A deep dive on "The Noonday Demon"
Today, we are going to discuss a voluminous book called "The Noonday Demon," which has a really cool cover.
One day, I was having lunch with a famous psychologist, and during the meal, a friend asked what to do about a friend who suffered from severe depression. The psychologist recommended reading "The Noonday Demon," an encyclopedic book on depression that covers every aspect of the disorder in detail. I overheard this and thought, since there's such a good book, why not share it with everyone and help them understand what depression is all about.
The author of this book has experienced depression himself and has managed to overcome its curse. He continues to struggle with depression but lives a relatively normal life. He conducted thorough research and wrote this book from his own perspective. The reason the book is so thick is that it contains many case studies. We don't need to discuss every single case of depression, but we will mainly focus on the theoretical aspects. For details about the cases, you can read the book yourself.
First, depression is divided into mild and severe cases. How can we describe the difference between mild and severe depression? There used to be some scales, where answering certain questions would indicate if you have mild, moderate, or severe symptoms. The author thinks this division is too simplistic.
In reality, the feeling of depression is challenging to classify. The author suggests using adjectives to describe it more accurately. Mild depression is like corrosion, as if a piece of iron slowly rusts, whereas severe depression is like a sudden collapse, like stepping into a void, and everything crumbles. His depressive episodes began without warning, and one day he couldn't get out of bed, or even eat during severe episodes.
Many doctors, especially in the past, didn't consider depression a typical illness. Patients would complain about pain or discomfort, and doctors would often say, "You're just depressed; you have no other problems." This makes it sound like depression isn't a real illness. But has anyone ever told you, "You just have emphysema, and no other diseases"? No, because emphysema is a typical disease, and so is depression. It causes chemical changes in our bodies, altering the neurotransmitters and electrical signals in our system.
What makes depression so complex? It's not a purely chemical issue like diabetes. We know that diabetes is due to problems with insulin secretion, so injecting insulin can quickly fix the issue. However, the brain isn't that simple. When depression strikes, serotonin levels are definitely low, but we can't just inject serotonin into your body to fix it. This complexity is one reason why depression is so difficult to treat.
People who have never experienced depression cannot understand it. The author uses metaphors to describe the feeling, like standing on the edge of a cliff. Every day, you live on the edge of a cliff, trembling, unsure of your next step, and at risk of suddenly falling from the cliff and being shattered. This is why many people with depression become disabled. They feel unable to do anything, curling up like a child, paralyzed because they fear any movement will send them tumbling off the cliff.
So why is this book called "The Noonday Demon"? It's important to distinguish between depression and pain. Sometimes, pain can bring enlightenment, elevate our lives, and serve as a way to express our emotions, but depression is not like that.
The author says, "When someone asked the desert hermit Saint Anthony how to tell the difference between a humble, unassuming angel and a devil in disguise, he said that the difference lies in how they leave you. When an angel leaves you, you feel stronger because of their presence; when a demon leaves you, you only feel terror. Grief is like a humble angel; when it leaves, you feel mentally clear and strong, aware of your depth. But depression is a demon that leaves you terrified."
So we must not confuse depression with simple pain. What we want to eliminate through medical treatment and conversation is not pain, but the feeling of living like a walking corpse. If someone loses a loved one, they will be very sad, cry, and perhaps not want to eat. They might feel extreme pain and heartache, but they have feelings. This is not depression; this is normal pain. These pains might make your mind clearer and serve as part of the recovery process. But if someone feels numb and lifeless, unable to tell if they are alive or dead, and has no goals in life, and is not sensitive to pain, this feeling is called depression. So we are not trying to solve pain, but the feeling of living like a walking corpse.
First, let's talk about the author's own collapse, which happened three years after his mother's death. In 1991, his mother passed away, and three years later, he collapsed. It could have been the death of his mother that triggered it, but the pain was suppressed. At the time, his novel was about to be published, and he had just bought a new house. He thought he had a happy childhood, with a younger brother, and they lived well together. His parents treated them well, and they had a loving and harmonious relationship. So he could not trace the source of his depression; it didn't seem to be a problem with his family of origin.
Then, when he graduated from college and traveled to Europe, he had a minor collapse in Budapest. Not long after arriving in Europe, he suddenly found himself suffering from insomnia, unable to sleep at night. The next day, when meeting people, he was trembling, had headaches, and felt nauseous, thinking he couldn't continue traveling. So, he immediately bought a plane ticket back to the United States, dragging his body as if he were seriously ill. When he returned to the US, his parents saw him and thought it was strange, asking, "What's wrong with you? Are you sick?" He wasn't sick; it was his first minor collapse. But he recovered soon after, so he didn't think much of it.
