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The Cartography of Melancholia


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by Joseph M. Schwartz, Ph.D.

In recent years there has been a growing body of memoir written by those suffering from depression about their experience of illness and treatment… Andrew Solomon made an initial contribution to this literary evocation of suffering in a 1998 New Yorker piece, a contribution that he has extended in his remarkable book, The Noonday Demon: An Atlas of Depression. The book is at once a harrowing personal account of his own relentless struggle with treatment-resistant depression, a far-reaching venture into cross-cultural field research, a scholarly, if at times somewhat tendentious, review of all aspects of the clinical literature on depression and related topics, and a meditation on the nature and meaning of suffering in our lives.

Presented as a collection of freestanding essays, The Noonday Demon covers enormous terrain. The chapter headings, Depression, Breakdowns, Treatments, Alternatives, Populations, Addiction, Suicide, History, Poverty, Evolution, and Hope, convey the breadth of Solomon’s ambition, an ambition realized with varying degrees of success for each of these subjects. The Noonday Demon is strongest when Solomon stays close to his own experience and that of the many resilient men and women who entrusted their stories to him. These personal accounts are profoundly moving and offer the opportunity to go deep inside the experience of depression as it is encountered and treated in such disparate places as Greenland, Cambodia, Senegal, and Appalachia. These accounts invariably illuminate and humanize Solomon’s attempt to digest and discuss the voluminous psychiatric and epidemiological literature on depression. As well written as it is, The Noonday Demon is not an easy read and not for the faint of heart. The chapter on Breakdowns is as stark and detailed a portrayal of the descent into melancholic madness as we are likely ever to encounter. But as analysts who take as our purview the human experience of illness, we need to travel that pathway with Solomon.

…As Solomon puts it, “Depression is not just a lot of pain; but too much pain can compost itself into depression. Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.… Grief is a humble angel who leaves you with strong, clear thoughts and a sense of your own depth. Depression is a demon who leaves you appalled” (p. 16). Inevitably, this demon makes its appearance in our consulting rooms.

…[W]hen patients inhabit the terrain that Solomon has taken as the focus of his inquiry, the interior landscape is arid and deserted. It is experienced by patients as timeless and ahistorical, and as their depression deepens and becomes cut loose from the life events that may have triggered it, it may become increasingly difficult as analysts for us to locate ourselves in this landscape or to find a story in which we can inhabit a character. We feel left with only limp encouragement to offer, a helping hand to extend in the hope that at some point it will be capable of being grasped, and more than anything else, a willingness to bear witness and remain a presence for however long it takes. The work is not as engaging as the moment-to-moment interplay of transference and countertransference, but it is work that we will be called upon to do. And for that I can think of no better preparation than Solomon’s The Noonday Demon: An Atlas of Depression.

(To read the full review, please visit PEP-Web.)