Case Conceptualization: Eleanor Roosevelt

Disclaimer: The opinions expressed in this case conceptualization may not necessarily reflect the opinions of other mental health professionals.  Any diagnosis presented in a case conceptualization is projected, and many not represent an actual diagnosis given to any individual.  Any diagnosis given in a conceptualization will be from the most up-to-date Diagnostic & Statistical Manual published by the American Psychiatric Association (current issue being utilized: DSM V-TR)

As I stated in the Preface, Eleanor Roosevelt is the human I most admire (since I don’t believe in having heroes).  The way she carried herself, her values, and her ability to balance her responsibilities while carrying a pleasant demeanor is no easy task, especially in this day and age.  Below her surface however, Eleanor had to work extremely hard to suppress the many challenges she endured throughout her life.  There is much to uncover, however her case conceptualization is one of the easier ones I will likely ever write, as our young lives run slightly parallel.

The primary area of focus in Eleanor’s childhood is her relationship with her parents: her mother appears to be a stern, snobby, entitled woman from a prominent family and acutely aware of her status, while her father was a free-spirited, charming man who sought as much enjoyment out of life as possible (to use a pop culture reference, I compare her mother to Mrs. Smails and her father to Al Czervik, both characters from Caddyshack).  Because Eleanor’s mother thought highly of herself, it’s logical that she would set high expectations for Eleanor; she made her feelings of disappointment known to Eleanor, which is the primary contributor to her low self-esteem.  Elliott, on the other hand, projected feelings of love and affection, in turn making her feel special.  Her reaction to their deaths speaks volumes, specifically Eleanor having a nonchalant feeling towards her mother’s but heartbreak towards her father’s.  As a result, Eleanor had created a fantasy world to escape (as mentioned in chapter 1, as a child this is the only coping mechanism she is capable of utilizing at this period of her life due to her developing brain).  We also may have another example of Oedipus complex like we saw in Charles Lindbergh’s case conceptualization, however in Eleanor’s case due to her being female, we refer to this as Electra complex.

In the midst of this adversity, Eleanor was sent to Allenswood, probably at the perfect time.  It is surprising to note that she adapted well, and even became known as one of the popular girls in the school!  While this likely provided a much-need confidence boost, it was likely Madame Souvestre’s mentorship provided the foundation for her “professional” confidence (in my professional opinion, I believe she experienced the life-long paradox of having sufficient confidence in her professional life coupled with almost non-existent confidence in her personal life).  Without this confidence boost, Eleanor would have likely faded into obscurity.

Upon Eleanor’s return from England as a now-young adult, it was customary for her to attend the local social balls to present herself; even though Eleanor had gained much confidence at Allenswood, it mostly disappeared once she returned home.  The reason for this is due to being back in an environment that reminded her of her mother’s disapproval (if she would have stayed in England, her new found confidence would have likely solidified).  I can imagine Eleanor hearing her mother’s criticism in her mind, which would bring back the feelings of insecurity.  It was during this time that Eleanor would reunite and fall in love with her fifth cousin Franklin.  Given the two were distantly related, it is easy to question the ethics of this relationship (as I had), however because they were not raised in close proximity to each other (even though they grew up less than 100 miles from each other) and due to them not having children with genetic defects (inbred children are more likely to be born with defects from parents with homogenous genetics), it is unnecessary to explore this area (I will however offer some professional advice: DO NOT marry any cousin, even though today 27 states legally allow you to marry your first cousin!; This is also a correction from chapter 2 when I stated this union would have been illegal)    

While Eleanor and Franklin were blissfully happy in their relationship, one member of the Roosevelt family was unhappy: Franklin’s mother Sara (I will go into more detail of this dynamic later).  In her memoir, Eleanor disclosed that after Franklin told Sara about the engagement, she took him on a cruise to the West Indies in an attempt to change his mind; the time away solidified his desire to marry Eleanor, likely setting off the chain of events in Eleanor and Sara’s complex dynamic (the stereotypical in-law conflict).

By 1910, Eleanor had settled into her role of wife and mother and seemed content, however Franklin’s journey into politics sent her into bastions she had not yet ventured.  While growing up in a well-to-do family allowed her the opportunity to mingle with a variety of people, she was never comfortable in her interactions; she only partook in the necessary social functions for Franklin.  Given that her low self-confidence was playing a significant role in her overall functioning, it is safe to rule out a diagnosis of Social Anxiety Disorder, specifically because those who struggle in this area (my hand raised high!) connect the struggle with being in social situations centered around those feelings of anxiety; because Eleanor’s struggles are rooted in overall low self-esteem, that would be directly connected to a dysthymia/depression diagnosis, and would not connect or overlap with anxiety.

