JULY 2, 2019
THE HUMAN BRAIN is our most cherished solipsistic riddle. We can’t help our fascination: it is ourselves but also something more, seeming to operate independently even of itself at times. Each day, it governs abstract thinking and concrete organization, shuffling and processing incoming data from the five senses while managing social interaction, quotidian tasks, novel thoughts, joy, heartbreak, surprise, and anger. At night, it takes this “day residue” and spins it into dreams, for purposes still mysterious. The brain also creates philosophy, and music, and poetry, and in many people, a sense of connection to an unseen entity often called “God.” Indeed, it seems to be more than a lump of carbon-based life. But when the human brain breaks down, it feels to the sufferer that is has become something far less: subhuman, weak, guilty, wretched. Despite its lack of pain receptors, it can experience enormous pain. In short, we house an organ both mighty and fragile, and for some, as evidenced by Mary Cregan’s The Scar, coming to terms with this duality becomes a life’s work.
I came to The Scar with a personal interest: I am depressive. I have been hospitalized more than once for the disorder, and at 27 I received several life-saving jolts of electroshock therapy at Lenox Hill Hospital in New York City. I currently take medication to keep depression at bay. I live with, manage, dread, battle, and, almost daily, confront its mythological stature in my life. It is unquestionably part of my identity, which is why, despite current political concerns about the term, I am comfortable with the word “depressive” as opposed to the more distancing phrase, “I have depression.” I don’t find the term confining — I can just as easily declare myself a “romantic” and an “optimist.” All three words describe my character. This is, for me, the most interesting aspect of The Scar — the credence it lends to the idea that a depressive tendency may indeed signal a difference in the character of those who possess it. Character is a tricky, stodgy, slippery, poetic, and emotional word. Merriam-Webster defines it as a “complex of mental and ethical traits marking and often individualizing a person or group.” But before I dive into the link between melancholia and character, here is Cregan’s tale.
It begins with an event so tragic that melancholy hardly seems to me an overreaction. Her newborn daughter Anna is born with a fatally underdeveloped heart and dies within a day of her birth. Many months later, Cregan — home alone after yet another painful day — attempts suicide. She describes the time between the death of her child and this act of violence as a slow, confusing spiral into ruminative madness, more formally known as melancholic depression. Swiftly hospitalized and on suicide watch, she is somehow left alone with a glass bottle; she makes a far more serious and nearly successful second attempt to end her life. It is only at this point that her doctors consider more “extreme” forms of treatment than the tricyclic antidepressant she had begun taking prior to these events. And so Cregan begins an odyssey through ECT and prolonged hospitalization, where she experiences new friendships, a respite from the demands of the outside world and of her marriage, and the beginnings of insight into an affliction that has been with us far longer than electricity and psychopharmacology. When she is discharged, she is fragile but well enough to begin the hard work of non-pathological grieving, which eventually concludes with a measure of acceptance both of the loss of Anna and of depression itself. That journey forms the book’s arc, with a kind of coda of rebirth with her second child, an effervescent son born many years later. In one of the book’s most moving passages, Cregan and her second husband visit Anna’s grave and bring their new son with them; they want him to meet “his sister.” This forms a much-needed psychic link between the diseased past and the healthy present, and a connection to Anna, who may be dead but for Cregan will never be “gone.”
Cregan affirms the medical and social belief that suicidal depression is not a normal response to loss, no matter how grievous that loss. Perhaps because of my own tendencies, it took a fair amount of persuasion to convince me, but persuade me Cregan did.
The Scar explores depressives’ social status, their own shame as well as that imposed by society, their pathological self-hatred, their kinship with centuries of fellow-sufferers, the evolution of ECT and SSRIs, and more. “Reading accounts of melancholia,” she writes, “I recognized that across expanses of time, countless people had felt what I had felt […] the anguish, the despair, the pathological guilt.” She traces the rapid disappearance of the word “melancholia” from medical and lay language, now mostly swept under the umbrella of “depression.” She herself, though, is actually diagnosed with major depression with melancholia, and she comes to understand that the latter “is a more specific and terrible ailment.” Freud, she writes, described it thus: “The distinguishing features of melancholia are a profoundly painful dejection […] a lowering of the self-regarding feelings to a degree that find utterance in self-reproaches and self-revilings.” Cregan later states that “in melancholia, we remain in the trauma of loss.” At some point in life, and often fairly early, all humans experience forms of loss: the death of pets or loved ones, for instance. Even seasonal change can force this reckoning. But for those with melancholic temperaments, this reckoning seems to leave its imprint more forcefully, and do more damage.
