Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness

CHAPTER 1 The Community Said He Was Crazy

In three key criteria —the factors that produce depression, the symptoms of
what psychiatrists call major depression, and the typical age of onset—the
case of Abraham Lincoln is perfect. It could be used in a psychiatry textbook
to illustrate a typical depression. Yet Lincoln's case is perfect, too, in a very
different sense: it forces us to reckon with the limits of diagnostic categories
and raises fundamental questions about the nature of illness and health.

Though great resources in research and clinical science have
been devoted to depression in the past few decades, we can neither cure it
nor fully explain it.What we can do is describe its general characteristics.
The perverse benefit of so much suffering is that we know a great deal about
what the sufferers have in common. To start, the principal factors behind
depression are biological predisposition and environmental influences. Some
people are more susceptible to depression simply by virtue of being born.
Depression and other mood disorders run in families, not only because of
what happens in those families, but because of the genetic material families
share. A person who has one parent or sibling with major depression is one
and a half to three times more likely than the general population to
experience it.
The standard way to investigate biological predisposition is simply
to list the cases of mental illness—or mental characteristics suggestive of
potential illness—in a family. With Lincoln, such a family history suggests
that he came by his depression, at least inpart, by old-fashioned inheritance.
His parents, Thomas and Nancy Lincoln, came from Virginia families that
crossed the Appalachian Mountains into Kentucky in the late eighteenth
century. They married in 1806 and had three children: Sarah, born February
10, 1807; Abraham, born February 12, 1809; and Thomas, born about 1811.
Though our information is imperfect, to say the least, both parents had
characteristics suggestive of melancholy. Nearly all the descriptions of
Nancy Lincoln have her as sad. For example, her cousin John Hanks said
her nature "was kindness, mildness, tenderness, sadness." And Lincoln
himself described his mother as "intellectual, sensitive and somewhat sad."
Tom Lincoln, a farmer and carpenter, was a social man with a talent for jokes
and stories, but he, too, had a somber streak. "He seemed to me," said his
stepgrandson, "to border on the serious—reflective." This seriousness could
tip into gloom. According to a neighbor in Kentucky, he "often got the 'blues,'
and had some strange sort of spells, and wanted to be alone all he could
when he had them." During these spells he would spend as much as half a
day alone in the fields or the woods. His behavior was strange enough to
make people wonder if Tom Lincoln was losing his mind.
Perhaps the most striking evidence of mental trouble in Abraham
Lincoln's family comes from his paternal relations. His great-uncle once told
a court of law that he had "a deranged mind." His uncle Mordecai Lincoln had
broad mood swings, which were probably intensified by his heavy drinking.
And Mordecai's family was thick with mental disease. All three of his sons—
who bore a strong physical resemblance to their first cousin Abraham—were
considered melancholy men. One settler who knew both the future president
and his cousins spoke of the two "Lincoln characteristics": "their moody
spells and great sense of humor." One of these Lincoln cousins swung wildly
between melancholia and mania and at times had a tenuous grip on reality,
writing letters and notes that suggest madness. Another first cousin of
Lincoln's had a daughter committed to the Illinois State Hospital for the
Insane. After a trial, a jury in Hancock County committed thirty-nine-year-old
Mary Jane Lincoln to the hospital, noting that "her disease is of thirteen years
duration." At the hospital, an attendant observed, "Her father was cousin to
Abraham Lincoln, and she has features much like his."
What is striking about the case of Mary Jane Lincoln is that the
jury, charged with answering the question of whether insanity ran in her
family, concluded that "the disease is with her hereditary." According to a
family historian who grew up in the late nineteenth century, the descendants
of Mordecai Lincoln "suffered from all the nervous disorders known. Some
were on the ragged edge." One family member who had frequent spells of
intense mental trouble referred to his condition as "the Lincoln horrors."
