The Noonday Demon: Audio Interview with Best-Selling Author, Andrew Solomon

Derrick Hull (Talkspace):

Hello and welcome — I’m Derrick Hull, Talkspace’s VP of Clinical Research and Development. Today we’re speaking with Andrew Solomon, Ph.D., a writer and lecturer on politics, culture and psychology; winner of the National Book Award; and an activist in LGBTQ rights, mental health, and the arts. He is Professor of Clinical Medical Psychology (in Psychiatry) at Columbia University Medical Center, and a former President of PEN American Center. Solomon’s book, the best-selling Far From the Tree (Scribner, 2012), tells the stories of families raising exceptional children who not only learn to deal with their challenges, but also find profound meaning in doing so. Solomon’s memoir, The Noonday Demon (Scribner, 2001), won the 2001 National Book Award for Nonfiction, was a finalist for the 2002 Pulitzer Prize, and is included in the London Times’ “One Hundred Best Books of the Decade.” Solomon lives with his husband, John, and son, George, in New York and London and is a dual national. He also has an extended family consisting of a daughter and John’s children.

Well, Andrew, welcome. I wanted to give a personal anecdote about why it’s so exciting to speak to you today. When I was in clinical training at Columbia University, we had your book, The Noonday Demon in our lab. And we would pass it around among all the graduate students. And for me, in particular, it was impactful because one aspect of clinical training that I think is sometimes a little problematic — is that as we talk about diagnostic categories as if they’re simple or straightforward, as if we know what they are — I think this is especially true for depression and anxiety where these two disorders are typically called the “common disorders,” which makes them seem straightforward and simple. 

One of the wonderful things about The Noonday Demon, and why it really stood out to me as a trainee, is the way in which it gives so much texture and depth and complexity to the ways in which depression presents, and how we try to understand what it means.

And the book, in such an incredible way, combines both your own internal experiences with scientific research and how it fits into the broader systemic way in which we approach mental illness. It’s really transformational. 

I know in the latest chapter you just added to it, you talk about getting letters from people who have struggled with depression as you have. But I wonder if you’ve heard from trainees, other individuals who were entering the field, and the impact that the book has had on them. Do you hear from folks like that?

Andrew Solomon:

I do hear from people like that. I think often those are people who have a great wish to help. But frequently when people are depressed, or indeed anxious, but especially when depressed, they kind of lose the power of description and they aren’t very well able to explain what they’re going through. And so I’ve had a lot of trainees who’ve been in touch with me and who’ve thanked me, both for the autobiographical sections and for the interviews I did with other people who suffered from depression, for giving them an idea of what it feels like and what the experience is like.

Derrick Hull:

You know, it made me wish in fact that there was a book like this for almost every diagnostic category. Although I feel selfish somewhat saying that because you mention in the book repeatedly what a difficult and challenging undertaking it was to write the book, in some ways helpful and transformational, and in other ways very painful. And so it feels like a lot to ask that there would be a book like this for every diagnostic category.

Andrew Solomon:

But it was, in fact, ultimately rewarding and, talking to other people who’ve written books on comparable subjects, I think for all of us, it’s not so much that people suspect that it’s cathartic — that you somehow release the demons by talking about them, or writing about them — it’s more that you take this experience that felt, while you were living it, like a barren, dry, useless experience and making of it something that is of value to other people. And so it sort of redeems in some sense, the time that you spent suffering. That doesn’t mean I would choose to do it again. If I could have my life again without depression, I would prefer that. But writing about it was not only redeeming — I mean it was difficult and it was painful — but also it has become rewarding and meaningful to me.

Derrick Hull:

And did you feel the same way, when you were adding the chapter to it, the one that came out?
(Well, four or five years ago now.) Was it a similar process? Did you feel like you were in a different place when you sat down to pen that chapter?

Andrew Solomon:

I was in a different place. My Brazilian publisher asked me to write an introduction for a reissue of the book and I sat down to do that. And as I began it, I thought, you know, I’ve been in this world for all these years. I’ve been talking about depression and I’ve learned a lot of things I didn’t know when I was writing the book. I started writing down notes about the different things that I’d learned. And as I did so, I got deeper and deeper into the reality of people’s lived experience. And I felt like there was a real need to expand what I’d said. And to bring it, not only up to date in terms of new treatments that have come along since I wrote the original book, but also to make it into a book that extended the sort of quality or the nature of empathy that I felt. 

I mean, at the time when the book came out, I had probably interviewed 30 people with depression about their experience. In the time since the book came out, I’ve probably had descriptions of depression sent to me by 15,000 or 20,000 people. It changes your perspective, and your point of view, and your sense of the urgency of it. And then, conveniently I’d had a sort of minor depression just before I wrote that chapter. And so I could fold that in there, too.

