“How does one not write a depressing book about depression?”

The Scar: A Personal History of Depression and Recovery BY Mary Cregan. W.W. Norton. 256 pages. $26.
The Scar: A Personal History of Depression and Recovery by Mary Cregan

Mary Cregan’s debut work of nonfiction, The Scar: A Personal History of Depression and Recovery, is likely shelved in the bookshop’s memoir section. And The Scar does present—with remarkable clarity, candor and narrative presence—the author’s own history with the illness; in particular, a descent into suicidal depression after the death of her newborn daughter, Anna, and the hospitalization and treatment, including electroshock therapy, medication and talk therapy, that followed. But this book is far more than a memoir: it is the result of decades of research on the medical history of the diagnosis, as well as the classification and treatment of depression and melancholia. To this rigorous and fascinating scholarship, Cregan has added the work of a variety of artists—from the ancient Greeks to Leonard Cohen. No surprise, then, that she teaches literature at Barnard College.

I spoke with Mary about her book while in Connemara, on the west coast of Ireland, where Mary had come after appearing at the Galway International Arts Festival.

You’ve intertwined your personal story to intersect with a larger history of mental illness. Did you always imagine the book being a cultural history of the illness as much as it would be a memoir?

For a long time I couldn’t figure out how to write the book because the subject is seen by most people as “depressing.” How does one not write a depressing book about depression? Add to that the trigger of the death of an infant, and it seemed a daunting thing to invite readers to enter into. Death, grief, suicide, illness: these are subjects that a lot of people prefer to avoid thinking about.

But I wanted to write about the strange experience of being taken over by an extreme state of mental illness and not understanding what was happening, and about being suicidal, being treated, and living with the diagnosis and recurring episodes that were my new reality. It was the alteration of consciousness that interested me. I wanted to describe its effects, particularly because depression is not well understood even though it affects millions of people, in varying degrees of severity. The mysteries of psychopathology, the development of drugs that alleviate mood disorders, the science of ECT, the beginnings of the asylum and ideas about confinement and treatment—all of these were fascinating subjects that offered me a larger framework for understanding my experience and telling my own story. I placed my own case history within a longer cultural history, alongside the stories of others who have been treated for mental illness in asylums and patients who were the recipients of early experiments with convulsive therapy, the first effective drugs, and so on.

The book highlights the difference between depression and melancholia. Can you talk a little about the distinction between the two?

Melancholia is a severe type of depression, and the distinction between the two words isn’t widely understood. In the early twentieth century the influential psychiatrist Adolf Meyer proposed that American psychiatry adopt the term “depression” for both psychological and biological forms of the disorder, and this usage was further entrenched when in 1980 the third edition of the profession’s Diagnostic and Statistical Manual created a diagnosis called major depressive disorder and listed “with melancholia” among its subtypes.

The problem with the current use of the word “depression” for an illness that can be deadly is that it is also used as in common speech for a temporary low mood that’s fully within the range of normal experience: “I’m depressed because I left my new gloves in a cab,” or “I had a fight with my boyfriend—I’m so depressed.” In stories from the late nineteenth and early twentieth centuries in the New York Times archive, the word “melancholia” is usually seen in the context of a small news report on a suicide. The word melancholia comes from ancient Greek, and the illness was described by the Hippocratic writers and recognized throughout history for its remarkably consistent symptoms. Biological psychiatrists understand melancholia as a severe mood disorder associated with very high levels of the stress hormone cortisol, a disordered sleep-wake cycle, slowed speech and movement, and diurnal swings in mood, which is darkest in the morning and improves slightly as the day goes on. Sufferers express an overwhelming sense of hopelessness, failure, and guilt. Sometimes they are psychotic, and often they are acutely suicidal.

This book is a life’s work— why write and publish it now?

It took me roughly four years to write, but the book reflects many years of thinking and reading about this mood disorder and its place in the history of psychiatry: the vicissitudes of diagnosis and drugs, the beginning of the asylum movement and what remains of that in today’s psychiatric hospitals, Freud’s ideas about mourning and melancholia. About a decade ago a study called into question the effectiveness of antidepressants, and if it was correct it seemed to me that all so-called progress in the treatment of depressive illness was nullified. It was not correct—more than two thirds of sufferers find relief with medication—but it was part of what led me to want to understand more about medications, their effects, and their role in my own recovery. I also wondered what would be different today in the prognosis of someone hospitalized with severe depression. A beginning question, in other words, was what has improved or changed in the time since I was in that position? Would most people now recognize the signs of a life-threatening depression in a friend or family member? And finally, I wanted to offer my own experience as a case history in this investigation, despite the exposure it would necessitate. I want to lessen the stigma and silence around depression and suicide, so the task was to help people understand how to recognize and learn more about depressive mood disorder through describing its effects on one person’s life—my own.

Though personal and scholarly aspects of The Scar get more word count, the emotional weighting given to poetry, painting, music, philosophy makes me wonder if any artworks in particular encouraged you to write this book?

When I first thought of writing the book, I was in graduate school and teaching. For professional reasons, I didn’t want to reveal the experiences I had in my twenties (the death of my first child from a congenital heart defect, followed closely by a suicidal depression, hospitalization, and ECT). But for a long time I was trying to make sense of what had happened or perhaps—since unexpected terrible events don’t make sense—just trying to adjust to an abruptly modified sense of self. During that period certain poems, memoirs, writings of various kinds, in addition to works of visual art, helped me to feel accompanied in the process of thinking it through. On the wall above my desk there were three postcards: one of Constable’s cloud studies, Simone Martini’s Annunciation with St. Margaret and St. Ansanus, and a photograph, taken through falling snow, of the angel of the Bethesda Fountain in Central Park. It’s good to glance up from work and see something that reminds you of beauty or healing or what you desire.

In writing the book itself, certain works I had read came back to me: the absurd predicament of Beckett’s clowns in Waiting for Godot, the elegies written by the sixteenth-century poet Jan Kochanowski on the death of his little girl, Plath’s Bell Jar and her protagonist’s experience of ECT, Didion’s Year of Magical Thinking and her refusal of accept the death of her husband. These and other writers held open the possibility that one’s own experience might finally find some expression and release. Other arts—film, painting, music—offer a similar possibility in different forms.

Have you noticed any difference in reader responses to this book—for example, between readers or audiences in the United States and Ireland?

The Scar was published in Ireland a month after it appeared in the US, and I did several public events there. Because depression has both psychological and physiological underpinnings, I focused on the cultural aspects of my own case, and suggested that my family’s Irishness and Catholicism had heightened certain aspects of my character: a hyperactive conscience, a readiness to feel guilt and responsibility, for instance. A sort of stoicism. Audiences in Ireland identified with these attributes (which, with the precipitous decline in the Church’s influence over the last few decades, are far less pronounced in young people).

This is not to say that responses in the US haven’t also been positive. People who recognize themselves in what I describe, or who recognize the experiences of their loved ones, have also found it a useful and informative and hopeful book to read.

Caoilinn Hughes is the author of the novel Orchid & the Wasp (Hogarth 2018), which won the Collyer Bristow Prize 2019. For her short fiction, she won an O. Henry Prize and The Moth Short Story Prize. Her second novel, The Wild Laughter, will be published in the US in July 2020.