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How to Be Depressed

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An unusual, searching, and poignant memoir of one man's quest to make sense of depression

George Scialabba is a prolific critic and essayist known for his incisive, wide-ranging commentary on literature, philosophy, religion, and politics. He is also, like millions of others, a lifelong sufferer from clinical depression. In How To Be Depressed, Scialabba presents an edited selection of his mental health records spanning decades of treatment, framed by an introduction and an interview with renowned podcaster Christopher Lydon. The book also includes a wry and ruminative collection of "tips for the depressed," organized into something like a glossary of terms--among which are the names of numerous medications he has tried or researched over the years. Together, these texts form an unusual, searching, and poignant hybrid of essay and memoir, inviting readers into the hospital and the therapy office as Scialabba and his caregivers try to make sense of this baffling disease.

In Scialabba's view, clinical depression amounts to an "utter waste." Unlike heart surgery or a broken leg, there is no relaxing convalescence and nothing to be learned (except, perhaps, who your friends are). It leaves you weakened and bewildered, unsure why you got sick or how you got well, praying that it never happens again but certain that it will. Scialabba documents his own struggles and draws from them insights that may prove useful to fellow-sufferers and general readers alike. In the place of dispensable banalities--"Hold on," "You will feel better," and so on--he offers an account of how it's been for him, in the hope that doing so might prove helpful to others.

224 pages, Hardcover

Published March 13, 2020

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5 stars
36 (26%)
4 stars
44 (32%)
3 stars
38 (28%)
2 stars
16 (11%)
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1 (<1%)
Displaying 1 - 26 of 26 reviews
Profile Image for Matt.
1,144 reviews760 followers
August 14, 2020

Proof that depression isn't just "in your head" or your attitude.

For a mind this well-stocked, articulate, and observant to suffer like this is yet another reason why mankind doesn't need more of the cosmic guilt trip.
Profile Image for Nicholas Lecchi.
10 reviews1 follower
February 10, 2021
For anyone going in expecting a Darkness Visible style exploration of depression (a book Scialabba mentions explicitly), they're probably going to be super disappointed by how the author has effectively delegated narrative duties to the various psychiatrists and therapists who have written the clinical evaluations that comprise virtually the whole of the book. Anybody who gives this form of, to borrow Scialabba's term, "anti-writing" a chance, however, will find that the book offers a lot emotionally. Interestingly, for as much detail as we get about Scialbba's neuroses and insecurities, it's also fascinating how events such as the death of his parents or the disintegration of his first committed romantic relationship he ever had are barely touched upon. The fact that this is so, in my opinion, only reinforces the sense that Sicalbba isn't setting out to actively "write" a story about himself so much as to utilize his life as a prism through which readers can get a sense of the evolution of how psychiatric practices (and perhaps society writ large) have come to understand depression as a phenomenon.

Though the narrative is gripping enough, I actually think that Scialabba is at his best when taking stock of the economic and political circumstances fueling the societal upswing in depression, and I think the interview conducted with him near the end of the book is strong enough to work as a stand-alone piece.
Profile Image for Marie-Therese.
412 reviews214 followers
January 29, 2021
1.5 stars

This book sounds interesting in the abstract but in practice it's terribly dull and Scialabba is not a very engaging narrator nor does he have any "tips" that aren't well-known to everyone who's ever suffered from depression or suffered with a depressive.

It's brief enough that I don't feel I wasted much time but I wouldn't recommend it to anyone.
Profile Image for Romany.
684 reviews
April 10, 2020
Strange and fascinating. A whole lifetime of depression and persistence.
Profile Image for Dean.
115 reviews2 followers
August 5, 2022
I'd assume that most of the people who are reading/ interested in reading this book are fellow depressives. Despite what my low score might indicate, I do appreciate any thoughtful attempt to talk about life with mental illness. Scialabba manages to avoid the pit falls of sentimentality or over-simplicity in this book, and seems to possess a clear idea of the role that depression has played in his life, as well as it's multitude of sources. For that, I appreciate having read this.

