The noonday demon

This being the result of reading the twenty year old book about depression at reference 1. Written by Andrew Solomon who started out studying English in both the US and the UK, then moved into writing, and after writing the present book, moved towards mainstream psychology. So presently, as well as being a writer and a personality, he is also a professor of clinical psychology at the Columbia University Medical Centre – although, oddly, their elaborate website told me little about him beyond his being male and ‘Columbia University, Department of Psychiatry, Division of Gender, Sexuality, and Health, Professor of Clinical Psychology (in Psychiatry)’.

A book of about 450 pages of text, organised into twelve roughly equal chapters and with about 100 pages of stuff at the end. A survey of the world of depression. Long but readable – with the qualification that there is an awful lot of stuff here and it seems unlikely that it has all been properly checked. And quite possibly somewhat out of date. Probably bought as the result of an article in the TLS. The first read has taken me about a month.

The noonday demon of the title is taken from Psalm 91 (in the Anglican numbering), in which the sixth verse reads ‘For the pestilence that walketh in the darkness: nor for the sickness that destroyeth in the noon-day’. That is to say the depression that cripples during the day, rather than the demons which come at night. We are also told that in the Middle Ages, depression, wrapped up under something called accidie, counted as one of the nine deadly sins, since cut down to seven.

Later on it came to be called melancholia, the subject of the famous Dürer engraving to be found towards the end of reference 6. While the famous book at reference 7 came about 100 years after that.

Solomon tells us quite a lot about his own battles with depression, a complaint which is the cause of much misery, shame and stigma, so it seems right to declare some interest, in that my mother suffered badly from manic-depression during the last ten years of her life. On top of which, two of my siblings and two of my aunts had mental health issues. And both my father-in-law and mother-in-law worked in what might then have been called the mental health industry, that is to say in the closing years of the large, thousand patient asylums, recent notice of which is to be found at reference 3. I dare say that such a background is more common than one might think: there is a lot of mental disorder about.

Highlights

I move onto a few highlights from the book itself.

There is a great deal of depression about and, it seems, there always has been. Nothing new about it. And it is far from being an affliction of the educated middle classes in the west; it gets everywhere, although the recorded incidence does vary with time, place and circumstance. And about twice as many women suffer from depression as men, although it is not clear why this should be so.

A lot of this depression could be described as minor; something one can live with, something which you may be expected you to live with, without fuss. But some of it is major and disabling. One is reduced to almost nothing, almost incapable of any kind of action.

There is a lot of depression among the poor and among those who have been the subject of much stress, for example combat veterans and the victims of domestic or sexual abuse. Depression, schizophrenia, anxiety, substance abuse and poverty are all mixed in together, although it is often hard to say which is the chicken and which is the egg.

Most depression can be mitigated by appropriate medication. But it can take a while to get the medication right and it is likely that the sufferer will be on medication for life. A weakness for depression is not cured.

Depression is also mitigated by psychiatric attention. Or by sustained personal attention from someone that cares. The problem with this being that people cost more than pills.

Despite its once bad reputation, ECT is and remains a useful intervention for many cases of severe depression.

Perhaps particularly in the US, there is the feeling that one is responsible for one’s mental state in a way that one is not responsible for one’s physical state, complaints like lung cancer and cirrhosis of the liver notwithstanding. One should just buck up and pull oneself out of it. Generally speaking, mental disorders are matters for shame and stigma in a way that physical disorders are not. 

Which is perhaps part of why provision for mental disorders in the health plans sold in the US is often poor. With no provision meaning that you have to pay your way, not an option for many poor depressives. While we should not get too smug here in the UK: we might do not do health plans (yet), but we do not make enough provision for mental health either.

Depression might well be triggered by something bad happening, by some external trigger. But once depression has got a grip on a person, removal of those triggers does not necessarily lift that depression: the depression has taken on a life of its own and has to be addressed directly, in its own right. Opening a door to explanations of the psycho-analytic variety?

Speculations

Given the prevalence of schizophrenia, manic-depression and depression, it is reasonable to ask why natural selection has not weeded them out.

Part of the answer might that depression might be thought of as unreasonable or inappropriate grief, and one can argue that grief is a useful and necessary counterpart to the love which binds us together.

Another candidate is the argument that depression is a evolutionary derivative of the one-on-one fights about pecking order which are common in the world of large animals, fights which are often more of a ritual than a combat. Nearly all of us have to learn how to lose, and mild depression is part of that.

