I bought The Noonday
Demon: An Atlas of Depression,
by Andrew Solomon (Scribner,
2001) soon after its publication, I
resisted the reading. I had read both
Joyce Carol Oatess review in the
June 24, 2001, The New York
Times and The Hidden Plague, by
Solomon in Out, July 2001. I knew
the impact of Mr. Solomons
writing. We had swapped emails
following the article on his mothers suicide in The New Yorker in 1998. Both of our mothers bore two sons; we were each the elder. What Mr. Solomon shared about his mother in The New Yorker article, I anticipated about my mother in his book. I wanted to read it in a setting where the topic might be most contrasted, so I took it to Hawaii.
My goal was to savor one of the twelve chapters per day. I boarded the return plane not having read half of the 571 pages. When I landed in Providence, RI, I had five pages left and read them before going to sleep that night. A friend who suffers from depression met me at the airport and heard my reaction to the book on the drive home. She said, I could have been one of those people he wrote about. I have to wait for the short version. Id love to read it but dont have the attention span. I dont think Ive read two books all the way through since... I cant remember when. She typifies the effort Mr. Solomon exerts communicating for those who are depressed, trying to accomplish what many take for granted in a day. Time, much time, is lost by those who have depression, and search as they may, like Proust, they learn it is lost forever, sometimes, even to memory.
The life of one depressed is uniquely distinguishable and bound with the lives of those around him so that the two elements become a third, like flour and yeast and water becoming dough. Depression strikes all economic classes, though Mr. Solomon becomes an advocate for the economically disadvantaged with depression.
Mr. Solomon has researched his book thoroughly and received the National Book Award for his efforts. As I read the pages, I wondered how much he left out, what notes he had sacrificed because the book was controlling him versus the reverse. Chapters VII, History, and XI, Evolution, I read with less interest than the others but recognize their importance to the authors continuing journey, his roadmap, his atlas, through this affliction. And, there were chapters and stories I finished with disappointment because I wanted to read more of what they offered. For example, Chapter XII on Hope, with its introduction of Angel, can and should be read by non-sufferers with gratitude and by sufferers with relief and prayer.
Mr. Solomon makes frequent literary references, spicing the work with the words of Shakespeare, Dickinson, Keats, Whitman, et al., but the most profound words other than his own are by Angel on p. 425:
As I write this, snow squalls.
In the four pages discussing A Note on Method, Mr. Solomon writes of the five years it took to write the book and the various twists and turns he encountered along the way. The author explains, Writing on depression is painful, sad, lonely, and stressful. Nonetheless, the idea that I was doing something that might be useful to others was uplifting; and my increased knowledge has been useful to me (13). Cathartic? No. But here is a spokesman for those who cannot communicate because depression eats their energy. His credibility is enhanced by his experiences. Drugs. Sex. Violence. He has lived them and writes about them personally and generally, striking an enviable balance that keeps the reader intrigued.
The following chapter synopses are intended to help those, like my friend, who do not have the attention span to read the book and, even in small chapter dosages, need a guide, and to encourage readers to explore the book itself.
Chapter I: Depression
The author defines the term and the origin of depression in the body, the brain, where chemical imbalances produce depression without ones control. Depression hits us all differently and in varying degrees. The distinguishing element is duration: how long a depression lasts determines whether you suffer from it beyond the expected experiences of life. The causes remain unknown, and one cannot control ones thoughts in its midst, yet depression teaches. Mr. Solomon offers a solution: Love. It sounds natural and agreeable but practicing it is the challenge.
Chapter II: Breakdowns
Mr. Solomon shares how the order of his life was disrupted by an intruder on little cat feet, sneaking in like Carl Sandbergs Fog, a metaphor for the state one experiences. Sometimes there is a forecast, little squalls before the storm. Sometimes there is no warning. There may be fear, abandon, a disintegration of the senses, and anxiety. A lot goes on in a depression, and the author shares the technical aspects of its presence.
Once predisposed to depression, the brain can return to it. What can happen to us physically, with heart damage for example, can happen mentally to our minds, and we need to recognize the significance of that possibility. It may never really leave. It may be triggered. Breakdowns are boxsteps two forward, one back. It may run in families. It certainly affects families and friends.
This chapter resonated for me because of my mother. I tried to imagine her experiences in the early part of the last century. She was born in 1914 and attempted to share with me some of what she could remember about her breakdowns. In those days, a visiting doctor gave B-12 shots, and no one understood the resistance to life. It was hell. My mothers last breakdown forced my father to agree to electroconvulsive therapy (ECT), shock treatments. I was in the service at the time and agreed that he did not have a choice. Commitment is scary, and caring for her himself strained a difficult relationship between two people who didnt know what was going on. The treatment got her to live with the depression, but the episodes continued in varying degrees until she died in 1980, at age 66, of her first myocardial infarction. Stress was not a descriptor in those days, but Im sure a factor in her bodys dis-ease. She took available medication. She lacked the bootstrap gene and the self-reliance gene.