After his mother's death in 1991, he had a relationship in 1992, broke up in 1993, and in 1994, his psychoanalyst was about to retire. He had been seeing a psychotherapist for counseling, and when this
therapist was about to retire, he found it hard to accept.
"It was in March of that year when I told the analyst that I had lost all feeling, and that a certain numbness had affected my relationships with everyone. I no longer cared about love, work, family, or friends. My writing pace slowed down more and more until it came to a complete stop." All of the passion, pursuit, desire, and love he had felt before seemed to have evaporated, and he suddenly lost all feeling.
At the end of August, he suddenly developed kidney stones. Kidney stones are very painful, and he went to the hospital for treatment. He experienced a lot of pain and subsequently had a breakdown. "Just before my 31st birthday, I completely collapsed. It seemed like my whole person had crumbled, and I no longer went out with anyone... The day before my birthday, I only went out once to buy some groceries. On my way home, I suddenly lost control of my lower abdomen and ended up soiling myself. I hurried home, feeling the filth spreading. As soon as I entered, I threw the shopping bag aside, rushed into the bathroom, took off my clothes, and then went to bed. I didn't sleep much that night, and I couldn't get up the next day. I knew I couldn't go to any restaurants. I wanted to call friends to cancel appointments, but I couldn't even make a phone call. I lay there motionless, trying to speak, trying to figure out what to do. I moved my tongue, but couldn't make any sound. I had forgotten how to speak. Then I started to cry, but there were no tears, only intermittent sounds. I lay on my back, wanting to turn over, but I couldn't remember how to do it. I tried to think about how to turn over, but the task seemed incredibly difficult. I thought maybe I had a stroke, and I cried for a while. Around 3 pm in the afternoon, I finally managed to get out of bed to use the bathroom, and then returned to bed shaking. Fortunately, my father called. I answered the phone, my voice trembling, and said, 'You must cancel tonight's plans.' 'What's wrong?' he kept asking me, but I didn't know what was wrong."
"During depression, your field of vision narrows and begins to close, as if you're watching television with a powerful static interference. You can see some images, but you can't really see them clearly unless there's a close-up shot, and you can't see people's faces - everything loses its boundaries. The air is thick and stagnant, like mashed bread dough. Depression is like blindness, with darkness gradually creeping in until it surrounds you completely; it's also like deafness, with fewer and fewer sounds heard until a terrible silence envelops everything, and you can't make any sound to pierce the silence. It feels as if the clothes on your body are slowly turning into wood, making your elbows and knees stiffer and heavier, and this isolated immobility will eventually wither and destroy you."
I once talked to a severely depressed person. He told me that every day he felt like he was walking in a dark tunnel, unable to see the end, seeing a glimmer of light in the distance, but never able to reach it. This is very similar to what the author describes. So, when we casually say that we're in a bad mood, it may not be a depressive episode. And when it does happen, it's a sudden collapse.
After the author's breakdown, he quickly sought medical help, started taking medication, and moved in with his father, who was already in his 70s. For more than a week, he couldn't get out of bed, turn over, eat, or bathe. The worst part was that he wanted to cut a piece of lamb chop, but his fingers couldn't control the knife and fork, so his father had to feed him during meals because he had completely lost these abilities. Imagine a man in his 30s being fed by his father, bite by bite.
During a depressive episode, many changes occur in a person's physiology: neurotransmitter function changes, synaptic function changes, the excitability between neurons increases or decreases, gene expression changes, metabolism levels in the frontal cortex decrease or accelerate, thyrotropin-releasing hormone (TRH) levels increase, dysfunction in the amygdala and possibly the hypothalamus, changes in melatonin levels, increased secretion of prolactin, reduced 24-hour body temperature fluctuations, abnormal 24-hour cortisol secretion, disruption of neural circuits connecting the thalamus, basal ganglia, and frontal lobe, increased blood flow to the frontal lobe of the dominant hemisphere, reduced blood flow to the occipital lobe, and decreased gastric juice secretion. It is difficult to understand all these phenomena: which are the causes of depression, which are symptoms of depression, and which are merely coincidental.
It is not easy to distinguish between these concurrent events, whether they cause depression or are caused by depression. But what we do know is that "the more depressive episodes, the greater the likelihood of recurrence. In the course of a lifetime, the condition generally worsens, and the intervals between episodes become shorter."