Derrick Hull:

Tens of thousands of people. It’s hard to imagine all the emotions and reactions you must have to receiving that kind of feedback from people.

Andrew Solomon:

There are days when it feels very rewarding and I’m glad that I’m able to help people. I get letters and I think, “okay, you need to see a different psychiatrist and you might be responsive to this kind of therapy.” And I feel very ready to comment. I’m not a doctor and so I don’t get back to those people with specific clinical advice, but I can point people in general directions. And there are other days when it’s totally overwhelming and I wake up and I think, “Oh, not again.” 

I mean last week I got a letter from someone in Iran. A woman in Iran who wrote to me about her experience with depression. She wrote me a letter that must have been six pages long, if it had been in ordinary type script. And I was very overwhelmed by all of the detail in it. And I read it kind of cursorily and I thought, “well, at some point I’ll have to return to that.” And today I got a rather insistent note from her saying, “I know you’re busy, but I need to hear from you. I’m desperate.” And sometimes the desperation of total strangers on the other side of the world feels very heavy.

Derrick Hull:

In some ways you’re speaking to something I was curious about, you know, as we were sitting down preparing for this and what the lived experience is like, what you’re already speaking to. So certainly there’s the clinical side of your own experience, but then there’s also being confronted with everybody else’s experience and in some ways those people are pulling for support from, insight from yourself. It’s made you a kind of figurehead for anxiety and depression — and that experience feels so complex. I wonder if you have more that you say about that entire experience over the last, gosh, it’s been going on for 19 years or so. Maybe longer.

Andrew Solomon:

Well, you become sort of, one of the depression people, and you’ll find yourself circling over and over again back to the other people who are in your field. Just this morning, I was in a meeting with a group of scientists who were working on funding new research in the field of mental illness more broadly, and we were discussing what they were doing and where it was going. And I felt like, “Oh good, I have my college friends, I have my depression friends,” just a crowd that I’ve gotten to know, the people who are on the circuit. 

But I also feel, in getting to know so many other people whom I wouldn’t otherwise have gotten to know simply because they’ve been open with me about their experience, that my life has been essentially very much enriched. I mean, there are many people who are acquaintances, or even whom I would have thought of as friends, who had never told me about their own difficulty and suffering. And after the book came out, people felt more at ease doing that. And I felt very lucky to be able to get to know those people so well.

Derrick Hull:

To focus on the aspect of writing the book a little bit more, as I was going back through The Noonday Demon in preparation for our talk today, one of the things that stood out to me is how much it’s a departure from a lot of the books that are written on psychology in general that will make a reference to say popular culture, or cite a couple studies, and then build the writing around that. The Noonday Demon is, in some ways, feels to me anyway, cut from a completely different kind of cloth. And so a question on the writing of it is, as you set about doing this, were there models that you were drawing on, or did you just sit down and start writing? How did this structure, this particular approach come together?

Andrew Solomon:

I felt that there were many good books about depression. There were books about the psychopharmacology that was being developed, there were books about the underlying biology. There were memoirs by individual people telling their stories. There were books by doctors about their narrative experience with their patients, there were all kinds of books that were coming out, there were histories that were epidemiological treatises, and I felt like nobody had to put it all together. I felt like if I was going to do something, I was going to do this. I was going to try to bring together all of those different ways of thinking about and considering this illness and try to collate them into something that would give people access to all the ways there are, or at least as many as I could, of thinking about it.

Derrick Hull:

That’s so interesting. Sort of a way of bringing together all the various strands into one place. If we could, I’d like to switch gears a little bit. You know, you mentioned earlier, participating with individuals who were doing research. I wonder if you have any comments, or would want to point out any research that’s going on now, or that’s getting ready to go on, that feels particularly promising, or new, or novel that we should be paying attention to?

Andrew Solomon:

I wish I could tell you that we’re at the brink of a tremendous breakthrough, but I think essentially our understanding of depression has not progressed very much in the last 10 years. I mean the breakthroughs…what have the breakthroughs been? 

You know, there’s deep brain stimulation in which an electrode is inserted into an area of the brain and used to stimulate the brains of people who have severe, intractable treatment-resistant depression. But I mean, that’s obviously not something that’s going to be used by an enormous number of people. There’s the work with ketamine, which indicates that that drug can actually cause people who are intensely suicidal to have an almost immediate remission of suicidal feelings. There are issues with ketamine because it has been a substance of abuse. There’s a lot of work going on now to try to figure out how to make ketamine therapy available to people and simpler to administer than it is at this point.

