We're delighted to present an extract from The Scar: A Personal History of Depression and Recovery by Mary Cregan, published by Lilliput Press.

In this intimate memoir, Mary Cregan shares deeply personal memories of loss, despair and self-inquiry and links them intelligently and sensitively with a medical and cultural history of depressive illness.

What Happened Next

Between the night I arrived in one hospital to give birth and the night I arrived in another to stay on one of its locked wards, a hundred or so days came and went. As I tried to adapt to my unexpectedly childless condition, it seemed to me that time moved too slowly. But the rhythm of the seasons was rolling along as usual: the dark closed in early, and Christmas came, and then the nights grew shorter again until the equinox balanced night and day. Human bodies are attuned to light and to seasonal change; mood and energy levels tend to rise in springtime. To me, time felt empty and non-progressive, and when spring arrived it made no difference. I had entered a state of living death.

At some point along that span of days, amid the shock and grief and as communication along certain pathways in my brain was shutting down, I arrived for an extended stay in what Susan Sontag called the kingdom of the sick. ‘Illness is the night-side of life,’ she wrote, in a book about her experience with cancer and the strange state of being ill. ‘Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.’ Sooner, rather than later, it was my turn.

Among the proofs of citizenship in that kingdom, at least where mental illness is concerned, is the experience of life in a psychiatric ward. Let’s say that the diagnosis – the professional assessment of symptoms – is the official passport. Mine was stamped, as I later learned, ‘Major depressive episode, with melancholia.’ No one ever mentioned melancholia when I was in the hospital; I only knew they were treating me for depression. I was depressed, of course, but I believed what was really wrong with me was a grievous fault of character. Depression was just the outward manifestation of my inferiority and failure. Much later, I learned that these overwhelmingly negative, self-punitive and delusional patterns of thought are classic symptoms of melancholia, an illness recognized and described for over two thousand years. So was my experience of slowed time: in the illness, distorted time perception and sleep disruption both result from a breakdown of the body’s circadian clock. But this understanding of what happened to me was long in coming.

Many years later, I asked my psychiatrist to make me a copy of the discharge summary – an encapsulated version of my case – that was sent to her because I was to be her patient when I left the hospital. On the first page of the typewritten case file is the underlined heading ‘Chief Complaint’, followed by a transcription of my own words: ‘I’ve felt like I’ve had to kill myself for the last two months and have been able to fight it off until now.’ I made this statement during the intake interview that was part of the admission process. This would be the first page of my chart. The nurses, my psychiatrist, the mental health workers, the social worker, all would add their notes as the record thickened with dated entries after that first day. Given the prominence of my chief complaint, I have to wonder why the hospital didn’t take seriously enough the statement that I could no longer fight the suicidal urge that had landed me in their care.

A search in The New York Times archives turns up many nineteenth- and early twentieth-century articles where the word ‘melancholia’ nearly always appears in the report of a desperate act of suicide, with headlines like ‘A Fatal Leap’ and ‘Suicide in Central Park’. Under a headline that reads, simply, ‘Brooklyn’, I found a case similar to my own: a quiet, seemingly compliant patient takes an action that surprises her keepers.

'Margaret Schmitt, aged 55 years, a lunatic, confined in the asylum at Flatbush, committed suicide some time during Thursday morning by strangling herself with a torn sheet in her cell. She was visited several times during the night by the nurses, and as she had always shown a quiet, inoffensive disposition, suffering chiefly from melancholia, it was not believed that she would make any attempt on her life.' 

While the status of major depressive disorder has come under fire on the grounds that it is a loose and somewhat arbitrary collection of symptoms rather than a discrete illness, historian Stanley Jackson has written of the ‘remarkable consistency’ with which melancholia has expressed itself across more than two millennia. He writes, ‘It is the clinical description that is essential – the symptoms and the signs, the observations that could be attested to by the sufferer or noted by another person.’ When I read Jackson’s book and others, I realized that the phrase ‘with melancholia’ in my diagnosis best expresses the experience I’ve been relating, and that melancholia is a more specific and terrible ailment than what is implied more generally by major depressive disorder, the diagnostic drawer into which it has been slipped. Reading accounts of melancholia, I recognized that across expanses of time, countless people had felt what I had felt. As described by sufferers and physicians alike, the consistent symptoms and signs – the sleeplessness, the anguish, the despair, the pathological guilt, the suicidal impulse – appear again and again. These voices helped me to place that bewildering period of my life in a longer, more communal perspective.

The Scar: A Personal History of Depression and Recovery by Mary Cregan (published by Lilliput Press) is out now.