The Noonday Demon, Chapter IV “Alternatives”
The quote Solomon uses to begin this chapter drew me in and made feel as though it was necessary to read this chapter in its entirety; the quote comes from Anton Chekhov and states “’If many remedies are prescribed for an illness, you may be certain that the illness has no cure’” (Solomon 135). I find it interesting that Chekhov is so sure of himself and his conviction that he uses the word ‘certain.’ Solomon goes on to describe the many different modes of treatment for depression, the most common/widely accepted were discussed and described in the previous chapter. Now, Solomon investigates the incredible number of “alternative” treatments, some of which are fairly promising/reputable but simply in very early stages of research, such as repeated transcranial magnetic stimulation (rTMS) and eye movement desensitization and reprocessing (EMDR) (Solomon 137, 139). Solomon ends this chapter’s introductory paragraph with a more optimistic tone, stating “the sheer quantity of alternative therapies reflects a persistent optimism in the face of the intractable problem of emotional pain” (Solomon 135). Although it is positive there is a (perceived) sense of optimism among those researching/pursuing a cure for depression, that optimism is often lost on the patients. They simply endure a frustrating, and often, never ending search for, not a cure, but more simply, something that will at least alleviate their symptoms of depression. Since so much is not understood about depression and how it works, when patients begin the process of searching for treatment, they begin a game of guessing and tinkering that may never end as different medications, and dosages of those medications, and combinations of different medications are seemingly thrown at them and a variety of different modes of therapy are suggested. It can be overwhelming and even unnerving that there seems to be no clear or right answer as every psychiatrist/psychologist/therapist has a different approach to treating depression and no one is necessarily right, but it is imperative that each patient finds a clinician who they respect and at least appreciate or agree with their approach to treatment.
This may lead one to think that a placebo could easily be conceived as a treatment in the depressed patient’s mind, but Solomon argues “it is my absolute belief that in the field of depression, there is no such thing as a placebo” (Solomon 137). Solomon elaborates with “if you have cancer and try an exotic treatment and then you think you are better, you may well be wrong. If you have depression and try an exotic treatment and think you are better, then you are better. Depression is a disease of thought processes and emotions, and if something changes your thought processes and emotions in the correct direction, that qualifies as recovery” (Solomon 137). I (think) I can see and understand the point Solomon is arguing – that depression is all about thoughts and emotions and if you can find a way to change those negative thought processes that often lead to negative emotions, then it doesn’t matter what you are doing. It works for you; you are feeling better; great – you are in recovery. However, the way Solomon presents this argument provides evidence for the degrading argument that depression is simply “all in your head,” and that it isn’t truly real, and a patient should be able to somehow wish it away. I feel Solomon’s argument here can provide fodder for those who do not believe depression is a disease because if it is a “true” disease, it would require a legitimate, well-researched, treatment. Maybe Solomon is trying to say that since there is currently no known cure for depression that no one can really bash any kind of treatment as long as at least one depressed individual finds relief as a result from practicing it.
Solomon asserts “the best treatment for depression is belief, which is in itself far more essential than what you believe in” (Solomon 137). This makes sense because depression is a disease of the mind, and if you believe that what you are doing is beneficial and that you will, at least eventually, get better then it makes sense that whatever you are doing to alleviate your symptoms will be beneficial. Also, if you strongly believe in some mode of therapy, it is more likely you will be persistent in your practice of it, which provides a depressed person something to do, and maybe even look forward to. If you are able to create some kind of schedule involving some type of therapeutic activity, then you are keeping yourself out of bed, for at least some period of time, and are active, hopefully, both mentally and physically.
Solomon later discusses the importance of sleep and the significant role it plays in depression. Solomon goes so far as to state: “Even people who do not suffer from depression have had the experience of waking up too early with a sensation of ominous dread; in fact, that fearful despairing state, which passes quickly, may be the closest that healthy people come to the experience of depression” (Solomon 144). I find this assertion very interesting. I never would have thought of this on my own, but I definitely agree with it. Solomon quotes Thomas Wehr of the NIMH “…it is in sleep that the depression is maintained and intensified” (Solomon 144). Wehr is referring to the fact that, generally, people with a diagnosis of depression tend to feel better as they continue throughout a day (Solomon 144). Wehr has even conducted experiments with “controlled sleep deprivation” (Solomon 144). The idea behind this intervention is to “….extend the day’s improvement” “by not letting someone go to sleep…” (Solomon 144). This idea that sleep makes depression worse is somewhat counterintuitive because for most illnesses, sleep/rest is recommended to allow the body to heal. Unlike most illnesses, depression is centered in the mind and when the mind/body is not fully conscious, as in sleep, the mind is free to go about whatever direction it likes, and in a depressed person, that is generally a downward spiral of negativity.