Depression: It's Complicated - Just Ask Lincoln

Patient Expert

In the book on bipolar I am working on, I ask readers to conceive of “up” as simply being higher than “down.” With down, though, I’m suggesting the very opposite - that depression is as complicated as one can get.

To illustrate my point, I bring up the example of Abraham Lincoln. Here’s the deal …

In his 2005 Lincoln’s Melancholy, author Joshua Shenk details two severe depressions Lincoln experienced as a young man. According to Mr Shenk, these two depressive episodes together would suffice for a modern clinician to make a diagnosis of “recurrent” major depression. As Mr Shenk points out, two previous depressions set up the strong possibility of a third and a fourth.

According to Goodwin and Jamison in the second edition to Manic-Depressive Illness, highly recurrent depression needs to be regarded as part of the bipolar spectrum.

Or was something different going on? Experts talk of “double depression,” major depression followed by mild depression, or “dysthymia.” The dysthymia, in turn, could have seamlessly transitioned into greater severity - three depressions in one, in effect. In this scenario, Lincoln’s depression would have assumed an unbroken “chronic” course.

Or was his dysthymia really something else? Perhaps mild depression was Lincoln’s true “normal,” part of his temperament or personality, as good as it was going to get for him. We know that throughout his life, Lincoln never shook off being depressed. Yet, we also know that Lincoln was a jokester who loved to laugh. Was this how he medicated his depression? Or was this a symptom of “atypical” depression?

Let’s confuse you even more …

Lincoln’s two early depressions coincided with devastating loss in his life. The first one followed the loss of a dear woman companion. At first, he seemed to be coping. Then winter set in and the bottom fell out.

His second depression coincided with an economic collapse that scuttled an ambitious public works program that the young politician had championed as a rising star in the Illinois legislature. The state was now saddled in huge debt, and Lincoln bore the brunt of the blame.

A more hard-boiled soul would have absorbed the brunt of both losses and moved on. But Lincoln took it personally. Winter set in. He broke off his engagement to Mary Todd (whom he later married) and descended into a black hole.

"I am now the most miserable man living," he wrote to a friend.

Maybe Lincoln’s strong capacity for empathy proved a hindrance. Maybe he couldn’t let go. Or maybe winter had something to do with it, a seasonal depression, what today we call “seasonal affective disorder.”

Or maybe Lincoln was especially vulnerable to stress, which can trigger depression. As Mr Shenk points out, these were changing times. For the first time in history, young men were no longer doomed to living the lives they were born into. But opportunity came at a huge cost, with no safety net or traditional family-community supports.

Feeding into stress and depression is early trauma. As a boy, Lincoln had lost both a mother and a sister. Plus he didn’t fit in on the farm or get along with his father. We can make the argument that by the time Lincoln reached adulthood, both his genes and environment made him a sitting duck.

Confused? We may call it “depression,” but when we open the hood and poke around to see what is really going on, we are forced to admit we have no idea.

Just to confuse you even more, against all odds, this social misfit, this extremely vulnerable man, went on to become one of the most transcendent figures in history. How could that be?

As I said, depression is complicated.