The Scar: A Personal History of Depression and Recovery, by Mary Cregan, Lilliput Press, 282 pp, €16, ISBN 978-1843517603
When Mary Cregan was twenty-seven her first baby, Anna, died at two days old. Following Anna’s death and funeral, heartrendingly described in this book, Cregan sank into a deep depression. A near-successful suicide attempt three months later left her with the eponymous scar on her neck. Thirty years on – now a lecturer in English literature and mother of a teenage son – she decided she wanted to “turn to the past and face it squarely … after decades of trying to keep it hidden and behind me”. She “sensed that writing about depression – and not just for myself – was the only way to wrestle with a subject so difficult to grasp and an inner experience so continually, unrelentingly frustrating”.
The book is more than what is indicated by its subtitle: “A Personal History of Depression and Recovery”. It is in part a reflective memoir of the writer’s mental health problems, her life trajectory and recovery, but this story is interwoven with critical accounts of the history and effects of psychiatric treatments – including asylums, electroconvulsive therapy (ECT) and anti-depressants. These accounts are well-researched and informative, evidencing that, as Cregan writes: “I had earned a doctorate in English literature and was comfortable doing research outside the discipline in which I had been trained.
The writer’s literary background and profession also enable her to provide valuable insights by referencing and quoting a wealth of writers – including Rainer Maria Rilke, Emily Dickinson, David Foster Wallace, Sylvia Plath, Joan Didion, TS Eliot and John Milton.
The chapter on loss and grief, “Where do the Dead go?”, is an interesting reflection on attitudes to death and mourning. The psychiatrists working with the writer after her baby’s death were operating within a Freudian paradigm, which would have been the norm in the United States at that time. Freud saw Trauerarbeit – “grief work” ‑ as a process of breaking the ties that bound the survivor to the deceased. The grief work model stresses the importance of “moving on” as quickly as possible to return to a “normal” level of functioning. Cregan herself feels more drawn to the belief that the dead remain with us in some way. Although she doesn’t refer to it, this is congruent with current thinking on “continuing bonds”, in which there has been a shift away from the idea that successful grieving requires “letting go” of the deceased. Continuing bonds recognises that death ends a life, not necessarily a relationship. The conversation, the relationship and the emotional link with the loved one can be continued and this has been found to be especially important in the case of losing a child.
Cregan is strongly of the opinion that the old-fashioned word melancholia should be used to describe what is currently called “major depression”. The term melancholia (black bile) was first used by Hippocrates in about 400 BC. Described by one of his followers four hundred years later as ‘”anguish and distress with dejection, silence, animosity, longing for death, suspicion and weeping”, melancholia was the term used for this and other similar states for nearly two thousand years. The term “depression” as a diagnosis began to be used only in the late nineteenth century and Cregan thinks that the casual frequency of its use today trivialises some serious conditions: “It matters that a fairly uncommon and dangerous syndrome shares a name with a common condition – depression – that in many people is not a state of illness.”
Another interesting theme is Cregan’s defence of ECT, which she credits with lifting her from the depths of melancholia. Outlining the history of the development of ECT, she objects to the way the treatment is represented in the media and by anti-ECT activists and writes “I would have ECT again without hesitation.”
Looking back, Cregan does not believe, as her psychiatrists at the time did, that “postpartum bereavement had caused the crisis … that it was situational”. She sees now that “it was the eruption of an unrecognised disorder that had been quietly present for years. Anna’s death had caused it to leap into visibility.” Unrecognised episodes had begun when Cregan was in high school, or perhaps earlier.
Dealing with melancholia/major depressive disorder is a lifelong challenge, and Cregan does not pretend that her life after recovery from the worst episode has been plain sailing. She describes how she has lived through further episodes of depression and struggled with the need to take medication in order to manage her life, while believing that anti-depressants have a flattening effect on her emotions. “When I’m tempted to stop taking my medication, it’s because I want to feel all that I’m capable of feeling. Not the very low lows, but the emotions of a person who is fully alive to the days and moments of her life, and not at a slight remove.”
This reader felt a sense of sadness emanating from The Scar. Although the writer has survived and learned to deal well with the burden of major depressive disorder and the challenges and suffering it brings, she still regrets ambitions not achieved, calling herself a failure for lack of accomplishment. At the end of the book, however, she acknowledges that “writing this book has made me acknowledge how thoroughly depression has shadowed my life” and how this, rather than personal failure, has limited her achievements. She now hopes to grow to accept things as they are and to “acknowledge imperfection as the natural and shared condition of being human”. What might help is the Buddhist practice of self-compassion, which entails extending compassion to one’s self in instances of perceived inadequacy, failure or general suffering, rather than hurting oneself with self-criticism.
This book conveys well the pain and suffering which can result from major depressive disorder, and the effects these can have on a life. The writer’s own individual experience of this is described effectively and movingly. The book is enriched by excellent accounts of the histories of various psychiatric treatments, any of which would serve as a useful and reliable reference source.
Marie Rooney is an education consultant. She was awarded an education doctorate by NUI Maynooth in 2010 for her thesis “Learning is my Prescription: Adult Education and Mental Health Recovery”.