In January 1841, a young Abraham Lincoln suffered his second breakdown. He collapsed, and was treated by a doctor who may have done him more harm than good. A new book explores how the Illinois lawyer went on to become president despite suffering from lifelong depression.

Robert Siegel talks with Joshua Wolf Shenk, author of Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness.

"When you read the reminiscences of Lincoln's friends and you hear him described in their terms, he's always the most depressed person they've every seen. It's always this radical gloom that they were shocked by," Shenk says.

Read an excerpt from the book's first chapter.

The Community Said He Was Crazy

In three key criteria -- the factors that produce depression, the symptoms of what psychiatrists call major depression, and the typical age of onset -- the case of Abraham Lincoln is perfect. It could be used in a psychiatry textbook to illustrate a typical depression. Yet Lincoln's case is perfect, too, in a very different sense: it forces us to reckon with the limits of diagnostic categories and raises fundamental questions about the nature of illness and health.

Though great resources in research and clinical science have been devoted to depression in the past few decades, we can neither cure it nor fully explain it. What we can do is describe its general characteristics. The perverse benefit of so much suffering is that we know a great deal about what the sufferers have in common. To start, the principal factors behind depression are biological predisposition and environmental influences. Some people are more susceptible to depression simply by virtue of being born. Depression and other mood disorders run in families, not only because of what happens in those families, but because of the genetic material families share. A person who has one parent or sibling with major depression is one and a half to three times more likely than the general population to experience it.

The standard way to investigate biological predisposition is simply to list the cases of mental illness -- or mental characteristics suggestive of potential illness -- in a family. With Lincoln, such a family history suggests that he came by his depression, at least in part, by old-fashioned inheritance. His parents, Thomas and Nancy Lincoln, came from Virginia families that crossed the Appalachian Mountains into Kentucky in the late eighteenth century. They married in 1806 and had three children: Sarah, born February 10, 1807; Abraham, born February 12, 1809; and Thomas, born about 1811. Though our information is imperfect, to say the least, both parents had characteristics suggestive of melancholy. Nearly all the descriptions of Nancy Lincoln have her as sad. For example, her cousin John Hanks said her nature "was kindness, mildness, tenderness, sadness." And Lincoln himself described his mother as "intellectual, sensitive and somewhat sad."

Tom Lincoln, a farmer and carpenter, was a social man with a talent for jokes and stories, but he, too, had a somber streak. "He seemed to me," said his stepgrandson, "to border on the serious -- reflective." This seriousness could tip into gloom. According to a neighbor in Kentucky, he "often got the ‘blues,' and had some strange sort of spells, and wanted to be alone all he could when he had them." During these spells he would spend as much as half a day alone in the fields or the woods. His behavior was strange enough to make people wonder if Tom Lincoln was losing his mind.

Perhaps the most striking evidence of mental trouble in Abraham Lincoln's family comes from his paternal relations. His great-uncle once told a court of law that he had "a deranged mind." His uncle Mordecai Lincoln had broad mood swings, which were probably intensified by his heavy drinking. And Mordecai's family was thick with mental disease. All three of his sons -- who bore a strong physical resemblance to their first cousin Abraham -- were considered melancholy men. One settler who knew both the future president and his cousins spoke of the two "Lincoln characteristics": "their moody spells and great sense of humor." One of these Lincoln cousins swung wildly between melancholia and mania and at times had a tenuous grip on reality, writing letters and notes that suggest madness. Another first cousin of Lincoln's had a daughter committed to the Illinois State Hospital for the Insane. After a trial, a jury in Hancock County committed thirty-nine-year-old Mary Jane Lincoln to the hospital, noting that "her disease is of thirteen years duration." At the hospital, an attendant observed, "Her father was cousin to Abraham Lincoln, and she has features much like his."

What is striking about the case of Mary Jane Lincoln is that the jury, charged with answering the question of whether insanity ran in her family, concluded that "the disease is with her hereditary." According to a family historian who grew up in the late nineteenth century, the descendants of Mordecai Lincoln "suffered from all the nervous disorders known. Some were on the ragged edge." One family member who had frequent spells of intense mental trouble referred to his condition as "the Lincoln horrors."