There’s some interesting new research on psilocybin that looks at how that substance, also found in magic mushrooms, which have been a substance of abuse — people taking them from their hallucinogenic properties — how psilocybin may be helpful. But in terms of the actual medications, there isn’t any new medication that’s come through. There are electroceuticals that use a variety of devices to provide electrical stimulus that goes from the outside of the hand and, in theory, has an effect on the brain. I don’t find this studies that have been done of that particularly convincing, but it’s certainly a kind of trend and something that’s out there. But essentially the best treatments we have, well the best treatment — in terms of its efficacy — is still electroconvulsive therapy, which is now much less traumatic than it was at the time the film One Flew Over the Cuckoo’s Nest was made. But it is still not very pleasant and can have adverse effects on memory. But, in general, the best line of treatment we have for people who are not going that route are the SSRIs that really have been in use for the last 25 years.

Derrick Hull:

But it’s interesting, you know, in reflecting on your impression of the literature, certainly the National Institute of Mental Health is concerned as well, that our understanding of almost any kind of diagnostic category doesn’t seem to be progressing very much. Given everything that you’ve just said, if somebody were to come to you for advice, say, in a general sort of way, is there one particular thing that you wish more people knew about mental wellness? How to take care of one’s mental health?

Andrew Solomon:

I think the things that I would say first are that people should be vigilant in looking for the signs of depression in particular, but mental illness in general, in themselves and in the people around them. And that the people who think that they might have a mental illness should go and talk to a doctor about it. The longer you have these illnesses, the more difficult they are to reverse. And people are constantly saying, “I really want to fight it out on my own.” I did initially, but if I didn’t, I might never have gone into the catastrophic depression that I went into. And so I think people should understand, even if the symptoms seem relatively mild, it’s worth seeing a doctor and it’s worth keeping a close eye on symptoms, and it’s worth seeing whether they’re escalating. Because if you can get early, early, early treatment, you’re probably not going to have such a severe problem.

And if you wait, and wait, and wait, and keep thinking, “I think I can do this, I think I can do this. I think I can do it on my own. I think I’m going to be okay.” That’s foolish. And it’s also foolish to do this thing that so many people do where they say, “I was prescribed this medication, but I take the really low dose.” Just take the dose that’s helpful to you. There’s no reward that’s going to be given to you in the next life for having taken 10 milligrams of Lexapro instead of 20 milligrams of Lexapro. The thing to do is to get better and to remember that life is short, and the time you spend not getting better, is time if you’re not feeling very well.

Derrick Hull:

It makes me wonder if you feel that stigma is a piece of this resistance towards getting help. And if so, have you seen many changes in stigma over the years that you’ve been seriously thinking about this issue?

Andrew Solomon:

Well, there’s no question that the stigma is not as bad as it was. I mean, when Bill Styron wrote his book Darkness Visible, in the 1980s, nobody was talking openly about the experience of depression. And the book was very, very shocking. And then very valuable to many people. Now, you know, it’s par for the course that celebrities come and they talk about their depression, and they talk about their anxiety, and people like Demi Lovato talk about all kinds of specifics of their experience, and you know, there’s definitely much more open public discussion. But it remains highly stigmatized and some of the stigma comes from people outside and some of the stigma comes from within. We still have a society that tends to convey mental illnesses as weaknesses of character. We still see these illnesses as almost a moral failing, in many instances, and that causes the people who are experiencing them to think of them in those terms.

Derrick Hull:

One thing that stood out to me as I was reading the final chapter that was added in The Noonday Demon is that you mentioned two resources that have been very helpful for you. One, a psychopharmacologist, and then another, a psychoanalyst. And I wonder if you would be willing to talk a little bit more about what working with your psychoanalyst has done for you. Have you tried other approaches to psychotherapy? How these have balanced in terms of your own needs.

Andrew Solomon:

The person with whom I do therapy is trained as a psychoanalyst. We do a sort of psychodynamic therapy, but I’m not in full time psychoanalysis and I’m not there every day. I have been seeing Dr. Friedman for 26 years, I think. So I haven’t tried a lot of other things, just because he’s the person I see. Though there was a period when he, for various personal reasons had to step away from his practice for about six months, and I went to see someone who did cognitive behavioral therapy because I was curious to see whether it would have a very dramatic effect on my well-being, which felt fragile at that point. I feel like the therapy, most of the time, is effectively useless. I feel like I see Dr. Friedman and I leave thinking, “Oh, well, he sends to me interesting things and we got to some interesting points, but I could probably figure it out a lot of that on my own.”

