Vincent van Gogh, Sorrowing Old Man (also known as At Heaven's Gate), 1890, detail (Alamy Stock Photo)

As  I read George Scialabba’s new book How To Be Depressed, I recalled that I’d been introduced to his writing almost a decade ago by a schizophrenic, manic-depressive homeless man. R. might have protested that term—technically, he lived in a small garage that a fellow parishioner at the church we all attended let him use. It was shocking to visit him there for the first time; nearly every square inch of the place was filled with musty stacks of the New York Review of Books, assorted newspapers, and books, leaving only a narrow path that led to a mattress. Before adding something to one of these piles, he’d open his latest acquisition and run his finger down its pages, searching for matches or “sparks” that might cause a destructive fire—a phobia caused by a traumatic incident in R.’s childhood.

My friends and I tried to look after R., taking him to dinner or paying his phone bill or letting him do laundry in our homes. I was drawn to R. partly because I couldn’t help but see some of myself in him, and had a gnawing fear that his plight would one day be my own. He was, in his way, an intellectual, who actually read at least a few of the periodicals he collected and enjoyed arguing about politics. I’d often see him in the local used bookstore I frequented, and that must have been where he pressed Scialabba’s What Are Intellectuals Good For? into my hands. “This is the good shit,” he solemnly professed, and he was right. R. had been an alcoholic, and I’d gleaned that when he finally kicked booze the withdrawal caused a breakdown from which he’d never quite recovered. I knew I sometimes drank too much, too, and for the wrong reasons—enough to watch myself. We shared both hypochondria and a dread of visiting the doctor. I wasn’t a manic depressive, but for much of the time I knew R. I was in the throes of the worst severe depression of my life.

One feature of that depression was that I developed an acute fear of becoming homeless—deepened, I think, by my friendship with R. If you spend any amount of time actually getting to know homeless people, you realize how quickly a life can become undone: an addiction that spirals out of control at the wrong time; a mental breakdown without family and friends to sustain you; a bad decision followed by a bad break. The depressed mind, usually so lethargic, nevertheless manages to conjure up the most elaborate scenarios of doom. However ridiculous it might seem, I made a number of my closest friends swear on their honor to take me in if I got to such a point. That fear of falling came back to me when I read this passage from the notes of one of Scialabba’s therapists:

He now has multiple fears of losing control, which he fantasizes would result in his becoming passive, being unable to hold a job, going on welfare or into a hospital, and not being able to take care of himself.

Such consuming worry about “losing control,” about being unable to keep it together, is a recurring theme in the literature about depression—not merely intense sadness, but the threat of personal dissolution. William Styron, in Darkness Visible, relays a conversation with a suffering friend who told him that his depression made him feel “helpless.” An especially wrenching scene in Andrew Solomon’s The Noonday Demon is when his father literally has to feed him. Depression makes ordinary tasks appear as looming impossibilities. Work suffers; social occasions become exhausting burdens; getting out of bed takes heroic effort.

This underlies one of the paradoxes of depression: it renders you unable to do what would help you tame your affliction. When I was depressed, I knew exercise stood a chance of minimizing my symptoms, but summoning the will to go for a jog or head to the gym was often beyond me. For years I resisted trying medication. The thought of finding a doctor, setting up an appointment, and then navigating insurance forms brought me close to panic. I only received treatment after bottoming out, nearly destroying the life I was keeping a tenuous hold on. One morning while lying in bed, not long after spending a night in jail, I had a brief moment of clarity: I crawled over to my desk and emailed my priest, telling him I needed help. Could he arrange for me to see a doctor? I still remember walking out of the doctor’s office a few days later, prescription in hand, crying from relief. It would take weeks for the Lexapro to take effect; the point was that I’d finally done something. For the first time in a long time, I’d moved forward.

As I slowly, if unevenly, learned to deal with my depression, I begged R. to see a doctor too, and perhaps try medication. He refused, pointing me to an old magazine article that cast doubt on such pharmaceutical interventions, while hinting at darker conspiracies about the mental-health profession’s role in our society. We argued and argued. I offered to set up an appointment with the doctor I’d seen, and gave him a blank signed check to cover the cost of his visit. He wouldn’t budge. Depression can leave us not only unable to love, but unable to accept love.


What we share most of all is our vulnerability to cruelty and chance, unexpected ruin or sudden defeat.

