Noonday demons and midnight sorrows: Biology and meaning in disordered and normal sadness

Andrew Solomon's The Noonday Demon and his article in this issue (on which we focus our commentary) present an eloquent, wide-ranging, and non-reductionist portrayal of depression as a disorder of both biology and meaning. Solomon illustrates the contributions that psychodynamic and pharmacological therapies alike can make to the treatment of depression, emphasizing the interplay between exploration of meaning and biological manipulation of the brain. We argue that the link between biology and meaning may help to explain the notion that depression yields distinctive truths; depression can yield truths or suggest meanings that otherwise are hidden from us by the normal biology of our meaning systems. We also identify several limitations of Solomon's discussion. First, in light of recent evidence, Solomon is occasionally overenthusiastic about the benefits of medication. Second, he overemphasizes the role of depression in creating negative social circumstances when most evidence indicates that the condition is more a consequence than a cause of social environments. Finally, in light of our recent exploration of how psychiatry has confused intense normal sadness with depressive disorder (Horwitz and Wakefield, 2007), we examine Solomon's views on the distinction between sadness and depressive disorder. We argue that, although Solomon recognizes the importance of distinguishing normal sadness from depressive disorder, and even astutely characterizes the difference as anchored in evolutionary psychology, at times he mischaracterizes likely cases of normal sadness as depressive disorder. Overall, however, Solomon provides an exceptionally well-drawn portrayal of the nature, causes, and treatments of depression.