Living with the noonday demon
What to do when a global health crisis exposes a pandemic of despair?
Content warning: This newsletter deals with depression, anxiety, and suicide.
My psychiatrist looked haggard when I saw him in a virtual appointment a few weeks ago.
It was late afternoon. I could see the bags under his eyes and the strain in his shoulders. He seemed relieved when I told him my cycles of depression were no worse than usual and that I didn’t want to fiddle with new medication levels during a pandemic.
Not to judge someone too harshly on their appearance via a cheesy laptop camera — Lord knows I look like reheated death from time to time — but I felt the need to ask how he was holding up. He said he was feeling tired because a lot of his patients were suffering and he was spread awfully thin.
This is a trying time for people working in mental health and healthcare in general. Patients who feel lonely in a good year are likely to feel even lonelier right now. Patients who are anxious in the base case have much to be anxious about. Social support networks are fraying: Twenty years after the publication of Bowling Alone, you can’t even go bowling anymore.
In June, Psychiatry Research published a paper by Yeen Huang and Ning Zhao that found “a major mental health burden” during the first months of the COVID-19 outbreak in China. Using an online survey of 7,236 self-selected volunteers, they reported:
Younger people reported a significantly higher prevalence of GAD [generalized anxiety disorder] and depressive symptoms than older people. Compared with other occupational groups, healthcare workers were more likely to have poor sleep quality. Multivariate logistic regression showed that age (< 35 years) and time spent focusing on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were at high risk for poor sleep quality.
The study found one in four healthcare workers experienced sleep problems, and it raised the possibility of PTSD among those workers (previous studies found similar symptoms among frontline workers during the SARS and MERS outbreaks).
We’re all going to feel the effects of COVID-19 one way or another, just as past generations felt the effects of Spanish flu or polio. Our lungs are at risk. So are our minds.
In The Atlantic, Elizabeth Flock wrote movingly about her experience living with depression during lockdown after moving to Taos, New Mexico:
We moved into a small adobe-style house, 30 minutes north of town, situated in a rolling expanse of sage. The gray-green brush stretches on for so long, and grows so tall, that it sometimes feels like we’re living waist deep in an ocean ...
The signs of depression look a lot like life in lockdown: social withdrawal, a feeling of hopelessness, trouble concentrating, a lack of exercise or the activities you once enjoyed, sleeping too much or not at all. It’s also confusing to experience depression or anxiety when it feels like others are dealing with so much more.
Is depression a pandemic? It’s a disease that has been linked to brain damage and cardiac distress. Left untreated, it destroys lives and rips apart families. It can drive people to suicide, the No. 10 leading cause of death in this country.
Here are two data points that aren’t necessarily comparable, but that point to the magnitude of the problem:
In 2017 the National Institute of Mental Health estimated 7.1% of all U.S. adults, or 17.3 million people, experienced at least one major depressive episode.
In March 2020 a Kaiser Family Foundation survey found 45% of U.S. adults said the pandemic had already affected their mental health. In April another Kaiser survey found 57% of adults were worried they would put themselves at risk of infection because they couldn’t afford to stay home and miss work.
I recently read a book by a guy who thought of depression as a pandemic that required collective action, not just individual treatment. Mark Fisher’s 2009 book Capitalist Realism is best known for its thesis that it’s easier to imagine the end of the world than the end of capitalism. It also deals with western medicine’s atomized approach to mental health:
We must convert widespread mental health problems from medicalized conditions into effective antagonisms. Affective disorders are forms of captured discontent; this disaffection can and must be channeled outwards, directed towards its real cause, Capital.
I read Fisher’s book with my guard up. It took me 30 years to come to terms with my depression and seek counseling and medication; I wasn’t interested in having someone talk me out of treatment. Selective serotonin reuptake inhibitors have taken the edge off my anxiety, while cognitive behavioral therapy has helped me counteract my own self-defeating thought patterns. I’m not about to shrug off all my depressive tendencies while waving my arms at the cloud of neoliberalism.
I believe Fisher made some flawed arguments. He spoke too broadly about mental illness without differentiating, say, bipolar disorder from schizophrenia. He pushed back too much against the prescription of psychiatric medication. Reading his rants could be harmful to someone who’s thinking of quitting therapy or throwing their meds down the drain.
But I kept a few pages earmarked because Fisher gave me a fourth way of thinking about depression.