Three elements of Lincoln's history -- the deep, pervasive sadness of his mother, the strange spells of his father, and the striking presence of mental illness in the family of his uncle and cousins -- suggest the likelihood of a biological predisposition toward depression. "Predisposition" means an increased risk of developing an illness. As opposed to traditional Mendelian inheritance -- in which one dominant gene or two recessive genes lead to an illness or trait -- genetic factors in psychiatric illnesses are additive and not categorical. "The genes confer only susceptibility in many cases," explains the psychiatrist S. Nassir Ghaemi, in The Concepts of Psychiatry, "not the illness. That is, they only increase the likelihood that fewer or less severe environmental factors are required for the illness to develop, compared with someone who has fewer disease-related genes."

What tips a person from tendency to actuality? For centuries, philosophers and physicians emphasized climate and diet. Today's experts focus on harsh life events and conditions, especially in early childhood. Lincoln's early life certainly had its harsh elements. His only brother died in infancy in Kentucky. In 1816, Abraham's eighth year, the family moved to southern Indiana. Two years later, in the fall of 1818, an infectious disease swept through their small rural community. Among those affected were Lincoln's aunt and uncle, Thomas and Elizabeth Sparrow, and his mother, Nancy Lincoln. Eventually, the disease would be traced to a poisonous root, eaten by cattle and then ingested by humans in milk or meat. But when Abraham watched his mother become ill, the disease was a grim mystery that went by various names, from "puking fever" to "river sickness" to "fall poison." Later, it became known as the "milk sick." "No announcement strikes the members of a western community with so much dread as the report of a case," said a newspaper of the time. A physician described the course of the illness: "When the individual is about to be taken down, he feels weary, trembles more or less under exertion, and often experiences pain, numbness and slight cramps." Nausea soon follows, then "a feeling of depression and burning at the pit of the stomach," then retching, twitching, and tossing side to side. Before long, the patient becomes "deathly pale and shrunk up," listless and indifferent, and lies, between fits of retching, in a "mild coma." First the Sparrows -- with whom the Lincolns were close -- took sick and died. Then Nancy Lincoln went to bed with the illness. Ill for about a week, she died on October 5, 1818. She was about thirty-five years old. Her son was nine.

In addition to the loss of his mother, aunt, and uncle, a year or so later Abraham faced the long absence of his father, who returned to Kentucky to court another bride. For two to six months, Tom Lincoln left his children alone with their twenty-year-old cousin, Dennis Hanks. When he returned, the children were dirty and poorly clothed. Lincoln later described himself at this time as "sad, if not pitiful."

The one constant in Abraham's life was his sister, Sarah. She was a thin, strong woman who resembled her father in stature, with brown hair and dark eyes. Like her brother, Sarah Lincoln had a sharp mind. She stayed with the family until 1826, when she married, set up house, and quickly became pregnant. On January 28, 1828, she gave birth to a stillborn child and shortly afterward died herself. "We went out and told Abe," recalled a neighbor. "I never will forget the scene. He sat down in the door of the smoke house and buried his face in his hands. The tears slowly trickled from between his bony fingers and his gaunt frame shook with sobs."

In the emotional development of a child, pervasive tension can be just as influential as loss. Lincoln's relationship with his father -- the only other member of his nuclear family who survived -- was so cool that observers wondered whether there was any love between them. The relationship was strained by a fundamental conflict. From a young age, Abraham showed a strong interest in his own education. At first his father helped him along, paying school fees and procuring books. "Abe read all the books he could lay

his hands on," said his stepmother. "And when he came across a passage that struck him he would write it down . . . then he would re-write it -- look at it -- repeat it." But at some point Tom Lincoln began to oppose the extent of his son's studies. Abraham sometimes neglected his farm work by reading. Tom would beat him for this, and for other infractions.