Now, there is improved medication. When you find it, take it; when it no longer works, find something else and take that and continue the medication, Mr. Solomon advises. You play chemical roulette.
What depression does to a relationship is overwhelming. Between two people, it is an intruder. Among more, it is, in Keatss words, La Belle Dame Sans Merci, the beautiful lady without mercy. Housewife activity probably preoccupied my mother, so she had no time to entertain the intruder until time allowed. Then, like an unwanted guest, it entered, walking in like the night. The worst of depression lies in a present moment that cannot escape the past it idealizes or deplores. (99).
Chapter III: Treatments
Mr. Solomon simplifies the treatment therapies into two divisions: talking and physical (which includes medication, electroshock, and ECT). One should complement the other. Consider who coordinates both these treatments. He advises meeting with a therapist whom you like. Of course, this makes sense, but so often, when vulnerable and indecisive and apathetic, we rely on others for decisions. Even under duress our instincts deserve attention.
Solomon discusses cognitive-behavior therapy (CBT) and interpersonal therapy for attaining the best records under talking therapy. On page 111, he cites English professors as helpful as professional therapists because of the quality of human understanding they possess. Teachers of English acquire adjunctive cross-discipline talents for persisting in reading and grading to a degree that other teachers do not. Writing and art can play a role. Side-effects must be considered with medication. Antidepressants affect the phases of sexual experiences; some people experience libido overflow. Viagra helps boost testosterone. Solomon admits to feeling like a dartboard for meds. Researchers are working in four new directions: prevention, specific drugs, faster drugs, and symptom versus biological position.
According to Solomon, the most successful physical treatment is the least clean, ECT, and he presents the procedure. Many want to live without drugs, but throughout the book, Mr. Solomon supports medication. There is a difference between being addictive and being dependent. Depression is a mental illness. Living with depression is like trying to keep your balance while you dance with a goat. (125). It is like being in a body with an alien director, the brain. He writes sensitively about faith and hope, and his last chapter, on Hope, is a stunner that I call the Book of the Bible according to the Disciple Andrew Solomon. For one with depression, living is the hardest work of life.
Chapter IV: Alternatives
Depression is a disease of thought processes and emotions, and if something changes your thought processes and emotions in the correct direction, that qualifies as a cure. (137). Exercise, diet, light boxes, massage, herbs, etc. deserve consideration. Homeopathy and journal writing are discussed within the books limits. Exercise produces endorphins; energy begets energy, like sugar craves sugar.
Solomon discusses friends and the buddy system and support groups. Surgery is a last resort and cingulotomy, in which a hole is drilled in the front of the skull and electrodes destroy brain tissue, results in no permanent change in memory or cognitive or intellectual function (164). The author also traveled to West Africa to participate in a ndeup ceremony, an animist ritual that predates voodoo. Gene therapy is remote. Solomons personal experience bolsters his credibility and adds intrigue to the facts.
Chapter V: Populations
No two people have the same depression. (173). More women than men suffer from it, which becomes more significant for mothers, with the effect on the mental health of children. Anaclitic depression occurs in young children. They need therapy as depression inhibits personality development. The elderly, African Americans, East Asians, gays, and the Inuits of Greenland, who are sunless for three months a year, each have significant experiences with depression.
Mr. Solomon writes that depression is underestimated in teens. In my 32-plus years in the classroom, I saw teens latching on to labels and letters too easily. Some wore ADD (attention deficit disorder) like a tattoo and with pride. The statement that 50% of high school students have thought about killing themselves makes me wonder, but Solomon documents it on page 461 (George Colt, The Enigma of Suicide, p.39). Suicide is discussed in literature and life, and some teens associate with the act when they hear and read of other teens committing suicide. Certainly, once it occurs in a locale, others imitate. For many teens, weighing what is serious and what is fleeting involves miscalculation, and something as serious as suicide deserves investigation regardless of how camouflaged or in what manner usually joking it surfaces. I think the statistic that is even more crucial about teens is the nearly 100% who don’t think that adults listen to them.
Chapter VI: Addiction
Mr. Solomon makes addiction comprehensible. He presents technical terms and may lose readers temporarily in the quality of substance he provides, but it is the simplification of complicated connections that demands that the book be read in its entirety; readers should not feel that a review suffices.
Put simply, addiction takes on a life of its own regardless of how one got there. Self-medication with illicit drugs defeats its purpose because the drug craves more drugs, having inhibited the sensitivity of dopamine receptors (a chemical in the neurotransmitters of the brain). Depression may be the cause of substance abuse; depression may be the result of substance abuse; depression may alter or exaggerate substance abuse; depression may coexist with substance abuse without affecting it; depression and substance abuse may be two symptoms of a single problem. (221).
Caffeine, nicotine, alcohol, and genes are discussed. Many still believe that marijuana is manageable. However, it is anti-motivational, and its leaves contain 400 identifiable compounds with unknown effects (229). Teens need to know this. Drugs exemplify the more is less cliché: the more you want the less pleasure you get. Mr. Solomon gives attention to opiates, hallucinogens, benzos (benzodiazepines see what I mean about doing his homework?).
