In this episode I have the great privilege of connecting with Andrew Solomon from the US, who is an author and Professor in Clinical Psychology at Columbia University. The following interview is based on his book The Noonday Demon – An Atlas of Depression which was first published in 2001. For this book he was awarded the National Book Award for 2002 and was a finalist for the Pulitzer Prize. His most recent book is called Far from the Tree: Parents, Children, and the Search for Identity (2012). Both books are available in Norwegian, and The Noonday Demon is also available in Swedish and Danish.
In our conversation we only skim the surface of what is probably one of the biggest challenges of our time, namely depression. In my own country (Norway) there seems to be a shift in the public discourse when it comes to mental health, and it is now quite common that the biggest newspapers and TV-stations devote time and space to issues such as depression, anxiety, suicide and eating disorders. Also, many celebrities have come forth and told their personal stories which has probably helped to widen the space for this kind of public dialogue. Nevertheless, my sense is that mental illness doesn’t receive enough attention, and collectively we probably need to do much more when it comes to both dealing with and talking about depression. If you doubt the seriousness of the issue at hand here is what The World Health Organization has to say:
Depression is a common illness worldwide, with an estimated 350 million people affected. Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. Especially when long-lasting and with moderate or severe intensity, depression may become a serious health condition. It can cause the affected person to suffer greatly and function poorly at work, at school and in the family. At its worst, depression can lead to suicide. Suicide results in an estimated 1 million deaths every year. (who.int 2012)
Andrew went through his own depression and therefore the book is thoroughly rooted in his own lived experience. At the same time he approaches the issue from many different cultural, psychological and medical angles. I too have a history with the “Noonday Demon” and I read his book intermittently while struggling with my latest round of depression. I found that taking part in his journey shone some light on my own, and I was able to brake some of the negative cycles that earlier would have kept me debilitated for weeks on end.
My wish is that our conversation will inspire people to engage the issue of depression in healthy ways and I hope that the growing transparency regarding mental health will only continue and deepen in the decades to come. I would be delighted to hear what you think about the themes we explore so feel free to contribute to the conversation by posting your comments below. If you don’t want to listen to the whole interview you could also read the short summary that follows. Enjoy!
(03:20) Andrew’s current work and life
Andrew starts of by sharing some highlights from his life following the first publication of his book back in 2001. In 2013 he earned his phd. and has now become a much sought after lecturer on the issues of depression, disabilities, difference and identity. He has also married his husband and is currently in the throws of writing a new book.
(05:50) How the book came about
I ask Andrew how it was that he came to write a book on depression and he explains how it emerged from the personal notes he took when living through his first depression and breakdown. At the time he thought it might give him a sense of clarity and control although he is not so sure if this was the case. Nevertheless, he ended up writing an article for The New Yorker in 1998 that received a lot attention, and in the process it became clear to him that the writings on depression were very diffuse – chaos in the kingdom – as he puts it.
(07:20) Engaging depression through public discourse
As mentioned above my sense is that there is a growing acceptance and spaciousness for public dialogue in relation to mental health issues, at least in my own country, the kingdom of Norway. Andrew agrees and has registered the same tendency in his own context, and at the same time he is amazed to see how many people can’t seem to talk about depression or respond to it. His main concern is that the public discourse is limited to a rather small and enlightened segment of the population.
(09:10) Andrew’s personal story with depression
Andrew shares his own story and points to some of the precursor events that led to his depression; his mother’s death in 2001, a relationship that unexpectedly came to an end, and the transition from moving back to the US after living in England for some years. Nevertheless, he weathered all these events, but after publishing his first novel The Stone Boat, which was a fictional story inspired by the process he went through when his mother died, he came to a point where he lost touch with himself. All the mundane things in life became painfully effortful. He could find himself sitting on a chair for one hour, knowing that he should get up and eat something, but not having the energy or will to do so. Later on the anxiety came which he describes as a hand grenade inside of him always wanting to burst out, and a sense of being constantly petrified, so much so that it came to a point where he was totally paralyzed. Finally, his condition became so sever that waking up one morning he thought he had had a stroke because he couldn’t move his arm to pick up the phone. After staring at the phone for 5 hours it finally rang, an he told his father on the other end of the line that something had gone horribly wrong.
