Book Review

The Noonday Demon: An Atlas of Depression

N Engl J Med 2002; 346:632February 21, 2002

Article

The Noonday Demon: An Atlas of Depression
By Andrew Solomon. 576 pp. New York, Scribner, 2001. $28. ISBN: 0-684-85466-X

Andrew Solomon is a successful and much admired author. He writes regularly for a number of periodicals and is an award-winning novelist. By his own account, he grew up as a healthy, happy, white American from a privileged background. He enjoyed positive relationships with his family and had a strong network of friends. Yet, in the early 1990s, depression crept up on him and took over his life, so that even getting out of bed and going to take a shower became an overwhelming challenge that he frequently failed to overcome. Despite success in his career, he became unable to undertake the simplest tasks, had frequent periods of intense anxiety, and avoided social contact with friends.

Solomon can give no easy explanation of why he is vulnerable to recurrent depression, and he does not associate any specific events with the onset of the episode he describes in detail. However, he clearly had all the classic symptoms of a major depressive episode and was so debilitated by this disorder that he returned to live with and be cared for by his 70-year-old father.

Solomon describes the incredible sense of loneliness that characterized this time in his life, and he writes graphically about the despair and hopelessness he felt. He tried a number of treatments, including psychoanalysis (which he says was “like firing a machine gun at the incoming tide”) and various types of medication (some of which he used simply to obliterate the day). Not wishing to kill himself by more conventional means, he decided, with the logic that characterizes a man on the edge, that indulging in frequent unsafe homosexual sex with strangers would put him at high risk for AIDS. He reasoned that if he contracted AIDS, he could finally escape his miserable existence, but he could also die in a way that would cause his family less distress than a sudden suicide and, he believed, would be more acceptable to the rest of society.

In the opening chapter of The Noonday Demon, Solomon digs deeply into his experiences and takes us on a vivid journey through his personal hell. However, he does not stop at the analysis of his own breakdowns; his insights into depression span not only autobiography, but also the scientific and historical roots of depression, its treatment, and the effect of this disorder on the Western world. Thus, this book is neither an autobiographical account of the experience of clinical depression nor a textbook exploration of the theory and therapy of this disorder. Solomon explores depression from personal, social, and political perspectives.

Such a project is ambitious, and those who have had clinical depression may be disappointed that he does not try to console other sufferers or to offer specific self-help techniques. Clinicians may quibble about his definitions and descriptions of various treatments and their mechanisms of effect (for example, he calls cognitive therapy a psychodynamic psychotherapy). However, such criticisms miss the point. Solomon has made an important contribution to the public understanding of the notion of depression. He uses his considerable skills as an author to explore the problems of definition and diagnosis — when, for instance, does human sadness become clinical depression? He derides attempts to use mathematical formulas to measure the severity of depression and emphasizes the need to view depression as a human condition afflicting the mind as well as the brain.

Solomon rails against the use of terms such as “chemical” in discussions of causation — not because he fails to recognize the importance of biologic change, but because such reductionist terminology is meaningless. Solomon cogently argues that, in the end, everything about a person can be described as chemical if one wishes to think in those terms: if depression is chemical, then so is love and so is intelligence. He also exposes the apparent conflict between the tendencies, on the one hand, to trivialize major depression and, on the other, to use selective serotonin-reuptake–inhibitor antidepressants as a panacea for an array of nonclinical problems. He makes a strong case for the appropriate diagnosis and treatment of clinical depression and deplores the ignorance that leaves many without the chance to receive adequate or appropriate treatment that might “give them back their life.”

One of the amazing things about this book is that Solomon writes about depression, loneliness, and his loss of belief in a capacity for love with humor, vitality, and passion. Although the personal meaning of his depression is a background theme throughout the book, the accounts of his interviews with sufferers, clinical experts, and health policy advisors, along with the opinions he expresses repeatedly, reveal his curiosity, intelligence, and wit. Although the focus is on the misery of depression as experienced by persons from various social and cultural contexts throughout the ages, this is not a depressing book to read. It is an accessible book that persons from clinical and nonclinical backgrounds can and should read.

Solomon gives insights into the experience of depression (he describes it as a living death) but manages to avoid trading in clichés. His candor about his own fight against depression and the elements of the experience that challenged him to learn, to change, and to salvage something positive do provide some hope for the future. He denies that the goal of writing the book was catharsis, stating that his intention was rather to reach out to others who experience the terrible isolation that results from depression. The author writes that the horrific loneliness he endured when he was depressed has enabled him to value intimacy. He expresses the view that, ultimately, this episode has made him a better person, and he concludes by reflecting, “each day I choose to be alive, is that not a rare joy?”

Jan Scott, M.D.
University of Glasgow, Glasgow G12 0XH, Scotland