To men who had been born and expected to die on farms, book learning had limited value. A man ought to be able to read the Bible (for his moral life) and legal documents (for his work life). Writing could help, too, as could basic arithmetic. Anything more was a luxury, and for working folks seemed frivolous. For generations, Lincoln men had cleared land, raised crops, and worked a trade. So when this boy slipped away from feeding livestock and splitting logs to write poetry and read stories, people thought him lazy. "Lincoln was lazy -- a very lazy man," remembered his cousin Dennis Hanks. "He was always reading -- scribbling -- writing -- ciphering -- writing poetry &c. &c."

Later, Lincoln's self-education would become the stuff of legend. Many parents have cited Lincoln's long walks to school and ferocious self-discipline to their children. But Lincoln pursued his interests in defiance of established norms. Far from being praised, he was consistently admonished. He may well have paid an emotional toll. Many studies have linked adult mental health to parental support in childhood. Lower levels of support correlate with increased levels of depressive symptoms, among other health problems, in adulthood. After Lincoln left home in his early twenties, his contact with his father was impersonal and infrequent.

When reviewing the facts of Lincoln's childhood, we should keep in mind some context. For example, in the early nineteenth century, one out of four infants died before their first birthday. And about one fourth of all children lost a mother or father before age fifteen. Of the eighteen American presidents in the nineteenth century, nine lost their mother, father, or both while they were children. None of Lincoln's contemporaries, nor Lincoln himself, mentioned the deaths of his siblings and mother as factors contributing to his melancholy. The melancholy was unusual, but the deaths were not. In the same vein, while we ought not to ignore Lincoln's conflict with his father and discount its possible emotional aftereffects, we risk missing more than we gain if we look at it exclusively through the lens of modern psychology. In fact, such a conflict between ambitious young men and their fathers was not uncommon in the early nineteenth century, a time of broad cultural and economic change.

Abraham was not evidently a wounded child, but signs point to his being sensitive. He spent a lot of time alone. He was serious about his studies and reading, and uncommonly eager to explore imaginative realms, which psychologists often observe in sensitive children. He also took up a popular cause among sensitive people, the welfare of animals. Some boys found it fun to set turtles on fire or throw them against trees. "Lincoln would Chide us -- tell us it was wrong -- would write against it," remembered one of his neighbors. His stepsister remembered him once "contending that an ants life was to it, as sweet as ours to us."

At the same time, Lincoln was a winsome child. Others sought him out, followed him in games, and applauded him when he mounted a stump and performed for them, pretending to be a preacher or a statesman. By the time he was a teenager, grown men would flock around him, eager to hear his jokes and stories. He was well liked.

Lincoln was not depressed in his late teens and early twenties -- at least not so far as anyone could see. When he left his family, at age twenty-one, he had no money or connections. His chief asset -- perhaps his only real asset -- was his golden character. Settling as a stranger in New Salem, a small village on a river bluff in central Illinois, he soon was among the best-liked men around. A gang of rough boys developed a fierce attachment to him after he made a stellar showing in a wrestling match, displaying not only physical strength but a sense of fairness. Others were impressed with Lincoln's wit and intelligence, noticing, for example, how when he recited the poetry of Robert Burns, he nailed the Scottish accent, the fierce emotion, and the devilish humor. Though Lincoln looked like a yokel -- tall and gangly, he had thick, black, unruly hair and he wore pants that ended above his ankles -- he had good ideas and a good manner. "He became popular with all classes," said Jason Duncan, a physician in New Salem.

After less than a year in New Salem, Lincoln declared himself as a candidate for the Illinois General Assembly. He was twenty-three years old. He lost the race but got nearly every vote in his precinct, which, said another candidate, was "mainly due to his personal popularity." When he volunteered for a state militia campaign against a band of Native Americans under Chief Black Hawk, a part of the bloody Black Hawk War, his company elected Lincoln captain. Nearly three decades later -- as a veteran of Congress and his party's nominee for president of the United States -- Lincoln wrote that this was "a success which gave me more pleasure than any I have had since."

