What Worked for Lincoln?

Patient Expert

"No element of Lincoln's character," declared his colleague Henry Whitney, "was so marked, obvious and ingrained as his mysterious and profound melancholy."

I've been reading Joshua Wolf Shenk's absorbing book on Abraham Lincoln's depression entitled Lincoln's Melancholy. I'm not sure how many people know that Lincoln suffered from lifelong depression (it was essentially dismissed by an influential biographer in the 1940s), but those of us with depression could see it written clearly on his face.

As you can imagine, in the 1800s, Lincoln's options for treating his melancholy were very limited, and nearly as painful as the illness itself. Operating under the theory that melancholy was caused by an excess of black bile present in the body, the treatment regimen involved, among other tortures, bleeding, blistering, inducing vomiting and diarrhea, fasting, and mustard rubs and sweating followed by a cold bath. I'm guessing that the only reason this method saw any success was due to patients saying, "Yes, yes, I feel much better" simply to get it to end.

Since talk therapy and psychoanalysis were not yet popular, there really weren't any treatment methods, per se -- at least nothing like what we have available to us now. Since we know that Lincoln didn't just drift through life, buffeted by his depression, how did he manage to keep it at bay enough to succeed as well as he did?

For one thing, Lincoln had a good support system. He was well-liked everywhere he went, personally if not always politically, and his likeability served him nicely. During a period in 1835, apparently his first major depressive episode, his friends and neighbors became alarmed at his frequent references to suicide and kept watch over him constantly, especially during "storms - fogs - damp, gloomy weather " for fear of an accident."

Second, although talk therapy and psychoanalysis didn't exist yet, one's ability to talk about depression without fear of being stigmatized did. The culture of the times didn't require that depression be hidden. Melancholy and strong emotions were romanticized, not only for women, but also for men (think Lord Byron). Lincoln could, and did, talk freely about his psychic pain with friends and even acquaintances and business associates.

But most importantly, Shenk tells us, Lincoln employed adaptations and coping mechanisms to manage his depression. Among these were humor, reading and writing poetry, and religious faith. Lincoln's famed sense of humor was apparently a way he fought his depression.

I think most people who survive depression utilize these adaptations to some extent, or they wouldn't make it through. I developed the habit of forcing myself to look for the silver lining in every cloud. When I was diagnosed and started treatment for depression, I found that this positive outlook developed because of depression, paradoxically, was now apparently ingrained in my personality, after so many years of use.

Of course, Lincoln had to use these adaptations to battle his depression because more effective treatment wasn't available. I'm happy to put those struggles behind me and rely on my antidepressants. But for people with depression who have not found successful treatment with medication or therapy, it might be worth making a conscious effort to find and nurture their own adaptations and coping mechanisms.