I have some suspicions about Andrew Solomon: he is the “heir to a substantial pharmaceutical fortune” that he is evidently too shy to talk about, which should automatically throw some uncertain light on his vast arsenal of content related to mental health, in particular depression. But his book Far From The Tree, deeply researched nonfiction about how parents handle children with mental, social and physical straits far different than their own, helped me make sense of the Columbine shootings in 1999, from which I was a mile away as a 7th grader and wasn’t able to begin processing until the 15-year anniversary. So I picked up his much older book, The Noonday Demon (published 2001) hoping for some similar guidance in a long-standing struggle of mine, which I alluded to in my last post. Depression has dogged me most of my life and it’s been taking much more ground lately, so I took The Noonday Demon out both in the hopes of help (more on why therapy isn’t working below) and to find afflicted others.
The first encounter I had with the book’s demon was with, not surprisingly, a Christian. The church has a long history of demonizing illnesses – meaning, locating the problem of pain, sickness or suffering on fallen angels crawling the planet at the behest of Satan to undo the works of God. There’s some deep and beautiful theology about the role of evil in human agony so it’s more complicated than that, but this swinging-from-the-rafters Pentecostal didn’t seem to care. She laid hands on me and began whispering a prayer of deliverance from demonic oppression; it was clear she had neither knowledge nor interest in the specifics of the noonday demon. “Send your warring angels to release her from the pull toward satanism. Cleanse her heart so she is no longer interested in evil but follows after only you.” She went on like this without inquiring how I was doing or how this was sitting with me for several more minutes, providing a perfect illustration for my first problem with the book.
Solomon asserts in the book and his other writings on depression that real, physical things are going on in the illness. This, what’s known as the biomedical model, has dubious and spotty evidence at best and is still only a theory (rather than a proven mechanism behind depression or any so-called mental illness). It’s confusing to assert the physicality of depression while mythologizing it by blaming a demon, which most people understand to be figurative and symbolic – except, obviously, for my lady minister on the bus. But either way, there’s a problem: her deliverance prayer felt extremely dismissive (I can’t imagine how it would feel for someone who isn’t a Christian) and victim-blaming, like maybe I wouldn’t be suffering if only I followed Jesus better. Connecting depression with a demon trivializes the sometimes utter debilitation since the modern world doesn’t think demons are real things; but it’s not accurate to say depression is a physical illness, either.
Solomon champions medications, even above, one gets the impression, therapy, and swiftly dismisses alternative forms of treatment. But the diagnostic criteria in the DSM does not include a range of serotonin levels that automatically indicate depression: it is “subjective experience” or “observation of others,” not any medical or genetic marker, that determines the diagnosis. But Solomon writes some people are not noticeably affected by severe cases of depression while others can be completely undone by milder forms of the disease. This just doesn’t make any sense. In the absence of solid, medical parameters, there is no objective way to measure depression (what else would account for five-and-counting iterations of the DSM?). What would constitute a “severe” depression other than the subjective experience – i.e. being “totally disabled” by it or the observations of others? At the same time, it is vitally important to remember, though, that, as a substance-abuse worker he quotes on page 429 says, functionality does not always indicate pain level.
It is common to refer to those we know are suffering from mental-health issues as “battling demons” in this culture and Solomon does explain – at the end – his reasoning for the title; still, my first encounter his book provoked demonstrated that we are not as a culture ready for metaphor in the realm of mental illness. In the chapter on treatments, Solomon actually, contradictorily enough, affirms the subjective nature of mental health, after coming down firmly and demonstrably on the side of chemical fixes: “If you try an exotic treatment and think you’re better,” he writes, “then you’re better.” This comes weirdly close to insinuating the same thing my bus deliverer did: that if you just try harder somehow, whether in prayer, Bible reading, thought patterns, whatever, then you’re better.
But, to read Solomon’s advice on treatments, the real ways you recover from depression are therapy and medication (and don’t worry about whether those medications were tested on animals). The conventional two-options approach he so commends fails to adequately acknowledge the structural and institutional contributors to depression (such as environmental devastation, economic turmoil, social prejudice, inability to find meaningful work, etc.). Therapy and medication can certainly be effective treatments but there’s a reason they’re not more effective (and why few new drugs are being developed): the “problem” of depression is not always on the individual suffering from it: it’s not, in my opinion, too far-fetched to hope that someday, “caring for the planet,” “getting special interests out of politics,” “eradicating soul-crushing labor,” and the like will be included in “treatment plans” for depression.
You’ve likely noticed that this post is heavier on the criticism side than my previous posts. This is to reflect the lack of back-and-forth interaction between and my first respondent. While the detailed discussion of issues I found with this book will continue in my next post, I was able to find more open engagement and actual dialogue so stay tuned.