The Noonday Demon

As a change from normal, this post is going to be a review and assessment of "The Noonday Demon", by Andrew Solomon, which is one of the most significant assessments of depression, from someone who has - and continues to - experience it

Overall, the book is 450 pages long, and the pages have a lot of words on them. What is more, the words are not quick and easy. It is a difficult book to read, not least because the subject matter is very difficult and challenging. He tells some of his own story, his own depressive breakdowns. He did not have an easy time of it. It is an interesting insight into what depression feels like, for those who have not experienced it.

However, this is not, to my mind, the most important or significant aspect of the book. Rather, he then explores what depression means and implies in modern (American) Society. As a Brit, there are some times when the discussion is not completely relevant, but interesting nonetheless. He covers a number of topics: treatments;demographics;addiction; suicide;history;poverty;politics and evolution. He finishes with an interesting chapter on hope, which I will return to later.

The treatments mainly cover the various medications, and their history and development. While interesting, the work is becoming dated (the book was published in 2002), and most of this data updated is available in the internet. However he does cover ECT, a treatment that it would appear is more common in the US than in Europe. The European model is far more based on medications and talking therapies, whereas the US model was, it would appear, differently structured. Of course, this may have all changed.

The demographics is an interesting section. What becomes clear is that the big-scale statistics indicating that 1 in 5 women and 1 in 10 men will suffer from depression at some time in their life is reflected across most sub-groups, although there are some interesting and important differences. What becomes clear is that there are no groups who are immune, there is no-one who can claim that they could never suffer. One interesting population is the Innuit, who have an 80% change overall of suffering, which may reflect a cultural difference, but is also very sobering reading. We also find in the poverty section that being poor does seem to be a stronger indicator for depression, especially unreported depression. Once again, the differences between the US and the UK become significant - and should make another good reason for keeping and supporting the NHS - the cost in the US of people who cannot afford to be treated is probably very significant, although it is incredibly difficult to quantify.

The section on addiction is quite sobering reading. What is clear is that addiction can easily hide depression, sometimes, it would seem, serving to hide it completely, and the depression only becomes an issue if the person breaks their addiction - at which point the depression that may have been a driver for their addiction may overwhelm them. It is, apparently, not uncommon for recovering addicts to take their own life, which may be related to a depressive breakdown because they are no longer handling it through their addiction. The suicide section is also a challenging read, and one of the best assessments of suicidal feelings that I have read. The psychology of suicide is very complex, and exceptionally difficult to analyse, not least because one cannot do post-event analysis.

The historical analysis is very useful from a church perspective, because there are some churches today that are still reflecting the position that the church held on depression and suicide from centuries ago. The fear of mental illness historically - both in the church and in society - is disturbing reading, but also shows that untreated depression (and other mental illness) has been an aspect of society for thousands of years. What is more, the indications are that most mental illness does not get better if untreated, but may be hidden because the stigma attached to mental illness is substantial.

This stigma is still significant, even though it rarely results in a lynch mob or stoning today, and this does make the politics of managing mental illness a challenge. Once again, the book addresses the US situation, but the challenges of providing the support and resources to the mentally ill is the same wherever you are. This is especially the case for depressives, who are, by the nature of their illness, not liable to be motivated to action and to campaign over years for change. The real political problem is that resources for the mentally ill are not seen as contributing to the economy directly, although in truth, they do enable people to be productive. What is more, politicians are aware of the stigma of mental illness, and so are very unlikely to admit to it, meaning that there are very few active and experienced campaigners in the positions of power.

The discussion of evolution is addressing the question of why, from an evolutionary perspective, depression is still a significant part of our makeup. The conclusions reflect one of the core issues with treatment, that it is not clear what causes depression, or how it should be treated. The problems come because the factors that cause depression also seem to have other impacts, other effects, that might be positive. If he comes to any conclusions, it is that depression may be a result of the society we live in and the challenges of adapting to this society. It could, therefore, be argued that depression is a normal response to the society we live in, and those who do not suffer from depression are the ones who are deluded, the ones who do not see reality properly.

His final chapter on hope is a positive end to a difficult book. However, it also reflects some of my experiences, and may show a place for Christianity in treatment of depression in particular, and mental illness in general. Hope is critical to most illnesses, and hope is something that Christianity can provide. This is not to deny that sometimes Christians and the Church crush and destroy hope, but Christianity is about hope, it is about a belief that there is something more than the world we see around us. That is a really positive note to end the book on, which I was glad about.

Is this book worth a read? Well maybe, if you have the stamina and strength for it. It is not an easy book to read, but it does provide a vital insight into what depression actually means to the sufferer and to the society that we live in. Of course, realism does not make for gentle reading.