One of my biggest takeaways from reading this book is that many people, including myself, would advise a person with depression to take less medication. It is irresponsible for someone without medical knowledge to say, "Medicine is always a bit toxic. You seem fine now; you can gradually reduce it."
The author states: "Often, patients who initially respond well to medication, if they repeatedly go through the process of taking medication and stopping it, the medication will no longer be effective; with each episode, the risk of depression turning into an incurable chronic disease increases by 10%. As Post (an expert) explains, 'It's a bit like early-stage cancer, where medication is very effective, but once cancer cells metastasize, medication doesn't work. If there are too many episodes, the brain's biochemical processes undergo adverse, likely permanent, changes. At this stage, many psychotherapists are still working in completely the wrong direction.'"
"There are three independent events that always occur simultaneously: a decrease in serotonin receptors, an increase in cortisol, and depression." That is, depression, a decrease in serotonin, and an increase in cortisol always occur together; we do not know their order, like the question of whether the chicken or the egg came first. However, we can clearly see that once the relationship between cortisol and stress is disrupted, you become hysterical. When researchers injected baboons with cortisol, causing an increase in cortisol levels, the baboons would suddenly become explosive and hysterical over small things like a banana. This is the effect of cortisol.
"Once you are under too much stress, causing your cortisol levels to continuously rise, your cortisol system will be damaged and will become difficult to stop once activated. After that, the elevated cortisol levels from minor traumas will not be able to return to normal as they would in a typical environment." Can you understand? Normally, we have a little bit of stress, and we recover and get through it. But when your cortisol levels are too high, reaching a state where the cortisol system is damaged, you may not be able to recover like a normal person.
"Once damaged, it is prone to repeated damage, with smaller and smaller external pressures required; the same is true for the cortisol system. Some people have heart attacks after physical exhaustion, and for them, even sitting in an armchair can trigger a recurrence—the heart is already worn out, and sometimes it doesn't take much to make it stop working. The mind follows the same rule."
Think about it, none of us would dare to advise a diabetes patient to reduce their medication intake, saying that if their diabetes index is normal today, they should stop taking medication; nor would we dare to advise a patient with heart disease or high blood pressure to stop taking medication, saying it's fine, they won't die. We would never casually advise someone with these diseases to stop taking medication. They all require long-term medication, and the problem of side effects may arise from long-term medication, which needs to be managed. But if you don't take medication, the result is certain: not taking medication will make the disease increasingly difficult to treat.
In this book, the author interviewed many doctors, and they all warned against casually advising others to stop taking medication, as it is a very dangerous thing to do. After taking the medication, the author found it effective after one week, and it took six months for the medication to gradually take effect. He then attended some events in a drowsy state because he is a well-known writer and often needs to attend book clubs and other events. Once, while attending an event at a university campus, he suddenly lay down on the muddy ground halfway through walking. His friend told him that he couldn't lie on the ground and suggested that they walk a few more steps to a chair nearby. But he couldn't even walk those few steps, so he had to lie flat on the spot, right on the ground.
When is a patient most at risk? It's during the semi-recovery phase, because that's when they have the ability to commit suicide. When they are completely broken down, they want to die, but they have no way to do so. But when their physical strength starts to recover, they take some medication, go out and are able to eat by themselves, they begin to feel dangerous and don't want to live anymore.
The author thought of a strange way to die: he hoped to contract AIDS, so he engaged in a lot of risky social interactions. He felt sure that he would get AIDS. But one detail betrayed him: when he later went for an HIV (Human Immunodeficiency Virus) test, the doctor told him that the result was negative, and he felt a slight happiness in his heart. This proved that he didn't actually want to die. Although he had previously taken many risky actions, he decided not to commit suicide after that because he realized it was not what he truly wanted but rather was controlled by the disease.
Many people say that always taking medication is terrible, and now that you are healthy, you can gradually stop taking it. John Grayden is an expert who says, "I may not know what the long-term effects of taking medication are, as no one has taken antidepressants for 80 years. But I do know the consequences of not taking medication, taking it intermittently, or improperly reducing the dosage: it can damage the brain. You have to start bearing the consequences of turning chronic, experiencing increasingly severe relapses, and enduring unnecessary pain levels. We never treat diabetes or hypertension with intermittent medication, so why treat depression this way? Where does this strange social pressure come from? Without medication, the relapse rate of this disease is 80% within a year, but with medication, the recovery rate is 80%." There is such a big difference. "People worry about the side effects of lifelong medication, but compared to the lethal power of untreated depression, these side effects are almost negligible." This is a very important point to understand.
