"I was much further out than you thought And not waving but drowning." - Stevie Smith This is a paper I wrote in grad school about depression and treatments for it. After practicing for over two years now, I realized that depression can be described like a blanket that covers you. It is this feeling of loneliness that you cannot shake off. You are covered in it and it is so difficult to get out of it. The blanket can even feel comfortable that you don't want to take it off you. Sometimes CBT, EFT or psychoanalysis will not be enough to help you shake off melancholy. "Lincoln's Melancholy Years"
A tall man with long gangly arms in a black suit walked into the clinician’s office. He stood about 6 feet and 4 inches tall with coarse dark hair and his eyes sunken. His pants seemed to hang around his ankles, too short for his stature. His face looked very weathered but kind. He had high cheeked bones, thick lips and a mole on his right cheek. He joked that he played basketball and that the clinician must play miniature golf because she was short.
The gentleman had an enigmatic presence. He was charming and funny yet he looked very awkward and desolate as he sat in a chair. He was carrying a book, which looked like a journal, in his big hands. He spoke in a slightly high pitched voice, which did not match his big stature.
Abraham Lincoln disclosed that he had been contemplating suicide. He said that he felt so miserable that dying was the only way of ending the pain of misery, or he could decide to live but fear that the misery will never end. He reported that his lawyer friends locked him in his bedroom and took his dagger, razor and gun when he told them that he wanted to end his life.
Lincoln mentioned that writing poetry helped him cope with his sadness. He read a part of his poem to the clinician.
To ease me of this power to think,
That through my bosom raves,
I’ll headlong leap from hell’s high brink,
And wallow in its waves.
Though devils yell, and burning chains
May waken long regret;
Their frightful screams, and piercing pains,
Will help me to forget.
—Abraham Lincoln, “The Suicide’s Soliloquy”
Lincoln also said that his job as the president of the United States prevented him from ending his life because he had the desire to accomplish something so great for his country.
Since Lincoln never spoke to a therapist but only to his fellow lawyers, he never received proper mental health care before. But he engaged himself in a lot of projects and worked diligently for a long time to improve his mood. He knew that his creative side was an excellent outlet for him to distract himself from committing suicide. His poetry and his successful political career were evidence of his resilience. He seemed to have developed a self-understanding that he wanted to live because he had this desire to accomplish something so great for his country. Even when he was stricken with unbearable sadness, he was able to rouse himself from it and did his duties.
Lincoln’s poetry and letters showed how depression felt like for him. He felt so miserable that dying was the only way of ending the pain of misery. He reported that during the cold months, his depression would worsen.
He mentioned that he was worried about his political career, he married the wrong woman and he saw a lot death. He said, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better I cannot tell. I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”
The client showed desperation of finding a cure to his depression. He reported of taking opiates and cocaine to relieve his pain but with no avail. Seeing a therapist was his last option to help him continue to live and lead the country in this time of war.
Abraham Lincoln was a 50-year-old Caucasian man. He was the 16thpresident of the United States. He was married to Mary Todd. He described his marriage to Mary as unsatisfactory. He said that they had a lot more differences than similarities. He described her as luxurious while he was very modest.
Mary and Abraham had four sons named Bob, Eddie, Willie and Tad. Eddie died when he was 4 years old of pulmonary tuberculosis. Willie died when he was 11 years old of typhoid fever. Tad died recently at age 18 of tuberculosis. Only Bob lived into adulthood and became a lawyer like Abraham.
Abraham Lincoln was born to Nancy and Thomas Lincoln. He had a sister named Sandy and a little brother who died in infancy. Both Nancy and Thomas displayed signs of depression, although they were never diagnosed. Abraham described his mother as intellectual, sensitive and somewhat sad. He had a short but loving relationship with his mother. His mother died when he was nine years old, the same year that his aunt and uncle died. All three of them died of a horrible disease called, “milk illness”. Abraham saw his mother suffered a slow death from this illness.
Thomas Lincoln, Abraham’s father, was said to be funny but serious at times that made the people around him thought that he was losing his mind. This could be a mild cause of manic disorder. Lincoln’s paternal cousins were also described to have had mood swings. It was called the “Lincoln Characteristics” which was described as moody with a great sense of humor by their friends. Abraham’s relationship with his father, as he described it, was cold and loveless. Abraham recalled his father beating him when he neglected to do his farm work because he would rather read books.
Abraham and his sister also experienced neglect when his father married a new bride and left them with their 20-year-old cousin. The siblings were constantly dirty, poorly clothed and barely ate. Abraham described that time as, “sad, if not pitiful”.
It seemed that the only constant person in Abraham’s life was his sister, Sandy, who was a strong woman. She later died after giving birth to a stillborn child. Abraham described this as another devastating time.
Abraham and his family also moved a lot when he was a child. A lot of illnesses plagued America at that time that killed a lot of his friends and family. At age 8, he witnessed the death of his friends from typhoid fever. He also told the sad story of the time he lost a dear friend named, Anna Rutledge, when he was 26 years old. She will always be the love of his life. When she died, that was the first time Abraham contemplated about suicide.
According to the DSM-5 Lincoln’s melancholy was a major depressive episode. His episodes of depressed mood, decrease pleasure that lasted at least two weeks with symptoms of agitations, fatigue, feelings of worthlessness and thoughts of death or suicide are all indicative of major depression.
