Thank you for Joshua Wolf Shenk's insightful and moving "Lincoln's Great Depression" (October Atlantic). This article captures more than just the history of the great man's mental state; it also provides comfort to those of us who suffer depression today. The author saw Lincoln's "melancholy" as part of his character, one playing a primary role in the way he viewed the world and approached the heartbreaking national issues that had defeated so many others. The moment when Lincoln said he desired to live and "link his name with something that would redound to the interest of his fellow man" was pure inspiration. Depression is ugly and deadly, and treatment is often necessary to keep it from becoming catastrophic, but it can express the values we hold and the way we will fight for them.
Lincoln's chronic depression also makes sense of the "pre-cognitive" dream he related three days before his murder. He told friends that in this dream he entered the White House and saw mourners around a corpse with a covered face. "Who is dead in the White House?" he asked one of the attending soldiers. "The president," was the answer. "He was killed by an assassin." Now we can see this dream not as a spooky prediction but instead as a function of Lincoln's melancholy. Anyone who has suffered depression will attest that such dreams are common.
Mark A. Wilson
The pivotal idea in Joshua Wolf Shenk's article is found in his remark "Today the connection between spiritual and psychological well-being is often passed over by psychologists and psychiatrists, who consider their work a branch of secular medicine and science. But for most of Lincoln's lifetime scientists assumed there was some relationship between mental and spiritual life."
Only in modern times has this spiritual component been excised from consideration of mental health. Under today's paradigm Lincoln would have been placed on an escalating regimen of mind-altering toxins, electric shocks to the brain, or both. Under those circumstances where might Lincoln have experienced the discernment, the spiritual insight, the meaningful and integrative struggle?
The spirit is the seat of wisdom and the supreme cognitive agent. We ignore it at our peril.
St. Simons Island, Ga.
Joshua Wolf Shenk's well-reasoned analysis mentions that Lincoln medicated himself with "blue mass," a compound containing elemental mercury that was often prescribed for depression, then known as "melancholia" (black bile). I and colleagues have published evidence that Lincoln took a sufficient amount of this potent neurotoxin to cause many of the signs and symptoms of acute mental distress documented by his friends, especially in the 1850s. Lincoln wisely stopped the medication on his own soon after his 1861 inauguration, because, he said, it made him "cross." We believe he might not have achieved his great leadership in the war years had he continued taking mercury.
Norbert Hirschhorn, M.D.
From his early days sitting around the courthouse, mesmerizing young lawyers with bawdy tales, to moments of levity during the Civil War, Lincoln saw humor as possibly the only way to mitigate the melancholia in his life. Whether using humor as metaphor or just relieving an awkward moment, he used it often. He poked fun at generals, made light of his competition with Stephen A. Douglas for the affections of Mary Todd, needled self-righteous preachers, and never failed to endear himself to others with jokes about his humble beginnings.
While Joshua Wolf Shenk is right that Lincoln's early battles with depression would help him cope with future personal and political struggles, this great man also recognized that humor was perhaps the only antidote at a time when medicine wasn't a suitable alternative.
Corral De Tierra, Calif.
Joshua Wolf Shenk did not mention the prevalent medical thinking that Lincoln was a victim of Marfan syndrome, which may have contributed to his depression.
Although this genetic condition is not highly associated with depression as a single psychiatric entity, those with morphologic deformities of any nature do harbor such a psychopathology when other factors are involved. Depression is seen more frequently when Marfan syndrome strikes someone who has gained a certain level of celebrity, accomplishment, and responsibility, all of which apply to Lincoln.
Because Marfan syndrome is associated with Lincolnesque joint laxity, ocular pathologies, long bone and digital excesses, and arm spans disproportionate to body height, the suspicion that Lincoln had this condition has intrigued researchers for decades. I know of a group that got permission to borrow from the Smithsonian a fragment of Lincoln's skull bone that was retrieved after the assassin's bullet struck. A planned DNA study may one day tell us the full story.
Don Sloan, M.D.
New York Medical College
New York, N.Y.
An interesting alternative analysis of Lincoln's mental, neurological, and physiological condition, titled "Abraham Lincoln's Organic and Emotional Neurosis," was published in the April 1952 issue of the A.M.A. Archives of Neurology and Psychiatry. Written by Edward Kempf, M.D., this analysis, though dated, convincingly postulates that Lincoln's mental aberrations may have been symptomatic of brain damage caused by a blow to the head that he received at age ten, when a recalcitrant workhorse kicked him. He was deeply unconscious for a prolonged period afterward, and for a while was thought to be dead. A pronounced indentation on the left side of his forehead is clearly visible in his life mask.
Kempf's article isn't the final word on Lincoln's mental condition by any means, but it successfully connects many disparate mental symptoms, physical traits, and life events.