That being said, I can't quite understand what made Scialabba think it was a good idea to devote the majority of this short book to an exhaustive litany of all the treatment he has received for his depression over the last 50 years, and on top of that, to call what is effectively a medical record bookended with brief reflections on depression How to be Depressed. Maybe I'm asking too much of my literature, but I'd hoped I'd finish a book on depression feeling better about my own mental health situation - instead, after slogging through one man's mostly unsuccessful, life-long struggle, I'm not exactly galvanized. This isn't to say that I need every book to be an uplifting and life-affirming, one look at the other books I've logged on this site would tell you that. But it at least needs to be entertaining. The most generous standpoint I could take on this book is that Scialabba meant the title to be taken as ironic - we have here, after all, is a life lived under the aegis of institutionalized mental health care, along with all it's cold clinical language, alien descriptions, and treatment goals that sound like something out of a quarterly corporate report. But no where else in the book are we given a clear idea why Scialabba thought it worthwhile to include this material. Look, I'm not opposed to the use of endless monotonous lists in a book. Sometimes they can be used to hypnotic effect, and to drive home the brutal mundanity of reality (Bolano's 2666 springs to mind). But typically this technique is employed in much longer works, and don't make up the majority of the book as they do here.

Depression is, in part, a narcissistic disease. The black hole inside you can make you think that all time and space is bending inward towards your internal abyss, and it's very easy to forget that your perception isn't even one fraction of a fraction of what is actually happening in the world. People and events take on outsized importance, blissfully unaware of the monstrous shadow they are casting on the screen of your mind. While is far from my prerogative to criticize a man more than twice my age, and who has faced a degree of mental illness that haven't, I wonder what role this depressive narcissism plays in this book. The best treatment I have found for my own depression has been anything that helps me, however briefly, shirk the heavy weight of suffocating identity that it drapes over your entire world. Admittedly, Scialabba does give some tidbits of advice near the end of the book, as a kind of brief nod to the book's title. These range from helpful-if-obvious (exercise, friendship) to rather bizarre; let the record show that our author suggests various nut butters and Game of Thrones as part of an effective treatment. But over two-thirds of this book is painfully restricted to the most specific experience of depression, delivered with no comment. To read it is a painful reminder of that weight of identity, and the undignified pursuit of help from the powers that be.

Writing this now, it's hard for me not to feel a little bad for criticizing this work which was clearly borne from a lifetime of suffering. But if, like me, you are interested in insight about mental health problems and practical ideas about how to survive them, world literature is littered with great books full of ideas. How to Be Depressed would perhaps stand better as a blog post or a Twitter feed.
Profile Image for S*****.
21 reviews8 followers
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July 27, 2023
I became interested in this book after reading Matt Sitman’s piece, Muddling Through, in Commonweal. I really enjoyed its “anti-writing”ness and clinical distance. In some ways, it’s the reason why the potential triteness of the comments and solutions
Scialabba offers never fully comes to pass.

The hard thing about reading pieces that explicitly touch on mental illness, I think, is feeling torn between the power of putting a name to a heretofore unknown condition—it’s often only then that you can get better—and the risk of identifying with that condition, which can then enshrine or reproduce that way of being regardless of whether or not it actually existed.

The medical distance the book takes is so frank in its portrayal of some of Scialabba’s lowest moments that it’s sometimes hard to keep reading. It’s not a very personal or memoir-ish rendition of his experiences with depression; it’s iterative, futile, and without plot or a redemptive final moment. In some ways, that makes it easier to read.
Profile Image for Mikael  Hall.
155 reviews13 followers
December 2, 2025
helt okej, inget banbrytande. intressant att publicera sina journaler, har själv funderat på det samma som litterärt grepp.
48 reviews1 follower
August 24, 2020
George Scialabba has created a fascinating document by allowing us to peer into his anguished soul through the eyes of his therapists and psychopharmacologists. Following Mr. Scialabba's journey through depression in this way is a singular tour through the warped world of American health care and psychiatry. As he mentions, the changing nature of session minutes is interesting to behold. One amusing facet was a recurring suggestion that his anxieties might stem from latent homosexual tendencies by an early therapist, perhaps due to the central focus of his obsessional malady around leaving Opus Dei.