If a propensity for melancholic depression is a character trait, are there other character traits shared by melancholics? I suspect that even the successfully medicated mind of a depressive remains different from the so-called healthy norm. The Scar does indeed connect depressives with several key traits: heightened empathy, excessive rumination, a sense of being haunted, and a pathological sense of personal responsibility. Of her fellow hospital inmates, Cregan writes, “Meg and Jacob were both traumatized by what their families had been through: in their illnesses they seemed at once to suffer and carry on their families’ pain.” Of her own mindset upon discharge: “My mood was fragile, and I continued to be haunted by the meaninglessness of things.” Of the Catholic school lesson that taught her she was responsible for Christ’s suffering, she writes: “Something in my character made me take all those teachings very seriously […] why did I accept the weight when other children appeared to be relatively unconcerned?” And of experiencing a creeping feeling that “there’s something wrong with me,” she writes: “The something wrong was a mood disorder I had lived with unawares for a long time, and which was indistinguishable from the inward, pessimistic, and self-critical aspects of my character.”
In reasonable amounts, most of us would agree that thoughtfulness is not a bad quality. Same for a well-developed conscience, an ability to empathize and to connect with others who suffer. These traits can make for contributive, warm, and lively members of society. Empathy has led to great art. It is the universal in the specific. It allows for catharsis and healing. Thoughtfulness speaks for itself. And so on. But what about their more extreme or darker aspects that can lend themselves to downward spirals? After reading The Scar, I got a notepad and wrote a small list, drawing only from my personal experience.
Potential Predictors of Depressive Personality:
- Suggestibility: One’s universe easily shattering when another person contradicts (even in the smallest way) one’s assumptions about reality. The other day my daughter was excited to take a dance class with her friend. When she found out the friend had opted not to take the class, she was not merely disappointed, she was devastated. She no longer felt the class was any good, questioning why she had wanted to take it at all. A light breeze can do the damage of a hurricane.
- Excessive awareness of other people’s social and primal motivations. This is a burdensome system of chronic assumptions and monitoring that defeats spontaneous pleasure in conversational discourse. It is sensitivity run wild, without enough ego to balance it.
- An excessive concern with personal dignity, and believing all too frequently that yours or someone else’s has been compromised. I feel this acutely on the bus, for example, when one person knocks into another, and in failing to apologize also fails to acknowledge the other’s humanity. This concern also leads to an exhausting policing of my own behavior, which ironically distances me from the people whose humanity I am trying to honor.
- At times, a sense of exclusion from some aspect of human understanding, rather like staring through a window into a brightly lit, well-populated room from a dark, rainy street corner.
I don’t know exactly what this list reveals, other than heightened sensitivity that at times borders on paranoia. Character is hard to pin down. It is at once the source of my humanity and of the thoughts that keep me up at night. It is where guilt comes from, and where I derive the courage and energy to do “the right thing” in difficult circumstances, as well as the need to question what the “right thing” even is. Character creates intense need for human connection and also the need to respect other individuals’ boundaries. When I was little, my mother would tell me that artistic achievement required the ability to defer gratification — the miseries of my weekly ballet classes “built character.” Most of us feel the presence of character; by turns it rests and flares — and by definition it is acutely responsive to changes in circumstance. But does my list reveal such a difference in degree that it becomes a difference in kind? I don’t mean that depressives possess some sort of flawless or exaggerated moral might — I am subject to the same selfish and petty thoughts as anyone else; certainly I have behaved badly in my life. Still — I feel that my melancholy, and therefore my character — is tied to outsize empathy and outsize hunger for connection.
Cregan discusses the emergence of a “second self” in childhood who covers for the melancholy inner self’s “sadness” and “separateness.” In her case, a telling “visitation” marked her early childhood; she remembers running down her house’s stairs into the vestibule, feeling a cold dread passing through her. By the time she emerges into the sunlight outdoors, the feeling has vanished, but the memory of the experience remains. Does this apprehension — almost supernatural in feeling — come from core personality? Cregan describes a fear that “something in me was making me unfit for love […] for being part of the human community.”
