The Scar is a powerful, thoughtful, and moving book, part memoir about the author’s illness across some 30 years, part history of depression and its treatment and part essay to evoke cultural and personal values about sickness, suffering, health, and death. Cregan, a gifted stylist herself, draws on literature that deals with human suffering, mortality, and wisdom.  She frankly describes her sorrows and hopes, the death of her baby, her attempts to kill herself, and her survival today with many blessings.   
The title refers to a scar on her neck, a result of her effort to cut her throat with a piece of glass so that she would die. This attempt, in a hospital, reflects the depth of her illness and the failure of her caregivers to prevent it. Her book explores the complexity and variety of mental patients and the range of medical responses—some useful, some not—to  treat them. Writing as a survivor, she draws on her journal, hospital records, emails, interviews, and more; she is part journalist, detective, archivist, and forensic pathologist—as if doing an autopsy on the suicide she attempted.
Ch. 1
What Happened describes the birth and immediate death of her daughter Anna and her descent into depression and initial hospitalization.

Ch. 2
What Happened Next discusses mental hospitals and her perceptions of being a patient in one. A dramatic paragraph describes her cutting her throat (p. 51).

Ch. 3
How to Save a Life presents electroconvulsive therapy (ECT), from the jarring images of “One Flew Over the Cuckoo’s Nest” to her own experience of some 17 treatments; she reports that these helped in recovery.

Ch. 4
The Paradise of Bedlams gives a history of mental hospitals. She is hospitalized three months, “a prisoner,” in her term.

Ch. 5
Where Do the Dead Go? explores the dilemmas of the living as they mourn the deaths of people they love, including approaches from Judaism and Christianity. Mary has nightmares about her lost baby. She discusses Freud, Rilke, T. S. Eliot and others. She buries Anna’s ashes.

Ch. 6
Early Blues discusses modern attempts of science and the pharmaceutical industry to create drugs for mental illnesses, with influences from psychodynamic and biological concepts.

Ch. 7
The Promise of Prozac discusses that famous (notorious?) drug; she takes it on and off while working on her PhD, then other drugs as they became available.

Ch. 8
No Feeling Is Final sums up many themes.  She’s in her late 30s, remarried, and trying to conceive. After IVF, she’s pregnant. Baby Luke is born. She understands that the scar on her neck has an analogue with Odysseus’ scar on his leg: a symbol of survival through hard, even desperate times, for her a “double trauma: the loss of my child, the loss of myself”  (p. 243).  


For readers interested in the topics Cregan explores, this is a superb book because of the pervasive intelligence, the synthetic approach, and the attractive style.   

Cregan’s text ranges from the personal to the technical, the analytic to the speculative,
and the historical to contemporary cultural values. She shares with us the pain of deep depression, the fear that it will return, her guilt that she caused it somehow, or inherited it from her stoic, Irish ancestors. She understands that, even from her youth, she was a “double self: I presented to others the person they expected to see—going along, doing fine—while acquiescing to my circumstances and trying to manage my misery privately” (p. 198). Perhaps all of us have felt something of that, but in her case it was severe.            

She wonders about the recent development of drugs, their extensive marketing, their side-effects, the debate among experts, even whether she should have been taking them “for the past twenty-five years” (p. 228). She concludes she should stay on them (even with their risks) because her depression may redevelop as it has in the past.

Mental health issues are many and fraught with dreadful histories of people chained in lunatic asylums or otherwise mistreated and forgotten. This book discusses 20th-century models of Freud, Emil Kraepelin, Adolf Meyer, Karl Menninger, and the revised editions of the DSM (The Diagnostic and Statistical Manual of Mental Disorders), none of which appear to solve the elaborate mysteries of the brain’s anatomy and biochemistry, the life events people experience, and cultural values that influence us. From her own experience with many prescribed drugs, she concludes that the available drugs “are a blunt instrument, modifying neural pathways in ways not understood, creating change but not cure.” They are “imperfect…but life-saving nonetheless” (p. 231). 

Cregan presents complex information clearly and with an essayistic testing of the truth and implications of current wisdom. She understands the limits of language but also its power to evoke: “if the healthy mind is a glass of clear water, depression is what happens if you add successive drops of ink and stir. Each addition darkens the consciousness with the mind, and the vision looking out from it” (p.163).

As the issues of illness, healing, and death are perennial, many texts, old and new, have dealt with them. Cregan enriches her discussion with references to Virginia Woolf, Samuel Beckett, Freud, Joan Didion, Eavan Boland, Czeslaw Milosz, Ken Kesey, Stevie Smith, the Psalms and other scripture, William Styron, Dante, Milton, C. G Jung, Hilda Doolittle, Rainer Maria Rilke, Anne Sexton, Leonard Cohen, and Greek myths.


W.W. Norton & Company

Place Published

New York



Page Count