The Noonday Demon

by Andrew Solomon

The conflict between psychodynamic therapy and medication is ultimately a conflict on moral grounds; we tend categorically to assume that if the problem is responsive to psychotherapeutic dialogue, it is a problem you should be able to overcome with simple rigor, while a problem responsive to the ingestion of chemicals is not your fault and requires no rigor of you. It is true both that very little depression is entirely the fault of the sufferer, and that almost all depression can be ameliorated with rigor. Antidepressants help those who help themselves. If you push yourself too hard, you will make yourself worse, but you must push hard enough if you really want to get out. Medication and therapy are tools to be used as necessary. Neither blame nor indulge yourself. Melvin McInnis, a psychiatrist at Johns Hopkins Hospital, speaks of “volition, emotion, and cognition” running along in interlocked cycles, almost like biorhythms. Your emotion affects volition and cognition, but it doesn’t take them over.