Depression forces itself through the cracks of one’s life, finding the weak spots particular to the person it inundates. Like consciousness itself, depression seems to dwell in that hazy realm where matter and spirit meet, and we turn inward to pursue its elusive essence. Exploring what caused a person’s depression, however, what set it off on the particular course it ran, necessarily ends in an overdetermined tangle—one reason why the shelves overflow with depression memoirs. We keep trying to pin depression down, but fail again and again. Styron’s depression set upon him when he was around sixty years old, likely “triggered” when he suddenly gave up alcohol and began taking a dangerous sleeping medication. But as Styron meditates on what happened to him, the chain of causation extends ever backward—he realizes three main characters in his novels kill themselves, a fact that suggests the storm had been gathering for many years. Then he presses on to childhood wounds. Would a man who’d led a different life sink into depression after he quit drinking? Styron gets to the end of Darkness Visible and confesses, “The very number of hypotheses is testimony to the malady’s all but impenetrable mystery.”

Of course, depression memoirs also try to express what depression feels like, the experience of being cut down by it. But there’s something false about the very act of writing about depression in that way. Generally speaking, the people who write memoirs don’t do so while they’re strung out from an addiction, exhausted by chemotherapy, or enduring a family crisis—or while they’re in the throes of depression. Memoirs are written by survivors, and survival imposes a retrospective sense of resolution on a person’s depression that the actual experience of it entirely lacks. Scialabba agrees with William James’s classic formulation: depression is an anguish “unknown to normal life,” because, as Scialabba puts it in the book’s moving introduction, no other pain feels “unlimited in both intensity and duration.” Depression seems like it will never end; life becomes an eternal, excruciating present. Your life no longer has a narrative, which is precisely what a memoir needs.

What makes Scialabba’s How To Be Depressed such a brilliant and unusual contribution to the literature of depression is the elegant solution he found to this predicament. He doesn’t write about himself—other people do. Rather than produce another “memoir,” he reproduces the notes his therapists and doctors took over the years. “They’re a very distinct form of writing,” Scialabba observes. “They’re almost a form of anti-writing.” This allows readers to encounter his depression from the outside; he relinquishes control of his story, sapping it of all dramatic pacing. There is only depression’s pathetic waste, observed in pitiless detail over the decades.

This is very different from reading, say, Kay Jamison’s memoir An Unquiet Mind. She writes of “moods and madness,” and the reader first encounters her running around the parking lot of the UCLA Medical Center at 2 a.m., “trying to use up a boundless, restless, manic energy.” In another book, Touched with Fire, Jamison connects manic depression to “the artistic temperament”—which can’t help but lend the illness an air of intrigue and allure. Even Styron’s account of his depression gives it a certain romance; the memoir’s opening scene finds him in Paris, about to accept a prestigious literary prize. His depression, safely behind him by its final pages, becomes a dark, harrowing interlude that adds grit to an otherwise enviable life.

Not so for Scialabba. He circles around the same problems over and over, especially his break with Opus Dei, into which he’d been recruited while an undergraduate at Harvard—a decision that also meant leaving, though never entirely leaving behind, the Catholic Church. As one therapist reports:

The overall problem he notes was that he was a very devout Catholic, part of a religious order, which he left at 21 during the summer between college and graduate school. He was so agitated he had to drop out of graduate school. Seemingly, the pieces of his life never came back together. He did not feel able to do any intellectual work, never resumed his life again.

If these notes convey the futility of depression, they also fill in enough of Scialabba’s story for readers to follow along. It might be “a story without a plot, without characters, without hope” as Scialabba claims, but a sketch of the man emerges: his Italian, working-class upbringing in Boston; confessions that he’s buying too many books and records; his obsessive thinking, indecisiveness, and scrupulosity attacks; the ups and downs of trying to write.

I found this material oddly absorbing, though I came to it knowing that Scialabba is one of the best social critics of our time. (He’s an occasional contributor to this magazine.) But that doesn’t mean it’s easy reading. Publishing his mental-health files was an act of self-exposure, and what’s revealed is rarely flattering, especially when his complaints are rendered so unsparingly:

Mr. Scialabba spoke of an incident that may have precipitated his last depression. He was having long and difficult dental work done and when he found the dentist unsympathetic with his pain, he abruptly terminated the dental work which he now regrets.


Presently Mr. Scialabba has a number of male friends, writers and intellectuals with whom he constantly compares himself and to whom he feels inferior. He had opportunities to teach freshman English at Boston University and at Boston College this year, but was so anxious and agitated at the prospect that he declined. He felt that this disappointed his friends greatly, and certainly disappointed himself. Mr. Scialabba describes himself as a “dabbler” in intellectual history and politics who can impress people superficially but is lacking in depth, because he could not commit himself intellectually any more than he could emotionally.

How To Be Depressed does not end with an epiphany or a cure. The therapists’ notes just stop as they get closer to the present, followed by an interview with Scialabba and a glossary-like “tips for the depressed.” There is no grand, inspiring conclusion—just some hints about how decades of dealing with depression have taught him to adapt his life to it and muddle through.


Scialabba has provided not just a profound account of depression, but a reminder of how precarious our lives can be, and how much we need each other.