Solomon states he is no longer independent, but reliant on drugs a cousin of addiction (237). Drugs may help you tolerate the misery, but medical advice and coordination is essential. As with a therapist, find someone you trust and like.
Chapter VII: Suicide
While discussing this review, a colleague asked me, How does one survive to write about suicide therapy?
Depression makes the consideration of suicide prominent. Is suicide a human right? Should people be forced to live against their wills? For every successful suicide there are sixteen attempts (251). How prone someone is to suicide is determined by personality, genetics, childhood and rearing, alcoholism or substance abuse, chronic illness, and cholesterol level. (253).
Often we cite reason as something that differentiates us from other animals. Suicide is also a differentiation. Suicide is chronically underreported. (259). Though he admires his mother for her suicide in 1991 (ovarian cancer) and wrote about it in The New Yorker, in 1998, he cites it as “the cataclysm of my life” (268). As scary as suicide may be, for some, including Mr. Solomon, losing the ability to commit suicide is even more haunting.
Chapter VIII: History
Depression has been with us a long time. Discussion of early description and treatment of depression throughout history and literature could fill a book; Mr. Solomon gives it pages 285334. Of most interest is the source for the book title, The Noonday Demon, which comes from Cassian, who, in Psalms, describes what we define as depression as the noonday demon, melancholia, a sin that consumes the day and night. Most demons need the cover of night, but Depression stands in full glare of the sun, unchallenged by recognition. (293).
I have used the term demons in a students sentence to stimulate writing classes: You dont know the demons in my head. That sentence has elicited some of the liveliest writings and class discussions from both teens and senior citizens. My friend, waiting for my Mr. Solomon abridgement, often tells me of the voices in her head, which she also calls the demons. Though I understand the need for the chapter, I did not find it as essential as others.
Chapter IX: Poverty
If the previous chapter elicited minimal interest from me, this one was a dark horse one I expected to be mildly interesting and turned out to be one of my top three. In it, Mr. Solomon advocates for a class to which he doesnt belong, without giving other classes or groups the same space of attention, thereby highlighting povertys singularity. So often, we advise people to pull themselves up by their bootstraps. Solomon says the poor may have no bootstraps and cannot pull themselves up (336). In my own life, especially with reference to my mother, I have often asked, What if you dont have the bootstrap gene?
The poor require intervention, medication, and therapy. They often pass problems on to children. As a society, we could save money by treating the poor, among whom there is no depression screening. Solomons reaction to case studies and his inclusion of people and their stories fascinate in the same way we rush toward an accident but turn our faces at the gruesome sights.
The truth I had discovered was intolerably stranger than fiction. (360). Mr. Solomon had to rewrite a version of the chapter in a newsmagazine because editors thought that readers would not believe it. We need to empower the trained and professionals.
I liked this chapter, particularly, because Mr. Solomon states that, by helping adults with depression, we help children, who will then have a chance at a better life.
Chapter X: Politics
The topic of this chapter put me off; the writing put me on. Mr. Solomon makes sense about the attention that is necessary to devote to politics regarding depression. Politics determine treatment, by whom, where, diagnosis, and funding intervention. Definitions influence policy, which affects sufferers. Depressed people are the new invisible people. Depression is the last label in the frontier to be revealed, and coming out about it must be encouraged.
Some of us exude confidentiality to friends but continue to hear the warning about not sharing what we were told. The warning is especially reiterated when the topic is depression. There is a danger, here, of being tiresome, believing that all anyone wants to hear about is your depression. Prejudice is alive and well around this disease, too, even though notables have experienced it.
It is costly: $2,0002,500 for the simplest depression, and three weeks of hospitalization starts at $14,000 (371). Mr. Solomon has gone to Washington as a journalist and activist and requested a hearing on suicide because we lose 31,000 people a year to it. The state with the best record for those depressed? Pennsylvania, where exemplary supportive systems exist. Depression, like sex, retains an unquenchable aura of mystery. It is new every time. (400).
Chapter XI: Evolution
Where and how does depression fit in with the development of human beings? Though somewhat technical, I think Solomon included this chapter because, without it, his credibility would be vulnerable, and its inclusion is essential to the cause of treating depression.
Chapter XII: Hope
This is my favorite chapter. If you can only read one chapter in the book, make it this one. In these pages, you will meet Angel, whose poem I quoted earlier. Here, you will read his purpose and his bias, the need for a sense of humor, irretrievable time, the importance of love, and what you can do for depressed friends and relatives. The slogan is blunt their isolation (437), and I include it here because of the importance of the message and to confound any delay of action and because people need each other now.
Notes, bibliography, and index sections end the book. I have used each of these sections to find more information, and I praise their inclusion. For his sake, I hope that the next adverse topic about which Solomon writes he has to experience vicariously. If there is any gift from his experience with depression, it goes to the reader. Solomon has made depression understandable. As an atlas, it is only one mans journey, but he speaks for many who deserve to be heard by so many more.