The Noonday Demon: An Atlas of Depression

Reviewed by: Ivan Oransky, MD

Disclosures

November 08, 2001

Introduction

By Andrew Solomon
Scribner
Copyright 2001
571 pages
ISBN: 068485466X
$20.00 hardcover

Perhaps because the unexamined life is not worth living, according to Socrates, writers with depression have examined their lives quite often. Literary personal narratives about mental illness, particularly depression, have become a sort of genre unto themselves. There's William Styron's Darkness Visible,[1] Kay Redfield Jamison's An Unquiet Mind,[2] and, most recently, Nell Casey's collection Unholy Ghost,[3] among countless others. Despite the crowded field, many of these are uniquely powerful and instructive, opening a window into a world of suffering.

Into the genre comes Andrew Solomon's The Noonday Demon: An Atlas of Depression. On the continuum, Solomon's entry falls somewhere between Styron's -- that of a layman writing only about his own experience -- and Jamison's, based on her own experience but drawing on her training in psychology. Solomon, a layman novelist and nonfiction writer, manages to synthesize painstaking research and personal narrative into a compelling book.

Solomon spent 5 years researching and writing this book, which got a boost from an extremely well-received article on his depression in The New Yorker in 1998,[4] and it shows. His understanding of the nuances of the illness, his command of important facts and figures, and his ability to analyze the material rival that of many psychiatrists. Yet the book, chock-full of information as it is (though not in fact an "atlas" like Frank Netter's Atlas of Human Anatomy, for example) is eminently readable.

One of the book's many strengths is that Solomon is adept -- in ways that many physicians find themselves hamstrung -- in explaining difficult concepts simply and evocatively. Often this is accomplished through metaphors. Describing the relationship between mild depression and major depression, which he conflates with "breakdowns," he writes: "It takes time for a rusting iron-framed building to collapse, but the rust is ceaselessly powdering the solid, thinning it, eviscerating it" (17). These and other explanations would make this an excellent book for doctors to recommend to their newly diagnosed patients. Solomon also skillfully weaves the history of how various cultures looked at depression, and the contributions of philosophy to the illness, while giving the condition breath and life through stories from those souls disrupted by the disease.

It's not difficult to find stories of a disorder that affects some 15% of the population, but Solomon's use of such anecdotes is quite effective. Some may bring the reader to tears, like the one about the Cambodian woman who was forced to watch as soldiers raped her daughter, then murdered her. And there is the incredibly poignant story of how Solomon's mother, suffering from terminal ovarian cancer, committed suicide with the help of her family.

But there is no wasted treacle or pathos in these stories, just important lessons about endurance, recovery, and hope. The Cambodian woman, Phaly Nuon, set up a successful orphanage and center for depressed women in Phnom Penh, and has been a candidate for the Nobel Prize. And Solomon is only relieved that his mother was able to take control of her own pain and suffering. Other stories are more typical of the experience of depression in that they do not revolve solely around major life trauma, and they remain powerful.

Solomon is careful to disclose his own potential conflict of interest: his father is chief executive of Forest Laboratories, US distributors of Celexa (citalopram). Despite being the financial and medical beneficiary of the pharmaceutical industry -- he lists a number of medications he has taken or still takes -- he is hardly an apologist, or an unthinking booster, of the industry. As he does with many of the other contentious issues in the book, he takes a measured, sanguine approach to the subject. Big pharmaceutical executives are neither unscrupulous misers nor saints. He believes in medications, as well as in other biological interventions such as electroconvulsive therapy, but he also believes strongly in psychotherapy. "Medication and therapy should not compete for a limited population of depressives; they should be complementary therapies that can be used together or separately depending on the situation of the patient," he writes (101). And he's absolutely right to cast aspersions on psychiatrists who wish to maintain the ridiculous and counterproductive war between these "two minds."

Solomon makes a good deal of the increasing incidence of depression, attributing it at one point to "modernity" (31), but he fails to take into account the fact that increasing numbers of diagnoses do not necessarily mean that there are more patients with the disease. Just as in any disease, as diagnostic techniques change or become more sensitive, the number of diagnoses can increase without any change in the population with the illness. The premise and conclusion of the chapter on "Evolution," in which he describes the work of evolutionists who've studied the history of human depression, is also questionable. Solomon ignores, as others have, the fact that human evolution has largely disembarked from the journey prescribed by Charles Darwin's natural selection. Human civilization protects many who might have otherwise perished, and that's nothing to be ashamed of. It's not necessarily helpful to ask, as Solomon does, "Why would such an obviously unpleasant and essentially unproductive condition occur in so large a part of the population?" (401). It assumes some hidden benefit or exception to the rule, when in fact that answer may be "just because," or "it's an historical artifact of no real significance." Still, the discussion of potential answers is illuminating, and Solomon admits that a definitive answer is less important than the discussion.

A refreshing sense of humor emerges. "My favorite," Solomon writes, "came from a woman in Tucson who wrote simply, 'Did you ever consider leaving Manhattan?'" (136). Indeed, Solomon is an optimist, and he ends the book on an uplifting note, with a chapter entitled "Hope." The book aims to be an important tool, in the struggle to "remove the burden of stigma from mental illness." Although every one of the 443 pages of text is about depression, The Noonday Demon manages to be moving, provocative, and thoughtful without really being depressing at all.

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