About the Author

Mary Cregan is a lecturer in English literature at Barnard College in New York City. She holds an undergraduate degree from Middlebury College and a PhD in English and Comparative Literature from Columbia University. Her work has been published in a variety of publications, including The New York Times, The Irish Times, The Chronicle of Higher Education, and the Financial Times. The Scar is her first book.

Preface

Going through a box of old photographs recently, I came upon one taken long ago at a baby shower in a friend’s New York apartment. I’m seated at the center of the photograph, wearing a gray winter dress, my eight-month pregnancy mostly hidden behind the gift-box on my lap. I’m twenty-seven. A small stuffed bear sits at my feet beside its crumpled wrapping paper. My husband is to my left, looking relaxed, holding a beer, and several of our college friends are in the photo as well, drinking, eating, watching me open their presents. I’m holding up another gift I’ve just unwrapped: a newborn’s onesie in white, sprinkled with tiny bears outlined in pink and blue. Looking at this young woman many years later, I feel a rush of fear and pity for her, unprepared as she is for what will unfold a few weeks later when her baby dies.

Another photograph sits on the desk where I write. It was taken thirteen years later, after a divorce and remarriage, on a visit to Arizona in the springtime. In the background, out of focus, is a blur of mountain, aspen trees, and blue sky. In the foreground, in close-up, I’m hugging my rosy-cheeked nine-month-old son, his broad forehead and dark hair much like my own, his eyes lit up in a smile as his father snaps the picture. On a hike that day, I had let the baby down from his carrier to test his legs and watched him grasp the big round boulders along the side of the trail. The photograph was taken a moment later, just as I’ve lifted him up, and our faces reflect the pleasure of being outdoors in the sunshine. I keep this photograph on my desk because it radiates happiness and comfort: it reminds me of what I’ve been given, and how love for my husband and son continues to anchor and sustain me.

This book is about the difficult path I traveled between the moments captured in these two photographs. After the death of my infant daughter, I fell into a depression so severe and unrelenting that I was admitted to a psychiatric hospital where I nearly succeeded in taking my own life. Since then, I have never taken the fact of my existence for granted. Instead of living as I do now—teaching, writing, spending time with friends and family, taking pleasure in watching my son grow up—I might be nothing more than a fading memory in the minds of those who knew me as a woman who died young, in sad and desperate circumstances. I’m aware, as I remember that long-ago day of gift-giving, that my own life has been another kind of gift: a second chance. Even so, the depression that emerged so clearly at that time has never entirely left me. It is the trace of bad luck that lingers, amid so much good fortune that has come to me since.

Depression is far more widely acknowledged today than it was back then. The word “depression” is ubiquitous, and the disorder is too—though depression takes a variety of forms and diagnostic labels. In 2016, nearly 11 percent of Americans from eighteen to twenty-five experienced a major depressive episode (as did nine percent of adolescents from twelve to seventeen and 6.7 percent of the general adult population). The correlation between depression and suicide is striking: the risk is significantly higher for people with mood disorders, and highest among those who have been hospitalized.

When I was diagnosed with a major depressive episode in the wake of my first child’s death, I had no idea what the long-term implications of that diagnosis would be. I didn’t even grasp that I was facing a long-term situation. Nobody could tell me whether my depression was the result of an inherited vulnerability, or whether it was rooted in my temperament, or my life experience, or to what extent it was a combination of all of these. Nor could even the most dedicated and sympathetic doctors provide clear answers to what seemed the simplest and most urgent questions: What exactly was depression? Why did some medications work, while others didn’t? Would I ever be able to put it behind me?

Five years ago, I began trying to answer these questions, initially in an effort to understand competing claims in an ongoing debate about whether the antidepressants I’d been taking for many years were merely expensive placebos. I had already read a number of memoirs and other popular books on depression, but I began to investigate the subject more widely and intensively. I had earned a doctorate in English literature and was comfortable doing research outside of the discipline in which I had been trained. And as someone who had lived with depression—and experienced the worst of it—I approached medical, social, and cultural questions about the disorder and its treatment from an insider’s perspective that few of the historians and scientists who have written on the subject can provide.

Once I decided to include my own history in this investigation, I worried about the exposure that would come with publishing what I was writing. In my large Irish Catholic family, the tacit understanding was that it was best not to draw attention to oneself. A couple of decades leading discussions and lecturing in college literature classrooms had brought me a greater ease with the self-exposure necessary for teaching. Yet in all professional settings and most social ones, this particular story—my past, my diagnosis, the vulnerability to recurrence, the ongoing, quiet necessity of dealing with being depressed for months at a time—has remained deeply private.

A couple of years into the project, a close friend asked me why on earth I would want to revisit the worst days of my life. The simplest answer is that after decades of trying to keep it hidden and behind me, I wanted to turn to the past and face it squarely. Those who have lived through a traumatic experience will know what I mean. I wanted to understand what had happened. Having survived to tell this story, I’ve long known that I have something to say about what happened back then.

The first two chapters were the hardest to write (and because of the sadness they contain, may be the hardest to read). But once I had written them and better understood the gravity of my subject, I realized that telling this story—and sharing it through publication—was a way of refusing the shame and stigma that still cling to the subjects of mental illness and suicide. I often think about what might have been different for that young woman at the baby shower, who didn’t know that help existed for the inchoate feelings she had long had about herself, and who didn’t realize that while feeling devastated was a normal response to the loss of an infant, feeling suicidal was not. This book is written for her, and for the young women in my family who have inherited the same vulnerability. It is also for the countless people who find themselves struggling to cope with internal forces that feel overwhelming but—as I try to show in these pages—are survivable.

This book is more than a memoir. It seeks to build a bridge from my individual narrative to the broader landscapes of literature, cultural history, and science, where the questions I’ve been asking have been addressed by many who came before me—writers, poets, psychiatrists, historians, chemists, and neuroscientists. I’ve found a deep satisfaction and a sense of fellowship in reading writers of the past, who did not have the benefit of even the partial scientific explanations we now have. Centuries-old accounts provided accurate descriptions of the harrowing state of mind that leads to suicide and a confirmation that the illness that beset me has been described with great consistency across time. When we lose sight of the long history of the illness formerly called melancholia, we lose this sense of continuity. While the experience of depression is intensely solitary, reading has been a way of binding myself to the larger effort at understanding and to the community of sufferers. Recognizing my own experience in that of others—those who endured the peculiar madness of melancholia, those who laid themselves down the first time for shock treatment, those who fell again and again into the void and had to make their hesitating way back—has been a means of finding a history into which I could insert myself, one in which my experience makes some sense.

In the chapters that follow, my accounts of loss and mourning, melancholia, shock treatment, the asylum, and the development of antidepressant drugs situate my personal experience within the long, hopeful, and as yet incomplete movement toward effective treatment and cure. I’ve been able to return to the person I was in my twenties and thirties aided by hospital records, notebook entries, and the memories of people who were close to me at the time, even as I’m also present in these pages as a much older self, reflecting on the repercussions of these events and the continuing presence of depressive episodes over the past three decades. Sometimes memoir and context are interwoven; sometimes they are juxtaposed. In both cases, it is my hope that those who are not experts—those afflicted with depression as well as their loved ones—will have a better understanding of the past and of the road ahead, and at the same time, I hope to allow those whose lives are committed to treating depression to see one patient’s experience from the inside.