In his first four years in New Salem, Lincoln struck his new friends and neighbors as sunny and indefatigable. "I never saw Mr Lincoln angry or desponding," said a fellow soldier in the Black Hawk War, "but always cheerful." Indeed, "the whole company, even amid trouble and suffering, received Strength & fortitude, by his bouancy and elasticity." Once Lincoln stopped at the house of a neighbor, Elizabeth Abell, after working in the fields. He was scratched all over from briar thorns. Abell fussed over him, but Lincoln laughed about it and said it was the poor man's lot. "Certainly," she said years later, "he was the best natured man I ever got acquainted with." Asked by a biographer whether the Lincoln she knew was a "sad man," Abell answered, "I never considered him so. He was always social and lively and had great aspirations." Crucially, his liveliness and sociability served him well in politics. Campaigning again for the state legislature in 1834, he went out to a field where a group of about thirty men were working the harvest. A friend of Lincoln's, J. R. Herndon, introduced him. The men said that they couldn't vote for a man who didn't know how to do field work. "Boys," Lincoln said, "if that is all I am sure of your votes. "He picked up a scythe and went to work. "I dont think he Lost a vote in the Croud," Herndon wrote.

Lincoln won the election easily. When a mentor in the legislature recommended that he study law, he took the challenge. It would be a good profession to accompany politics, in particular the politics of the Whig party, which drew its strength from the growing number of urban and industrial professionals. In the early nineteenth century, attorneys commanded a kind of awe, embodying the stately Anglo-Saxon tradition of common law and domestic order. Gaining "the secrets of that science," explained the poet-author William Allen Butler, would give a person a perpetual glow, for the law, "more than all other human forces, directs the progress of events."

It is a mark of Lincoln's soaring ambition that, four years from the fields, he sought to join such ranks, at a time when all but five percent of the men in his area did manual work for a living. It was a sign of his pluck that he did it virtually all on his own. While other young men learned the law at universities -- or, more commonly, under the tutelage of an established attorney -- Lincoln, as he noted in his memoir, "studied with nobody." This was hardly the only mark of his ambition. A lawyer named Lynn McNulty Greene remembered Lincoln telling him that "all his folks seemed to have good sense but none of them had become distinguished, and he believed it was for him to become so." This language suggests that Lincoln had, more than a personal desire, a sense of calling. "Mr. Lincoln," explained his friend O. H. Browning, "believed that there was a predestined work for him in the world . . . Even in his early days he had a strong conviction that he was born for better things than then seemed likely or even possible . . .While I think he was a man of very strong ambition, I think it had its origin in this sentiment, that he was destined for something nobler than he was for the time engaged in." In his first published political speech, Lincoln wrote, "Every man is said to have his peculiar ambition. Whether it be true or not, I can say for one that I have no other so great as that of being truly esteemed of my fellow men, by rendering myself worthy of their esteem."

But there were cracks in Lincoln's sunny disposition. "If the good people in their wisdom shall see fit to keep me in the background," he said in that same speech, "I have been too familiar with disappointments to be very much chagrined." At times, his faith in personal progress gave way and his familiarity with disappointments shone through. Back from the militia campaign, Lincoln and a partner opened their own store, buying the stock on credit. When the store failed, Lincoln was in serious financial jeopardy. Seeing him despondent, his new friends got him a crucial political appointment, as New Salem's postmaster. Later, he was made deputy surveyor, too. These jobs, Lincoln noted, "procured bread, and kept soul and body together." Nevertheless, his debt soon caught up with him: a creditor seized his surveying equipment -- including his horse, his compass, and his chain -- and put it up for auction. An older man named James Short saw Lincoln moping about and heard him say he might "let the whole thing go." Short tried to cheer him up. Then he went and bought the equipment for $120 (about $2,500 in modern dollars) and returned it to Lincoln.