Eleanor had adjusted to life as a political spouse decently well, however having to make another adjustment to caregiver for Franklin after his polio diagnosis must have been taxing, especially if you account for her discovery around that time of Franklin’s affair with Lucy Mercer (I did not go into details regarding this since Franklin is not my subject, and I would guess their letters have not been published and are unlikely to be made public).  Even with this adversity, Eleanor performed her caregiving as any wife would do at the time.  Since there is still no cure for polio, Eleanor’s caregiving responsibilities would only comprise of support with completing activities of daily living.

Eleanor’s transition to First Lady of the United States was more seamless than expected.  In a way, Eleanor lucked out by gradually transitioning upward so the expectation of the role was already known, therefore easing whatever pressure she might have experienced; it also helped that previous first ladies took on the role of hostess than active participants, so it gave her freedom to take on the active role that cemented her legacy.

As discussed in chapter 4, life hit Eleanor hard with the death of her brother Hall in 1941. I can imagine the difficulty Eleanor experienced with grief during this time considering her overwhelming schedule left little time to mourn as well as process being the last living member of her family. In just a few years, she would have to mourn the death of her husband, which was likely complicated by the public's affection for a president that got them through some of the most difficult times in the country's existence. Luckily she left the White House at ease and satisfied if a bit nostalgic about all that was accomplished during her husband's tenure. In the aftermath, she made her living adjustment to minimize reminders of Franklin, specifically moving into Val-Kill cottage (as mentioned in chapter 5) instead of living in the main house on the Hyde Park estate. While Eleanor did not likely experience Prolonged Grief Disorder, the grief she felt over Franklin's death likely remained for the rest of her life due to countless visitors to the estate and his grave.

While many might believe that Eleanor would slow down after Franklin’s death (and that hypothesis is logical given how humans mourn their loved ones), she (like with so many areas of her life) would break the mold by finding herself busier than at any time in her life.  What is also interesting about her life post-Franklin is that she finally, at age 60 found her calling (proof that it is never too late to follow your passion).  Finally her self-confidence struggles and depression symptoms disappeared, and unlikely never appeared again in her life.

The inside story on Eleanor is a simple but significant one, one that likely contributes to her diagnosis: while I do not have definitive proof (as Eleanor would not have written or spoken on this issue given the time period), it is reported that her mother-in-law Sara constantly told her grandchildren what a horrible mother they had… with Eleanor present!  Sara Roosevelt had known Eleanor since childhood, and was well aware of the adversity she faced, which I believe Sara took advantage of.  Sara was a manipulative woman who ensured Franklin saw her as the most important woman in his life, which explains why Sara kept a close leash on Eleanor, as evidenced by Sara moving into the house next door after their wedding as well as doing “everything for me”.  In turn, Eleanor felt she could not function as a wife or mother without Sara; Eleanor already struggled significantly with self-esteem, and the struggle with Sara worsened it, likely how Sara wanted it.  She already had her mother’s negativity in the back on her mind, then compounding Sara’s behavior likely made married life difficult to tolerate.  While Eleanor would never admit it, I’m sure Sara’s death brought some relief.

So what is Eleanor’s diagnosis?  Ethically, I would diagnose her with Other Specified Depressive Disorder, Depressive Episode with Insufficient Symptoms.  The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition – Text Revision (DSM-5-TR) defines this diagnosis as “depressed affect and at least one of the other eight symptoms of a major depressive episode associated with clinically significant distress or impairment” (p. 209)  While Eleanor never spelled out many of the criteria to qualify for a diagnosis of either Persistent Depressive Disorder or Major Depressive Disorder, one of these diagnoses would likely still fit due to repeated reports in her writings of feelings of sadness throughout her life as well as her struggle with self-esteem. (she had referred to the term depression a few times in her memoir)

One question remains: should Eleanor Roosevelt’s legacy be one worth remembering?  Without question: she not only set the new precedent for the First Lady’s role in the White House, but also assisted in crafting a document that established rights for every living human being.  Eleanor’s legacy will truly endure for generations to come.