Sara Galbraith, Psy.D. was a doctoral student enrolled in a course that focused on the preparation of psycho-biographies (the psychological study of one person's life). In this course, the instructor and students focused on the life of Abraham Lincoln. Each student prepared an essay that concerned the manner in which a contemporary psychologist or psychotherapist might have interpreted the life or Lincoln or might have even treated him as a patient. Sara chose to consider the way in which Aaron Beck (a noted expert on the treatment of depression) might have assisted President Lincoln. In this essay, Sara responds to a set of questions posed by the instructor.
Like many of our doctoral students in clnical psychology, Sara Galbraith came to PSP as a licensed MFT therapist. After graduating from PSP, Dr. Galbraith has continued to provide high quality psychotherapeutic services, while also serving as a PSP faculty member.
AARON BECK ON ABRAHAM LINCOLN’S DEPRESSION
Historians have many different views on the life of Abraham Lincoln, but most agree that Lincoln suffered from some form of depression throughout his life. Accounts of his young adulthood indicate that he may have had Bipolar II Disorder in that his moods often fluctuated rapidly from grandiosity to depression. Later in life, accounts describe a more Major Depressive Disorder than a Bipolar Disorder. It is fascinating to look at Lincoln’s depression and theorize on how it could have been explained and treated. Psychiatrist and theorist Aaron Beck would have assessed and treated Mr. Lincoln using his cognitive approach to depression. Lincoln probably would have liked a cognitive behavioral approach because he did not like to discuss or elaborate on his childhood and Beck would not spend a lot of time discussing the past. Beck would be much more interested in focusing on and treating Mr. Lincoln’s current symptoms. Answering the following four questions will explain how Aaron Beck might have explained, treated and even been perplexed by Mr. Lincoln’s depression.
1. What is a particularly interesting or important time of Lincoln’s life?
Lincoln’s early adulthood prior to being elected President would have been especially interesting to theorist Aaron Beck because this is when Lincoln experienced some of his most severe and debilitating depressions. Lincoln was struggling both personally and professionally during this time and he often had turbulent mood swings. He seemed to swing between being overly optimistic and ambitious to being completely hopeless and depressed about his future. Beck would be interested in what his cognitions or thoughts were during his depressed periods. We already know that Lincoln often told himself that he was “not an accomplished lawyer” even though there was a lot of evidence to the contrary. Beck would have also been interested in Lincoln’s responses to losing elections and his tendency to focus more on his failures than his successes. Also, his almost obsessive desire to make a difference in the world and better his country. It is interesting that during his non-political years in adulthood he was often frustrated and unhappy. It did not seem he could be happy or consider himself successful unless he was moving toward making a difference in the world. It would also be interesting to Beck that once Lincoln finally married his mood swings were moderated. He seemed to move from a bipolar disorder to a major depressive disorder. He had clear stimulus for his depressions during this time: death of his first fiancé, election losses, financial problems and a broken engagement. Did the consistency and structure of family life moderate his mood? Was self-care better after he was married with a wife to look after him so that he was healthier and less vulnerable to stress and depression?
2. In what way is this period in Lincoln’s life explainable or illuminated by your theory?
Beck’s cognitive theory of depression is based on the view that negatively distorted thinking patterns are the basis for depressed behavior and symptoms. Basically, depression is a disturbance of cognition (thought) not mood. Beck postulates that the essence of depression is three core schemas or dysfunctional beliefs: 1) The self is defective- views himself in a negative way-regards himself as worthless, undesirable and defective 2) All experiences are defeats or failures-construes experiences in a negative way and 3) The future is hopeless-views future in a negative way, assume suffering will continue. Beck believes a person’s depression is due to learned negative views of self, others and the world.
It does appear that Lincoln had low self esteem and a negative view of himself. As mentioned earlier, he did not see himself as a good lawyer. He constantly worried about his ability to provide for himself and a family. He did not seem to have a lot of faith in his abilities although rationally he knew he was an intelligent and capable man. He also took his defeats very hard and blamed and doubted himself. Every time he lost an election it validated his belief that he was defective.
