Mary Lincoln, Public Health, and the Cost of Ignoring What We Know

I am not an expert in science, medicine, psychiatry, or even history. What I am is someone who has spent much of his life working in public health and cancer prevention.

For years, I have found myself returning to the story of Mary Todd Lincoln.

Not because I want to diagnose her, nor am I remotely qualified to do so.

What draws me back to her story is that parts of it still feel familiar.

In my work, I have heard from countless people who felt dismissed before they were understood. Many women, in particular, have shared stories of having symptoms minimized, explained away, or attributed to something other than what was actually happening.

No, we cannot fully know what Mary Lincoln experienced.

But many people know what it feels like to be misunderstood.

Many know what it feels like to be judged before they are heard.

Many know what it feels like to have assumptions made about them before anyone takes the time to understand them.

Much of what was written about Mary Lincoln came from physicians, journalists, political figures, and historians who were trying to understand her through the knowledge available at the time. Many were men, and that undoubtedly shaped some of the assumptions of the era.

But the larger issue was not gender alone.

It was the absence of scientific understanding.

When evidence is limited, assumptions tend to fill the gap.

Bias fills the gap.

People begin explaining what they do not understand through the lens of what they think they know.

That is one of the reasons science matters.

Science is not perfect, but it creates a process that challenges assumptions with evidence.

The goal is not to eliminate human bias entirely.

The goal is to keep bias from becoming the final answer.

That was then.

What concerns me is now.

Today we have generations of scientific discovery behind us. We understand disease, prevention, trauma, public health, and the many factors that influence health outcomes in ways previous generations could not have imagined.

Yet we are living through a moment when evidence is increasingly treated as optional.

The social determinants of health are one example of this.

Some dismiss them as politics or ideology. They are neither.

They are observations.

They are what we have learned by paying attention.

They reflect decades of research showing that health is shaped not only by biology, but also by the conditions in which people live, learn, work, and age.

Part of the challenge is that public health rarely fits into a sound bite.

Public health is measured not by what happens today, but by what happens years from now.

A misleading social media post can spread around the world in minutes. A scientific explanation may take years of research and far more than thirty seconds to explain.

The shorter the message, the easier it is to remember.

The more emotional the message, the easier it is to share.

Whether it is true is often a secondary consideration.

I understand that challenge personally. I have spent much of my career working in prevention and public health, and I have never been particularly good at reducing complicated issues into catchy slogans.

The truth is that many of our most important health challenges do not come with simple answers.

But complexity should not be mistaken for weakness.

Sometimes the longer explanation is the honest one.

Sometimes the answer that takes five minutes is more accurate than the answer that takes five seconds.

What concerns me is that we are not simply ignoring science.

We are turning back the clock.

After generations of progress in medicine, public health, and scientific understanding, we are increasingly being encouraged to distrust expertise and replace evidence with opinion.

The consequences are not theoretical.

We are seeing the return of diseases that previous generations worked incredibly hard to control or nearly eliminate.

Children are becoming sick from preventable illnesses.

Families are making life-altering decisions based on misinformation.

Sooner or later, every one of us becomes a patient, a caregiver, a family member, or a friend searching for answers. That is a terrible time to discover that we have stopped valuing the people and institutions dedicated to finding them.

Future generations will inherit the damage.

Mary Lincoln lived in an age that lacked many of the answers.

We are choosing to walk away from answers that already exist.

That is not progress.

It is retreat.

History may forgive those who lacked the knowledge to do better.

It will be far less forgiving of those who possessed the knowledge and chose to abandon it.

That is not how we make America healthier.

That is how we make America sicker.

This article originally appeared on Bill Couzen’s Substack.