The first theory of depression in many cultures was a spiritual one. Melancholia was a problem of the soul. In his 2001 book on depression, The Noonday Demon, Andrew Solomon pointed out a depiction of the daemonio meridiano in 16th-century Latin translations of the 90th Psalm:
The second and third theories are the psychoanalytic and psychobiological frameworks that reached maturity in the 20th century. Solomon places the beginning of this era of thought in 1895: “The unconscious, as formulated by Freud, replaced the common notion of a soul and established a new locus and cause of melancholia.”
The fourth theory that Fisher espoused was a structural theory of depression. Fisher moved the locus off of the body entirely, positioning it somewhere in the ambient despair of alienated labor under late capitalism. Depression in his view was a symptom of precarious employment, eroded class solidarity, withered labor unions, and the constant drumbeat of propaganda declaring there is “no alternative” to capitalism.
Depending how you talk about it, the fourth theory of depression can sound a lot like the first. David Graeber describes a state of “moral scriptlessness” afflicting office workers in his 2019 book Bullshit Jobs. Solomon quotes lines of a Matthew Arnold poem lamenting a lack of “certitude, nor peace, nor help for pain” and then writes: “This is the form that modern depression takes; the crisis of losing God is far more common than the crisis of being cursed by Him.”
Fisher phrased his complaint this way:
The specter of big government plays an essential libidinal function for capitalist realism. It is there to be blamed precisely for its failure to act as a centralizing power, the anger directed at it much like the fury Thomas Hardy supposedly spat at God for not existing …
[A]t the level of the political unconscious, it is impossible to accept that there are no overall controllers, that the closest thing we have to ruling powers now are nebulous, unaccountable interests exercising corporate irresponsibility.
As for me, I have felt more grief than clinical depression these past few months. We use the term “depressing” as a shorthand for a bleak state of affairs, but for one reason or another, I’m mostly able to take in the daily stream of bad news without falling into a depressive episode.
I have drawn closer to God. I feel more joy spending time with my wife and children than I have in years. I have also joined the Democratic Socialists of America and renewed my faith in solidarity to thwart the death-dealers of capitalism and imperialism.
But I know the noonday demon still stalks me. He’ll come around again, and I’d better be prepared.
In the Chinese mental health study, Huang and Zhao offer some guidelines for protecting mental health during the pandemic:
First, psychological interventions should be directed to vulnerable populations which include the suspected and diagnosed patients, young people, and healthcare workers, especially physicians and nurses working directly with patients or quarantined people.
Second, try to control and limit the time of receiving COVID-19 related information within two hours a day, focus only on the necessary information (such as facts and data) and avoid receiving too many harmful rumors (Grein et al., 2000).
Third, maintain a normal rhythm of work and rest as much as possible, exercise regularly to promote sleep quality, and do not pay too much attention to outbreak information before going to sleep.
These are easier recommendations to give than to follow, particularly if you are alone or are caring for small children. They are practical steps though, like these ones published by the CDC.
In less practical terms, I continue to draw inspiration from a passage in Solomon’s book. After weighing the various theories of depression and seeking to understand his own sorrow, he offers us this synthesis:
Few of us want to, or can, give up modernity of thought any more than we want to give up modernity of material existence. But we must start doing small things now to lower the level of socio-emotional pollution. We must look for faith (in anything: God or the self or other people or politics or beauty or just about anything else) and structure. We must help the disenfranchised whose suffering undermines much of the world’s joy …
At some point, a point we have not quite reached but will, I think, reach soon, the level of damage will begin to be more terrible than the advances we buy with that damage. There will be no revolution, but there will be the advent, perhaps, of different kinds of schools, different models of family and community, different processes of information. If we are to continue on earth, we will have to do so. We will balance treating illness with changing the circumstances that cause it. We will look to prevention as much as to cure. In the maturity of the new millennium, we will, I hope, save this earth’s rain forests, the ozone layer, the rivers and streams, the oceans; and we will also save, I hope, the minds and hearts of the people who live here. Then we will curb our escalating fear of the demons of the noon—our anxiety and depression.
I can’t express hope more eloquently than that. I break with Solomon on one point, though: I choose to believe there will be a revolution.
The National Suicide Prevention Hotline is 1-800-273-8255.
The books I mentioned in this newsletter are available to purchase via the Brutal South Bookshop page.
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I wrote a song called “Noonday Demon” that appears on my band’s latest EP, “fear.” You can stream or download it on Bandcamp.
The picture at the top is “Evening, McDonald Lake, Glacier National Park” (1942) by Ansel Adams.
The picture near the bottom is “New Church, Taos Pueblo, New Mexico” (c. 1929) also by Ansel Adams.