But I feel like he’s there and paying attention so that when I start to descend into another round of depression, there’s someone who knows me, and who knows what I’m going through, and who knows what I’ve been through in the past, and who can say, “I’m worried about this. And if you’re reporting that, that’s a problem.” It’s very stabilizing. And the consistency of it is very stabilizing. The fact that I do it over, and over, and over, and over again with the same person. He knows me unbelievably well. He knows certain things about me that nobody else really does know. There’s a kind of wealth in the intimacy that he and I have established over the course of these many, many years that is invaluable. And he’s now getting older and I suspect will eventually need to retire or to draw back from doing the work that we do together.

And he saw me through the most catastrophic depression, and he saw me through the period before I had found a husband, or had children, or in a time when I was…when my life felt much more vulnerable than it feels right now. And I don’t imagine I’ll be able to strike up quite that relationship with anybody else. Though I’m sure there are other people who would be able to help me. But given that I fluctuate — even when I’m feeling well — I think it’s really important to go there. And I must say that it’s often enjoyable, too.

Derrick Hull:

Well, losing that kind of relationship will certainly be quite a loss when the time comes.

Andrew Solomon:

I’m hoping that he doesn’t withdraw at the same time that my aging father dies. I’d like those things not to happen at the same time.

Derrick Hull:

Certainly. Certainly. How about thoughts on digital mental health treatment? Do you have many thoughts on approaches to either offering self-directed training for depression or other kinds of digitally mediated treatment?

Andrew Solomon:

I think that digital treatment has some potential for people who for one reason or another are not able to access any other form of treatment. I think its usefulness is going to be somewhat limited because I think that the real healing from depression is a result either of medical interventions, which can’t be performed digitally, medications or whatever else it is. Or they’re the result of establishing any human relationship. 

I mean, even for me, and I don’t feel short in any way of intimate relationships all around me, I feel like Dr. Freedman’s ability to help me has risen out of the dynamic that exists between the two of us. And I think a lot of depression is actually the result of interacting too often in digital context rather than in direct ones. 

You know, there’s a study that I became quite fascinated by, in which a group of very young children — who came from some non-Asian background in, I think it was California — had a woman who came and spoke to them in Chinese and played with them for an hour once a week. And she did that for a year. And then another group of children had the same woman, saying many of the same things, but she was on a screen. And the children were fascinated by the screen, as little ones are, and watched her very closely, but she was on a screen rather than in person. And at the end of the year they tested the children and the children who had been visited in person could distinguish all of the tones that are necessary for the use of Mandarin Chinese. And the children who would watch the screen couldn’t recognize any of the tones that were significant in speaking Mandarin Chinese. 

I just don’t think that the digital presence is comparable. I think it can be useful. And I think it can be useful as a supplement. I think it can be helpful when nothing else is available, but I don’t think you will ever have the same power as direct interaction.

Derrick Hull:

And it sounds like you feel too, that even for the digitally mediated treatments that are out there, that some component of relationship is critical to any success that they would have.

Andrew Solomon:

I don’t want to say it’s critical to any success that they would have, but I would say it generally is enormously helpful to the success that people seek.

Derrick Hull:

Fair enough. One last question, if we could, as your children get older, how have you found it’s helpful to talk to them about mental health — your own mental health and mental health in general — or even preparing them for understanding how to be in touch with their own health?

Andrew Solomon:

It’s a delicate balance. My children are 12 and 10 and I want them to know that if they suffer from any form of mental health challenge, that they should feel free to come to me and to talk to me about it. And that I’m very open to it. They know that I’ve had depression. They know that I take medication for depression. I’ve talked about it with them from time to time. 

I don’t want to engage them so deeply in my depression that they ever sense that I’m somehow an unstable figure in their lives and might suddenly disappear. And I think children tend to leap very quickly to the catastrophic logic of any of these challenges. 

So when I’m talking to them about it, I am very open and I say, “you know, some day you may have some of these things, too, and if you do, I hope you’ll come and talk to me about them. I’ve really been helped by doctors and by medication, and I’m really doing fine, and so on and so forth. I tried to do it in a very calm, reasonable, non-overwrought sort of way.

Derrick Hull:

Perfect. Well, Andrew, I can’t thank you enough. Honestly, both personally, and from Talkspace, and from others on the team who’ve helped prepare for this interview and thanking you for your time and your generosity of spirit and sharing your experience with us — it’s been a pleasure speaking with you. 

Andrew Solomon’s most recent book is Far and Away: Reporting From the brink of Change, which is a collection of his international reporting, and his audible original New Family Values draws on dozens of intimate interviews to redefine what it means to be an ideal family in America today. 

Andrew, with that, I want to thank you again and good luck.

Andrew Solomon:

It’s been a tremendous pleasure. Thank you.