Full disclosure -I suffer from depression. I take medication and participate in Cognitive Behavioral Therapy. I have tried to manage this depression unmedicated -I have exercised and ate ideally, and I’ve spent cumulative weeks and months living out of backpacks in the backcountry. I’ve meditated and even fought in amateur MMA. I have tried supplementation and nutritional remedies. None of this has been sufficient. I am in possession of the kind of brain that does not function well without pharmacological intervention. This is not something that reflects poorly on my value as a person, but, obviously, neither is it something I’m inherently pleased about. I am one of the luckier ones -my mood disorder responds well to a single frontline SSRI, at a relatively low dose that elicits few side effects. I do not need to keep in balance a constantly rotating program of disparate classes of drugs, and the medication I do take leaves me mostly unencumbered. It is off-patent, cheap, and easy for me to obtain -even if I were to lose my health insurance.
The Noonday Demon: An Atlas of Depression is by far the best book I have read on the subject. Andrew Solomon is not only a competent and engaging writer, but a humblingly studious and thoughtful one. His prose is subtle and incisive, and the human empathy he brings to his work is made even more powerful by his own debilitating experiences with the disease. The kind of writing he has done here might be described as brutal were it not handled with such care. Every line has the feeling of meticulous editing and reworking, the kind of obsessive polishing that only very good source material can stand up to. This book is personal narrative and case study and sociology and advocacy writing and medical exposition and history. It comes at the topic of depression with the aim of encircling the vastness of it and its many practical concerns in a totally holistic fashion. The evolutionary impetus for the disease is addressed, as is the history of treatment. Many people of every imaginable experience are profiled, and the research for all contemporary methods of treatment are examined. Race, gender, sexuality and class are all considered at their points of influence. At over six hundred pages, the book seems like a daunting endeavor, and I took my time with it, but I can’t think of any part I would want to cut.
Depression is a mostly unseen epidemic, and because many of the deaths that it contributes to are so seemingly unconnected, it’s difficult to say how many people die as a result of their depression, beyond the most obvious examples. But the taboo against discussing it seems to be growing weaker all the time, and everything we can do to further weaken it makes it easier for people who cannot yet seek vital help. In that vein, Andrew Solomon’s work is both compelling on its own objective merits and on the imperative conversations it opens up.