Afterward, he experienced another collapse, but this time he had experience. When he collapsed again later, he said, "I already have a set of post-collapse activation procedures. I know which doctor to call and what to say; I know when to put away the razor blades and walk the dog regularly; I make a round of phone calls and say directly that I'm depressed. Several newlywed friends moved in with me for two months, helping me through the hardest times, talking with me about my anxieties and fears, telling me stories, taking care of my meals, and easing my loneliness—they all became my lifelong soulmates. At my lowest point, my brother unexpectedly flew in from California and appeared at my doorstep. My father continued to take care of me as well. To my knowledge, the following methods saved me." This passage is essential: "Quick action; having a good doctor ready to understand your situation; being very clear about your patterns; maintaining regular sleep and diet habits no matter how repulsive; immediate stress reduction; exercise; mobilizing the love you have."
What inspiration does this offer for us? The inspiration is that when a friend around you needs such help, you should step forward to help them and give them enough care, rather than just standing by and saying simple words like "Keep going, you can do it" or "There's no problem, depression is mainly about being strong yourself"... Such words can make them collapse even more. You'd be better off taking care of their meals, helping them get dressed, and helping them bathe. At the most challenging times for this author, it was his friends who helped him bathe because he didn't have the strength to do so. They took care of him like a child every day.
We now have a rough idea of what a collapse looks like, so let's look at treatment methods. Treatments can be broadly divided into two types: talk therapy and physiological intervention. Physiological intervention includes medication and electroconvulsive therapy. Talk therapy and physiological intervention are not mutually exclusive. We had some misconceptions in the past, thinking that you should either take medication first and then go for talk therapy or try talk therapy first and then take medication. The author believes there is no need for this; you can undergo both therapies simultaneously, as they complement each other.
In terms of medication, "Prozac is a very tolerant gift." The person who said this was from Eli Lilly, the pharmaceutical company. They believe that after taking Prozac, patients will become happier and more open-minded. I had a friend who took Prozac before, and after taking it, he told me that he felt like he had no worries, and his mood improved a lot after taking Prozac. He had mild symptoms.
"An approach to evaluate a psychiatrist is to observe how accurate their judgment of you appears, and the art of initial screening lies in asking the right questions." That is, you need to find a good doctor because the quality of talk therapy doctors varies greatly. The author changed 11 therapists in 6 weeks, mainly because many of them were unreliable. Some people study psychology just to cure their illness. "I've seen that most good psychiatrists start by letting patients tell their stories and then quickly switch to highly structured interviews," meaning they have a set of routines and systems.
In conversation therapy, the two most successful treatments for depression are Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy. We have discussed CBT in many books, such as those on overcoming stress and stress management, where you need to learn acquired optimism. A person prone to depression is likely to experience learned pessimism and helplessness, while an optimistic person will exhibit learned optimism. For example, when we encounter something terrible, a person with learned optimism might think: this is an opportunity, this is great. Cognitive Behavioral Therapy has been proven to be effective. So, what is Interpersonal Therapy?
“Interpersonal Therapy focuses on the reality of everyday life, treating and repairing current issues without considering the entire framework of a person's life history.” Interpersonal Therapy does not aim to make patients more profound individuals. Instead, it teaches patients how to make the most of whatever situation they are in. This short-term therapy has clear boundaries and limitations. Interpersonal Therapy assumes that many depressed people have some sources of life stress, either triggering depression or resulting from it, and these stressors can be cleared through wise interactions with others. The therapy is divided into two stages. In the first stage, the therapist helps the patient understand depression as an external pain and informs them that this condition is widespread. The patient's symptoms are sorted and named – naming is an essential first step in treatment.
“In the second stage, patients accept their role as a sufferer and seek improvement. They list all their current interpersonal relationships and, together with the therapist, define what they get from each relationship and what they want. The therapist and patient work together to find the best strategy for the patient to get what they need in life.” Problems are categorized into four types: grief, role differences when dealing with friends and family, stressful transitions in personal or professional life, and loneliness. These are four external factors that cause stress. Afterward, the therapist and patient set achievable goals and decide how long to work towards them. Interpersonal Therapy neatly and explicitly outlines a person's life. In short, Cognitive Therapy helps resolve your thoughts, while Interpersonal Therapy helps resolve your actual life situation. These are the two methods of conversation therapy.
What about drug therapy? Currently, the most popular drugs on the market are SSRIs, which can increase serotonin levels in the brain. Prozac, Zoloft, Paxil, Lexapro, and Celexa are all examples of these drugs. These medications must not be taken without a prescription, and you definitely should not buy them on your own. They are all strictly regulated prescription drugs, and you need to find a qualified doctor.