Three elements of Lincoln's history—the deep, pervasive sadness
of his mother, the strange spells of his father, and the striking presence of
mental illness in the family of his uncle and cousins—suggest the likelihood
of a biological predisposition toward depression. "Predisposition" means an
increased risk of developing an illness. As opposed to traditional Mendelian
inheritance—in which one dominant gene or two recessive genes lead to an
illness or trait—genetic factors in psychiatric illnesses are additive and not
categorical. "The genes confer only susceptibility in many cases," explains
the psychiatrist S. Nassir Ghaemi, in The Concepts of Psychiatry, "not the
illness. That is, they only increase the likelihood that fewer or less severe
environmental factors are required for the illness to develop, compared with
someone who has fewer disease-related genes."
What tips a person from tendency to actuality? For centuries,
philosophers and physicians emphasized climate and diet. Today's experts
focus on harsh life events and conditions, especially in early childhood.
Lincoln's early life certainly had its harsh elements. His only brother died in
infancy in Kentucky. In 1816, Abraham's eighth year, the family moved to
southern Indiana. Two years later, in the fall of 1818, an infectious disease
swept through their small rural community. Among those affected were
Lincoln's aunt and uncle, Thomas and Elizabeth Sparrow, and his mother,
Nancy Lincoln. Eventually, the disease would be traced to a poisonous root,
eaten by cattle and then ingested by humans in milk or meat. But when
Abraham watched his mother become ill, the disease was a grim mystery
that went by various names, from "puking fever" to "river sickness" to "fall
poison." Later, it became known as the "milk sick." "No announcement
strikes the members of a western community with so much dread as the
report of a case," said a newspaper of the time. A physician described the
course of the illness: "When the individual is about to be taken down, he feels
weary, trembles more or less under exertion, and often experiences pain,
numbness and slight cramps." Nausea soon follows, then "a feeling of
depression and burning at the pit of the stomach," then retching, twitching,
and tossing side to side. Before long, the patient becomes "deathly pale and
shrunk up," listless and indifferent, and lies, between fits of retching, in
a "mild coma." First the Sparrows— with whom the Lincolns were close—
took sick and died. Then Nancy Lincoln went to bed with the illness. Ill for
about a week, she died on October 5, 1818. She was about thirty-five years
old. Her son was nine.
In addition to the loss of his mother, aunt, and uncle, a year or so
later Abraham faced the long absence of his father, who returned to Kentucky
to court another bride. For two to six months, Tom Lincoln left his children
alone with their twenty-year-old cousin, Dennis Hanks. When he returned,
the children were dirty and poorly clothed. Lincoln later described himself at
this time as "sad, if not pitiful."
The one constant in Abraham's life was his sister, Sarah. She
was a thin, strong woman who resembled her father in stature, with brown
hair and dark eyes. Like her brother, Sarah Lincoln had a sharp mind. She
stayed with the family until 1826, when she married, set up house, and
quickly became pregnant. On January 28, 1828, she gave birth to a stillborn
child and shortly afterward died herself. "We went out and told Abe," recalled
a neighbor. "I never will forget the scene. He sat down in the door of the
smoke house and buried his face in his hands. The tears slowly trickled from
between his bony fingers and his gaunt frame shook with sobs."

In the emotional development of a child, pervasive tension can be just as
influential as loss. Lincoln's relationship with his father—the only other
member of his nuclear family who survived—was so cool that observers
wondered whether there was any love between them. The relationship was
strained by a fundamental conflict. From a young age, Abraham showed a
strong interest in his own education. At first his father helped him along,
paying school fees and procuring books. "Abe read all the books he could lay
his hands on," said his stepmother. "And when he came across a passage
that struck him he would write it down . . . then he would re-write it—look at
it—repeat it." But at some point Tom Lincoln began to oppose the extent of
his son's studies. Abraham sometimes neglected his farm work by reading.
Tom would beat him for this, and for other infractions.
