Combining a scholar's care and thoroughness with searing personal insight, Karp brings the private experience of depression into sharp relief, drawing on a remarkable series of intimate interviews with fifty depressed men and women. By turns poignant, disturbing, mordantly funny, and wise, Karp's interviews cause us to marvel at the courage of depressed people in dealing with extraordinary and debilitating pain.

We hear what depression feels like, what it means to receive an "official" clinical diagnosis, and what depressed persons think of the battalion of mental health experts - doctors, nurses, social workers, sociologists, psychologists, and therapists - employed to help them. We learn the personal significance that patients attach to beginning a prescribed daily drug regimen, and their ongoing struggle to make sense of biochemical explanations and metaphors of depression as a disease. Ranging in age from their early twenties to their mid-sixties, the people Karp profiles reflect on their working lives and career aspirations, and confide strategies for overcoming paralyzing episodes of hopelessness.

They reveal how depression affects their intimate relationships, and, in a separate chapter, spouses, children, parents, and friends provide their own often overlooked point of view. Throughout, Karp probes the myriad ways society contributes to widespread alienation and emotional exhaustion.