My guest today is Andrew Solomon, journalist, lecturer and best-selling author of The Noonday Demon: An Atlas of Depression [Scribner, 2001; Please note: The Noonday Demon is being reissued this month with a new chapter that brings it up to date].
JB: Welcome to OpEdNews, Andrew. Your book won many awards and has been translated into two dozen languages. It's become a national best-seller in seven countries. Why do you think there has been so much global interest in the subject?
AS: The issue of depression is a universal one. It is, as I sometimes have said, the family secret everyone has. It seems to me that there have been many good books about depression, but that they have been somewhat disparate. There has been a proliferation of books about the science, books about the psychodynamics, books about history, personal memoirs, and so on, but nothing that brought them all together. My book is synthetic; it pulls together all these discourses. I'd like to think that in doing so, it mitigates some of the isolation that is the bane of depressives, both by showing those suffering depression that they are not alone, and by giving them something to explain their state to friends or parents or spouses who don't seem to understand. One of the symptoms of depression is the belief that no one else has ever been through anything comparable. This book provides some ballast in the other direction; it demonstrates that there is no life untouched by depression, that those who are not themselves afflicted must know others who are.
JB: Contemporary Americans seem to feel proprietorial toward depression, that it's a modern, local phenomenon. That is both true and totally untrue. Can you explain, please?
AS: One of my objectives in writing my book was to break down the idea of depression as a modern, Western, middle-class illness by demonstrating that it has existed across cultures, across history, and across socioeconomic groups. In looking at non-Western models, I went to Cambodia and looked at depression among survivors of the Khmer Rouge; I went to Greenland to look at depression among the Inuit; and I went to Senegal to study tribal rituals for the treatment of depression. I ended up participating in an Ndeup, a West African ritual for the treatment of depression that reach its apex when I was put in a makeshift wedding bed, in the central square of the town, with a ram, while the entire village danced around us in concentric circles. At a key moment, I was yanked to my feet, my loincloth was pulled off, the ram's throat was slit, and I was covered in the blood of the freshly slaughtered ram. I met numerous people who said their lives had been changed by the Ndeup, and some years later, when I was in Rwanda working on my next book, I recounted this experience, and the person I was talking to said, "You know, we don't have anything quite like that here; this is East Africa and it's different. But we had terrible problems with Western mental health workers after the genocide here. They used a technique that did not involve getting out into the sunshine, like what you've described; didn't involve music, which gets the blood flowing; didn't entail specifying the depression as an external invasion that could be cast out; and didn't involve opening up about the need for help and involving the whole village in support. Instead, people were taken one at a time into dingy little rooms and asked to talk for 50 minutes about how miserable they were. Which just made them feel worse, and we had to put a stop to it." So I came away from that experience thinking that while depression is a universal, ideas of how to respond to it are highly culturally specific.
I went back and looked at historical documents about depression. Depression has been described for at least 2,500 years and known, I'm sure, for much longer than that. Hippocrates' definition, so far as I'm concerned, is closer to the mark than the strange mathematics of the DSM-4 with its checklists of symptoms. Hippocrates described an illness that afflicted his patients. He said it most frequently occurred in the autumn and winter. The symptoms, and I quote, were "sadness, anxiety, moral dejection, tendency to suicide, aversion to food, despondency, sleeplessness, irritability and restlessness, accompanied by prolonged fear." I think that's very clearly depression as we know it. There was tension between Hippocrates, who said that was this was an organic dysfunction of the brain that should be treated with oral remedies--which is to say that he didn't have the SSRIs, but he had the idea of the SSRIs--and Plato, who insisted that it was a philosophical problem that needed to be addressed through dialogue, which is essentially the idea of psychoanalysis or of the talking therapies as a general category. They argued about it quite a lot. And they argued about it in much the same tone of voice in which it gets argued about today. Hippocrates denounced Plato's version, saying that all that philosophers have written on these natural sciences no more pertains to medicine than to painting. Plato, meanwhile, had harsh words for Hippocrates' failure to understand the complexity of the human soul. These were urgent arguments.