These streaks of sadness and worry may have been minor depressions. But it wasn't until 1835 that serious concern emerged about Lincoln's mental health. That summer, remembered the schoolteacher Mentor Graham, Lincoln "somewhat injured his health and Constitution." The first sign of trouble came with his intense study of law. He "read hard -- day and night -- terribly hard," remembered Isaac Cogdal, a stonemason. At times, Lincoln seemed oblivious to his friends and surroundings. "He became emaciated," said Henry McHenry, a farmer in the area, "and his best friends were afraid that he would craze himself -- make himself derange."

Around the same time, an epidemic of what doctors called "bilious fever" -- typhoid, probably -- spread through the area. Doctors administered heroic doses of mercury, quinine, and jalap, a powerful purgative. According to one recollection, Lincoln helped tend to the sick, build coffins for the dead, and assist in the burials -- despite the fact that he was "suffering himself with the chills and fever on alternate days. "He was probably affected mentally, too, by the waves of death washing across his new home -- reminiscent, perhaps, of the "milk sick" that had devastated his family in his youth.

Among the severely afflicted families were Lincoln's friends the Rutledges. Originally from South Carolina, they had been among the first to settle in New Salem, opening a tavern and boarding house, where Lincoln stayed and took meals when he first arrived. He knew the family well and had become friends with Anna Mayes Rutledge, a bright, pretty young woman with flowing blond hair and large blue eyes. In August 1835, Ann took sick. As she lay in bed in her family's cabin, Lincoln visited her often. "It was very evident that he was much distressed," remembered a neighbor named John Jones. She died on August 25. Around the time of her funeral, the weather turned cold and wet. Lincoln said he couldn't bear the idea of rain falling on Ann's grave -- and this was the first sign people had that he was in the midst of an emotional collapse. "As to the condition of Lincoln's Mind after the death of Miss R., "Henry McHenry recalled, "after that Event he seemed quite changed, he seemed Retired, & loved Solitude, he seemed wrapped in profound thought, indifferent, to transpiring Events, had but Little to say, but would take his gun and wander off in the woods by him self, away from the association of even those he most esteemed, this gloom seemed to deepen for some time, so as to give anxiety to his friends in regard to his Mind."

Indeed, the anxiety was widespread, both for Lincoln's immediate safety and for his long-term mental health. Lincoln "told Me that he felt like Committing Suicide often," remembered Mentor Graham, and his neighbors mobilized to keep him safe. One friend recalled, "Mr Lincolns friends . . . were Compelled to keep watch and ward over Mr Lincoln, he being from the sudden shock somewhat temporarily deranged. We watched during storms -- fogs -- damp gloomy weather . . . for fear of an accident." Another villager said, "Lincoln was locked up by his friends . . . to prevent derangement or suicide." People wondered whether Lincoln had fallen off the deep end. "That was the time the community said he was crazy," remembered Elizabeth Abell.

The fact that Lincoln broke down after Rutledge's death, of course, doesn't necessarily mean that her death produced his breakdown. This is an important point, because from the very earliest writings on Lincoln, his relationship with Ann Rutledge has been controversial. Questions about whether he loved her and whether they were engaged have been debated fiercely, and still are. The myths and countermyths about this young woman played a big role in the early historiography of Lincoln -- and, amazingly, played a large role in pushing Lincoln's melancholy to the margins of history. More on this in the Afterword, but for now the essential point is that leading scholars have long said that what we think about Lincoln's first breakdown must hinge on what we think about his relationship with Ann Rutledge. If his love for her is a myth, this thinking goes, then the breakdown must be a myth, too.

In fact, in the eyes of the New Salem villagers, questions of a love affair followed hard and irrefutable knowledge of an emotional collapse. As the original accounts make clear, his breakdown was impossible to miss. Nearly everyone in the community who gave testimony spoke of it, remembering its contours even decades later. Lincoln, after all, had become immensely popular, loved by young ruffians and old families alike. Now, all of a sudden he was openly moping and threatening to kill himself. Why? people asked. What accounted for the great change?