(13:55) The different ways in which depression takes hold of our lives
In the book he fleshes out the details from this major breakdown and he describes how he finally got help in different ways, including medication, therapy and help from friends and family. In our conversation we move on and I ask him how a mild depression unfolds, since depression is a condition that manifests itself on a continuum. Some people might not even be aware of how the illness has taken root in their mind and body while the most severe conditions can lead to a total collapse, which subsequently can lead to different forms of break down, hospitalization, and in worst cases, suicide. Andrew comments that for him the opposite of depression is not happiness but vitality, and for people struggling with either mild or severe depression this loss of vitality is the main problem. He describes it further as a “closing down” and not being “able to rise to the occasion of one’s own life”. He also explains how depression often leads to loneliness because people who are struck by the disease often loose the ability to confide to one’s friends. Many depressed people come to a point where they just feel the company of other people exhausting, and it’s easy to see how this can become a vicious circle and an invitation for the “Noonday Demon” to bore it’s claws ever deeper into a person’s soul.
(16:57) The Noonday Demon, explaining the title of his book
Speaking of demons, how was it that Andrew chose this title? He explains how the title is inspired by Psalm 92 where the term is used and which was held in the middle ages to be a description of depression. Unlike the other “demons” that came during night the demon of depression came during the day, hence the name. Andrew also describes depression as being “stuck in a swamp” or being weighted down day after day, and for some people, year after year.
(18:55) Understanding the symptoms of depression
This tendency for depression to just run in the background, slowly creeping in and possessing a person’s body and mind, is maybe also why so many people can go for long periods of time without seeking help or making the necessary corrections. For me, the most revealing and enlightening parts of his book were all the detailed stories from people struggling with depression together with the many descriptions of how depression shows up in terms of symptoms. Learning to recognize some of the tell tales of depression has had a huge impact on my own health and it has also helped me to relate to others who deal with similar issues. Andrew points to a whole range of typical symptoms, such as disrupted appetite, disregulated sleep patterns; either sleeping too much and still feeling constantly tired, or not being able sleep at all, lack of personal hygiene and care for one’s own appearance, the loss of interest for most things and a general loss of vitality; the sense that even the most mundane tasks and problems in life can become insurmountable, and in general, a very pessimistic and nihilistic outlook on life. In the long run depression can cause a person to loose the sense of wanting to be alive. Such a feeling is of course prevalent among people who are suicidal, but the feeling can also apply to other people who are gripped by depression.
(22: 40) The tendency to romanticize depression
Historically there has probably been a tendency for romanticizing depression, and as Andrew comments, depression and melancholy has been seen as the source for much imagination and creativity. I must admit that I’ve probably at times been overly attached to my own sickness, seeing it as a partial way out of something, or maybe as a way to legitimize my own destructive behavior. At the same time, this is perhaps the way in which depression takes control over a human being, that it keeps the person stuck in a destructive loop, a downward spiraling path which is difficult to alter. Andrew points to another form of romanticizing, namely the tendency for wanting to tough it out and solve the problem by oneself, in stead of seeking help in some manner. Andrew’s argument is that if one finds meaning in the depression one could of course choose to cherish the experience, but one should also keep in mind that the time spent in the lure of depression will forever be lost. Is it worth it? Nevertheless, Andrew adds to this discussion the fact that depressed people seem to have a more accurate and clear view on life, seeing things as they really are, while “healthy” people might be overly positive in certain situations. On the other side of the street one could probably argue, as Andrew does himself, that depressed people react overly pessimistic, experiencing unbearable amounts of grief in situations that healthy people would shrug of as only a nuisance. Regaining this ability to experience and express the full range of emotions that are available to us, in a balanced and appropriate way, is probably one of the most important and positive transformations that occur when one is able to finally brake out of the claws of the Noonday Demon.