By the time the book describes the arrival of Prozac in the late 1980s, we have already spent a lot of time in Cregan’s complex interior world. Can a pill, we ask, possibly “cure” a character defect? Or is it better put this way: can medication free a depressive from the punitive aspects of her character, thereby enabling the rewarding aspects of this same character to emerge and thrive? Psychologist and historian Peter Kramer, whose career has focused on the SSRI revolution, fears any confusion or equation of depressive tendency with creative talent and impulse. He worries that deeply depressed people will eschew medication to preserve their artistic or expressive gifts, believing these gifts to be intimately tied to their miseries. But what if the truth lies in the middle? What if medicated depressives do still retain a core aspect of their illness — the parts of their characters that make for their particularity and even profundity? I am not suggesting that all artists, or even all great artists, have melancholic temperaments. Artistic talent spans an enormous continuum of personality types. But I do think it makes sense to consider that depressives — both inherently and because of what they’ve endured — often have robust characters. We so often associate fragility with the depressed, but suppose the opposite is also true: it could be argued that depressives confront the truths most people avoid. Cregan wonders if “our less rosy outlook is just another name for realism.” In the same way introversion is getting another look, perhaps being depressive can be considered for its other — more positive — traits.
There is still much we don’t understand about depression, and about its treatments, in part because we don’t fully understand how the human brain works. When I was a little girl, my father — a doctor, lover of science, and devout skeptic and atheist — used to say that the fundamental question was how the brain gives rise to the mind. His tone would grow spooky with reverence.
In a chapter on ECT, Cregan quotes from Frankenstein: “The rain pattered dismally against the panes […] by the glimmer of the half-extinguished light, I saw the dull yellow eye of the creature open; it breathed hard, and a convulsive motion agitated its limbs.” She likens the imagery to popular conceptions of shock therapy, wherein the body is unnaturally animated by a current of electricity. I think of ECT as a “reanimation” of brains that have been reduced to the mental coma of depression. Many people, less familiar with the procedure, consider ECT to be the stuff of nightmares.
Maybe we are frightened by Frankenstein’s monster not because he is so different from us but because he is the same — he is animated by unseen forces, as are we. Our system of bone and muscle and tissue and neurotransmitter looks seamless only to the naked eye and only when its engines are in perfect health and at full maturity. In a toddler’s unsteady gait, for example, we see jagged and unrefined neural impulses, possibly impulses passing through immature, unmyelinated neural pathways. We see, in other words, humanity’s blueprint, and we reckon with being a sum of our parts, with being a machine, with being reliant on many things converging in just the right way, in just the right amounts, at just the right places at multiple bodily levels. If there are so many points of potential disruption, then how easy it is for the machine to break! And when the locus of all this movement — the brain — is somehow, mysteriously, violently disrupted by mental illness, how quickly the other organs follow suit and fall into riot. Depressives often report many physical disturbances and maladies that seem to multiply with the duration of their primary illness.
Cregan poignantly demonstrates the hard-won pragmatism of those who have battled mental illness. “Despite the discomfort and the temporary memory loss it caused,” she writes, “I would have ECT again without hesitation.” Confronting public fears of shock treatment, she ultimately responds with a shrug — it’s not that dangerous, it’s not even that invasive, and it saves lives. My sentiments exactly. Deeply depressed people do not have the luxury of fearing ECT, and Cregan (as did I, and many others) came out of the hospital grateful for these machine-induced seizures.
In addition to exploring character, Cregan’s book argues that literary, poetic, and mythological context can help us survive depression. Images of heroic quests and triumphant returns encourage sufferers. William Styron uses the poet’s ascent out of hell at the end of Dante’s The Inferno as a representation of his triumph over depression in Darkness Visible. In mythology, we find representations of our greatest abstract fears; we also find images that restore hope and peace of mind. At the end of The Scar, Cregan mentions The Angel of the Waters, a statue that hovers over Bethesda Terrace in Central Park. She keeps a postcard image of it above her desk: “I love the angel’s attitude of arrival, its hand lifted in a gesture that seems to say: Be comforted. Be blessed. […] [I]t conveys to all who see it a message that the pain we endure can be healed.” I have my own Angel of the Waters taped to the wall above my bed: a painting my daughter made one idle Saturday. It depicts a roaring sea, large blue raindrops pouring down from on high, and a tiny sailboat making its way through the torrent.
The Scar is framed by Cregan’s own heroic quest — she must survive her child’s death. To do this, she must wage a mighty battle with melancholy, stare down existential truths in the midst of hormones and neurotransmitters running amok. The book is most vivid, indeed most alive, in the letter she writes to her dead daughter at the end. She lays aside grief with the motion of her pen, affirming her own life as she honors her daughter’s passing.
In recent years, there has been a flurry of reporting from the mental illness front, and new memoirs specifically about depression. But it’s still rare to find an account that conveys the patterns of the illness so clearly. While reading The Scar, you break when Cregan breaks, you heal when she fully returns to life. These eternal patterns — day following night, spring following winter, hope following madness — will resonate with any reader while offering affirmation for those peculiarly bound by these cycles. In providing kinship to its fellow traveler, The Scar becomes the best sort of memoir — one that serves a higher purpose.