To men who had been born and expected to die on farms, book
learning had limited value. A man ought to be able to read the Bible (for his
moral life) and legal documents (for his work life). Writing could help, too, as
could basic arithmetic. Anything more was a luxury, and for working folks
seemed frivolous. For generations, Lincoln men had cleared land, raised
crops, and worked a trade. So when this boy slipped away from feeding
livestock and splitting logs to write poetry and read stories, people thought
him lazy. "Lincoln was lazy—a very lazy man," remembered his cousin
Dennis Hanks. "He was always reading—scribbling— writing—ciphering—
writing poetry &c. &c."
Later, Lincoln's self-education would become the stuff of legend.
Many parents have cited Lincoln's long walks to school and ferocious self-
discipline to their children. But Lincoln pursued his interests in defiance of
established norms. Far from being praised, he was consistently admonished.
He may well have paid an emotional toll. Many studies have linked adult
mental health to parental support in childhood. Lower levels of support
correlate with increased levels of depressive symptoms, among other health
problems, in adulthood. After Lincoln left home in his early twenties, his
contact with his father was impersonal and infrequent.
When reviewing the facts of Lincoln's childhood, we should keep
in mind some context. For example, in the early nineteenth century, one out
of four infants died before their first birthday. And about one fourth of all
children lost a mother or father before age fifteen. Of the eighteen American
presidents in the nineteenth century, nine lost their mother, father, or both
while they were children. None of Lincoln's contemporaries, nor Lincoln
himself, mentioned the deaths of his siblings and mother as factors
contributing to his melancholy. The melancholy was unusual, but the deaths
were not. In the same vein, while we ought not to ignore Lincoln's conflict
with his father and discount its possible emotional aftereffects, we risk
missing more than we gain if we look at it exclusively through the lens of
modern psychology. In fact, such a conflict between ambitious young men
and their fathers was not uncommon in the early nineteenth century, a time
of broad cultural and economic change.
Abraham was not evidently a wounded child, but signs point to his
being sensitive. He spent a lot of time alone. He was serious about his
studies and reading, and uncommonly eager to explore imaginative realms,
which psychologists often observe in sensitive children. He also took up a
popular cause among sensitive people, the welfare of animals. Some boys
found it fun to set turtles on fire or throw them against trees. "Lincoln would
Chide us—tell us it was wrong—would write against it," remembered one of
his neighbors. His stepsister remembered him once "contending that an ants
life was to it, as sweet as ours to us."
At the same time, Lincoln was a winsome child. Others sought
him out, followed him in games, and applauded him when he mounted a
stump and performed for them, pretending to be a preacher or a statesman.
By the time he was a teenager, grown men would flock around him, eager to
hear his jokes and stories. He was well liked.

Lincoln was not depressed in his late teens and early twenties—at least not
so far as anyone could see. When he left his family, at age twenty-one, he
had no money or connections. His chief asset—perhaps his only real asset—
was his golden character. Settling as a stranger in New Salem, a small
village on a river bluff in central Illinois, he soon was among the best-liked
men around. A gang of rough boys developed a fierce attachment to him after
he made a stellar showing in a wrestling match, displaying not only physical
strength but a sense of fairness. Others were impressed with Lincoln's wit
and intelligence, noticing, for example, how when he recited the poetry of
Robert Burns, he nailed the Scottish accent, the fierce emotion, and the
devilish humor. Though Lincoln looked like a yokel—tall and gangly, he had
thick, black, unruly hair and he wore pants that ended above his ankles—he
had good ideas and a good manner. "He became popular with all classes,"
said Jason Duncan, a physician in New Salem.
After less than a year in New Salem, Lincoln declared himself as
a candidate for the Illinois General Assembly. He was twenty-three years old.
He lost the race but got nearly every vote in his precinct, which, said another
candidate, was "mainly due to his personal popularity." When he volunteered
for a state militia campaign against a band of Native Americans under Chief
Black Hawk, a part of the bloody Black Hawk War, his company elected
Lincoln captain. Nearly three decades later—as a veteran of Congress and
his party's nominee for president of the United States—Lincoln wrote that
this was "a success which gave me more pleasure than any I have had since."
