Book Review: The Noonday Demon. An Anatomy of Depression by Andrew Soloman

Vintage UK 2002 Random House ISBN 0-09 927713-1

Autobiography/Mental Health UK £8.99

The title is puzzling for those of us educated in an Old-Testament -free
zone. Our curiosity is not satisfied until Chapter VIII where the quotation,
 from the psalms, appears. It also appears in the index, which is really
 comprehensive and well organised; fifteen pages of small print covering
 everything from adrenaline to Xanax.

Early scholars interpreted the noonday demon as ‘weariness and distress of 
the heart’ and Solomon chose the phrase because it describes so exactly
 what one experiences in depression:

Most demons – most forms of anguish – rely on the cover of night; to see 
them clearly is to defeat them. Depression stands in the full glare of the 
sun, unchallenged by recognition. You can know all the why and the
 wherefore and suffer just as much as if you were shrouded in ignorance.
There is almost no other mental state of which the same can be said.

Andrew Solomon emphasises he is not a doctor, psychologist or even
 philosopher. He is a writer and his writing is a pleasure to read. This book
 is a vivid narrative of his own story and those of many others, interleaved 
into an exhaustive account of  ‘the historical, social, biological, chemical
 and medical implications of this crippling disease’. Chapter headings
 include populations, addiction, suicide, history, poverty, politics, evolution
 and hope.

Before any of this, the book explores the perennial question: what is
 ‘depression’? How does it differ from sadness? Solomon suggests:

Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance. It is tumbleweed distress that thrives on thin air…it can be described only in metaphor and allegory. Grief is a humble angel who leaves you with strong, clear thoughts and a sense of your own depth. Depression is a demon who leaves you appalled.

The old debate between chemical treatments and the psychological therapies is thoroughly investigated. Not surprisingly the author dismisses 
the either/or approach and firmly takes the view that both are essential. You 
have to keep fighting the malaise, with psychotherapy and, if necessary,
 with drugs. ‘To take medication as part of the battle is to battle fiercely, and 
to refuse it would be as ludicrously self-destructive as entering a modern
 war on horseback. It is not weak to take medications.’

It must be said – and Solomon says it early on – that he is generally in
 favour of the pharmaceutical industry, in spite of its faults. His father 
worked in pharmaceuticals. He argues-and it is hard to disagree- that we
 would not have the SSRIs that have saved so many lives, without the
 companies that sponsored the research. Their motives were not solely profit 
driven, he claims, but we may suspect that it is capitalism more than 
altruism that fuels progress. We must also be very vigilant regarding 
research into side-effects.

The chapter on alternative treatments is surprisingly funny and hopeful -
something of a relief after so much melancholia.

It used to be said that despair was a sin against the Holy Spirit. Others-not 
Solomon-see depression/melancholia as a search for the Divine. The 
message he finds in the psalms is, however, full of hope:

His truth shall compass thee with a shield:
Thou shalt not be afraid of the terror of the night
of the arrow that flieth in the day
of the pestilence that walketh in darkness:
of invasion, or of the noonday demon.

Paula Loughlin