On May 19, 1875, Mary Todd Lincoln, the widow of the assassinated president, was put on trial for insanity in a Chicago courtroom by her only surviving son, Robert. She was found insane within hours, by an all-male jury, after testimony from physicians who had not formally examined her. She was committed that afternoon to Bellevue Place, a private asylum in Batavia, Illinois. She was 56. She would be released roughly four months later, after waging one of the most determined and successful patient-led campaigns against involuntary commitment in nineteenth-century America. Whether she had a serious psychiatric illness, and if so what kind, is a question modern historians and clinicians have continued to revisit.
Mary Todd Lincoln's commitment is one of the most thoroughly documented examples of nineteenth-century American psychiatric practice as it was applied to a woman of means. It is also a case study in how grief, gendered medical assumptions, and family conflict could combine to produce an institutional outcome.
Early life
Mary Ann Todd was born in 1818 in Lexington, Kentucky, into a slaveholding political family. She was educated, multilingual in English and French, and unusually engaged in politics for a woman of her era. She married Abraham Lincoln in 1842. They had four sons, three of whom died in childhood or adolescence: Edward at three, William at eleven (during Lincoln's first term as president), and Thomas "Tad" at eighteen, six years after the assassination. Only Robert, the eldest, survived her.
The losses
Any modern clinical picture of Mary Todd Lincoln has to start with the losses. She buried three of her four children. Her husband was shot beside her in the box at Ford's Theatre on April 14, 1865, dying the following morning. She remained partly responsible for managing significant unpaid estate matters in the years that followed, in a country that had no formal provision for presidential widows. She was, by 1875, a woman who had survived an extraordinary sequence of traumatic losses with no professional support and limited social tolerance for visible grief in older women.
The 1875 trial
By 1875 Mary Todd Lincoln was living alone in Chicago, sometimes in hotels, sometimes in rented rooms. Her son Robert, by then a successful Chicago attorney, had become concerned about several patterns: large purchases of items she did not appear to need (gloves, drapes, jewellery she stored in trunks), her belief that someone was trying to poison her, occasional difficulty sleeping, and a willingness to carry large sums of money sewn into her clothing.
Robert organised a commitment proceeding under Illinois law, which at the time required only a jury verdict — not a clinical examination — to commit a person to an asylum. He retained Leonard Swett, an old Lincoln family friend and lawyer, who arrived at his mother's hotel with a writ and convinced her to attend the courtroom. She was not informed in advance that she was the defendant. Once at the courthouse, she heard for the first time the testimony of seventeen witnesses, including physicians who had not formally examined her, hotel staff, and her son. Her own attorney, also chosen by Robert, did not cross-examine. She was found insane within three hours and committed that afternoon.
Bellevue Place
Bellevue Place was a small private asylum for women in Batavia, Illinois, run by Dr Richard Patterson. Conditions for upper-class patients there were considerably better than in public institutions of the era. Mary Todd Lincoln had her own suite, took meals with the Patterson family, and was allowed correspondence and visitors. She spent her time reading, writing letters, and quietly building her case for release.
Working with her friend Myra Bradwell, the first female lawyer in Illinois, she gathered support, contacted journalists, and pressed publicly for re-evaluation. Within four months, she had been transferred to her sister's home in Springfield and, the following year, declared restored to "reason and capable to manage her own estate." She lived for another six years, mostly in Europe, in poor physical health but legally sound. She died in 1882 at age 63.
About the diagnosis
Modern reanalyses of Mary Todd Lincoln have produced a wider range of suggestions than perhaps any other historical figure in this series. Among the proposals from credentialed clinicians and historians:
- Bipolar disorder — argued in particular by historian Jean Baker, drawing on the documented mood swings, the sleep disruption, and the periods of impulsive spending.
- Complicated grief and depression — supported by the sequence of traumatic losses and the lack of clear evidence of psychotic symptoms outside of stress periods.
- Pernicious anaemia / B12 deficiency — proposed in a 2016 paper drawing on her physical symptoms and the neuropsychiatric features of severe B12 deficiency.
- Migraine with aura — proposed to account for some of her visual disturbances.
- No psychiatric illness — proposed by some historians who read the 1875 commitment as primarily a function of family conflict, gendered assumptions, and Robert's genuine but mistaken concern.
Schizophrenia is generally not on the modern shortlist. Her presentation does not fit well: no documented sustained hallucinations or fixed delusional system, normal cognitive function across decades, and an ability to organise a sophisticated legal and public-relations campaign from inside an asylum that few people with active schizophrenia could have managed.
What her story teaches
1. Grief is not the same as illness
Much of what was used as evidence of Mary Todd Lincoln's "insanity" — talking to her dead husband, fearfulness, distrust of people who had previously betrayed her financially — would today be read as ordinary features of severe and complicated grief. The DSM-5-TR's recent inclusion of "prolonged grief disorder" reflects, in part, a longstanding recognition that grief responses can be intense and extended without being psychiatric illness in the older sense.
2. Gendered assumptions shaped nineteenth-century commitment
Women of Mary Todd Lincoln's era could be committed for behaviours that would have raised no professional concern in a man — eccentric dress, intense religious feeling, "extravagant" spending, public anger. The commitment of a widow who refused to behave as her family thought a widow should behave is not unique in the historical record; it was relatively common, and the legal protections against it were minimal.
3. Patient advocacy can change outcomes
Mary Todd Lincoln's release from Bellevue Place was substantially her own work, with the help of Myra Bradwell. She used letters, sympathetic journalists, and the social standing she still retained to force a re-evaluation. The lesson is one that NAMI and modern patient advocacy organisations continue to make: people experiencing involuntary care need someone outside the system who is willing to push.
4. Historical cases deserve careful framing
It is tempting to project modern diagnoses onto historical figures with confidence. Mary Todd Lincoln's case is a useful corrective. The records are good, the clinicians and historians who have reviewed them are serious, and the conclusion remains that no single modern label fits cleanly. Honest uncertainty is a more respectful response than a confident diagnosis based on partial evidence.
This article is for educational purposes only and is not medical advice. Diagnoses of public figures are based on publicly available accounts and biographical sources, not direct clinical assessment. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.