Rumination disorder

The Noonday Demon: An Atlas of Depression, by Andrew Solomon (Scribner, 569 pp., $28)

The readers of the future may dub our time the Age of Mental Illness. Our writers are not more tortured than those of previous generations, but they are the first to attribute their suffering to their brains' neurochemistry.

Prozac, which works on that neurochemistry, was introduced in 1988. Today, an amazing one in ten Americans takes this drug or one of the other antidepressants it spawned. These rates are likely to rise, because only half of those with depression currently receive any treatment. Depression is "the family secret everyone has."

Andrew Solomon's interest in depression began with his own breakdown, which he describes with eloquence and humor. One of my psychotherapy patients who read this book said that the passage below helped her put into words what she had never been able to express:

My depression had grown on me as that vine had conquered the oak; it had been a sucking thing that had wrapped itself around me, ugly and more alive than I. It had had a life of its own that bit by bit asphyxiated all of my life out of me . . .

If Solomon had stopped there, this book would be just the most recent addition to the rapidly growing genre of mental-illness memoirs. But because Solomon is a reporter (part of this book appeared in The New Yorker, and sparked over a thousand letters), the book is also a solidly researched investigation into what appears to be a silent plague.

Depression is not new. Hippocrates declared depression a brain illness, while Plato thought its origins were to be found in childhood; their disagreement parallels the modern debate between psychopharmacologists and psychoanalysts. Obviously, the depressed have both brains and minds-and both need treatment. Not surprisingly, research shows that "the combination of drugs and therapy works better than either one alone." One of Solomon's themes is that the interaction between the brain and mind is complex, even mysterious; neither can be reduced to the other.

To complicate the picture, depression is woven into the fabric of numerous social problems, as both cause and effect. For example, poor people tend to be depressed, which both reflects their circumstances and saps their motivation to improve them. Most users of both legal and illegal drugs are also endeavoring to "self-medicate" an underlying mood disorder. Substance abuse and depression can be found deeply entwined in many family trees, and it's not hard to understand why. Drugs offer immediate pleasure and relief of suffering, but can disrupt life in ways that lead to further despair.

The social implications of this argument are tricky. On the one hand, does it make sense to jail substantial portions of the population for their flawed attempts to medicate an illness? I have had many patients tell me that only marijuana relieves their depression. On the other hand, we are increasingly excusing all kinds of behavior, even murder, with the explanation that the perpetrator was depressed. "Engaging in violent acts is not a good way to treat depression. It is, however, effective," says Solomon, who confesses to having seriously assaulted a lover who dumped him. "I came home that night covered in blood-mine and his-and with a feeling of both horror and exhilaration." Solomon admits that this does not "relieve [him] of responsibility for violence," but he expresses only qualified remorse:

People expressed horror at my attack . . . I was chagrined by what I had done; yet though one part of me regrets the suffering of my friend, another part of me does not rue what happened, because I sincerely believe that I would have gone irretrievably crazy if I had not done it.

Here Solomon is dead wrong. Controlling his violent impulses would have done him no harm, and would have saved his friend a trip to the emergency room.

From an evolutionary point of view the big question is: Why didn't natural selection weed out depressive genes? Depressives have low reproduction rates (depression destroys libido) and high mortality. Logically they should have gone the way of the dodo. Solomon's best guess is that we need psychic pain sensors, just as we do physical ones. Depression is like nausea: When you involuntarily "get sick," it serves a protective function. Something in your psychic life is rancid, and you must expel it or withdraw from it.

While depression distorts reality (making one's life feel worthless, hopeless, and meaningless), in a paradoxical way it also reveals reality, by forcing one to be aware of what is wrong with oneself and the world. Freud observed that the melancholic has a "keener eye for the truth than others who are not melancholic." That's because healthy people sustain themselves with "positive self-enhancing illusions." The non-depressed grossly overestimate how many Martians they have killed on a video game; depressives don't. The non-depressed rate themselves more highly than their peers on various skills and personality traits. Depressives, who supposedly suffer from low self-esteem, accurately match the assessments of their peers when rating themselves. "Depressives have seen the world too clearly," says Solomon.

Depression forces introspection, to the point of obsessive rumination. "The unexamined life is unavailable to the depressed," says Solomon. Perhaps this explains why so many depressives become writers-to record their endless introspection. The majority of great writers have been depressed or manic-depressive, according to evidence presented by psychiatrist Kay Jamison. But the Greeks anticipated this too. Aristotle wrote: "All of those who have attained excellence in poetry, in art, and in politics, even Socrates and Plato, had a melancholic habitus."

"On the happy day we lose depression, we will lose a great deal with it," writes Solomon. Life would be "flatter" if we muted the "brain's circuitry of suffering." Every day would be like a sunny stroll down the beach. "Welcome this pain," wrote Ovid, "and you will learn from it." Solomon feels his surprise visit from Hell has taught him a great deal about suffering, compassion, humility, and character. It even helped him discover his soul. All of which raises the question: Is it better to medicate our suffering or to work with it creatively, as artists and religious mystics do? Solomon would reject this dichotomy. His medication has not freed him from pain entirely, but it has given him the strength to get out of bed, so he can write down what he has learned from his study of suffering.

What can we learn from the 28 million Americans taking antidepressants? Modernity is making us sick, says Solomon. He likens recent changes in society-the breakdown of the family, the loss of religious faith, and increasing levels of stress and isolation-to an ecological disaster: They have stripped us of the "social ozone layer" that used to protect us. Undoubtedly, there are other causes as well. Our circuitry of suffering is sending us a message. Do we have ears to hear it?

COPYRIGHT 2001 National Review, Inc.
COPYRIGHT 2001 Gale Group