FOR A TOPIC about which American society seems to have a conversation quite frequently (particularly when celebrities are involved), “depression” is bewildering territory. Where does it come from, and why would evolution preserve something so disabling and agonizing as a feature of the species? Can it be driven off? What kind of documentation of it can be made? Is it possible to narrate and interpret, or does it defeat exegesis? What do you say to someone in its grip? In his new book, How To Be Depressed, the renowned journalist and critic George Scialabba observes that “[t]he pain of a severe clinical depression is the worst thing in the world.” This, it turns out, is both pretty much all you can ever say about the topic and a door opening onto the vast field of what we might call depression humanism.

Literary writing offers no shortage of engagements. The English poet William Cowper wrote, in a piece sometimes titled “Lines Written During a Fit of Insanity,” of how “I, fed with judgment, in a fleshly tomb, am / Buried above ground.” For Keats, it was the force that threatened to slide from an artistically productive “melancholy fit” into psychological paralysis that would “drown the wakeful anguish of the soul.” Virginia Woolf’s journals record the madness that drove her to suicide. Freud and Walter Benjamin and Hank Williams and Sylvia Plath all diagnosed it as a core affliction of modernity. In the late 20th century, David Foster Wallace would devote much of a huge novel, Infinite Jest, to the depressive psyche’s relationship with addiction, entertainment, capital, and nothingness. William James, that archivist of human states, deemed it “a positive and active anguish, a form of psychical neuralgia.” In other words, for a disease that often produces torpor, fatigue, and boredom, there is nothing neutral or muffled about it. Depression hurts. Scialabba’s own iteration of melancholy is diagnosed as “agitated depression,” meaning, essentially, a persistent low-grade depression mixed with grinding anxiety, at times worsening into terrifying troughs which push him into the hospital.

If there is a conclusion to Scialabba’s work, it’s that while depression will almost certainly never be eliminated as a feature of many existences, American society, economics, and politics make the condition far worse: more pervasive, more intense, more intractable, more unbearable, more likely to end in death. (Between 1999 and 2018, the suicide rate in the United States rose 35 percent; it is now the second-leading killer of people ages 10 to 34.) Depression might have roots in brain chemistry and early experience — “an unlucky ratio of stress to strength, circumstance to constitution,” as Scialabba wryly puts it — but it is also a problem of political economy. The leadership class of our necrotic empire has simply decided to let its people suffer far more than they need to, bringing to mind Auden’s lines about how “[s]omebody chose their pain, / What needn’t have happened did.”

Compare the Pentagon’s budget for the F-35 fighter jet ($1.5 trillion for a machine that doesn’t even work) with the anemic federal funding for depression research (around $400 million in 2017, or somewhat over a dollar for every person in the country). The world we have built for ourselves using the engines of transnational capitalism — where education is expensive but culturally devalued, where few people earn enough to live comfortably, where debt stalks nearly everyone, where community has been swapped out for consumption, where the planet itself is boiling alive — is killing us. This book raids dark territory. Grown from the soil of the author’s life, it also subtends a grim meta-narrative about American reality.

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Depression entails a biopolitics, and in the United States it’s a nasty, deprived one. The disease clearly has major endogenous neurochemical components, but our deeply unequal society, with its shredded social-democratic safety nets and brutal labor markets, makes depression so much worse for so many people. “Economic insecurity is an epidemic stress,” Scialabba writes, and economic insecurity is what the United States has specialized in since the Reagan revolution. You can imagine what the coronavirus pandemic and subsequent economic collapse are adding.

It does help to be affluent. Wealth buys you some happiness and a decent (albeit not impregnable) degree of shelter from mental illness: “There is no doubt that good fortune is the best antidepressant,” and you’re screwed if you happen to be “unfamous, solitary, low-income.” While money doesn’t cure melancholy, life stings less if you can afford material supports. “Depression,” Scialabba reflects, “may give you a deeper appreciation of Karl Marx’s observations about money as social power. Rich people may or may not be happier than non-rich people, but the quality of their unhappiness is definitely better.”

Scialabba himself is not a rich person — book reviewing isn’t especially lucrative — but he was “blessed with an enlightened employer” (Harvard, where he was on staff for decades) and “a strong union.” This enabled him to receive excellent lifelong care, which may have saved his life. So if we want to fight depression, we should, alongside scientific research, be strengthening and expanding labor unions, ending right-to-work laws, and enacting Medicare For All (a potential boon for our collective mental health). Depression is not just political, but it is political nonetheless, and to pretend otherwise is stupid and cruel.

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Scialabba maintains that “the phenomenology of depression is endlessly varied.” And he’s right — part of the difficulty of diagnosing or just talking about the disease is that everyone experiences it differently (common symptoms like anhedonia, loss of appetite, sleep disruption, anxiety, sexual dysfunction, suicidal ideation notwithstanding).

But, paradoxically, depression is also boring. This is true for the sufferer — those tedious gray days — and for the people around them, who, Scialabba emphasizes, can do little besides reassure you that things will get better, that this too shall pass.