One of the most stigmatized treatments is Electroconvulsive Therapy (ECT). I have seen a friend undergo ECT, and as family and friends, we feel heartbroken. The patient will wear two electrodes on their temples, and when the electricity is turned on, their body will tremble. Many patients in hospitals are also terrified of this treatment. However, the actual effectiveness of ECT is much more significant than that of medication.
Let's first clarify what electroconvulsive therapy (ECT) is and what it does. "Among patients whose symptoms improved after receiving ECT, about half still felt good a year later." That is, a single ECT treatment can last a year and the patients are in good condition. "The other half needed repeated rounds of ECT or regular maintenance ECT," which means occasional ECT treatments. "ECT is effective quickly. Many patients feel a significant improvement within days of receiving ECT, in stark contrast to the long and slow process of medication taking effect. Due to its rapid effect and high success rate, ECT is particularly suitable for patients with severe suicidal tendencies and those who repeatedly self-harm, posing a threat to their lives."
What are the side effects of ECT? The patient may forget things for a period of time, experiencing memory loss, and may feel like they are still living in yesterday when in reality, time has passed. The author, who is also a patient, conducted extensive research and interviews with numerous doctors. He concluded that ECT is the most stigmatized treatment.
In the book, there is a case where a person decided to commit suicide. One day, as they walked down the street, they hesitated at a fork in the road: one path led to suicide, and the other to ECT treatment. In the end, they decided to undergo ECT, and eventually recovered, with their brain feeling much more comfortable and their work and life returning to normal. This is just one form of treatment, and we must not view it as an injury, a destruction, or abuse of the patient. Excessive fear and horror may lead to patients and their families rejecting this form of treatment, potentially pushing them in another direction.
Faith can also be helpful. What are the benefits of faith? It can give meaning to your suffering. Depressed people may feel that their suffering is meaningless and see no reason to continue living. However, when you assign meaning to suffering, you become more willing to fight and endure it.
There are also many alternative therapies. This author tried various suggestions, such as knitting cats and dogs, tap dancing classes, energy healing, hiking, mountain climbing, dietary adjustments, transcranial magnetic stimulation, eye movement desensitization and reprocessing therapy, massage, aromatherapy, and outdoor exploration, all of which may help treat depression. In the most bizarre case, he participated in a Senegalese ritual where he was placed in a sack tied to a goat, praying for his soul to be taken away. He didn't ridicule these experiences and thought that perhaps exercise, hiking, aromatherapy, or massage might help him, or even the Senegalese ritual, as he felt better after these activities.
Now let's discuss some background information about depression, starting with the affected population. Women are twice as likely to suffer from depression as men. Why is this? Some say it is because women have two peak periods for depression: postpartum and menopause. Both are characterized by significant hormonal fluctuations, leading to emotional collapse. Another important reason is that men synthesize serotonin 50% faster than women, meaning men recover more quickly and are less likely to suffer from depression.
The rate of childhood depression is becoming higher and higher nowadays. If a child suffers from depression, the worst thing is that their energy can only be used to fight depression. Apart from fighting depression, their energy doesn't allow them to do anything else, because depression has consumed all of a child's energy. The most extreme case is that the youngest depression patient may be only three months old. Doctors have seen depression in a three-month-old baby, who doesn't look at their mother and doesn't respond to anyone calling them. Although their ears have no problem, they don't want to pay attention to anyone. It's strange that they are depressed.
"Depressed children usually grow up to be depressed adults. …Depression has a certain incidence rate before entering adolescence, but the peak is in adolescence, with at least 5% of teenagers suffering from clinical depression. At this stage, depression is often accompanied by substance abuse and anxiety disorders. Parents tend to underestimate the degree of depression in their adolescent children. Of course, adolescent depression is not easy to distinguish, because normal adolescence itself is very similar to depression, a period prone to extreme emotions and extreme sensitivity to pain."
We often see many such tragedies happening around us, where many parents do not think their child has depression, believing it's just adolescence or a bad temper, so they ignore the treatment. "The development of secondary sexual characteristics often triggers emotional distress." "The earlier depression starts, the stronger the resistance to treatment." That is, the earlier the depression occurs, the more difficult it is to treat. Therefore, parents should give enough attention.