In his first four years in New Salem, Lincoln struck his new friends
and neighbors as sunny and indefatigable. "I never saw Mr Lincoln angry or
desponding," said a fellow soldier in the Black Hawk War, "but always
cheerful." Indeed, "the whole company, even amid trouble and suffering,
received Strength & fortitude, by his bouancy and elasticity." Once Lincoln
stopped at the house of a neighbor, Elizabeth Abell, after working in the
fields. He was scratched all over from briar thorns. Abell fussed over him, but
Lincoln laughed about it and said it was the poor man's lot. "Certainly," she
said years later, "he was the best natured man I ever got acquainted with."
Asked by a biographer whether the Lincoln she knew was a "sad man," Abell
answered, "I never considered him so. He was always social and lively and
had great aspirations." Crucially, his liveliness and sociability served him well
in politics. Campaigning again for the state legislature in 1834, he went out to
a field where a group of about thirty men were working the harvest. A friend of
Lincoln's, J. R. Herndon, introduced him. The men said that they couldn't
vote for a man who didn't know how to do field work. "Boys," Lincoln said, "if
that is all I am sure of your votes. "He picked up a scythe and went to
work. "I dont think he Lost a vote in the Croud," Herndon wrote.
Lincoln won the election easily. When a mentor in the legislature
recommended that he study law, he took the challenge. It would be a good
profession to accompany politics, in particular the politics of the Whig party,
which drew its strength from the growing number of urban and industrial
professionals. In the early nineteenth century, attorneys commanded a kind
of awe, embodying the stately Anglo-Saxon tradition of common law and
domestic order. Gaining "the secrets of that science," explained the poet-
author William Allen Butler, would give a person a perpetual glow, for the
law, "more than all other human forces, directs the progress of events."
It is a mark of Lincoln's soaring ambition that, four years from the
fields, he sought to join such ranks, at a time when all but five percent of the
men in his area did manual work for a living. It was a sign of his pluck that he
did it virtually all on his own. While other young men learned the law at
universities—or, more commonly, under the tutelage of an established
attorney—Lincoln, as he noted in his memoir, "studied with nobody." This
was hardly the only mark of his ambition. A lawyer named Lynn McNulty
Greene remembered Lincoln telling him that "all his folks seemed to have
good sense but none of them had become distinguished, and he believed it
was for him to become so." This language suggests that Lincoln had, more
than a personal desire, a sense of calling. "Mr. Lincoln," explained his friend
O. H. Browning, "believed that there was a predestined work for him in the
world . . . Even in his early days he had a strong conviction that he was born
for better things than then seemed likely or even possible . . .While I think he
was a man of very strong ambition, I think it had its origin in this sentiment,
that he was destined for something nobler than he was for the time engaged
in." In his first published political speech, Lincoln wrote, "Every man is said to
have his peculiar ambition. Whether it be true or not, I can say for one that I
have no other so great as that of being truly esteemed of my fellow men, by
rendering myself worthy of their esteem."
But there were cracks in Lincoln's sunny disposition. "If the good
people in their wisdom shall see fit to keep me in the background," he said in
that same speech, "I have been too familiar with disappointments to be very
much chagrined." At times, his faith in personal progress gave way and his
familiarity with disappointments shone through. Back from the militia
campaign, Lincoln and a partner opened their own store, buying the stock on
credit. When the store failed, Lincoln was in serious financial jeopardy.
Seeing him despondent, his new friends got him a crucial political
appointment, as New Salem's postmaster. Later, he was made deputy
surveyor, too. These jobs, Lincoln noted, "procured bread, and kept soul and
body together."Nevertheless, his debt soon caught up with him: a creditor
seized his surveying equipment—including his horse, his compass, and his
chain—and put it up for auction. An older man named James Short saw
Lincoln moping about and heard him say he might "let the whole thing go."