Many readers, especially those who have suffered from depression, will be fascinated by this final section of the book, which includes a list of the many medications Scialabba has tried over the years, and the details about his experiences with electroconvulsive therapy. (What depressive hasn’t found themselves talking to a fellow sufferer and ended up comparing pharmaceutical notes?) I can say from experience that his suggestions for depressed people are quite useful: how to force yourself out of bed in the morning, what food to stock your refrigerator with, the importance of staying hydrated, and how to manage your money and remember to pay bills. For him, as for many of us, depression is always lurking, even if it is not always acute. But when the worst hits, when life becomes nearly unbearable, his advice amounts to saying: hang on until it passes, because it will pass, eventually, no matter how much it feels like it won’t—and here’s what might help until then.

What comes through these everyday tips, and what permeates Scialabba’s entire book, is his deep compassion for those who share his plight. I keep coming back to these lines from one of his therapists:

His affect was alternately sad and angry. He started to cry at one point, talking about his own compassion for suffering people and his wish that his own suffering would be treated with similar compassion.

He means especially compassion from friends and family, and it’s a longing with which I’m familiar. To be depressed is to feel overwhelmed, that life is just too much. Part of his advice is to bluntly ask your loved ones to help you. “Don’t hesitate to ask friends for material help: to shop for you, to cook, to drive you to doctor’s appointments, to come over and watch television with you,” he writes, “or just be there while you clean the house or do your laundry or pay bills, if you find those things too hard to do by yourself.” I would add: don’t hesitate to offend someone by asking if they need this kind of help.

I’m certain my own life never entirely unraveled because of the love of my friends. I now literally know the answer to the question, “Which friend would you call to pick you up at jail?” And I remember when J. arrived after I did just that, bringing me a coffee and telling me everything would be all right. I remember my priest finding me that doctor. I remember those who have forgiven my slights and shameful behavior, especially my friends who endured the worst of it—the times when it was those closest to me I hurt the most. Perhaps not surprisingly, they were the friends who helped take care of R.; the friends who, after years of prodding and filling out paperwork, finally got R. a place of his own in a low-income apartment complex. These friends knew that real love is more than vague sentimentality, and that the people who need love the most rarely seem like the most deserving—indeed, they are often the most frustrating and difficult.

But Scialabba refuses to view such compassion only in private, personal terms, as if it could be discussed apart from politics and public policy. His might be the only book I’ve read that specifically mentions how important unions are for depressed people:

I was blessed with an enlightened employer and—even more important—a strong union, so I twice got to take a three-month paid medical leave. I don’t know what I would have done without them. This is one of many ways in which strong unions are a matter of life and death. There’s plenty of data proving that poverty and economic insecurity increase depression and suicide rates. There’s also plenty of data showing that the decline of (more accurately, the successful assault on) unions has increased poverty and economic insecurity.

Elsewhere, he rips into the One Percent, “who by the best scholarly estimates are hiding around nine trillion dollars in offshore tax havens.” Shame on them, and the governments that allow it, he says, for hoarding money that “could relieve an awful lot of unnecessary suffering.” A more generous and decent society, one that did not condemn those who get sick and fall on hard times to destitution or crushing debt, would be a society much better for the depressed. So would a health-care system that didn’t consist of labyrinthine private health-insurance markets, with their reams of paperwork and out-of-network traps.

Scialabba never directly addresses the question, but one wonders how much his politics relate to his experience of depression. He is a man of the Left, an advocate of democratic socialism. Contrary to the assertions of many on the Right, such commitments aren’t dependent on a naïve belief in progress or human perfectibility, an optimism about “human nature”—at least not in Scialabba’s view, and not in mine either. Instead, such a politics can be based in human frailty, the understanding that we’re less free than we want to admit, and that the illusions of “meritocracy” mostly just flatter those who have been more fortunate, or had the resources to evade consequences for their misdeeds and mistakes. This politics is democratic in the deepest sense: what we share most of all is our vulnerability to cruelty and chance, unexpected ruin or sudden defeat. It recognizes the unchosen limits and circumstances that mark our lives, which no amount of bootstrapping can overcome.

There are those who want to build a world where lives bend but do not break when sickness or strife hits, and then there are those who are serenely confident that their prosperity and position are the outcome of their striving, and that they are beyond the reach of such afflictions. Perhaps what puts someone on one side of that divide or the other is how much they can truly imagine losing. By sharing his struggles, Scialabba has provided not just a profound account of depression, but a reminder of how precarious our lives can be, and how much we need each other.


How To Be Depressed
George Scialabba
University of Pennsylvania Press, $27.50, 224 pp.

Matthew Sitman is an associate editor of Commonweal. You can follow him on Twitter.

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Published in the July / August 2020 issue: View Contents
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