While he maintains employment at something approaching a sinecure at Harvard, it's meager pay, and even lower status, is a constantly-inflamed sore spot. It gives him the chance to read books and write his reviews and critiques. However, at the moments we can glimpse in the doctor's notes, the job just barely suffices. Constantly wracked by feelings of uncertainty and inadequacy, I found it impossible not to feel his pain.

Two things stand out to me. First is the seemingly haphazard nature of the medicines that are prescribed and mixed, with dosages fluctuating like the stock market. The whole process comes off looking like a scattershot approach without much in the way of scientific rationale. Scialabba himself does not have a high appraisal of the nature of pharmaceuticals, as is evident from his comments following the therapy notes and a very pointed non-acknowledgement. It is enough to make one squeamish about the high levels of prescribed psychiatric drugs in the US.

The second is the cyclical nature of the human experience. The same anxieties resurface again and again without fail, perhaps changing clothes but still fundamentally the same. Certainly, this could be due to the vantage point of the doctor's office. Like returning to one's hometown, the passage of time is apparent, as is the feeling that not nearly enough progress has been made. Perhaps this is my own anxiety that we are condemned to live forever with our foibles, never able to overcome them. That there is, or will be, a moment in our lives when reality becomes unmoored, as it did when George gives up his faith, and we may never truly recover from it. How to Be Depressed at least signals that we are not alone in that struggle.
126 reviews2 followers
November 26, 2022
I found the introduction and the documentia section very enlightening to read. Not only for the specific comments and responses of the George as patient to life and treatment. More importantly to the trends which were shown in the notes taken - which were mentioned in the third section of the book. Mental health notes have moved from relatively free form observations of the patient/client to instead liability guides for ER hospitals.

This became especially evident both at the start of Dr Woodcourt’s note taking (in 1983). I suspect this was also a stylistic difference. But the depth engaged with was closer to signposting than it was to fleshing issues or commenting on perspective beyond the dry ‘affect’. That said, he seemed to show a genuine care even if it involved reaching for any number of cocktail drugs - which towards the beginning of his therapeutic tenure looked a bit like ‘I want to try this on you’ and ‘I think this will work on you’; taking a very biochemical view.

At the end of his duration (2008), the notes take a turn for the colder. They explain almost nothing, and read more like an insurance company’s legislative checklist - ‘you understand that if it turns out you do have a tree taller than 2m near your home your cover may be partially or totally voided’.

The three star rating is largely from the back two sections of the book. The interview felt a bit too ungrounded for my view. The author tried to make serious points, and the interviewer was almost trying to reify and pre-polish them. The final section also I suspect rubbed me slightly the wrong way for its conversion of description into prescription - though that probably says equal amounts about me as it does the author.

Given it’s a short and relatively straight forward read, it’s not one to avoid. Though as the introduction notes, it doesn’t seem some theoretical framework, but a patchwork recount. It reads like a strange second-ish person narrative of the everyday, and less like a theoretical architecture of melancholia (or whichever other title the condition is ascribed).
Profile Image for Alex Strohschein.
834 reviews155 followers
November 21, 2022
This is a curious book that I first heard about from editor and podcaster Matthew Sitman. The vast bulk of 'How to Be Depressed' is comprised of the medical notes written by George Scialabba's various therapists and doctors sandwiched between an impassioned essay and later a conversation between Scialabba and Christopher Lydon and Scialabba's tips for dealing with depression/the depressed (this was the most useful portion of the book for me).

The past half-year has been abysmal for me and while I realize my own blues are fairly natural and aren't nearly as severe or long-lasting as Scialabba, I found him to be someone I could empathize with through the notes written by medical professionals. Scialabba is a Harvard graduate who works at a menial job he is overqualified for but he uses book reviews as his creative outlet - and as the "documentia" attest, not only does he write book reviews for major publications but he is even recognized and receives awards for these pieces. Still, he often feels fragile, insecure, and anxious and especially self-conscious and jealous when he compares himself to others who are "further along" in life (I think a lot of us can relate to this and we have to remind ourselves of what Theodore Roosevelt said - "Comparison is the thief of joy"). Scialabba is prescribed a variety of drugs to help deal with his depression and he also undergoes electroconvulsive therapy (ECT); unlike many depressives he does not really contemplate suicide.