Short tried to cheer him up. Then he went and bought the equipment for $120
(about $2,500 in modern dollars) and returned it to Lincoln.
These streaks of sadness and worry may have been minor
depressions. But it wasn't until 1835 that serious concern emerged
about Lincoln's mental health. That summer, remembered the schoolteacher
Mentor Graham, Lincoln "somewhat injured his health and Constitution." The
first sign of trouble came with his intense study of law. He "read hard— day
and night—terribly hard," remembered Isaac Cogdal, a stonemason. At
times, Lincoln seemed oblivious to his friends and surroundings. "He became
emaciated," said Henry McHenry, a farmer in the area, "and his best friends
were afraid that he would craze himself—make himself derange."

Around the same time, an epidemic of what doctors called "bilious fever"—
typhoid, probably—spread through the area. Doctors administered heroic
doses of mercury, quinine, and jalap, a powerful purgative. According to one
recollection, Lincoln helped tend to the sick, build coffins for the dead, and
assist in the burials—despite the fact that he was "suffering himself with the
chills and fever on alternate days. "He was probably affected mentally, too,
by the waves of death washing across his new home—reminiscent, perhaps,
of the "milk sick" that had devastated his family in his youth.
Among the severely afflicted families were Lincoln's friends the
Rutledges. Originally from South Carolina, they had been among the first to
settle in New Salem, opening a tavern and boarding house, where Lincoln
stayed and took meals when he first arrived. He knew the family well and had
become friends with Anna Mayes Rutledge, a bright, pretty young woman
with flowing blond hair and large blue eyes. In August 1835, Ann took sick.
As she lay in bed in her family's cabin, Lincoln visited her often. "It was very
evident that he was much distressed," remembered a neighbor named John
Jones. She died on August 25. Around the time of her funeral, the weather
turned cold and wet. Lincoln said he couldn't bear the idea of rain falling on
Ann's grave—and this was the first sign people had that he was in the midst
of an emotional collapse. "As to the condition of Lincoln's Mind after the
death of Miss R., "Henry McHenry recalled, "after that Event he seemed quite
changed, he seemed Retired, & loved Solitude, he seemed wrapped in
profound thought, indifferent, to transpiring Events, had but Little to say, but
would take his gun and wander off in the woods by him self, away from the
association of even those he most esteemed, this gloom seemed to deepen
for some time, so as to give anxiety to his friends in regard to his Mind."
Indeed, the anxiety was widespread, both for Lincoln's immediate
safety and for his long-term mental health. Lincoln "told Me that he felt like
Committing Suicide often," remembered Mentor Graham, and his neighbors
mobilized to keep him safe. One friend recalled, "Mr Lincolns friends . . .
were Compelled to keep watch and ward over Mr Lincoln, he being from the
sudden shock somewhat temporarily deranged. We watched during storms—
fogs—damp gloomy weather . . . for fear of an accident." Another villager
said, "Lincoln was locked up by his friends . . . to prevent derangement or
suicide." People wondered whether Lincoln had fallen off the deep end. "That
was the time the community said he was crazy," remembered Elizabeth
Abell.
The fact that Lincoln broke down after Rutledge's death, of course,
doesn't necessarily mean that her death produced his breakdown. This is an
important point, because from the very earliest writings on Lincoln, his
relationship with Ann Rutledge has been controversial. Questions about
whether he loved her and whether they were engaged have been debated
fiercely, and still are. The myths and countermyths about this young woman
played a big role in the early historiography of Lincoln— and, amazingly,
played a large role in pushing Lincoln's melancholy to the margins of history.
More on this in the Afterword, but for now the essential point is that leading
scholars have long said that what we think about Lincoln's first breakdown
must hinge on what we think about his relationship with Ann Rutledge. If his
love for her is a myth, this thinking goes, then the breakdown must be a
myth, too.
