Books/Film
The Noonday Demon: An Atlas of Depression
A book review by Andrew E. Slaby, M.D., Ph.D., M.P.H.
The Noonday Demon: An Atlas of Depression, by Andrew Solomon (Scribner April 2002, paper, 576 pages, ISBN: 0684854678)
Marcel Proust, the French writer who was recurrently depressed (but did not suicide) wrote: “Just as a lover listens to his beloved, so too does a person in pain listen to his body.” People who die by suicide do not want to die; they simply want to end the pain often caused by depression. If there were another way to end the pain, they would seek it. Failing to find a source of reprieve, they become hopeless. More than depression, hopelessness predicts who will die by suicide.
No current book could be described more aptly as a discussion of the anatomy of melancholia, a term used by Robert Burton for his 17th century treatise on his own depression, than Andrew Solomon’s Noonday Demon. The title of the book is taken from Cassian, who wrote in the fifth century of the “sixth combat” with “weariness and distress of the heart”; that, he said, was the “noonday demon,” spoken of in the 19th psalm, and which produced disdain, disgust, sluggishness and contempt for other men.
In this well-researched, documented and skillfully crafted volume, Solomon has woven his own struggle with depression and the impact of the death of his mother with a state-of-the-art review of what is known about the etiology of depression and its treatment. He describes medical interventions as well as alternative therapies used throughout the world (some of which he sought out and experienced himself) and places them in a historical and cultural context. He also discusses his experiences with various forms of treatment, including self-medication with drugs. The impact of depression on various populations (including women, the aging, and medically infirm) is discussed, as are factors that converge to make them consider, or in fact die by, suicide. In addition to a detailed discussion of the pain he has experienced, he includes a number of other examples drawn from interviews of friends, patients both within and outside of hospitals, in other cultures and in multiple social strata.
The chapters on addiction and suicide and the discussion of animal models of depression are particularly thought provoking. Reflecting on the use of drugs and alcohol at times of despair, he characterizes depression as enabling addiction. Resisting desire takes too much will and energy. When you are depressed, it is hard to say no to drugs, alcohol or, for some, food. Depression weakens the person, and Solomon feels this weakness is the surest way to addiction. This may explain why substance abuse is so often the presenting sign of depression in adolescents – a group that does not show the same degrees of sleep, appetite and sexual interest disturbance we see in depressed adults.
Suicide, the author contends, is at least as independent of depression as is substance abuse. Some who suicide have not demonstrated symptoms of depression or at least have not experienced it for some time. As our understanding of self-inflicted death grows, we are learning that impulsivity even independent of depression may be important in understanding who is at risk for suicide. Some people suffer all their lives and daily think of dying or wanting to be dead, but, despite the ravages of psychiatric disorders, the pain associated with chronic illnesses or poverty, or existence in concentration camps or psychological, physical, and sexual abuse, do not kill themselves.
The discussion of animal models of depression illustrates the complex role of environmental stress, corticosteroid production in the body, neurotrophin and neurotransmitters. Human beings are not alone in experiencing the pain of loss, depression or suicide. Attachment to another can lead both to experiencing the pain of loss, as well as the limitation of life’s experiences, even for subprimates. Solomon cites what appears to have been a suicide of an octopus trained to perform in a circus. When the circus was disbanded, the color hue of the octopus changed, indicating to zoologists an alteration in mood after no one paid attention to the repertoire of tricks it had learned to entertain spectators, and it stabbed itself. In other instances, serotonin levels in the brains of monkeys were found to decrease when separated from their mothers in infancy, resulting in psychotic behavior. Dominant males moved from colonies of marsupials into other colonies where they were not dominant experienced weight loss, disrupted sleep and lowered sexual performance. Antidepressants that increase serotonin were shown to reverse the trends in both instances. In fact, as monkeys rise in dominance in peer groups, enhancing their power, their serotonin levels rise.
Solomon ends the book with an optimistic note. He explains that while he does not enjoy experiencing depression, he “love(s) the depression” itself and what he learns of himself while in it. It forces him, he contends, to look deeper into life and find and cling to reasons for living. He finds it a “rare joy” to choose each day, sometimes gamely and sometimes against reason, to be alive.
Whether or not you agree with his affirmation that depression not only obliterates joy, but also teaches us a great deal about joy, it is hard to disagree with him when he says:
“If you read these pages closely, you can learn how to be depressed; what to feel, what to think, what to do. Nonetheless, the individuality of every person’s struggle is unbreachable. Depression, like sex, retains an unquenchable aura of mystery. It is new every time.” (p. 400).
Solomon leaves the reader with an understanding of the complexity of the struggle to live for one who is depressed, and sometimes of their decision to die.
Book reviewer Andrew E. Slaby, M.D., Ph.D., M.P.H., is clinical professor of psychiatry at New York University and New York Medical College, and is in private practice in New York City and Summit, N.J. Past president of the American Association of Suicidology (AAS), Slaby has authored or edited numerous books, including “No One Saw My Pain: Why Teens Kill Themselves.”
Award-winning book author Andrew Solomon is a regular contributor to “The New Yorker,” “ArtForum” and “The New York Times Magazine.” He is the recipient of the 2001 National Book Award and was a finalist for the “Los Angeles Times” First Fiction Award.
