Book Review

Lincoln's Melancholy

By Joshua Wolf Shenk (Houghton Mifflin Company, New York, 2005, 350 pp.)

Reviewed by Roy Hanu Hart, M.D.

In a faraway Caucasian village, Leo Tolstoy found a tribe of Circassians who, although knowing little of the outside world, had heard of Abraham Lincoln, "the greatest [among men] the stars had ever seen."

They wanted to know what he looked like, and Tolstoy managed to come up with a photograph of him. A young Circassian scrutinized the photo at length until he finally said, "His eyes are full of tears and his lips are sad with a sweet sorrow." This is how psychohistorian Joshua Wolf Shenk begins his study of Lincoln's melancholy.

Shenk's biography is supersaturated with accounts of Lincoln's deep sadness and sorrow -- melancholy, to use that older term -- calling to mind historian David Herbert Donald's description of him: "Lincoln...virtually dripped melancholy as he walked" [We Are Lincoln Men, p. 73].

Shenk proceeds with a clinical eye to dissect Lincoln's lifelong struggle with depression that almost ended in suicide at least on one occasion during his younger years, but also -- and this is key to Lincoln -- helped bring out the best in him.

The author is quite familiar with the Diagnostic and Statistical Manual of Mental Disorders and makes use of our current psychonosological terminology to zero in on Lincoln's condition. (DSM designations include unipolar depression, dysthmia, chronic depression, and major depressive disorder [the author rules out bipolar disorder, another affective disorder]). Shenk sticks with that older diagnostic label: melancholy.

He points out that severe states of melancholy warranted the formidable term melancholia, just as the less severe form was termed hypochondriasis (not the way we define it today). Hypochondriasis was thought to be a condition affecting organs below (hypo) the cartilage of the rib cage (khondros) -- the liver, gallbladder, spleen, stomach and intestine -- where black bile originated. In Lincoln's time people still adhered to the humoral theory of disease that had come down from antiquity. A preponderance of black bile was associated with a melancholy temperament and character.

Hypochondriasis in the early 19th century was fairly common. In Herman Melville's Moby-Dick, Ishmael is given to dour moods and refers to his "hypos" -- the "blues." Lincoln would say, "That gives me the hypo," as he fell into one of his gloomy states.

Lincoln's gloomy nature and frequent bouts of depression did not handicap him professionally, and he carried on a successful law practice in Springfield, Ilinois. He also served in the Illinois State Legislature and had a term in Congress prior to assuming the presidency.

Suffering was part of the natural world for Lincoln, who endured family deaths as well as depression. In Lincoln we realize that intense suffering can coexist with great achievement. According to his law partner, William Herndon, he looked upon suffering as both "medicinal and educational." Lincoln found in suffering an agent of personal growth.

Depression wasn't a bar to holding high office in Lincoln's time as it has been in ours, Shenk points out. Thomas Eagleton, he relates, was chosen as George McGovern's running mate in 1972, but was forced off the ticket when it was discolsed that he had been treated with ECT -- "electroshock." Even Gerald Ford had to dispel rumors that he had seen a psychotherapist when he was being considered by Congress to replace Spiro Agnew as vice president in 1973. The New York Times (July 26, 1972) summed it up: seeking treatment for a mental/emotional problem "is still an unforgivable sin for an American politician."

There was a religious side to Lincoln, who had been raised in the stern Calvinistic tradition. He did not believe that confession or repentance wiped the slate clean of sin, and held to the view that punishment was the instrument of soul cleansing.

Following the death of his son Eddie in 1850, the Reverend James Smith would drop by the Lincoln household to chat -- and would manage to bring up points from his book The Christian's Defense. Lincoln remained unconvinced that Christian orthodoxy held the answers to his questioning nature. He did rent a pew at Smith's First Presbyterian Church, but never became a member. Later, in Washington, he maintained the same sort of attitude toward traditional religion.

Lincoln belonged to the tradition of freethinkers -- Benjamin Franklin, George Washington and Thomas Jefferson were among these. The freethought movement was broad enough to include the antireligious all the way to those like Lincoln who exhibited a private, unconventional faith.

He revealed a religio-philosophical approach toward life that fell within the boundaries of fatalism: "...events on earth were preordained and humans were powerless to change them." But Lincoln also referred to a divine plan, quoting Shakespeare on this: "There's a divinity that shapes our ends/Rough-hew them as we will." Brutus, for instance, had merely followed the path hewed out for him that led to the fatal encounter with Caesar on the ides of March, 44 B.C.E.

His law partner, Herndon, adhered to free will: "that man was free and could act without a motive." Lincoln said it could not be "because the motive was born before the man.,"

He liked to read and discuss The Age of Reason by Thomas Paine, an avowed deist. Deists believed that an impersonal First Cause had set the universe in motion, which then operated solely on physical laws. On social issues, they were strong proponents of virtue, reason and tolerance, extolling the French Revolution and opposing slavery.

Deism was a rational religion that challenged Christian orthodoxy. It started as an outgrowth of the Enlightenment, reached its zenith in the 1790s, and began to wan in the early years of the 19th century. Lincoln embraced a number of its tenets, such as the rejection of miracles, revelation, Jesus' divinity, and the infalliblity of scripture.

Yet Lincoln was fond of quoting from the Bible. "A house divided against itself cannot stand" is taken from Luke 11:17, and "Woe unto the world because of offenses!" from Matthew 18:7. Both quotes are in his Second Inaugural Address.

The Bible was of some comfort to the perenially gloomy Lincoln, but it was humor that helped maintain his mental equilibrium. Lincoln never tired of telling humorous stories and jokes. The New Yorker's cartoon editor, Robert Mankoff, said that the essence of humor is unhappiness. Shenk mentions Buster Keaton, Rodney Dangerfield and John Belushi as examples of comedians who suffered regular and severe depressions. The survival of the Jews during centuries of persecution in no small measure can be attributed to their utilization of humor in the service of the ego. Lincoln did the same.

Neuropsychiatrists, in particular, will be interested in Lincoln's recourse to "blue mass" pills, a popular nostrum of the time, to self-treat his depression. Snake oil in a pill, it was prescribed for tuberculosis and melancholy and almost anything inbetween. Its active ingredient was elemental mercury.

Lincolnists note that he experienced emotional outbursts -- fits of rage and unexplained bizarre actions -- raising the issue of mercury poisoning. Apparently, he stopped using blue mass in 1861 when he went to Washington.

He certainly exhibited some evidence of erythism, or Mad Hatter's disease, during the time he used it. Once he stopped blue mass, sequelae (such as, insomnia, depression, social withdrawal, feelings of worthlessness) could still occur, since mercury is slowly excreted from its stores. We now can confirm, from SPECT studies, that mercury in the brain can cause a dysregulation in the posterior cingulate cortex which is associated with attention/concentration deficits and anxiety/agitation.

The full statement by David Herbert Donald, quoted in part above, reads: "Lincoln was a fatalist who virtualy dripped melancholy as he walked." But melancholy actually made him stronger, and fatalism drove him on with a conviction that he was preordained to carry out some great task in this life.

Historians have routinely mentioned Lincoln's lifelong melancholy, but Joshua Shenk is the first to probe deeply into his "mental health." That Lincoln was able to channel his depression into creativity is one more attestation to his greatness, and we are indebted to Shenk for making this clear to us.