Another group of people are the elderly. The proportion of elderly people living in nursing homes who suffer from depression is twice that of those living at home. This is because nursing homes are full of elderly people, all living together in their twilight years. More importantly, many symptoms of elderly people may seem like depression, as they appear listless, sitting there without talking. So many people think they are just getting old. But in fact, they may have entered a state of depression. For the elderly, electroconvulsive therapy is more effective than drug therapy. The elderly's body absorbs drugs slowly, but electric stimulation can quickly wake them up. Often, depression is a precursor to Alzheimer's disease, meaning that after an elderly person suffers from depression, they may quickly enter a state of Alzheimer's. We have talked about a book called "Ending Alzheimer's", which discusses this issue.
Different cultures treat depression differently, such as East Asians who particularly avoid the topic of depression.
Regarding the topic of suicide, I hesitated for a long time whether to talk about it or not. The author also mentioned that discussing suicide might stimulate those who want to commit suicide. However, if we don't talk about it, people may not pay attention to this issue, which could lead to many problems becoming more serious. The author says that suicide is not a symptom of depression, but another coexisting issue.
We used to think that a symptom of severe depression was attempting suicide. But the author says it's not; some people suffer from severe depression for a long time, but they never think about suicide. They live a good life, although they are in pain, but they don't want to commit suicide. Some people don't have depression, and then they encounter a small change in their life, and they suddenly commit suicide. This is another issue, not a symptom of depression. Of course, there is a possibility that they coexist.
The author, after interviewing experts, concluded that there is a subtle but important difference between "wanting to be dead, wanting to die, and wanting to commit suicide." These three things are not the same. "Most people occasionally wish they were dead, to reset everything and be free from sadness. In depression, many people want to die, wanting to actively change their situation and escape from the conscious pain. Wanting to commit suicide requires extraordinary passion and specific, directed violence. Suicide is not a passive result, but a product of action. Suicide requires a firm belief that the terrible situation will never improve, as well as abundant energy, strong will, and at least a bit of impulsiveness."
If someone around you, or even a celebrity, commits suicide, it can lead to many people imitating the act. Therefore, it is helpful to protect potential suicide victims by not overly publicizing suicide news in mass media. The author's mother committed suicide. She had cancer, and at the end, she was in great pain, with chemotherapy no longer able to treat her body. So, she told her whole family (including the author, his father, and brother) that she wanted to choose her own way out. This incident had a significant impact on him, making him feel that it was terrible and shouldn't have happened, but at the same time, he felt that his mother's choice seemed to have its own reasons.
The author shared a quote that illustrates his inner struggle: "I talk about suicide not because it is always a tragedy for the deceased, but because for those left behind, suicide always comes too quickly, too suddenly... Nietzsche once said that thoughts of suicide allow many people to survive the darkest moments of the night, and I would say that the more thoroughly one contemplates rational suicide, the more likely one is to be spared from irrational suicide. 'If I can survive this moment, I can always end my life in the next moment,' is precisely the knowledge that allows me to endure this moment without being completely overwhelmed. Suicidal tendencies may be a symptom of depression, but they are also a factor in alleviating depression. Thoughts of suicide help people endure depression. As long as what I can give or receive is better than pain, I hope to continue living."
What does this mean? In typical TV shows where someone is about to commit suicide, and someone else urges them, "Think about your family, don't do this, don't jump." The more you say this, the more likely they are to take the leap. Persuading someone not to commit suicide is a technical skill, not something ordinary people can do. The more you tell them to think about their family, the heavier their psychological burden becomes. Conversely, as the author suggests: you have the right (to commit suicide), you can exercise this right at any time in the future, but now you can try to see if there are other opportunities because you have reserved this right, and no one says you can't do it. When you give them this right, they may be more willing to try again and continue.
Some mental health professionals use a method that asks the person to imagine the process: how to die, what it will be like after death, whether it will be painful when dying, and how the people around them will feel and react. This way, by thinking about the consequences of suicide, they might weigh their options and decide not to go through with it. This requires the intervention of professionals, as ordinary people find it challenging to get involved in such situations.
The next topic is about the relationship between poverty and depression. The longer a person experiences poverty and depression, the more severe their depression becomes. Many impoverished people with depression do not receive treatment. First, they lack the resources to seek treatment, and secondly, they do not come to the attention of medical researchers. There are many things that we cannot determine whether they are symptoms of depression or a result of a miserable life. A miserable life makes depression a norm, leading to many impoverished people's depression being neglected and untreated, which requires society as a whole to pay attention to this issue.