As such, depression constitutes a narrative problem. How do you work the shapeless into a rhetorical structure of ideas? Scialabba deprecates How To Be Depressed as “this long whine,” and he maintains that it is “not a memoir, not an argument.” The former claim is unfair, because the book is sensitive, wry, and learned in the way his essays are. But he’s right that there are no definitive conclusions or any attempt at full topical coverage; this is not an omnivorous encyclopedia of art, science, and culture like Andrew Solomon’s 2001 masterpiece The Noonday Demon, nor does it have a cohesive arc with a beginning, middle, and end, like William Styron’s Darkness Visible (a best seller in the 1990s). It is, instead, a fractured, thin, nervous book comprising four sections — a chapter developed from an essay in The Baffler; a collection of medical documents; an interview; and a glossary of melancholia — and as such it replicates the discontinuous, quietly frantic, shuffling pain of major depression. Scialabba solves the literary problem of the disease by not trying to directly solve it.

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The longest section in the book, “Documentia,” isn’t anything he wrote, but texts he collected: clinician’s notes spanning from 1969 (when depression and anxiety first struck, soon after he left the conservative Catholic sect Opus Dei) until the mid-2010s. It must have been a strange experience, editing this, seeing one’s painful life described from the outside in neutered prose — “almost a form of anti-writing” — and with standardized diagnostic frameworks. The documents are subtly chilling. Consider a doctor’s observation from 2005, by which point Scialabba had long been a respected critic: “He still has a worm’s eye view of himself and his life.” Or there’s an intake evaluation from the late 1980s, which notes that his “[s]elf-estimation alternates between harsh self-criticism and timid grandiosity.” Or a psychologist’s interpretation of his anxieties about attachment:

[H]e lives alone, he has some friends, but he only allows people to get so close to him. His best friend is an old one from the past but one who lives in New York, and I gather the friendship is expressed mostly by letter. There have been many women in his life but the relationships have always been short-lived, and when he begins to sense that the woman wants to go further with the relationship, he begins to find things that are wrong and creates such distance that the relationship breaks off.

He was 38 at the time this was written. Despite every success, imposter syndrome — the fear that he was a “dabbler” (his word) in the world of letters despite his elite education and respectable bylines — stalks these records. He “feels he’s a ‘fake’ and people will find out,” notes another caregiver.

But Scialabba does more than collect records and arrange them chronologically. He’s also a critic. Since the 1960s, he emphasizes, medical document-keeping has changed. In privatized health-care markets, where cost and risk are transferred to individuals, therapists write less openly and less interestingly, and contra the rich narration and character descriptions that distinguish his earlier records, now a patient’s archive is about “handing you expeditiously on to the next provider, the notes a sort of bill of lading.” There are plenty of kind, skilled, well-meaning individual doctors and therapists, but the system in which they practice turns patients into sources of revenue trailed by miscellaneous records — healing is almost epiphenomenal.

Following Mark Fisher, we might call this discourse a style of capitalist realism. But, Scialabba argues, “[e]ven the most comprehensively bureaucratized medical knowledge can be made to speak, if only we are willing to listen closely to the blank spaces, the paraphrases, and even the acronyms.” Read this way, the final line of “Documentia” is an eerie statement that intends to affirm the patient’s health but ends up suggesting something else: “Discharged from unit without incident.” In other words, Scialabba was a quiet, bill-paying visitor.

The weakest part of How To Be Depressed is the final one, Scialabba’s recommendations for getting through an episode. Everything is sensible — try to pay your bills, get dressed every day, eat, stay hydrated, take walks — and nothing is wrong. He’s correct, for example, that loved ones can sustain you at the lowest ebb: “The communion of hearts is healing.” Nonetheless “Tips for the Depressed” is mundane and pretty obvious; much of it may be downright useless if you’re in a staggering depression and don’t get out of bed until two in the afternoon. Besides, most experienced depressives already know what he says here. It is the putting of knowledge into action that’s so difficult when you are sick.

How To Be Depressed expresses consistent skepticism about medicine’s capacity to treat depression. Scialabba writes in the acknowledgments: “I’m not sure whether, and how much, to thank the many psychotherapists and psychopharmacologists who appear (pseudonymously) in this book. They all tried, but depression defeated them.” This is not the record of a cured man, someone in recovery with a curative regimen to share. It is the notebook of a person who barely survived.

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In the interview with journalist Christopher Lydon that makes up the third section, Scialabba quotes D. H. Lawrence on modernity’s soul-sickness: “We have fallen into the mistake of living from our little needs until we have almost lost our deeper needs in a sort of madness.” Of course, that could mean a lot of things, and Scialabba leaves open the question of how we might reconnect with such needs and how exactly they pertain to melancholy. Much of the time, anyway, there is no full recovery or escape from depression. Instead, you learn to live with it and appreciate the oases of “blessed everyday unhappiness.” Where this lands you in the hypercapitalist United States, with its prevailing cults of happiness, health, and austerity budgeting, is a frightening issue.

Scialabba has been one of the finest observers of American politics and culture since the 1980s; his essays and reviews, on everything from Vietnam to Christopher Lasch to the Bush/Cheney administration to the aftermath of the Great Recession, are a rich education. That’s why I wish this book were longer and more unified, less of a miscellany. I wish there were more that was genuinely new. The political acuity, psychological sensitivity, and rhetorical wit that distinguish his book reviews aren’t absent here, but they do feel underutilized.

Yet this is still one of the better books on depression that has appeared since the turn of the century, and it belongs in the Scialabba collected library that hopefully a scholar will compile someday. For now, besides this present text, his marvelous books (What Are Intellectuals Good For? and For the Republic in particular) remain out of print — something else, in this awful plague year, to be depressed about.

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Ryan Boyd (@ryanaboyd on Twitter) lives in Los Angeles and teaches writing at the University of Southern California.