Lincoln had a biological disposition for depression. Lincoln’s family history of deep, pervasive sadness of his mother, the mood swings of his father and the presence of mental illness in his father’s side of the family were evidence of biological disposition toward depression. Lincoln also experienced harsh life events from his childhood. His formative years were full of adversities. Studies have also linked adult mental health to parental support in childhood. Lower levels of parental support correlate with increased level of depressive symptoms. Lincoln lost his mother when he was nine and he did not have a lot of support and love from his father. The only constant person in his life was his sister who also died. In his life time, Lincoln saw a lot death.
Lincoln was very likable. He was funny and he was a good story teller. He was strong and witty, sensitive and cheerful that it was not surprising that he was popular with all classes. But his friends said that Lincoln’s “melancholy dripped from him as he walked”. Lincoln said that politics and poetry were his distraction. He admitted to had wept in public and recited sad poetry. He also knew that he told jokes and stories at odd times because laughter was necessary for his survival.
Depression can cause distorted ideas of self. It can take over one’s view of reality. Cognitive therapy can be effective in defusing negative thoughts. Cognitive therapy provides tools that can change negative thoughts. Lincoln could benefit from cognitive psychotherapy.
Cognitive behavior therapy (CBT) focuses on the here and now and it works really well with mindfulness techniques. Aaron Beck’s cognitive therapy (CT) for depression will target Lincoln’s distorted thoughts of himself and will help him stop his negative thoughts and replace them with positive thoughts. Depression is a disturbance of cognition and not the mood. Lincoln viewed himself in negative ways by regarding himself as worthless, undesirable and defective. Lincoln viewed his experiences as defeats and failures. Lincoln was hopeless and viewed his future in negative ways and believed that his suffering will continue.
Lincoln already used a lot of behavioral techniques to cope with his depression. Lincoln wrote about his depression and expressed his sadness through his poetry and letters. He also surrounded himself with friends and he told jokes. Lincoln viewed the present and his future in a pessimistic way. He wanted to live a different life from his father though. Although he had a lot of early losses, he found solace in books and friends.
CT believes in being positive and optimistic with depressed patients. By being an empathetic and optimistic therapist and someone who understood Lincoln’s fears and desire to succeed would help alleviate his depression. The clinician gave books for Lincoln to read about coping with depression since Lincoln enjoyed reading. The clinician also suggested some self-care routines. The clinician would suggest for Lincoln to try meditation first thing in the morning. Lincoln would practice some light stretching in the morning with mindful breathing. Lincoln would practice walking meditation around the White House garden. Every morning he would also write in his gratitude journal of all the people and things he is grateful for.
Emotional Freedom Technique (EFT) would be the specific intervention the clinician would use for Lincoln. EFT is similar to Thought-field therapy (TFT), which uses a series of step-by-step “algorithms” that combine tapping sequences of meridian points and cognitive-behavioral affirmations to alleviate trauma, anxiety or depression.
Emotional feelings affect the body’s system. Energy disruptions are the reason why people have emotional issue like grief, anger, guilt, depression, trauma and fear. EFT tapping and focused wording tune in on the issue and get rid of the energy disruptions.
For Lincoln’s treatment, he would be asked to identify a specific issue each session. An example of this would be the pain he felt when he lost Anne Rutledge, his first love. Then he would assign a number to his pain from 0-10 scale where 10 is the worst pain he ever had and 0 is for no pain. Then we would create his affirmation. For emotional issues, like Lincoln’s, the clinician can recreate the memories in his mind and assess his discomforts. In designing his phrase there are two goals to achieve. The goals are to acknowledge the problem and then to accept himself in spite of it.
Lincoln would be guided to tap on 9 meridian points: top of the head, eyebrow, side of the eye, under the eye, under the nose, on the chin, on the collar bone, under the arm and side of the hand while saying this phrase, “Even though I feel so hopeless, I deeply and completely accept myself”.
The language that was used should aim at the negative thought because the negative feeling created the energy disruptions. EFT tapping with the cognitive-behavior affirmation of accepting yourself stresses positive self thought. It is acknowledging and validating the client’s feelings but also focusing the positivity of self acceptance and self love.
The goal is to lessen the negative thoughts that Lincoln had and to stop his suicidal ideation. Abraham Lincoln would undergo cognitive psychotherapy with the clinician every week. Lincoln and his clinician would continue talking about his childhood experience and about the people he lost during his lifetime. Each session, the clinician would only focus on one traumatic experience. Then the clinician would focus on one specific feeling that Lincoln has and they will do EFT.
Lincoln would continue to write in his journal and write poetry as a creative outlet. He is also to keep a gratitude journal where he will write every three days about a person or an experience that he was grateful for. Lincoln is to practice mindful breathing when he wakes up in the morning with some light stretches. He will also do walking meditation every morning before he starts his duties of being the president of the United States.
Not only did Abraham Lincoln suffer from serious bouts of depression, but he also tried to give advice to others he knew were suffering. Lincoln’s depressions, whether they lasted for hours, days, weeks, or months always came to an end. Knowing this, he could encourage others. It would seem his own experience led him to believe that depression was not a permanent condition.