Reprinted from Barron’s, September 3, 2001
Depression
Guide: You’re Not Alone
The brave art of
fighting the deep blues
The Noonday Demon: An Atlas Of Depression
By Andrew Solomon
Scribner & Sons
571 pp., $28
Reviewed by David L. Nathan, MD
Who has failed to notice the overwhelming number of books
in the Self-Help and Psychology sections of bookstores these days?
Though few close the gap between good science and good reading,
Andrew Solomon’s The Noonday Demon succeeds brilliantly. This is
a multidimensional, complex work, and may be the best lay guide
ever written for understanding and surviving depression.
The book consists of self-contained sections on different aspects
of depression. People personally touched by depression, either as
sufferers or as friends or family of the afflicted, will find the
book front-loaded with countless pearls of wisdom on depression
and its many modalities of treatment.
The author, himself afflicted with severe depression, has done his
homework, drawing extensively from the most respected sources in
the field. He provides dozens of first-hand accounts of people who
have experienced depression, although the heterogeneity of his and
others’ personal experiences shows that depression is a final, common
pathway of many different psychological and physiological processes.
Solomon, in choosing not to limit his discussion to the most common
depressive illness, known among psychiatrists as “major depression,”
allows more people to see their own situations in the stories he
However, this approach could also lead the reader to confusion.
Bipolar disorder, thyroid imbalance and childhood trauma can all
lead a person to depression, but the causes are obviously very different.
Likewise, different people need different treatments. Antidepressants
can often be lifesaving, although they can make some with bipolar
disorder worse. He outlines proven courses of treatment, putting
heavy emphasis on the combination of medications and psychotherapy.
And he stresses the potentially lethal dangers of undertreating
depression.
There is an informed discussion about alternative treatments, which
includes a look at the studies of their safety and efficacy. Solomon
avoids the pitfall of elevating alternative approaches over conventional
ones. “That God put a certain configuration of molecule into
a plant and left another configuration of molecule to be developed
by human science hardly recommends the first arrangement over the
”
Solomon’s personal experiences loom large throughout the first part
of the book, which is understandable given that he continued to
suffer recurrences even as he did his research and writing. He looks
at the stigma and shame that often drive the issue underground,
although he suggests that his self-disclosure “... made it
easier to bear the illness and easier to forestall its return. I’d
”
Solomon is honest, sometimes painfully so, when discussing his own
story of self-destructiveness, suicidal thoughts and noncompliance
with treatment. Somehow, the author even succeeds in injecting a
wry sense of humor, for example when he notes the isolation he felt
at what should have been a pleasant dinner party: “I’m afraid
I can’t actually follow what you’re saying because I’ve been taking
”
In later chapters, the book waxes academic — for example in its
discussion of how depression affects different populations, categorized
by gender, age, sexual orientation, ethnicity, and degree of substance
abuse.
In a chapter entitled “Evolution,” he pursues the elusive
answer to the question of why humans suffer from depression, focusing
on the proposition that depression is too common in humans to be
There is a concise chapter on approaches to depression in different
times and cultures, a generally sad discussion of dark times that
helps explain our current biases against psychiatric illness. The
author also looks at depression among the poor, and how society
might start to better serve this under-treated group.
In “Politics,” perhaps the most important chapter of the
latter half of the book, Solomon focuses on how Americans as a society
He points out that, while federal and state governments struggle
to pass mental-health parity legislation, depression costs the United
States an estimated $43 billion annually. Insurance companies strongly
oppose providing coverage for psychiatric conditions on a par with
other medical conditions, even though both can lead to suffering,
loss of work productivity, societal ills and death. The author critiques
the accomplishments and shortcomings of all sectors of mental health-care
provision.
While this book should become the standard layperson’s text on depression,
it has some shortcomings. Although the chapter on suicide deals
mainly with its connection to depression, there is a lengthy philosophical
discussion of “rational” suicide, an inappropriate digression
As in other works of this genre, it seems as if the author romanticizes
his and others’ experiences, though perhaps this is a necessary
device to capture the reader’s attention and bring the illness to
life.
Finally, Solomon’s writing style is highly intellectual, which may
make the book inaccessible to some of its target audience: The acutely
depressed tend to lack the ability to concentrate well enough to
read at this level. Solomon’s wisdom will be very valuable to family
and friends of depressives, inasmuch as it provides an indispensable
and unique tool for helping and understanding loved ones. And it
is probably even more valuable for those readers who have little
personal experience with depression, because it provides a clear
window into the illness.
At the outset of the book, Solomon invokes the theme of depression
as a teacher, and in this finds the support of many writers throughout
history.
The close of The Noonday Demon is a
view of the future, drawing upon what Solomon has learned and gained
from depression. He concludes, “The opposite of depression
is not happiness but vitality, and my life, as I write this, is
vital, even when sad.”
