The Noonday Demon, Chapter III “Treatments”
Solomon begins this crucial chapter with a discussion of the main two treatments for depression – therapy and medication and argues that the two should not be seen complementary, and sometimes one will not reach its full efficacy unless the other is present (Solomon 101). Solomon also states that “it’s fashionable for psychiatrists to tell you first the cause of your depression (lowered serotonin levels or early trauma are the most popular)”; Solomon’s use of the words ‘fashionable’ and ‘popular’ highlight the ever-changing nature of the treatment of mental illness as little is truly understood and as more research is conducted and information becomes available, new approaches are taken (Solomon 101). Solomon’s two different “popular” proposed causes of depression could not be more different; one is an external event/memory (“early trauma”) and the other, “lowered serotonin levels,” is an internal chemical imbalance. How can two fundamentally different causes lead to the same effect? Does an “early trauma” result in lowered serotonin levels?
Solomon goes on to discuss and describe therapy. Solomon proposes “talking therapies come out of psychoanalysis, which in turn comes out of the ritual disclosure of dangerous thoughts first formalized in the Church confessional” (Solomon 102). If Catholics practice a form of therapy on a regular basis, even without a formal diagnosis of depression, do they have lower rates of depression? A study was conducted in 1979 that highlighted the fact that a “therapist” does not need a fancy degree in order to be a good therapist, but, rather that “certain criteria [are] met [in both the person acting as therapist and the patient]: that both the therapist and patient were acting in good faith; that the client believed that the therapist understood the technique; and that the client liked and respected the therapist; and that the therapist had an ability to form understanding relationships” (Solomon 111). The study proved this theory by selecting English professors determined to hold all these characteristics and comparing them to “professional therapists”; the English professors were just as effective therapists as the “professionals” (Solomon 111).
Solomon refers to his personal experience in working with a “psychopharmacologist” (Solomon 105). I wonder if a ‘psychopharmacologist’ is the same as a psychiatrist. The term psychopharmacologist emphasizes the person’s knowledge of prescription medications, while ‘psychiatrist’ implies an ability to provide therapy (like talk therapy) beyond medication. Solomon also discusses his personal experiences with various therapists and the importance of finding a therapist who you really like and trust (Solomon 105). Solomon asserts “if you think you are smarter than your doctor [or therapist], you are probably right” (Solomon 105-106). This comment was personally comforting and validating as I have gone through my fair share of therapists and have even felt quite disturbed that someone has, at the least, completed a Master’s degree and yet seem to be incredibly shortsighted.
Solomon had the opportunity to interview a Holocaust survivor who shared she survived the experience by focusing on her hair, rather than the horrible things taking place around her because “if she let herself think about what was going on, she would go crazy and die” (Solomon 109). This woman “thought about when [she] could wash [her hair],…..about trying to comb it with [her] fingers…how to act with the guards to make sure they didn’t shave [her] head entirely. [She] spent hours battling the lice that were all over the camp” (Solomon 109). It is amazing that this woman had the ability to come up with this therapeutic distraction on her own, under such difficult, taxing, and inhumane circumstances. Most people require another to suggest such a therapeutic technique to them when undergoing some kind of difficulty in life.
Solomon then goes on to explain antidepressants and how they work, or rather, how we think they work. After reading Solomon’s explanation on page 114, my first thought was that you would want an antidepressant that affects as many different neurotransmitters/neurotransmitter sites in the brain as possible because then you have a greater chance of having a positive effect, but if you are taking an antidepressant that affects more than one neurotransmitter, then you are introducing multiple variables at one time, and you have no idea which aspect of the antidepressant is working (if any) or why. One of the most prevalent negative side effects of antidepressants, highlighted by the introduction and ‘popularity’ of Prozac, is a side effect that negatively affects sexual intercourse (Solomon 115). Solomon also explains that these negative sexual side effects can also cause “sexual anxiety,” which can lead to the “develop[ment of] a psychological aversion to sexual interaction, which makes the symptoms worse” (Solomon 116). This leads to a cycle that can be incredibly difficult to discern whether “the sexual problems…..are a result of the [initial] depression” or the “sexual problems…are the result of antidepressant therapy” (Solomon 116). Solomon discusses the direction antidepressant research is currently taking: “It is popular at the moment to try for so-called clean drugs, drugs that have highly specific effects” (Solomon 118). This makes sense because it would allow for a better understanding of the cause or causes of depression and would also hopefully lead to negative side effects. However, “it seems that the more things you muck around with in the human brain, the more effective the treatment is likely to be for depression” (Solomon 118). This underscores the complex nature of depression and the human brain, itself.
Solomon then moves on to a less popular but “most successful physical treatment for depression,” which also happens to be “the least clean and specific [treatment] of all” – ECT (Solomon 120). ECT has been in use since the early-mid 20th century but significant advances have been made in terms of its administration to allow for a much more tolerant experience for the patient. It is interesting that such an old and hardly understood treatment is so effective. ECT “is used in pregnant women,” which I don’t understand because general anesthesia is part of the administration of ECT; isn’t it dangerous for a pregnant woman to undergo general anesthesia? (Solomon 120). Solomon discusses Martha Manning’s experience with ECT, which is considered to be an overall success, yet Manning still takes multiple medications (Solomon 121). Does ECT ‘simply’ make it possible for medications to work in previously drug-resistant cases?
Solomon quotes James Ballenger on the presence of human suffering and Robert Post’s, chief of the Biological Psychiatry Branch of the NIMH, explanation of the complex anatomy that is the brain and all the neurons and their many synapses that make the brain work, which leads Post to say “’Getting them to all run just so that people are wonderfully happy all the time – we’re a long, long way from that’” (Solomon 124). This makes me think of the British philosopher David Pearce and his personal endeavors end suffering, even for animals, by practicing veganism.
Solomon then discusses the effects the word ‘normal’ has on people diagnosed with depression, as they are generally made to feel that their depression, and therefore themselves, are abnormal (Solomon 124). Does the word ‘abnormal’ convey/have any kind of negative connotation/judgment inherently? Can this word be used without any kind of negative connotation/judgment? Solomon describes a conversation he had with one individual who feared he was going crazy and was relieved to discover he was “just” experiencing clinical depression, which Solomon states is the “normal way to go crazy” (Solomon 124). It is sad that someone would rather have the label of “clinically depressed” and everything one experiences with that diagnosis than think they may ‘simply’ be the slightest bit crazy. Solomon then describes another person who overcame her depression by identifying all sources of anxiety in her life and drastically cutting them out (Solomon 125). This shows both significant insight and willpower on her part, two things that most people with depression are unable to harness or utilize in any way. This woman quit her job, “broke up with [her] boyfriend and never really looked for another one,” transitioned to living alone, “stopped going to parties that run late,…moved to a smaller place,….dropped most of [her] friends, [and] gave up, pretty much, on makeup and clothes” (Solomon 125). Could most, if not all, of these things this woman gave up be considered characteristic of or integral to Western culture? Is this why depression is so prevalent in Western countries? Solomon wraps up this section by quoting the Unabomber from his manifesto “….In effect, antidepressants are a means of modifying an individual’s internal state in such a way as to enable him to tolerate social conditioning that he would otherwise find intolerable” (Solomon 125). Why is our instinct to alter the individual rather than his/her society/external circumstances/relationships? Wouldn’t altering these other things be far more effective and result in fewer depression diagnoses in the long run? This approach promotes the idea that something is wrong with the individual, supporting stigma associated with depression.