When it came to personal relationships, Lincoln seemed to lack self confidence. He did not seem to see himself as a worthy husband. He also seemed to be pessimistic rather than optimistic about his future in thinking that he could not support a family despite the many successes he’d had as a lawyer. Beck would have loved to challenge and evaluate these negative cognitions. One friend noted that Lincoln seemed reluctant to marry anyone who was willing to accept him. It was as if he saw himself as so defective (one of Beck’s core schemas) that he did not want to be with someone who would want a defective person.
Lincoln already used a lot of behavioral techniques to cope with his depression that Beck would have approved of. For example he wrote about his depressions and expressed his feelings through poetry and letters. He talked to and gained support from his friend Joshua Speed. He changed his environment by going to stay at Speed’s family home. He surrounded himself with positive individuals and gained a broad support group while traveling on the circuit by telling jokes and building camaraderie.
3. What are aspects of his life at this time that are not explained by your theory?
Beck believed that the depression prone individual acquires certain negative attitudes regarding himself, the outside world and his future during the developmental period. As a result of these attitudes he becomes sensitive to certain specific stresses such as being deprived, thwarted or rejected. When exposed to stresses he responds with ideas of self-blame, pessimism and personal deficiency.
While it does seem that Lincoln often responded to stress by blaming himself and becoming pessimistic about the future, it did not seem to come from negative attitudes acquired during his early developmental years. It seems he was given the message as a child that he was intelligent and quick witted. He also seemed to be optimistic about the future as a young man and knew he wanted a different life from his father. Although he had a lot of early losses he found his own solace in books and family members (step-mother, Sister Sarah).
Additionally, Lincoln apparently saw himself as intelligent and intellectually superior to most individuals and this wouldn’t fit with Beck’s theory that depressed individuals see themselves inadequate. He also reestablished himself and moved forward instead of falling into apathy as Beck would have predicted.
Also, he did not always have a negative view of the world and others. He appeared to believe in the good in others. He wanted a world where people worked together, as equals, for the common good.
4. What are the ways in which you would be most helpful to Lincoln during this period?
Beck would have used a combination of cognitive and behavioral therapy. Beck would have assisted him in identifying his persistent negative constructs such as (I am not an accomplished Lawyer, I have not contributed to my country, I am not going to leave a legacy, etc.) that accompany his depressed affect. He would note the frequency and circumstances of these automatic thoughts. He would have had him record and monitor these cognitions. He would then look at the stimulus-cognition-affect pattern. He would identify themes among cognitions and help Lincoln evaluate validity and accuracy. Beck would have worked on correcting these distorted themes with logic and experimental testing. Example: When he said he wasn’t an accomplished Lawyer. How many cases have you won/lost? How do clients respond to you? He might even help Lincoln develop a counteracting statement such as “I am a good and accomplished Lawyer who helps a lot of people”
Additionally, Beck would have challenged one of Lincoln’s assumptions and tested its validity. One of Lincoln’s assumptions appeared to be that his life was meaningless and he was worthless unless he made a big difference in the world and somehow changed his country. Beck would have said something like “Is nothing worth anything except changing the world?” or “Does nothing else in your life matter except those actions that might improve the country?”
Beck believed in being positive and optimistic with depressed patients. He stated, “I have found that optimistic statements about the outcome may encourage the patient to become more active and may help to neutralize the all-pervasive pessimism” (Beck, 1967, p. 316). Just having someone to talk to who was positive and optimistic and who understood his fears and desire to succeed probably would have helped Lincoln and alleviated some of his depression. Beck would have also given him books and materials to read about coping with depression. Lincoln would have liked this as he loved reading and wanted to understand things. Beck would have also had him improve his self-care routines as Lincoln appeared to have a tendency to get caught up in work and neglect his own needs. Additionally, Lincoln tended to take to his bed during his depressive episodes and Beck would have emphasized the importance of keeping to a daily schedule and routine.
Working with Lincoln in this cognitive manner may have changed the course of our country in that it might have caused Lincoln to focus more on his family and personal happiness that on changing the world. He might have not had the same drive to become President if he’d challenged his assumption that one had to make a difference and leave a legacy of positive change to be worth something.
Beck, A. T. (1967). Depression, Causes and Treatment. Philadelphia: University of Pennsylvania Press.
Beck, A. T., Rush, A.J., Shaw, B. and Emery, B. (1979). Cognitive Therapy of Depression. New York: Guilford Press.
Donald, D. H. (1995). Lincoln. New York: Simon & Schuster.