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The Noonday Demon: An Atlas of Depression
By Andrew Solomon
Touchstone Books
Paperback 576 pp $16

When I first began taking antidepressants 20 years ago -- long before the Prozac era -- the topic was virtually taboo. Although I recognized that the pills I was taking were essential to my emotional well-being, I felt ashamed of needing them. I told only a few close friends that I was taking antidepressants, and carefully monitored their reactions before disclosing my shameful secret to others.

Times have certainly changed. Since Prozac (the first of a new class of antidepressants called SSRIs that also includes Zoloft and Paxil) was introduced in the late 1980s, the subject of depression has come out of the closet. People now compare notes on their antidepressant drug regimens at cocktail parties the same way they chat about jobs or apartments. And many widely read books, most notably psychiatrist Peter Kramer's Listening to Prozac, have helped introduce the subject of depression to a broader audience.

With so many books on the market about depression, it is often difficult to find the most compelling ones. However, Andrew Solomon's passionate and riveting study, The Noonday Demon: An Atlas of Depression, is one that shouldn't be overlooked. (Derived from one of the Psalms in the Bible, the phrase "noonday demon" aptly conveys the destructive forces of depression.) Both a memoir and a journalistic investigation, it won the National Book Award for nonfiction in 2001.

For anyone who has suffered from depression, or is close to someone with the condition, it is a valuable resource. By exploring depression from multiple perspectives -- personal, medical, cultural, historical, and political -- Solomon incorporates information from many different sources, and develops his theme with a sense of genuine compassion for those who suffer from the illness.

That number, of course, includes Solomon himself. Throughout the book, he shares the details of his own harrowing descent into depression, which he believes was triggered by his mother's early death from cancer.

Solomon is a graceful and eloquent writer, and more often than not his prose succeeds in conveying the distinctive despair that depression can cause: "It seemed to take the most colossal effort to do simple things," he writes. "I remember bursting into tears because I had used up the cake of soap that was in the shower. I cried because one of the keys stuck for a second on my computer. I found everything excruciatingly difficult, and so, for example, the prospect of lifting the telephone receiver seemed to me like bench-pressing four hundred pounds. The reality that I had to put on not just one but two socks and then two shoes so overwhelmed me that I wanted to go back to bed."

Such personal descriptions of depression can be moving and informative, but The Noonday Demon really distinguishes itself when Solomon moves beyond his own experiences. One of the most illuminating aspects of his study is an examination of depression among different demographic groups. After exploring the various theories seeking to explain why women have higher rates of the ailment than men -- a phenomenon he ascribes to both biological and sociocultural factors -- he addresses the often-overlooked problem of depression among the elderly.

Not only are the elderly frequently isolated from family and friends, he explains, but reduced physical ability and the decline in the level of neurotransmitters in the brain can wreak havoc on their emotional well-being. Unfortunately, he adds, even those close to the elderly frequently fail to recognize the condition. "The elderly depressed are chronically undertreated, in large part because we as a society see old age as depressing," he writes. "The assumption that it is logical for old people to be miserable prevents us from ministering to that misery, leaving many people to live out their final days in unnecessary extreme emotional pain."

Solomon goes on to examine the critical link between poverty and depression. Stereotypes about people on welfare include the idea that they are lazy or simply irresponsible -- in other words, that their plight is the result of character defects. Yet Solomon cites research indicating that the rate of depression among welfare recipients is three times that among the general population, even as their access to treatment remains far below middle-class standards. Moreover, it can be difficult to diagnose depression among the indigent, since dissatisfaction with their lives is understandably endemic.

"This means that most people who are poor and depressed stay poor and depressed; in fact, the longer they stay poor and depressed, the more poor and depressed they become," he writes. "Poverty is depressing and depression is impoverishing, leading as it does to dysfunction and isolation. In this era of welfare reform, we are asking that the poor pull themselves up by their bootstraps, but the indigent who suffer from major depression have no bootstraps and cannot pull themselves up."

The book is populated by fellow sufferers whom Solomon interviewed at length, and he relates their stories of pain and courage with sensitivity and understanding. He also occasionally extends his exploration beyond the Western viewpoint, discussing depression among Cambodians and the Inuit of Greenland, for example. In an entertaining episode, he describes his travels to Senegal to undergo a "ndeup" -- a traditional ritual designed to placate the spirits believed responsible for causing mental illness.

Solomon finds the procedure, which involves drums and blankets and dancing, as well as the blood and intestines of a ram, unusually invigorating, not the least because it does not presume that the sufferer is somehow to blame for the condition. "It provided a way of thinking about the affliction of depression -- as a thing external to and separate from the person who suffers," he writes.

On occasion, when he writes about his own struggle with depression, Solomon's novelist voice veers dangerously close to melodrama. The accounts of his three breakdowns can also feel repetitive and, at times, indistinguishable from one another. But these are small faults that don't detract from the book's power. Ultimately, Solomon manages to make The Noonday Demon an uplifting book. In a final chapter called, appropriately, "Hope," he relates how he has come to terms with his mental ailment, and has even learned to embrace it. The happiness attained in the face of anguish, he writes, shines all the brighter because he is aware of how tenuous and fragile it really is.

"Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping," he writes. "I hate those feelings, but I know that they have driven me to look deeper at life, to find and cling to reasons for living. I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely and sometimes against the moment's reason, to be alive. Is that not a rare joy?"

-- David Tuller, a former staff writer for the San Francisco Chronicle, has written for The New York Times, the Washington Post, and Salon.com. He is also the author of "Cracks in the Iron Closet: Travels in Gay and Lesbian Russia" (Faber &Faber 1996).

First published June 4, 2003
Last updated November 21, 2007
Copyright © 2003 Consumer Health Interactive