Leonard Cohen (1934–2016) was one of the most fascinating, enigmatic and greatest lyricists of all time, renowned for his plaintive ballads and poems such as ‘The Darkness’ (from his 2012 album Old Ideas). His career as a singer lasted almost 50 years; he released 14 studio albums and eight live albums.

Although Cohen spent many years in sunny places, such as Hydra and California, in his soul it always seemed to be winter. He became known as the unsettling poet of despair and depression, high priest of pathos and godfather of gloom. His rasping voice, scorched by a million Marlboro Lights, exuded misery. Since early adolescence, he admitted having to deal with a sadness he could only attribute to an unexplained ‘biological reason’: ‘my depression, so bleak and anguished, was just crucial, and I couldn't shake it; it wouldn't go away’. His melancholy flowed like an underground river through all of his work: Cohen's lyrics contain very specific images that communicate the phenomenological nature of depression with extreme clarity.

In a desperate attempt to find release from this depressive river and cope with his sadness, over his life Leonard Cohen tried several types of drugs – emotional, spiritual, illegal and medicinal. He had countless women and tumultuous relationships and several religions (in 1994 he retired for 5 years in a Buddhist monastery in Los Angeles). Leonard Cohen spent his life ploughing his way through drugs (for example, LSD and amphetamines) and drinks (four bottles of wine a day). He also admitted to trying antidepressants and mood-stabilisers, which eventually proved incompatible with his erratic lifestyle because they impaired his libido. Conversely, he did not trust psychotherapy and psychological explanations to which he ‘preferred the conventional distractions of wine, women and song. And religion’.

Leonard Cohen's life holds a strong educational message for academic medicine, demonstrating that individual depressive features can coexist with a successful professional career. His life also teaches how to recognise these features in a non-stigmatising approach.

Leonard Cohen understood human darkness and sadness to the point that he performed free live concerts in mental institutions such as the Henderson Hospital in London, and the Napa State mental hospital in California, stating: ‘there would be an empathy between the people who had this experience [being in mental hospitals] and the experience as documented in my songs’. His personal and artistic account of depression contributes to overcoming the stigma associated with mental disturbances, teaching us that darkness is a fundamental part of the human being and that our omnipresent imperfections are the very glimmers through which some light may get in. In this view, to crack the physical barriers of the hospital walls, any effective treatment would then need empathy, understanding and psychological hospitality. These messages are particularly important for junior doctors, given that they are at higher risk of developing depressive symptoms but find it difficult to disclose them and seek help.

Leonard Cohen (1934–2016) at the Geneva Arena, 27 October 2008 (figure reprint permission: CC BY-SA 2.0 fr).