(27:40) Benefitting others
I ask Andrew how it was for him to research and explore depression, and enter deep into the the lives of depressed people, when he himself was struggling with the same condition. He admits that at times it would weigh him down, but looking back at what he describes as “a useless and barren stretch of my life”, he felt he was able to turn this situation into something positive, something which could be of benefit to others. It was also inspiring for him to experience the resilience that many of his interviewees manifested in the face of their own predicament.
(30:40) Becoming resilient in the face of depression
Speaking of resilience, I ask Andrew to single out some of the key points that he believes can foster resilience in the face of depression. He was struck by how different people related to their own condition, seeing some people trying to block out and forget the time when they were down in the hole, while others were able to integrate the ordeal into the narrative of their lives, and for this reason, find a sense of meaning based one what they had experienced. Interestingly enough, the people who had walled of the experience from their lives were also the people who were most prone to have a relapse. As Andrew makes clear, depression is a cyclical condition and if one has suppressed the experience a new depressive cycle will feel like an ambush. On the contrary, if one has integrated the fact that one has been depressed one is also more prepared and able to remember how the last round unfolded, and consequently, also remember how one was able to come out of it.
(33:00) The value of hope
Another theme we explore is the role of hope in overcoming depression. Andrew describes severe depression as precisely the lack of hope and explains why the rediscovery of hope is so important. One of the main problems with depression is that one tends to universalize from temporary experience. Therefore it is often said that suicide is a permanent solution to a temporary problem! But if one is able to retain “an optimism of the intellect”, as he puts it, one is also able to steer out of the seemingly hopeless situation one is in.
(34:50) A multi-pronged approach to dealing with depression
The main intention with this podcast show is to explore holistic and integrative approaches to personal, relational and societal transformation, and my sense is that Andrew’s approach is aligned with this intention. I ask him what he would suggest people could do if they feel the impulse to brake their own cycle of depression, and he answers by fleshing out what he describes as “multi pronged approach”; make sure you don’t loose connection to the people you love and the people that love you, physical exercise can be as effective as anti-depressants for people who don’t exercise, regularized sleeping and eating, and of course, taking advantage of what we know when it comes to medical treatment (both medication and some kind of psycho-therapy). Cognitive behavioral therapy can be of great help to most people, so can the different therapeutic approaches that seeks to uncover the root causes of depression, seeing it in relation to past experience and one’s biographical history.
(39:10) The value of alternative approaches to treatment
We also discuss alternative approaches to dealing with depression. Before writing the book Andrew saw himself as a conservative, only seeing the validity in medication and cognitive behavioral therapy. But through his encounter with so many different people he came to appreciate the complexity and difference in people’s personality structures. What might work for some people could be of no use to others. He also discusses the role of placebo and how the individual feeling of one’s own condition is an important marker in terms of assessing if a person is getting better or not.
(42:10) Seeing depression through different cultural lenses
Another aspect of his book which I thoroughly appreciate is the multi-cultural approach, exploring how depression is understood and how it manifests in different cultures around the world. Andrew’s central concern with writing the book was to break down the idea of depression as being a modern, western and middle-class illness. One of his explorations took him to Senegal in West Africa were he took part in a tribal ritual, an exorcism designed to cure a person of depression (or what they might understand as an evil spirit that had possessed the person). Andrew explains how the whole village took part in the ritual and how he himself got to experience the ritual first hand. The high point of the ritual was when they slaughtered a ram and covered him with blood, while dancing around him in concentrative circles. He further discusses how this approach is contrasted to western methods that are much more sterile and individually centered, in the way that the treatment seldom involves the whole community.
(46:20) Going forward – learning to live with depression
Towards the end of our conversation I ask Andrew how he is doing today, in regards to his own condition. Going through six cycles of depression he finally acknowledged that he would need some kind of treatment for the rest of his life. However, in general he is at a much better place today and he has learned to act pro-actively when a new cycle of depression is ready to ambush him.
To end of this summary I would like to encourage all the listeners to check out the book and also have a look at Andrew’s website where you can find additional resources and links to his other books, talks and much more: www.andrewsolomon.com. The Noonday Demon is available in more than 20 different languages and I actually read the Norwegian translation which I found to be really good (so thanks to Heidi Grinde for an excellent job).