The search for oral remedies became wonderfully bizarre. Chrysippus of Cnidus, one of Hippocrates' followers, believed that the answer to depression was the consumption of more cauliflower, and he cautioned against basil, which he said was likely to make people depressed. And Philagrius, another follower, believed that depression came from the loss of too much sperm in wet dreams and prescribed a mixture of ginger, pepper, epithem and honey to control them--a remedy which seems to have gone out of vogue. What's really interesting, though, is that in the ancient world, depression was seen as no more of a stigmatized or terrible illness than something like dyspepsia. It was talked about quite openly. The people who had it used the word "melancholy" or various version of the world "melancholia" quite readily. And that remained true through the early Christian period. Then Thomas Aquinas categorized all illnesses as illnesses of the body or illnesses of the soul, and he classed the mental illnesses as illnesses of the soul.
It was at that moment that this enormous stigma became attached to depression, because an illness of the soul was a mark of God's disfavor and therefore a very shaming thing. Shortly thereafter, in the Spanish Inquisition, the idea was put forward that people who were severely depressed had despaired of ultimate redemption and that they therefore were not true believers. So you could actually get imprisoned or even executed for being depressed in Inquisition Spain. It was from this medieval theology that the stigma that still holds to depression originally rose. What's extraordinary about reading all of this historical material is how specific and how peculiar the arguments are about depression being a shameful business.
As we see with Hippocrates and Plato, a lot of the arguments that we think of as very contemporary arguments have actually run throughout history. After that medieval period when there was enormous stigma attached to depression, there followed a renaissance tendency to glamorize depression and to look at it as reflecting a depth of feeling and soul. This is the time of the wonderful writings of Robert Burton on the subject of depression. The Age of Reason saw depressives as people who didn't have very much reason, and they were therefore dealt with quite harshly. So things swing back and forth throughout history. The one thing that does seem to be true is that the more effective the treatment, the more readily the illness is acknowledged. Chekhov once said if many treatments are prescribed for an illness, you may be certain it has no cure. And depression certainly has no cure. But it does have many treatments. As these treatments have proliferated, acknowledging of the illness has come to be more fruitful. If you acknowledged that you were depressed in medieval Spain, not only were you in trouble with the Inquisition but also, what did you do once you'd acknowledged it? There was nothing to be achieved; you were given emetics and told to get on with your life. Now, there's a great value to acknowledging you're depressed because you can seek out meaningful treatment. As people perceive that, more people talk about it.
JB: What a juicy answer! Now that we've dispelled the notion that depression is an illness of our particular place and time, let's nevertheless turn more local. After all, this is where we find ourselves. You mentioned earlier that "no life [is] untouched by depression". What do you mean by that? Can you provide some numbers and/or statistics to back up that claim?
AS: I'd be more inclined to produce anecdote. I meet a great many people, and I've yet to meet anyone whose response to my commenting on depression has been other than: "I've been having a rough time for years" or "I'm so worried about my sister" or "My boss seems so withdrawn at the moment." Or something else along those lines. It's not that everyone has the condition--not at all. But everyone who is woven into the social fabric has had to deal with depression's effect on someone they know or love, and those who are not woven in are often not woven in because they are already depressed. Any condition that directly affects as much as twenty percent of the population will have an indirect effect on everyone else.
JB: When I heard you speak last fall, you had strong opinions and a lot to say about what we should do if we suspect that a loved one is suffering from depression. It was a long way from "just be patient; it'll blow over." Can you please reprise the gist of that message?
AS: Depression is a disease of loneliness--both real and imagined. A depressed person will often express the wish to be left alone because human interaction feels stressful and purposeless. But don't leave depressed people alone. Alone is where the condition escalates; alone is where it devolves into suicide. Sometimes a depressed person can't manage much interaction and you need to sit by his bed. Sometimes, she can't bear to have you in the room, and you have to go sit outside the door. But don't ever go away any farther than that. The cornerstone of resilience is the knowledge that you are loved, and that knowledge slips away from depressed people when there is any possibility of doubt. Don't push the depressed person to do what he cannot do; don't press her to dance on a broken leg. But be gently encouraging, so that she or he can remember that there is a life worth living on the other side of the disease.