We do not really know what causes depression. Or what constitutes depression. Or why one person gets depressed as a result of circumstances that do not trouble another. Yet illness of the mind is real illness, with real physical symptoms. Depression is the leading cause of disability in the U.S. for people over the age of five. A quarter of the world's population is affected by mood disorders. It seems endemic to modern life.
Hence the need to bring depression, and its sufferers, out of the shadows. Not that there's any shortage of material on the subject. Alongside some noxious self-help manuals, there have been remarkable personal accounts-William Styron's Darkness Visible, A. Alvarez's A Savage God-and excellent academic texts like Kay Redfield Jamison's Night Falls Fast. But Andrew Solomon's The Noonday Demon: An Anatomy of Depression (Chatto & Windus; 560 pages) is poised to become the book for a generation that, more than any other, has this "living death" at its core.
A contributor to the New Yorker and the New York Times, Solomon interweaves a personal narrative with scientific, philosophical, historical, political and cultural insights into what he describes as "the demon that visits at noon," when one least expects it. The result is an elegantly written, meticulously researched book that is empathetic and enlightening, scholarly and useful.
When Solomon had his first breakdown six years ago, he was a successful novelist, from a close-knit family, with a wide circle of friends. But shortly before his 31st birthday, "hell came to pay me a surprise visit." What followed is the hard stuff of severe depression. "My whole system seemed to be caving in," he writes. On his way home from the grocery store, he loses control of his bowels and soils himself. Over the following weeks, he becomes near-catatonic, unable to move, talk, eat or sleep. Aware of the ridiculousness of his situation, he nonetheless cannot do anything about it. He remembers "lying frozen, crying because I was too frightened to take a shower, and at the same time knowing that showers are not scary." He is "defeated by the difficulty of getting a piece of lamb chop onto my fork."
With psychoanalysis, the support of loved ones and a cocktail of antidepressants, Solomon starts to recover-only to find himself "feeling well enough for suicide." Wishing to end his life with the least possible damage to the people around him, he attempts-unsuccessfully-to become infected with hiv through casual sexual encounters. In a bizarre twist, the knowledge that he might die lifts his depression, which in turn diminishes the wish to die. After eight months, Solomon's first breakdown is quietly over.
In these confessional times, it would have been easy for Solomon to limit himself to a personal memoir. But he uses his story as a springboard for a wide-ranging discussion about depression. Prozac is especially popular, he explains, not so much for its efficacy as for its safety and comparatively minimal side-effects. The most successful physical treatment, he says, is the "least clean and specific" of all: electroconvulsive therapy, or ect. He criticizes the powerful Veterans Administration for spending less than 12% of its research budget on psychiatry, when mental disorders may be the biggest problem for American veterans. We learn that despite a dramatic rise in suicide among adolescents, the highest rate is among men over 65.
Most moving of all is Solomon's portrayal of the pain of others in different cultures and classes. In Cambodia, he is "humbled to the ground" by the story of Phaly Nuon, forced to watch as her 12-year-old daughter was gang-raped and murdered by the Khmer Rouge. She came through the darkness by "forgetting, loving, working" and now helps others do the same. He visits Greenland, where depression affects as much as 80% of the population. Yet the Inuits' taboo against "being a cloud in the sky for other people" prevents them from seeking help. Solomon's tales of suffering among America's poor, where depression occurs three times as often as among the general population, were rejected by a big-circulation newsmagazine as so "implausibly horrendous it becomes comical." Yet poorer people are often transformed after they are diagnosed as depressed. Being told you are sick, he notes, is infinitely more cheering than being told you are worthless.
Since his first breakdown, Solomon has suffered two relapses, one while writing this book. Depression is "always there, waiting in the wings." Yet he has learned to embrace his suffering, citing the Russian proverb that "if you wake up feeling no pain, you know you're dead." Depression has taught him "what it means to be human, what is good in being human." It has allowed him to come to terms with his terminally ill mother's suicide and forced him to confront his confusion over his sexuality. Solomon apologizes that "no book can span the reach of human suffering." This one comes close.