Abraham Lincoln is routinely ranked by historians as our greatest president. There have been roughly 16,000 books written about him, including Joshua Wolf Shenk’s Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness. What’s perhaps most interesting about Lincoln’s struggle with depression is how publicly accepted his melancholy was, compared to the stigma associated with depressive states today.
Had Lincoln been alive in this century, he would have likely been diagnosed with depression, especially as a young man, according to Shenk. He cites Lincoln’s friends’ “suicide watch” over him; two major breakdowns, replete with many of the official symptoms of depression; dark Lincoln quotes, such as “I am now the most miserable man living”; and observations by friends and acquaintances, including William Herndon, Lincoln’s law partner, who said, “Gloom and sadness were his predominant state.”
So how did a man struggling with so much melancholy twice get elected president? Shenk believes that in the 1860s, Lincoln’s depression may have actually helped him politically more than it hurt him, since it gained him sympathy and drew people toward him. Shenk writes that the president’s depression “seemed not a matter of shame but an intriguing aspect of his character, and indeed an aspect of his grand nature.”
Lincoln’s depression may have helped him politically more than it hurt him. It gained him sympathy and drew people toward him.
Today that’s hardly how we think of people who are struggling with depression, which has, like most mental illness, become stigmatized. It’s hard to imagine a politician with Lincoln’s emotional struggles winning a U.S. presidential nomination.
So how did this shift happen: from empathy for people dealing with this incredibly common disorder to an all-out stigma? I believe the answer lies, perhaps surprisingly, in the move to make depression a disease. While it was a good idea to eliminate the notion that a depressed person has some sort of character defect, that stigma has been replaced by one of “biochemical defect.”
In a report released in 2012, “Myth: Reframing Mental Illness as a ‘Brain Disease’ Reduces Stigma,” the Canadian Health Services Research Foundation (CHSRF) noted that, “despite good intentions, evidence actually shows that anti-stigma campaigns emphasizing the biological nature of mental illness have not been effective, and have often made the problem worse.” This review of the research cites several studies to back up this claim. One example is a 2010 study in Psychiatry Research which reported that, for the general public, the acceptance of the “biogenetic model of mental illness”—meaning that these disorders are brought on by a combination of biology and genetics, so are beyond someone’s control—was linked to others wanting more distance from the mentally ill, an unexpected negative consequence, and one that clearly seems to work against efforts to end stigma.
Also in 2012, a Scandinavian journal analyzed attitudes about mental illness from 16 studies and found that the general public was more likely to accept that mental illness is caused by biology—but it also reported people either didn’t change their attitude toward the mentally ill or even felt more negatively toward them.
So how can believing that people are depressed (or schizophrenic, or have some other disorder because of something beyond their control) make attitudes toward them even worse? The CHSRF review explained it this way: While the public is less likely to blame the mentally ill for their problems, “the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous...leading to avoidance.”
When we think of mental illnesses as biological diseases, sufferers are seen as less responsive to treatment, and there’s a sense they may never recover, which contributes to the stigma, said the authors of the review. “Biological explanations can also instill an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different,” they added.
And how do we end this sort of stigma? The CHSRF researchers think that any programs which stop the marginalizing of the mentally ill should emphasize that psychological, social, and other factors play a role too—not just a person’s biology. In short, people struggling with these illnesses can and do recover.
In nearly three decades of clinical experience, I’ve found that the best way to end stigma is to rehumanize and depathologize our emotional struggles. This includes getting the word out that no matter how frightening the emotional experience, sufferers are not essentially diseased. To echo the researchers—since this bears repeating—they can and do recover.
Why do you think the stigma around mental illness persists? Do you think the biological disease explanation of these disorders is contributing to stigma?
Bruce E. Levine, Ph.D,. is a practicing clinical psychologist who writes and speaks on how society, culture, politics, and psychology intersect. His latest book is Get Up, Stand Up. Earlier books include Surviving America’s Depression Epidemic and Commonsense Rebellion. TakePart.com