In January 1841, Abraham Lincoln, then a state legislator in Illinois, wrote to his law partner about securing a post for a physician who was then treating him for a nervous disorder called hypochondriasis, or hypo for short, a condition we would call major depression. “I have, within the last few days, been making a most discreditable exhibition of myself in the way of hypochondriaism and thereby got an impression that Dr. Henry is necessary to my existence. Unless he gets that place, he leaves Springfield. You therefore see how much I am interested in the matter.” And what was the treatment Lincoln was receiving?
As Joshua Shenk’s study, Lincoln’s Melancholy reports, he likely undertook some version of the accepted remedies used by most practitioners. These were drawn from the first textbook of mental diseases in the United States prepared by Dr. Benjamin Rush. This was the physician and political figure who became famous as a signer of the Declaration of Independence and the foremost medical expert of the time. Rush’s approach to “hypo” was to scourge the body with biblical fury and so shock the patient back to a state of normality. Bleeding out enormous quantities, more than was drawn for any physical disease, was the first step, followed by purgatives that would violently empty stomach and bowels (mercury, arsenic or strychnine were the favored agents), immersion in successive hot and cold baths, painful mustard rubs, stimulants that could set off more intestinal fireworks, a starvation diet, vigorous exercise – all of which usually reduced a patient to trembling weakness. That was the point – to shake the black bile out of the system and kick start it at more balanced mental rhythms.
What Lincoln found, though, was just what many a disappointed taker of the latest medication today might find. It didn’t work. He later became interested in alternative theories that grew from more recent science indicating that mental diseases related not to bodily humours but to the sensitivities of the nervous system. One physician known to Lincoln recovered from his own depression through a program of vigorous exercise and improved diet. The theories of animal magnetism and Mesmerism were also coming into vogue. There is evidence that Lincoln knew of these and may have sampled such treatments for the chronic depression that plagued him all his life. And he may have taken the opium that was another favorite remedy for mental problems. But nothing in the way of medical treatment seems to have worked for him.
Like patients today who have gone through the gamut of medications, electroconvulsive treatments, transcranial magnetic stimulation, vagus nerve implant, diet or other innovative approaches only to find recurrence after recurrence of the worst depression, Lincoln was left to his own resources to salvage his life or face what he felt was a certain suicide. As he put it in his most famous quote on this subject:
“I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I can not tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”
Shenk brings into focus the choices Lincoln made in dealing with long spells of serious depression in a way that parallels what every person responding to this illness may face. Despite the radically different values and medical ideas of the early mid-nineteenth century, we can draw out of this story the familiar rhythms of change that affect our thinking about depression today. In Shenk’s view, Lincoln was able to adapt to unremitting bouts of depression throughout his life not because he found external treatments but because he found a transcendent purpose in his life that changed his view of this affliction. That did not come easily.
For years, his electoral successes, including four terms in the state legislature and his election to Congress, did nothing to change the cycle of depression. Through these years, however, he never ceased to cultivate the self-discipline that was a basic tool in gaining stability. Many observers noticed his frequent withdrawal from others, often in the midst of a public gathering, to retire into a striking gloomy meditation. Yet these retreats, Shenk speculates, could have reflected not the domination of the man by his melancholy but rather the outward signs of his struggle to gain control over its effects. He also turned to poetry for relief and himself wrote about his perceptions of life and certain places, though only a few of his poems survive. Most famously, he used his amazing sense of humor and great gifts as a story-teller to further rework or contain his own dark moods.
His higher purpose was not just to advance his political career but ultimately to try to save the institutions of freedom in the republic. The first great opportunity for him to focus himself on a powerful purpose arose in the debates over slavery that preceded the Civil War. Here he found a narrative, according to Shenk, that summarized the history of the republic in a way that paralleled the challenged in his own life. Once that purpose was clear to him, he could see his dark melancholic periods as times of testing, renewal, even spiritual growth. This was so even though each breakthrough in advancing his and his country’s goal was followed by more depression, tragedy and personal suffering, concluding with his own assassination. Especially toward the end, he was able to achieve a serenity about his condition when he looked toward nothing less than a rebirth and renewal of freedom in the United States following the Civil War. In a sense that terrible conflict was like the country’s destructive depression, and by going through such suffering it could emerge with new strength and purpose. That seems to have been the way Lincoln came to see his own condition. In a letter of late 1862 to a young woman despairing after the death of her father, Lincoln wrote:
“In this sad world of ours, sorrow comes to all; and, to the young, it comes with bitterest agony, because it takes them unawares. The older have learned to ever expect it. … You can not now realize that you will ever feel better. Is not this so? And yet it is a mistake. You are sure to be happy again. To know this, which is certainly true, will make you some less miserable now. I have had experience enough to know what I say; and you need only to believe it, to feel better at once. The memory of your dear Father, instead of an agony, will yet be a sad sweet feeling in your heart, of a purer, and holier sort than you have known before.”
He is clearly recounting part of his own strategy for dealing with his depressive periods. Not only is he emphasizing the discipline of focusing on the inevitable re-emergence of good feeling while in the depths of despair. He is also convinced that something “purer” and “holier” will emerge as a result of this loss and suffering. By focusing his mind mightily on what would follow the darkness and by retaining his great strength of commitment to a purpose much higher than his own well-being, he was able to manage and contain the depression that threatened to drive him to suicide when it had first emerged in his mid-twenties. Of course, none of us is a Lincoln or destined to deal with such tremendous concerns as slavery and the survival of the American republic. But that is beside the point. Looking at the basic phases of Lincoln’s reaction to depression, we can see the same dynamic at work that we all go through. Part of his rich legacy is that powerful example.