In fact, in the eyes of the New Salem villagers, questions of a love
affair followed hard and irrefutable knowledge of an emotional collapse. As the
original accounts make clear, his breakdown was impossible to miss. Nearly
everyone in the community who gave testimony spoke of it, remembering its
contours even decades later. Lincoln, after all, had become immensely
popular, loved by young ruffians and old families alike. Now, all of a sudden
he was openly moping and threatening to kill himself. Why? people
asked.What accounted for the great change?
It was in an attempt to answer this question that people turned to
his relationship with Rutledge. He had obviously been upset by her illness.
And after her funeral he had fallen off an emotional cliff. "The effect upon Mr
Lincoln's mind was terrible," said Ann's brother, Robert Rutledge. "He
became plunged in despair, and many of his friends feared that reason would
desert her throne. His extraordinary emotions were regarded as strong
evidence of the existence of the tenderest relations between himself and the
deceased." Notice the careful progression from fact (Lincoln's breakdown
after Ann's death) to inference (they must have been tenderly involved).
James Short, who was the Rutledges' neighbor, came to a similar
conclusion. "I did not know of any engagement or tender passages between
Mr L and Miss R at the time," Short said. "But after her death . . . he seemed
to be so much affected and grieved so hardly that I then supposed there must
have been something of the kind." Because Lincoln "grieved so hardly" and
became "plunged in despair," it seemed reasonable to his friends that there
must have been some proximate cause.
In fact, major depression, in people who are vulnerable to it, can
be set off by all manner of circumstances. What would appear to a non-
depressed person to be an ordinary or insignificant stimulus can through a
depressive's eyes look rather profound. "It's not the large things that send a
man to the madhouse, "Charles Bukowski has written. "No, it's the
continuing series of small tragedies . . . a shoelace that snaps, with no time
left." In this light, it is worth noting that, according to reminiscences, the
pivotal moment for Lincoln wasn't Rutledge's death but the dismal weather
that followed. After the death, wrote John Hill, the son of Lincoln's friend
Samuel Hill, "Lincoln bore up under it very well until some days afterwards a
heavy rain fell, which unnerved him and—(the balance you know)." The
intonation here suggests an understanding among Lincoln's friends that there
was something precarious about him, and that—like Bukowski's shoelace—a
factor as ordinary as poor weather could send him reeling. As we will see,
cold temperatures would contribute to Lincoln's second breakdown. Lincoln
himself would write that "exposure to bad weather" had proved by his
experience "to be verry severe on defective nerves."
For whatever reason, or combination of reasons, in the late
summer of 1835 Lincoln's depression was pushed out into the open. After
several weeks of worrisome behavior—talking about suicide, wandering alone
in the woods with his gun—an older couple in the area took him into their
home. Bowling Green, a large, merry man who was the justice of the peace—
and who became, other villagers said, a kind of second father to Lincoln—and
his wife, Nancy, took care of Lincoln for one or two weeks. When he had
improved somewhat, they let him go, but he was, Mrs. Green said, "quite
melancholy for months."
Lincoln's behavior matches what the Diagnostic and Statistical
Manual of Mental Disorders, the handbook of mental health professionals,
labels a major depressive episode. Such an episode is characterized by
depressed mood and/or a marked decrease in pleasure for at least two
weeks. Other symptoms may include a change in appetite or weight,
excessive or insufficient sleep, agitation or lethargy, fatigue or loss of energy,
feelings of worthlessness or inappropriate guilt, indecisiveness or trouble
thinking or concentrating, and thoughts of death and/or suicide. To be
classified as major depression, at least five of these symptoms must be
present, marking a definite change from usual functioning and with significant
distress or impaired functioning. If the symptoms follow the death of a loved
one by less than two months, it might be considered mourning unless, as in
Lincoln's case, there is "suicidal ideation"—to ideate is to form an idea about
something—or other equally severe symptoms. "What helps make the case
for the diagnosis of depression," says Kay Redfield Jamison, a professor of
psychiatry at Johns Hopkins University, "is Lincoln's suicidal behavior and
the fact that it provoked a 'suicide watch.' Today people are much more
sophisticated about suicide, but it's pretty unusual to do that. It speaks to
the seriousness of what was happening with Lincoln."
