by Bill Williams
Like alcoholism, serious depression probably affects nearly every family in America, directly or indirectly.
And yet, despite huge advances in treatment, depression’s causes and even a workable definition of the disease remain elusive.
Andrew Solomon has produced a masterly account of the illness, and it will likely become an essential reference work in the field. Solomon knows the monster first hand. He has suffered two severe breakdowns and had another that was less severe while writing this book.
One marvels at the breadth and depth of this account, knowing that for a time Solomon could barely get out of bed, let alone write a coherent sentence.
Solomon weighs evidence from philosophy, history, medicine and sociology, teasing out the factors that may or may not contribute to depression. The index, notes and bibliography alone take up more than 100 pages.
Despite Solomon’s sagacity and completeness, the book is never ponderous or dull. Solomon mixes personal narrative, anecdote and research findings in an absorbing, flowing narrative.
Researchers estimate that 3 percent of Americans, some 19 million people, suffer from chronic depression. More than 2 million of those are children. Ten percent of people can expect to have a major depressive episode at some point.
Solomon compares his depression to a vine, “a sucking thing that had wrapped itself around me, ugly and more alive than I.” He felt like wartime Dresden, “like a city that was being destroyed and could not shield itself from the bombs.”
Depression is a disease of loneliness that “imposes a dread isolation,” he says. Depressed people lose the capacity to feel love or joy. All people feel grief on occasion, but depression is “grief out of proportion to circumstance.”
Researchers believe that depression, much like alcoholism, stems from a genetic predisposition triggered by external factors. Cause and effect blur in a huge conundrum. Does alcohol abuse, for example, cause depression, or is it the other way around?
Solomon says that escalating rates of depression “are without question the consequence of modernity.” He argues persuasively that the pace of life, alienation, family breakdown, loneliness and the failure of belief systems that give meaning to life have been catastrophic in terms of mental illness.
Regarding treatment, he says the debate about therapy vs. medication is bogus. Each plays a vital role. He also cites the value of faith and religious belief, saying they give people dignity and purpose and a reason to carry on.
Will also is important. Sufferers do not get better without the desire to do so. “We would all like Prozac to do it for us, but in my experience, Prozac doesn’t do it unless we help it along,” Solomon says.
Serious depression alters brain chemistry. Those who suffer breakdowns are more likely to experience them again. To function, depressed people often must stay on prescribed drugs for life.
Depression takes a particularly heavy toll on the poor, who receive far less treatment than those in the middle class. Welfare recipients have a rate of depression three times that of the general population. Solomon argues that it would be cost effective for society to do more to treat depression among the indigent so they would have a better chance of functioning day to day.
The book includes a short but disturbing section on the author’s experience with violence and depression. He has turned violent several times while depressed. He once savagely beat a man who was a former lover. Although he does not “endorse” violence, he says, people cannot deny its “inbred curative power.” He supplies no evidence to support that bizarre theory.
On the whole, however, this is a landmark book about a widespread malady. Anyone who has suffered from depression or has a family member or friend caught in its grip should find it valuable.
Many people have asked Solomon what they can do for depressed friends. “My answer is actually simple: Blunt their isolation. Do it with cups of tea or with long talks or by sitting in a room nearby and staying silent or in whatever way suits the circumstances.”
Solomon ends with a chapter titled “Hope,” in which he says he is grateful for his depression, for having been to “the Gulag” and survived it.
He knows he is not free of depression. “Meanwhile, however, I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, when hell came to pay me a surprise visit. It’s a precious discovery.”