One of the ironies of mental illness is that the people who know most about it are least trusted to explain it. It is up to the sane to explain insanity. It is as if the only authoritative travel books were those written by people who have never actually been in the terrain in question. People who have actually experienced illnesses such as profound depression are by definition hard to credit: they have been there but they are not all there. In terms of intellectual expertise, mental illness is like death as envisaged by Hamlet: the undiscovered country from which no traveller ever really returns. If you were deranged at the time you were there, how can you map the territory for the rest of us?
This is, of course, one way the stigmatisation of mental illness works. It robs the sufferers of full possession of their own experience. They can tell us about it in raw narrative form. But they cannot be trusted to interpret it through research and scholarship and all the disciplines that require a cool and methodical objectivity. And this of course is deeply wrong. For many, many travellers do indeed return from the country of the deranged mind. If, like the Irish-American writer and academic Mary Cregan, they are scholars and thinkers, they return to those very disciplines. Yet how are they to write? Subjectively within the frame of memoir – this is what happened to me? Or objectively within the frame of academic expertise – this is what my experience means when seen through the lens of history, literature and culture? It is very difficult, and indeed quite subversive, to do both at the same time and it is Cregan’s ability to manage it that makes The Scar so remarkable and so important.
I originally read The Scar in manuscript last year (full disclosure: I am mentioned in the acknowledgements) and my initial feeling was to want it to be all memoir. The scar that gives Cregan her title is literal as well as mental. She begins with a visit to a physiotherapist who notices the diagonal scar on the left side of her neck and asks her how she got it. She says “I’d rather not talk about it.” But when the next physio asks, she gives the answer: “I gave birth to a child who died and I got very depressed. The scar is from a suicide attempt.” Cregan is laconically brilliant on the embarrassment of the therapist and on her own regret for telling the truth: “I’ve gone through life wanting people to assume that I’m a rational, dependable, normal person, and the best and easiest way to do that is not to talk of it at all.”
If the social pressure is for silence, the internal pressure is for forgetting. Cregan makes it clear that she has no desire to remember what happened to her when she was 27, happily married and having her first child. In a sense, The Scar begins as an anti-memoir, a struggle against memory. But the physical vestige of her past is too prominent: “Instead, the scar is there in the bathroom mirror each morning when I brush my teeth, a daily reminder of my surreal descent into mental illness. Three months after my daughter died, I was so depressed that I had to be hospitalised. On my second morning in a locked ward, I stepped into the shower with a glass of moisturiser and dropped it on the floor. Then I felt the left side of my neck for the strong pulse of the artery and pulled a large piece of broken glass firmly across it.”
Cregan’s descriptive prose is so potent, so vivid and yet so restrained, that I suspect the initial impulse of most readers will be, as mine was, to want the book to remain on this plane of direct personal experience. But this is to fall into the trap of prejudice by reinforcing the idea that the person who has suffered in this way has nothing to offer except a subjective account of how it felt. She has much more to offer: a superbly intelligent and subtle interrogation of depression itself as a way of understanding these experiences, whether – as for most of its history – as “melancholia” or in contemporary clinical usage as MMD (major depressive disorder). It is not that Cregan ever loses sight of her own story of illness and recovery – rather that she sees it (and allows us to see it) alternately from the inside and the outside, as both an extremely intimate and a broadly human truth.
Part of what she sees from outside herself is the genetic element of the illness, which in her case is Irish. The Irish disease, though, is not just the illness itself but the silence and shame that surround it: “In my large Irish Catholic family, the tacit understanding was that it was best not to draw attention to oneself.” Cregan recounts that when she was first admitted to the psychiatric hospital, a family history was taken. Her parents told the doctor that each of their fathers had obvious bouts of depression, but neither had sought help. Her own father then revealed that he himself was still on medication after an episode two years earlier. He had never told her. There is something wrenchingly Irish about this: “family history” revealed only as evidence of a disorder, not as a shared truth told between people who love each other.
But Cregan turns this painful irony around. Her gripping, elegant, constantly illuminating book reoccupies the clinical term “a history of depression”. She has that history but it does not have her. She has written herself both into and out of it. The larger story of depression and attempts to understand and treat it has, in the best sense, a therapeutic function for within it she is an entirely “normal person” who has lived with a very common human pain. And the telling of her smaller, more intimate story in such well-shaped words is a stage of healing too. Cregan got control of her condition (she gives credit both to talking cures and to medication and even shock therapy), married again and had a son. In her writing there is a coming to terms with the meaning of her scar tissue. It is an indelible mark of trauma, her loss of her child, her almost permanent loss of herself, her loss of the years she lived under the shadows of both depression itself and her shame at having it. The scar will not go away. But it only exists because the wound has somehow healed.