Lincoln's breakdown also fits with the typical age for a first
episode of major depression. Most serious psychiatric illnesses emerge at a
particular time in life. For example, in males, schizophrenia usually surfaces
in the late teenage years; manic depression in the late teens to early
twenties. Unipolar depression, which Lincoln would struggle with his whole
life, typically breaks into the open in the mid- to late twenties. Lincoln was
twenty-six.

Many people wonder if Marfan syndrome contributed to Lincoln's depression.
Marfan is an inherited genetic disorder that diminishes the strength of
connective tissue—the material that gives substance and support to bodily
structures, from tendons to heart valves. People with the syndrome tend to
be tall and thin, with elongated limbs out of proportion to their bodies. In other
words, they look like Lincoln, which is one reason some researchers suspect
he may have had the disorder. "Most of the Marfanologists think that it's a
fifty-fifty chance that he did have it," says Victor A. McKusick, a professor of
medical genetics at Johns Hopkins. "He might just by chance have been tall
and gangly. The physiognomy is a good clue, but you can't make the
diagnosis on that basis alone." Does Marfan syndrome cause depression? At
least one study has suggested a higher presence of depression in people
with the syndrome. But McKusick says, "From the massive numbers of
patients I have seen, there is no characteristic personality of Marfan patients.
I would think that Lincoln's depression was quite unrelated."
Another common question about Lincoln is whether he had manic
depression, which is also known as bipolar disorder. This diagnosis is given
to people who alternate between episodes of depression and mania —long
periods of intensely heightened energy, often marked by euphoria, racing
thoughts, disinhibition, and risk-taking. No evidence exists of mania in
Lincoln. He didn't indicate trouble with swings in mood so much as with the
low moods of depression. Nor did his contemporaries describe anything that
sounds like mania. It is possible that he had what psychiatrists call
hypomania—below full-scale mania, but still characterized by heightened
energy. Often people with serious depression alternate between depressed
moods and hypomanic ones. But here, too, there is no clear evidence of
anything clinically significant.
On the other hand, it's plain that Lincoln had major depressive
episodes. Even after he had brought himself under control, he still grappled
with desperate thoughts. Robert L. Wilson, who joined Lincoln as a candidate
for the state legislature in 1836, found him amiable and fun-loving. But one
day Lincoln took Wilson aside and told him something surprising. As Wilson
recalled, Lincoln told him "that although he appeared to enjoy life rapturously,
Still he was the victim of terrible melancholly He Sought company, and
indulged in fun and hilarity without restraint, or Stint as to time Still when by
himself, he told me that he was so overcome with mental depression, that he
never dare carry a knife in his pocket. And as long as I was intimately
acquainted with him, previous to his commencement of the practice of the
law, he never carried a pocket knife."
Of those who've had a single episode of major depression, more
than half will have a second. Lincoln's second breakdown, in the winter of
1840–1841, bore a remarkable similarity to the first. It came after a long
period of intense work, when Lincoln pushed himself hard in pursuit of an
ambitious goal. Then, under profound personal stress—and in a stretch of
bleak weather—he collapsed. Once again, he spoke openly about his
misery, hopelessness, and thoughts of suicide. He was unable to work. His
friends feared that he might kill himself, and that if he lived, he might go
insane. Lincoln himself despaired that he would never recover. This will be
explored in depth in Chapter 3.
For now, it suffices to say that the breakdown was a second
episode of major depression. According to the criteria in the Diagnostic and
Statistical Manual, this qualifies Lincoln for the diagnosis of "major
depressive disorder, recurrent." Strictly speaking, the illness is characterized
by two or more major depressive episodes, separated by at least a month.
