Demonizing depression, common in the Middle Ages, unfortunately remains with us. The medieval idea, based on a dubious interpretation of Biblical sources, was that depression invades the soul from an external diabolical source and possesses it. The depressed person is in that way distanced from the community, which itself stays conveniently free of the intruding devil. Viewing depression as a fringe phenomenon requiring some form of temporary or permanent isolation from the rest of us perpetuates this unholy tradition. The severely depressed are already burdened by loneliness so the isolation cure could well make their situation worse. What they most need, according to Andrew Solomon’s “atlas of depression” entitled Noonday Demon, is acceptance, friendship, an active interest in their sexuality, love, and belief—if not in God (though that might help), then in finding good reason to go on living.
Distinguishing sharply between the depressed and the non-depressed, Solomon suggests, is a self-congratulating illusion. Depression is an intensified form of our everyday moods—sadness, grief, and anxiety, for example, or the sense of futility that may come with a growing awareness of our mortality. If we have an important business meeting coming up, and it seems terrifying to us at three in the morning but manageable enough when we wake up at seven, we are probably suffering only from ordinary anxiety. But if we remain terrified at seven, our anxiety may be moving toward depression. Something similar can happen with grief over the loss of someone we love. Sooner or later the loss may appear as a fact we have to accept, but when our grief goes on indefinitely, it can become long lasting depression.
The first effort I made to promote my memoir, Unsuitable Treasure: An Ex-Jesuit Makes Peace with the Past, was before an audience of college students hopeful of recovering from their abuse of substances like alcohol or fetanyl. My purpose was to encourage them by dwelling on the story I tell of my alcoholic father whose drinking while I was a child often led him to treat me sadistically. When he finally recovered from his addiction, however, he grew into about as attentive and caring a father as a twelve year old boy could wish for. Recovery is important, I was saying to these young students, because awful consequences can come about later on when the addicted have other people in their lives counting on them.
Solomon has a chapter on addiction and depression that shows their close interconnection. Alcohol usually gives us a temporary high but is in fact a depressant. Since the lower mood that alcohol eventually produces may cause casual drinkers to drink more, depression can lead to alcohol addiction, which can make the addict still more depressed. So the addiction/depression cycle goes on, and the social stigma attached to one clings to the other as well. But since ordinary sadness can so readily slip into depression, this demonizing of the addicted and the depressed is a sign not of our superiority to them but of our fear that what has happened to them could happen to us as well.
Andrew Solomon himself suffered from severe depression, and what he says about the controversies surrounding how best to think about and treat depression is unusually sensible. We tend to regard depression, unlike heart disease or cancer, as an imbalance in the mind, not the body. So while we approve of bypasses and chemotherapy we are almost as wary of anti-depressants as we are of depressed persons themselves. But depression, much like addiction, afflicts both the mind and the body and therefore generally responds as well to carefully monitored pharmacological treatment as it does to talk therapy and support groups.
Recent increases in the number of suicides, opioid addicts, and victims of post traumatic stress disorder, all commonly associated with depression, should help us view it more as “our problem than “their problem.” Legislating government funding and extending insurance coverage to include this so-called merely mental illness can be a big help. But as Solomon points out toward the end of his book, what about our poor? These remedies normally do not reach the very population where depression related afflictions are most widespread. We remain connected to the indigent, however, by the simple fact that depression, perhaps severe depression, most likely touches all of us at some key point in our lives.
Finally Solomon contends that depressed persons are not exempt from taking some responsibility for their state of mind. We already know that heart and cancer patients help their treatment to a fair extent by taking a hopeful attitude toward it. The same is true of the depressed, who need not suffer passively. They can contribute to their recovery not just by trusting the remedies but by wanting them to be successful.