My re-posts about modern pschology and psychiatry continues with The Noonday Demon: an Atlas of Depression by Andrew Solomon. I chose this book because a couple of other books I read mentioned it, with praise.

Demon differs from those other books for several reasons. The author, Solomon, is a writer, not a medical expert. While the experts dealt with mental illness, in general, Solomon focusses on depression, from which he has suffered on and off for seven years (as of 2001, the year of the book’s publication). Solomon did extensive research to write the book, as evidenced by the 100 pages of footnotes and bibliography at the end. Demon is part memoir, part medical information, and part life stories of depression sufferers, many of whom contacted Solomon after an article he wrote about his depression was published in The New Yorker in 1998.

Solomon states up front that he disagrees with the current fashion of opposing medication treatment for depession because his father had a lifelong career in the pharmaceutical industry. As a result, Solomon can view the pharmaceuticals as both capitalist and compassionate, with a genuine desire to cure.

Given the vast numbers of antidepressant prescriptions issued today, as in 2001, I don’t know if I’d call an anti-medication view fashionable. Solomon’s pro-meds view comes out through the book when he criticises doctors and patients who favour going off medication once the person feels well, with relapse as a frequent result. 

Solomon, himself, suffered his first breakdown when he was 31, following his mother’s death.  Already in psychoanalysis, he sought treatment with medication, recovered, broke down a second time, recovered, and suffered a mini-breakdown before completing the book a year later. As a result, his descriptions of his own experience are detailed and fresh. At the time of writing, he was taking about 12 pills a day, some for side effects of his antidepressant and anxiety meds, and expected to continue on a cocktail of medication for life.  He accepts the genetic view of mental illness and all his life story cases portray it as a lifelong disease. This would be my main quibble with the book: there is no sense that someone might recover from this demon state until the distant day some major physical treatment is found.

When The Noonday Demon was published, Solomon was 38 years old. He wrote in the book that he was fine with popping pills for life even though he knew they wouldn’t completely do the trick. It beat the alternative of more frequent and severe breakdowns. He’s now 52, and doing well, from my brief Google search. He’s married, with kids, still writes articles and books and is a professor of clinical psychology at Columbia University. I’d like to know if he’s still taking multiple medications and still relapsing regularly into depression and, if so, is he still okay with this after sixteen years?

The Noonday Demon is a big book, large in scope and information. The medical details are as sound as any I’ve read written by practicing psychiatrists and psychologists; Solomon’s opinions seem as valid as any expert’s, partly because there is no final word on mental illness. Solomon provides many extras the other experts don’t go near. He travelled far and wide to research alternative treatments and try them personally. An exorcism in Africa involved him hugging a ram, the two of them buried under layers of covers, before the ram was sacrificed, its blood drenched over Solomon’s body.

Solomon was open enough to find merit in most of these treatments, however unusual, although he didn’t suggest that any could compete with medication, ideally supplemented with psychoanalsis. His view of his fellow sufferers in the case histories is sympathetic. I was surprised, though, that after those hours of hugging, he didn’t show more sympathy toward the poor ram that was sacrificed to exorcise Solomon’s demons.

For February, Canada’s Psychology Month, I continue re-visiting my blog post reviews of popular psychology books.  Here’s the second re-post:

When Panic Attacks: the new, drug-free anxiety therapy that can change your life by David D. Burns, M.D.

I picked up this book because some 25 years ago I read Dr. Burns’ earlier bestseller, Feeling Good: the new mood therapy, for a psychology course and found its cognitive therapy approach enlightening. Everyone, I thought, could use a dose of cognitive therapy. In fact, the so-called normal might benefit as much the mentally ill.

When Panic Attacks is a self-help book for people with disabling anxiety. Dr. Burns includes charts as well as space for writing answers to his questions posed along  the way. He insists you can’t simply read what he says to get results; you need to be active in your therapy process, with pen in hand. I confess I didn’t write down anything. Mainly, I tried to relate the material to my most anxious, irrational moments, such as my panic when I see a mouse.

Dr. Burns takes a strong stand against the two pillars of modern psychiatry, medication and psychoanlysis. He calls them, generally, useless for anxiety and depression. I get the sense he never prescribes pills. Instead, he makes his patients work on their fears through daily mood logs and applying his 40 ways to defeat your anxiety, until one of those ways works.

His case studies make the process sound easy, but it probably is a lot of work — and scary. His 40 methods include Exposure Therapy, which involves flooding yourself with the object of fear. For me, this would involve bombarding myself with images of mice and rats or real ones. I’d rather take a pill. In addition, my rodent phobia doesn’t affect me enough to truly want to change. During the summer, I still outside on my patio, even though a mouse who lives in the brick wall is likely to scurry by.

Dr. Burns says that a problem with most methods of therapy is that they assume people want to change. In reality, we like the familiar and don’t want to confront our demons and darkest fears.

Anxieties, bad habits and addictions are also rewarding. He often asks his patients, “If you could push a magic button and make all your anxiety, depression or anger disappear right now, would you push that button?” A surprising number of people hesitate.

It seems bizarre, until you realize there are benefits to neurotic fears. He cites an example of a convenience store owner who developed post-traumatic stress disorder after being robbed and beaten at gunpoint. While working on one of Dr. Burns’ charts, the patient came to see that he didn’t want let go of his anger at the perpetrator. The robber deserved it. Anger allowed the patient to feel morally superior. He found satisfaction in being a victim. He believed hanging onto the anger might make him more vigilant against future attacks. All of these thoughts contributed to his continuing PTSD, which he decided, in the end, wasn’t worth these

benefits.