Another candidate concerns a failure of brain lateralisation. Humans are what they are because of cunning lateralisation, and sometimes this goes wrong. Some of this is addressed at references 4 and 5.

Another candidate is the Tree of Knowledge of ‘Paradise Lost’ of reference 8: we did not get depression until we knew about death, something one suspects that most other animals do not know about. And some workers argue that there is no knowledge without language, something else something that animals do not have, except in a very rudimentary fashion.

More generally, a brain is a complicated bit of machinery, which can go wrong and which does need maintenance. By way of analogy, think of a car – or perhaps of something much more complicated like a power station.

Some workers argue against the categorical classification of mental disorders. Arguing that while a strong schizophrenic is quite different from a strong depressive, there are plenty of people in the middle whom it is hard to classify. We have a spectrum rather than a couple of bins.

While Solomon closes with some observations about the upside of depression. You might not chose to get depression, but you may come away from it a better person. Evidence here including quotations from ‘Paradise Lost’.

Other matters

My own starting position was that if something very  bad happens in one’s life – perhaps a bereavement or a diagnosis of some life threatening disease – it is not unreasonable to be depressed. And that it would, somehow, be inappropriate to squash that depression with pills. I suppose what is less reasonable or desirable is for that depression to be prostrating, disabling or to render one incapable of action.

It is also the case that while depressives may not be able to act, they can have a more realistic and accurate view of their world than the optimists who can just charge ahead, sometimes to crash into some wall. One needs to have access to both views.

And I still believe that explanations at the Freudian, psycho-analytic level may turn out to be helpful after all. An early example of which is to be found at reference 9.

One might ask whether animals can suffer from depression, given that they can get in a state of helplessness which looks very like depression in humans, a state which is sometimes called learned helplessness, originally studied in dogs. Dogs can quite easily be taught that there is nothing that they can do to get them out of some pickle, after which they stop trying. They give up and become quite passive, just accepting whatever is thrown at them.

One might also ask whether it would be possible to be depressed in the absence of consciousness. On which I offer three observations. First, people who are depressed often seek oblivion in sleep, substances or suicide. You don’t feel bad when you are asleep. Second, given that it seems likely that lots of animals are conscious, it also seems likely that consciousness has been around since before modern humans came on the scene with their depressions. Which makes the question hypothetical, perhaps to the point of nonsense. Third, pets, particularly dogs, are used as part of therapy for people. But they may also need therapy of their own, having developed an unwanted behaviour without any there being any obvious physical cause. A charity rather grandly called the Animal Behaviour and Training Council maintains a register of such therapists. I would think there is something in this, it is not just some nonsense dreamed up by animal lovers – or people seeking to cash in from same.

Conclusions

There is a lot of depression about, all over the world, and it remains a major challenge, despite the availability of pills which help. 

And while we may be able to help, we still seem to be a long way from a satisfactory explanation of what has gone wrong in the brain of a seriously depressed person, this despite the huge amount of work and the huge amount of stuff written about it.

My next steps will be Freud at reference 9 and Riley at reference 10 – this last coming to me from the same place as the present book. But bought new rather than second hand.

Solomon has written useful book containing lots of good material: a good place to start. Perhaps also a good place to come back to in a month or two for a second read. 

PS: prompted by something in the Guardian, I wonder about the mental health of top flight footballers. All of whom live in a very competitive and stressful environment. Many of whom have spent their whole life immersed in football and are now expected to cope in a foreign country. I dare say the richer clubs recognise the problem and do what they can to mitigate it.

References

Reference 1: The noonday demon: an anatomy of depression – Andrew Solomon – 2001.

Reference 2: https://en.wikipedia.org/wiki/Andrew_Solomon. 

Reference 3: https://psmv5.blogspot.com/2022/05/horton-hospital.html. 

Reference 4: Is schizophrenia the price that Homo sapiens pays for language? – Timothy J. Crow – 1997.

Reference 5: Cerebral torque is human specific and unrelated to brain size – Li Xiang, Timothy Crow, Neil Roberts – 2019. See Annex D.

Reference 6: https://psmv4.blogspot.com/2020/08/waved-up-regions.html. 

Reference 7: The Anatomy of Melancholy – Robert Burton – 1621.

Reference 8: Paradise lost – John Milton – 1667. 

Reference 9: Mourning and melancholia – Freud – 1917.

Reference 10: A cure for darkness: the story of depression and how we treat it – Alex Riley – 2021.