"85% to 95% of Americans with severe mental illnesses are unemployed." This creates a vicious cycle where the more depressed you are, the worse your financial situation becomes, and the worse your financial situation, the more depressed you become. "There has been much debate about the causes of depression in the past decade, but one thing is clear: depression is usually the result of a genetic vulnerability being activated by external stressors." This means that depression itself has inherent issues – vulnerability – but external stressors activate it. "Checking for depression among the poor is like checking for emphysema among coal miners", meaning the rate of illness is very high.
"The incidence of schizophrenia is twice as high among low-income populations as among the middle class. Researchers initially assumed that the difficulties of life somehow triggered schizophrenia, but the latest research suggests that it is schizophrenia that causes life difficulties: mental illness is expensive and confusing... This 'downward drift hypothesis' seems to hold true for depression as well." So, depression leads to poverty, and in turn, poverty leads to depression.
Another chapter, titled "Evolution," discusses why humans experience depression. Some people describe depression as a kind of emotional hibernation, where people enter a state of "hibernation" when faced with immense pressure and pain, unable to adapt: unable to move or do anything at all, as a form of self-protection. However, why does this self-protection lead to self-harm? So, it seems we cannot simply apply evolutionary reasoning here. There are four possibilities.
"First, depression may have served some function in evolution prior to the emergence of humans, and this function has now been lost. Second, the pressures of modern life are incompatible with the evolution of our brains, and when we engage in activities that do not align with our evolutionary state, we become depressed." In primitive societies, people did not need to interact with many people; early humans interacted with groups of 50 to 70 people. The Dunbar's number, researched by psychologists, suggests that a person can interact with up to 150 people at most. Even with mobile phones and contact lists, you only interact with 150 people regularly. However, in modern life, we have to deal with too many people and various noises, which has completely changed the natural environment that we, as animals, were initially adapted to, leading to the generation of stress.
"Third, depression itself plays a beneficial role in human society, and sometimes it is a good thing for a person to be depressed. Finally, the genes associated with depression and the resulting biological structures are also related to other, more useful behaviors or feelings, i.e., depression is an incidental result of some useful mutation in brain physiology." Looking back at the origins of depression, we can draw some conclusions: it may be a form of hibernation to cope with anxiety and unease, a self-protective method that allows you to pull through.
After being diagnosed with depression, whether to tell others is an issue. The author believes that we should talk more about depression with others, meaning that you should bravely speak out and confide in the people around you. If someone is unwilling to listen, you can find someone else until you encounter someone willing to listen and help, as sharing can greatly reduce stress.
Lastly, the author talks about hope for the future and why he wrote this book. I think his reasons for writing this book also represent why I want to talk about it. The book is quite thick, filled with many case studies, and the most fascinating aspects are the detailed descriptions. However, it involves many physiological issues that I think are not suitable to discuss in great detail; if you have the opportunity, you can read the book yourself. So, why did he write this book?
"People always ask me why, why do you want to write a book about depression? They seem unable to understand why I would fully commit to this unpleasant topic, and I must admit that at the beginning of my research, I often thought my choice was foolish. I have given several appropriate answers. I said I felt I had something to say that others had not said before. I said that writing is an act of social responsibility, and I wanted to help people understand depression, learn how to best care for those with depression, and I admitted that I received a large advance payment and thought that the subject would capture the public's imagination, and I wanted to become famous and be loved. But it wasn't until I had written about three-quarters of the book that the full meaning of writing it became apparent to me. The strong and shattering vulnerability of those with depression was beyond my expectations. I was also unaware of the various ways in which this vulnerability interacts with personality and how complex it is. ... I feel that, in the long run, depression can make good people better and bad people worse. Depression can both destroy one's sense of proportion, leading to delusion and a false sense of helplessness, but it can also be a window to the truth. ... I chose to depict people I admire. Most of the characters in this book are strong, intelligent, resilient, or exceptional in other ways. ... I believe that these stories that have helped me can also help others. Some people with mild depression become completely disabled, while others with severe depression struggle to survive." Different people exhibit different character, approaches, and courage when facing depression.
The author says, "In my experience, no matter how good the medication is, it only gives you a way to reshape yourself; it doesn't reshape you by itself. We can never escape the choices themselves. The self lies in choices, every choice we make every day. It was my decision to take medication twice a day. It was my decision to talk to my father. It was my decision to call my brother, to raise a dog, to get up when the alarm clock rings, and sometimes to be ruthless, self-centered, or forgetful. ...In my view, thinking as the basis for existence is not as powerful as making choices. Our humanity lies not in chemical processes or environments, but in our willingness to use existing technology based on our place in time, our character, age, and environment."
