What did Beethoven, Lincoln and Hemingway have in common? According to CBS television star, Mandy Patinkin, all three had depression.
 
During the month when Lincoln’s birthday (February 12) is honoured, CBS Cares will run a destigmatisation campaign about mental illness using Honest Abe, now Sad Abe. Despite Presidents’ Day being celebrated this month, Lincoln’s name may become more associated with depression than Emancipation. Destigmatisation is a neologism used in therapeutic circles. Current dogma assumes that depression is under-treated because people are too embarrassed to ask for help. Therefore, pinning mental illness on the coattails of giants should remove the shame attached to a condition and draw sufferers into treatment.
 
Strangely, I’ve never had anyone drop into my office announcing their decision to seek treatment because of Lincoln, Hemingway, Mike Wallace or any other popular figure. However, in our daytime public confessionals -- Oprah, Tyra, Jerry, and others we know on a first name basis -- this kind of celebrity identification seems to be routine. Despite the gooey sentimentality of the Celebrity Misfit Hour, the viewers may actually get some useful information.
 
No helpful information is contained in the CBS commercials. Tagging room-temperature heroic figures with various human ailments yields zero insight into that person or the “illness”. Would Prozac have made Poe less creepy? Would a happier Sherman have not burned down Atlanta? You won’t find the answer at CBS Cares. Our passion for diagnosing the dead is another skin-deep facet of the diversity movement.
 
Yet, wouldn’t someone suffering from depression want to know more about how Beethoven, Hemingway and Lincoln lived with and dealt with depression in their lives? Not much is really known about Beethoven and depression. Hemingway was a horrible alcoholic who splattered his brains with a shotgun. He blamed electroconvulsive therapy for destroying his memory and ending his career. If alive today, he might have joined Tom Cruise in hyperkinetic eruptions against psychiatric treatment.
 
Lincoln’s struggles are the most astonishing. On the Great Emancipator’s birthday, the question of Lincoln’s depression deserves more than a 30-second, feel-good pitch. How did this untreated backwoodsman suffering from chronic mental illness become President? Did the depression impair or aid his decision making? Did his depression make him a better leader? It’s bad enough that Lincoln’s birthday, now only celebrated in a few states, has been replaced by Presidents’ Day. Who really wants to celebrate Harding and Polk, much less Nixon or Carter?
 
Fortunately, we can have a deeper understanding of this brilliant man and his “illness”. In 2005 Joshua Wolf Shenk provided an analysis of Lincoln and depression in his book, Lincoln’s Melancholy. Shenk goes beyond the usual agenda of the troubled genius exposé. The book doesn’t settle for simply emboldening sufferers. Shenk moves the questions about Lincoln’s mood disorder from the realm of pop history and posters for Mental Health Awareness Month to the level of serious scholarship. He proclaims his ambitious goal in the subtitle of the book: How Depression Challenged a President and Fueled his Greatness.
 
Shenk gathers convincing evidence supporting the diagnosis of major depression (a severe, mood disorder) and dysthymia (chronic, milder depression) for Lincoln. The author uses original, first-person accounts and Lincoln’s own writings to demonstrate episodes of depression involving long periods of withdrawal, misery, hopelessness and even suicidal thinking. According to Shenk, during an episode in his twenties Lincoln’s friends placed him on “suicide watch”. Shenk also notes that Lincoln “didn’t carry a knife in his pocket for fear of what he might do with it.” While a state legislator in 1841 Lincoln became confined to his home and was described as “sick in body & mind.” Even when Lincoln was not severely depressed, he lived with a smoldering, chronic melancholia. Shenk quotes a journalist who concluded that Lincoln had “a marked …predisposition to melancholy…”
 
Lincoln’s moodiness wasn’t a secret but was witnessed and reported by many of his acquaintances. The irony of the CBS Cares campaign to destigmatize depression by highlighting Lincoln is that a candidate with a similar history today would be hounded out of the running by his opponents and press, including the caring folks at CBS. The 1972 Democratic vice-presidential nominee, Senator Thomas Eagleton, didn’t last three weeks after the revelation of his hospitalisation for depression and electroconvulsive therapy.
 
Not only did Lincoln overcome crippling and life threatening symptoms; Shenk paradoxically argues that Lincoln’s depression strengthened him and prepared him for the greatest challenge of any American president. He concludes: “Lincoln didn’t do great work because he solved the problem of his melancholy. The problem of his melancholy was all the more fuel for the fire of his great work.”
 
Shenk suggests that the low expectations characteristic of melancholia, balanced with Lincoln’s desire to improve his country, produced a philosophy of “depressive realism”. Lincoln found his purpose in the conflict over slavery. He applied the lessons of his own suffering to the challenge of resolving slavery. He knew that evil at times must be tolerated but always denounced. Never a utopian, Lincoln had hoped to limit slavery and then see the institution whither away. Compared to the optimistic, self-assured General McClellan, who crumbled in the face of defeat, Lincoln was an impenetrable fortress against the expansion of slavery.
 
Compare Lincoln, the doleful commander-in-chief who persevered despite four years of mostly defeats and unprecedented losses, with our modern, compulsively buoyant politicians. The president with the biggest grin ever by man or horse, the willfully naïve Jimmy Carter, started his crusade for human rights by abandoning the Shah of Iran, only to encounter a far worse regime which paralyzed his administration. Even the contagiously sunny but more realistic Reagan quickly left Lebanon after the slaughter of 200 marines.
 
Shenk elevates Lincoln from modern poster child for mental health to iconoclast against the modern biological conception of depression. Psychiatry built the medical tower of mental disorders by equating emotional suffering with disease. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) identifies distress as a hallmark of mental disorder. The focus on distress is so entrenched that many perversions such as bestiality, sado-masochism and transvestitism are no longer classified as mental disorders unless the practitioner is “distressed” over the behavior.
 
Emotional suffering is only evidence of a mental disorder in the way that physical pain is evidence of disease. All aspects of depression -- brief versus chronic, mild versus severe -- have labels attached in the DSM. Sadness has no more meaning than a rash. Certain cognitive habits associated with depression are also deemed unhealthy. Hopelessness and low self esteem have acquired mythological powers for explaining our social problems.
 
Shenk’s Lincoln restores sanity and hope to our present notions about depression. The story of Lincoln and his troubled mind doesn’t follow any script, treatment algorithm or predictable outcomes. Lincoln’s Melancholy provides both surprising answers and true inspiration.
 
Theron Bowers MD is a psychiatrist Deep in the Heart of Texas and may be contacted at [email protected]