is crippled by Depression and finds little joy in her day-to-day existence. As is so often the case for those suffering from this most debilitating illness, Laney engages in all manner of self-destructive behaviours – from substances to sex – unable to prevent herself form jeopardising everything she holds dear. As Laney, Sarah Silverman delivers a remarkable performance devoid of pretence and brimming with authenticity. It is easy to imagine that for anybody who has not experienced the psychologically destructive nature of Depression – either personally or vicariously – or those who simply refuse to accept that it as a legitimate ailment, Laney presents as a selfish, somewhat pathetic figure. However, her behaviour and the treatment of those around her are driven by a desire to inflict the misery upon herself that she believes she deserves. One of many humiliations sees Laney antagonising a man she is having sex with in the back room of a bar, goading him to hurt her.

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Adapted from a novel by Amy Koppelman, which was based on her battles with Depression and self-loathing, I Smile Back is at times difficult to watch as Laney battles to keep control of the psychological demons that want to destroy her. She is mired in a fog of Depression that she cannot shake, despite a stint in rehab and her daily dose of medication. The film is remarkably accurate in its portrayal of the way in which this affliction can take control of your behaviour with no regard for the impact on those around you. Silverman’s performance is more than attention-getting awards bait – as anybody familiar with her portrayal of a similarly damaged character in Take This Waltz can testify — and it is probably safe to assume that her performance is influenced significantly by her own battles with Depression. Silverman’s Laney embodies the self-abuse, recklessness and public humiliation of somebody for whom each day is filled with anguish and a sense of hopelessness. In the opening moments, it is easy to think that perhaps Laney is simply dissatisfied with her role as a wife and mother, but we soon realise that her misery is far more deep seeded than that.

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Wisely, director Adam Salky never attempts to offer any definitive cause of Laney’s affliction because it is impossible to know for sure given the myriad theories that surround depressive disorders. Certainly, there are those things that exacerbate her condition, such as the resentment she feels towards the father (Chris Sarandon) who walked out on his family, but Laney’s despondency and despair extends far beyond her abandonment issues. Laney’s insurance-salesman husband Bruce (Josh Charles) is a pompous, wannabe self-help guru whose unctuous efforts to lure clients are often undermined by Laney’s acerbic barbs. He professes his love for Laney and, initially at least, he does all the right things to help her, but when he tells her “I just want you to be happy, like you used to be” the subtext is clear; he is sick of having to deal with the fallout from her behaviour, effectively delivering an ultimatum that she has to get better or else, as if there is some magic switch that can suddenly make years and years of self-loathing disappear.

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More so than any other film I can recall, I Smile Back delivers genuine insight into the difficulties of living with Depression, delivering an acute understanding of the torment and tumult experienced by those helpless to eradicate the urges that compel their self-destructive tendencies. Silverman’s performance is something quite special in a film that really needs to be seen. At a time when Depression, mental illness and suicide are at an all-time high, these are the types of stories that can help to bring the issue even more into the public consciousness. Confronting and heartbreaking at times, many will find this a hard slog and there is certainly no shiny, happy pay-off at the end, but I Smile Back might just be one of the most important films of the year; and one of the best.