"It can be said that, compared to non-depressed people, those with depression have a more accurate perception of the world around them. People who think they are not very likable may be closer to reality than those who think they are loved by everyone. Depressed people may have better judgment than healthy people. Some studies show that the performance of depressed and non-depressed people in answering abstract questions is equivalent. However, when asked about their control over specific events, the self-assessment of non-depressed people is invariably higher than their actual level, while the assessment of depressed people is quite accurate."
"After experiencing depression, people's fear of crises may be alleviated." That is, when you have experienced something, faced fear, and seen bad things happen, you may become stronger. "Virtue is not always about doing good deeds without seeking rewards, but loving others can bring a kind of peace that is unattainable when away from others."
Do you know the essence of positive psychology? If we were to condense positive psychology into one sentence, it would be "caring for others". When you learn to care for others, you have a positive mindset. "At the lowest point of depression, there is a terrible sense of loneliness, and from it, I learned the value of intimacy." That is, the author did not realize how important his father, brother, and friends were in the past. After experiencing depression, he discovered the invaluable nature of these relationships.
"People cannot choose whether or not to be depressed, nor can they choose when or how to recover, but they can choose what to do with their depression, especially after overcoming it. Some people recover briefly, knowing that they will fall back into it again. But during their recovery, they strive to use their experiences with depression to enrich and improve their lives. For others, depression is just a desperate situation from which they can never gain anything."
I believe that among those listening to us discuss this book, there is a relatively large proportion of people with depression. I hope you can take this part to heart. What do we do with our depression? Do we just see it as a miserable experience, or do we use it to help us see life more clearly, cherish interpersonal relationships more, and learn to care for others?
"An unexamined life is unacceptable for those with depression. This may be my biggest surprise discovery: it's not the depression that's awe-inspiring, but the people who encounter depression may become awe-inspiring because of it. I hope this basic fact can provide some nourishment to those who suffer, and that it can inspire patience and love in the hearts of those who have experienced pain."
Milton once said that if one does not recognize evil, they cannot taste good. In other words, to be a good person, you must understand the nature of evil. After experiencing depression, you will cherish the truth, goodness, and beauty of life even more.
What is the opposite of depression? The author says, "The opposite of depression is not happiness, but vitality." Depression is a state of losing vitality, not pain. So, "At this moment, as I write this, my life is full of vitality, even during times of sadness."
"Every day, I choose to live, sometimes stubbornly, sometimes against my better judgment at that moment. Isn't that a rare joy?" If you can treat every day of your life as a challenge, choosing to open your eyes and continue living, it is a courageous act in itself.
The last chapter, titled "Afterward," talks about the discussions and additional case studies that have arisen since the author wrote this book. He was diagnosed in 1991, and now, over 30 years later, there are more therapies and medications available. Society is becoming more understanding and compassionate towards those with depression.
Finally, we return to the theme of "The Noonday Demon."
The author concludes: "People always think that the present reality is eternal. I find it hard to buy a thick coat in August," even though we all know that winter coats are cheaper in the summer. "Similarly, when I feel good, like when I am writing these words, I feel like I could never feel as bad as I did before. But depression is a season, and I experience it cyclically, like winter, over and over again. Now I force myself to stockpile 'scarves' and 'thermal underwear,' even when everyone else is playing by the pool. I am constantly preparing to face the occasional onslaught of the demon. So what has changed for me? I not only prepare for winter during the summer, but I have also learned to envision spring when freezing. I work hard to prepare for the return of depression—even at my best, remembering how bad things can get—reminding me, to some extent, that there are comparable situations during times of weakness. Like winter, summer will come again. I have learned to imagine good feelings at my worst, and this skill, acquired at great cost, pierces the demonic darkness like the noonday sun."
When the demon arrives, what we need most is the light of noon. This light must be accumulated little by little when we are not sick. If you are a healthy person who has never experienced depression, reading this book can help you stockpile resources, build your mental fortitude, and understand the cyclical nature of these events: what comes will go, and it will pass. So do not despair during winter because when winter comes, spring will not be far away.
Practically speaking, I think the biggest inspiration this book offers is to face depression head-on, seek the support of good interpersonal relationships, take medication as prescribed, and seek help from mental health professionals. These are all normal ways of self-help, and when we are ill, we need treatment. When we can correctly discuss and view depression, everyone's life will improve. In daily life, cultivating good habits like going to bed early, waking up early, exercising regularly, and eating nutritious food can help us better manage our stress levels. Depression has both internal and external pressure factors, and tackling both aspects simultaneously will surely help us overcome depressive symptoms more quickly.