It was in an attempt to answer this question that people turned to his relationship with Rutledge. He had obviously been upset by her illness. And after her funeral he had fallen off an emotional cliff. "The effect upon Mr Lincoln's mind was terrible," said Ann's brother, Robert Rutledge. "He became plunged in despair, and many of his friends feared that reason would desert her throne. His extraordinary emotions were regarded as strong evidence of the existence of the tenderest relations between himself and the deceased." Notice the careful progression from fact (Lincoln's breakdown after Ann's death) to inference (they must have been tenderly involved). James Short, who was the Rutledges' neighbor, came to a similar conclusion. "I did not know of any engagement or tender passages between Mr L and Miss R at the time," Short said. "But after her death . . . he seemed to be so much affected and grieved so hardly that I then supposed there must have been something of the kind." Because Lincoln "grieved so hardly" and became "plunged in despair," it seemed reasonable to his friends that there must have been some proximate cause.

In fact, major depression, in people who are vulnerable to it, can be set off by all manner of circumstances. What would appear to a non-depressed person to be an ordinary or insignificant stimulus can through a depressive's eyes look rather profound. "It's not the large things that send a man to the madhouse, "Charles Bukowski has written. "No, it's the continuing series of small tragedies . . . a shoelace that snaps, with no time left." In this light, it is worth noting that, according to reminiscences, the pivotal moment for Lincoln wasn't Rutledge's death but the dismal weather that followed. After the death, wrote John Hill, the son of Lincoln's friend Samuel Hill, "Lincoln bore up under it very well until some days afterwards a heavy rain fell, which unnerved him and -- (the balance you know)." The intonation here suggests an understanding among Lincoln's friends that there was something precarious about him, and that -- like Bukowski's shoelace -- a factor as ordinary as poor weather could send him reeling. As we will see, cold temperatures would contribute to Lincoln's second breakdown. Lincoln himself would write that "exposure to bad weather" had proved by his experience "to be verry severe on defective nerves."

For whatever reason, or combination of reasons, in the late summer of 1835 Lincoln's depression was pushed out into the open. After several weeks of worrisome behavior -- talking about suicide, wandering alone in the woods with his gun -- an older couple in the area took him into their home. Bowling Green, a large, merry man who was the justice of the peace -- and who became, other villagers said, a kind of second father to Lincoln -- and his wife, Nancy, took care of Lincoln for one or two weeks. When he had improved somewhat, they let him go, but he was, Mrs. Green said, "quite melancholy for months."

Lincoln's behavior matches what the Diagnostic and Statistical Manual of Mental Disorders, the handbook of mental health professionals, labels a major depressive episode. Such an episode is characterized by depressed mood and/or a marked decrease in pleasure for at least two weeks. Other symptoms may include a change in appetite or weight, excessive or insufficient sleep, agitation or lethargy, fatigue or loss of energy, feelings of worthlessness or inappropriate guilt, indecisiveness or trouble thinking or concentrating, and thoughts of death and/or suicide. To be classified as major depression, at least five of these symptoms must be present, marking a definite change from usual functioning and with significant distress or impaired functioning. If the symptoms follow the death of a loved one by less than two months, it might be considered mourning unless, as in Lincoln's case, there is "suicidal ideation" -- to ideate is to form an idea about something -- or other equally severe symptoms. "What helps make the case for the diagnosis of depression," says Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University, "is Lincoln's suicidal behavior and the fact that it provoked a ‘suicide watch.' Today people are much more sophisticated about suicide, but it's pretty unusual to do that. It speaks to the seriousness of what was happening with Lincoln."

Lincoln's breakdown also fits with the typical age for a first episode of major depression. Most serious psychiatric illnesses emerge at a particular time in life. For example, in males, schizophrenia usually surfaces in the late teenage years; manic depression in the late teens to early twenties. Unipolar depression, which Lincoln would struggle with his whole life, typically breaks into the open in the mid- to late twenties. Lincoln was twenty-six.

From Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness Copyright © 2005 by Joshua Wolf Shenk. Reprinted by permission of Houghton Mifflin Company.

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