The Noonday Demon: An Atlas of Depression

by Andrew Solomon

The therapist begins by helping the patient make up a list of “life history data,” the sequence of difficulties that have led him to his current position. The therapist then charts responses to these difficulties and attempts to identify characteristic patterns of overreaction. The patient learns why he finds certain events so depressing and tries to free himself of inappropriate responses. This macroscopic part of CBT is followed by the microscopic, in which the patient learns to neutralize his “automatic thoughts.” Feelings are not direct responses to the world: what happens in the world affects our cognition, and cognition in turn affects feelings. If the patient can alter the cognition, then he can alter the concomitant mood states. A patient might, for example, learn to see her husband’s preoccupation as his reasonable response to the demands of the workplace rather than as a rejection. She might then be able to see how her own automatic thoughts (of being an unlovable jerk) turn into negative emotion (self-reproach) and identify how this negative emotion leads to depression. Once the cycle is broken, the patient can begin to achieve some self-control. The patient learns to distinguish between what actually happens and her ideas about what happens.