More broadly, it suggests an underlying problem that can be expected to
surface in various ways throughout a person's life. Consider: Someone with
two episodes of major depression has a seventy percent chance of
experiencing a third. And someone with three episodes has a ninety percent
chance of having a fourth. (The phrase "clinical depression" can be applied to
any incident of major depression or to people who experience major
depressive disorder.)
What the statistics suggest, the course of Lincoln's life confirms:
by the time he was in his early thirties, he faced a lifetime of depression.
Still, the quality and character of his illness would change through the years.
The acute fits of his young manhood gave way to less histrionic, but more
pervasive, spells of deep gloom. Dramatic public avowals of his misery gave
way to a private but persistent effort to endure and transcend his suffering.
Yet the suffering did not go away. As we will see, in his middle years Lincoln
demonstrated signs of chronic depression. And even when he began to do
the work for which he is remembered—and took evident satisfaction in finding
a great cause to which to apply his considerable talent—he continued to
suffer.
Modern diagnoses can help initiate a discussion of Lincoln's
troubles. With many physiological conditions, disease names are merely
pointers. They stand in for the "real thing," which can be directly observed.
But with psychological phenomena, language doesn't just name a reality; it
creates a reality. This is crucial, given that the pain of depression is
compounded, for sufferers, by the fact that it is hidden and often suspected of
not being genuine. "In virtually any other serious sickness," writes William
Styron in his memoir of depression, Darkness Visible, "a patient who felt
similar devastation would be lying flat in bed, possibly sedated and hooked
up to the tubes and wires of life support systems . . .His invalidism would be
necessary, unquestioned, and honorably attained. However, the sufferer of
depression has no such option." By identifying Lincoln's trouble directly and
clearly, we acknowledge it as a basic fact, just as he did.
Yet all too often medical diagnosis is used to end, rather than
begin, a conversation. To say, as recent scholars have, that Florence
Nightingale suffered from bipolar disorder or that the Salem witch trials were
driven by "epidemic hysteria, with conversion symptoms" is no substitute for
knowing how the individual figures, and the communities they lived in,
understood themselves. Such retrospective diagnoses often leave the
impression that modern psychiatric categories are infallible, when in fact they
are only one way to account for the complex reality of human trouble.
In their book The Perspectives of Psychiatry, Paul R. McHugh and
Phillip R. Slavney identify four approaches to a suffering person. The first
approach seeks to identify disease, or what the person has. The second
seeks to identify a person's dimension, or who he or she is. The third
focuses on behavior, or what the patient does. Each of these approaches has
some value for a study of Lincoln's life, but none so much as the "life story"
perspective, which seeks a holistic understanding of what patients want and
what they can become.
Diagnosis, we must remember, exists primarily to facilitate
treatment in a clinical setting. It is a snapshot at a moment in time. But here
we want to make sense of a whole life. As the writer and physician Oliver
Sacks has noted, "To restore the human subject at the centre—the suffering,
afflicted, fighting, human subject—we must deepen a case history to a
narrative or tale; only then do we have a 'who' as well as a 'what,' a real
person, a patient, in relation to disease." This distinction between case
history and narrative is right on point. The former tries to eliminate questions
with facts, whereas the latter draws on facts to articulate the essential
questions of a person's life.
Can we say that Lincoln was "mentally ill"? Without question, he
meets the U.S. surgeon general's definition of mental illness, since he
experienced "alterations in thinking, mood, or behavior" that were associated
with "distress and/or impaired functioning." Yet Lincoln also meets the
surgeon general's criteria for mental health: "the successful performance of
mental function, resulting in productive activities, fulfilling relationships with
other people, and the ability to adapt to change and to cope with adversity."
By this standard, few historical figures led such a healthy life.

Copyright © 2005 by Joshua Wolf Shenk. Reprinted by permission of
Houghton Mifflin Company.