I understand that some are frustrated with the architecture of this book but if you had bothered to read a review, read the synopsis, or flipped through the pages before attempting to read it you would have realized that most of the book is comprised of these short notes by mental health professionals.

And remember, never, ever, leave Opus Dei.
Profile Image for Dylan.
20 reviews36 followers
December 6, 2021
A majorly disappointing work which consists almost entirely of psychological/psychiatric transcripts. The only section written in the words of Scialabba himself are the last section, which provides generic depression tips. It is almost astonishing that this book is credited to Scialabba at all, as he has not written essentially any of it.

I was hoping for a uniquely insightful book doing justice to the descriptions posited by the back, blurbs, and reviews (which should of course, in the modern praise-inflation economy, never been taken too seriously). Unfortunately, it is instead mostly a clerical compendium of recurring, generally surface-level descriptions of Scialabba's anxieties and depressions rooted in his religious, sexual, and career-related history. Scialabba demonstrates his awareness of the anti-literary nature of modern psychological/psychiatric liability-focused notetaking in the "discussion" section, which is to his credit, and there is certainly something of value in seeing laid out in all its mundane detail the bureaucratese of the documentation--regardless, this book is not quite Kafka at the Psychologist, or How to be Depressed Under Late Capitalism (though I suspect neither of these were its intention). The documentation could have consisted of a shorter section, with more variety of explorations of depression--a section on the history of the documenting of depression--perhaps with representative samples--could have been valuable, or more historicizing, a la The Doomsday Demon.
24 reviews
September 13, 2020
This book is a scam and a ripoff and I am IRATE about it. 80% of the content--and I am not kidding--is literally a transcription of the man's psychiatric records since 1969, so his *doctors'* words. And the kicker is that the argument of the first chapter--which, mind you, is a PREVIOUSLY PUBLISHED ESSAY--is that MONEY would go a long way towards helping people with depression. Gee, I wonder if George Scialabba put this book out simply to cash in and not have to write a single new thing for it! A prev pub chapter, and his medical records???, plus some interview with someone else about him? The gall. And the gall of whoever wrote the back cover copy, the blurbs, the whole 9.

Oh, the utter malevolence and cruel irony of marketing this bullshit to the very population that you argue needs every penny they can get to help them survive their illness.

At least my rage got me out of my depression for a while. Fuck this book.
83 reviews1 follower
June 2, 2022
I haven't finished this book yet, so I'll come back and update after I'm done, but I think it's brilliant, and I think it helps that I read a wonderful essay by Matthew Sitman in Commonweal (https://www.commonwealmagazine.org/mu...) which introduced me to the book.

The title is a misnomer: it's not, in the main, a how-to guide.

But it definitely helped me.
Profile Image for M.
67 reviews5 followers
Read
March 11, 2025
This is the second time I’m reading this in the last five years. First time I was actually depressed. This time I’m in a the space marked by acedia and self-interest in what is a firmly fascist arc of American politics. He really gives helpful tips on how to navigate depression which I think apply even if you’re not ~~~depressed~~~. Excellent writing.
Profile Image for David Allen.
71 reviews1 follower
December 10, 2021
The essay at the front and interview and Tips for the Depressed chapter at the back are probably worth the price of admission but it's worth slogging through the years of dry, dispassionate clinical notes of GS's numerous mental health practitioners.
580 reviews
October 15, 2021
Interesting and ruminative read, particularly reading the clinical notes through time
Profile Image for Anna.
85 reviews2 followers
August 13, 2023
very cool writer i should read more of his stuff
31 reviews
May 13, 2025
Interesting structure and very skimmable read about one persons journey with depression. The interview at the end is the most illuminating part
Profile Image for Paula Inunciaga.
20 reviews1 follower
December 28, 2025
A very interesting and experimental way to tell a story by medical reports, I wish someone will use this for a fictional book. This one in particular, since it's not fiction, I found a bit boring and repetitive (just like life itself). My favourite part is how different specialists have distinct ways of reporting, and also the general style change through the years. I didn't like Scialabba's introduction writing style but then I found it quite funny how it matches perfectly with the descriptions of the individual we get to know later.
Displaying 1 - 26 of 26 reviews

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