American Journal of Law & Medicine

The presidents' mental health.

I. INTRODUCTION

Calvin Coolidge had a successful run in politics for over twenty years before ultimately becoming president of the United States in 1923. (1) Throughout Coolidge's first term as president, he worked long, hard hours, was active in Congress, and maintained a strong relationship with the media. (2) This changed, however, during the second term of his presidency. Less than a month after his second-term election, Coolidge's son died of blood poisoning] This traumatic event caused the President to enter into a deep depression. (4) In his autobiography, Coolidge admitted that when his son died, "the power and glory of the presidency went with him." (5) His grief, which has since been coined "pathological grief," had an effect on the President's mind, body and spirit. (6) President Coolidge lost interest in his job and began sleeping fourteen hours a day, ultimately earning a reputation as one of the most ineffectual presidents ever to hold office. (7) His depression rendered him incapable of making decisions, and as a result most of his duties were delegated to members of his Cabinet. (8) Though the White House knew for four years that Coolidge's depression rendered him incompetent, he remained in office until the end of his second term.

Naturally, Americans shudder at the notion of a president suffering from a serious ailment while in office. Beyond the fact that an illness could leave the president physically incapable of performing his job, there exists the even more horrifying idea of a president who is mentally incapable of performing the job but continues to do so. This note examines what happens when the man who leads the most powerful nation in the modern world suffers from an illness that adversely affects his ability to think clearly, make decisions, and run the country. Part II examines various instances in history when a president has suffered mental and psychological weaknesses while in office. Part III suggests that considering the magnitude of the position, presidents and presidential hopefuls should be subject to a more rigorous physical and psychological screening process. Part IV discusses the care the president receives from the White House medical team, and examines the role of the primary White House physician and the physician's duty to maintain confidentiality. Part V sets forth recommendations pertaining to the president's health, including alternate means of choosing the White House doctor, a proposed exception to the doctor's duty of confidentiality in cases of presidential mental infirmity, and a more ready invocation of the 25th Amendment.

II. MENTAL AND PSYCHOLOGICAL DISABILITIES OF AMERICAN PRESIDENTS

White House doctors have traditionally been concerned with four types of disabilities that have inflicted our presidents. (9) First, there is physical disability, the most notable example being Franklin D. Roosevelt, who was thought to be very intelligent and capable, but who was confined to a wheelchair after the age of thirty-nine because of polio. (10) Second, there is disability due to short-term illness. (11) During his notorious visit to Tokyo in January 1992, President George H. Bush, stricken with the flu, vomited on the Prime Minister of Japan and then fainted. (12) Although he recovered quickly, there was some speculation as to the political ramifications of the episode. (13) The third type of disability stems from the influence of medication on the president's mind and judgment, and the fourth is psychological disability. (14) The remainder of the discussion will focus primarily on the last two disabilities, as well as those instances where severe illness impairs the mind. Ailments of the mind, rather than the body, are often overlooked in the context of presidential health because they are the hardest to detect and the most difficult to treat. (15)

A. WOODROW WILSON

In October 1919, President Woodrow Wilson experienced a devastating stroke that left him incapacitated for over a year. (16) The stroke shortened his attention span and compromised his memory. (17) His White House physician, Dr. Cary Travers Grayson, and First Lady Edith Wilson went to great lengths to hide the extent of his disability from both the public and key members of the White House, including the Vice President, Thomas Marshall. (18) Edith Wilson took over many of her husband's duties during this time period. (19) All the while, the public was blissfully ignorant of his condition and the fact that unelected individuals were in control of the executive branch. (20)

B. JOHN F. KENNEDY

When President John F. Kennedy made public appearances, he radiated good health. During the 1960 election, Kennedy gained significant ground in the race against Nixon, in part due to his healthy physical appearance. (21) Kennedy appeared tanned, polished, and energetic during the presidential debates, while Nixon looked tired, pale, and scruffy. (22) What the public did not realize was that Kennedy's tan was a symptom of Addison's disease and his youthful enthusiasm was simply a mask for the intense exhaustion he felt on the campaign trail due to his illness. (23)

Today, it is no secret that John F. Kennedy was plagued with health problems, both before and during his presidency. He suffered severe back pain that made it difficult for him to walk without the aid of crutches. (24) He also wore a back brace and endured several unsuccessful surgeries to correct the problem. (25) Worse still, Kennedy had Addison's disease, which is caused by a deficiency of the adrenal cortical hormone and can be fatal if left untreated. (26) The symptoms of Addison's disease include fatigue, low blood pressure, weight loss, and muscle weakness, the combination of which can lead to impaired judgment. (27) Additionally, Kennedy had a thyroid insufficiency, high cholesterol, and anemia. (28)

Kennedy consumed a cocktail of drugs to control the constant pain caused by his multitude of ailments. (29) He also made frequent trips to Dr. Max Jacobson for treatment, a doctor who later became known as the infamous "Dr. Feelgood" because of his willingness to violate drug laws. (30) By one estimate, Kennedy was regularly ingesting painkillers, amphetamines (uppers), Phenobarbital (downers), sleeping pills, and testosterone. (31) He also received shots of cortisone, (32) which is known to boost energy, create feelings of euphoria and, in heavy doses, to produce psychotic episodes. (33) Kennedy often had a puffy look to his face, which is indicative of a cortisone overdose. (34)

The average person would find it next to impossible to properly function, let alone run a country, under the influence of the above-mentioned prescription drugs. Yet Kennedy seemed to manage quite well. He initiated several successful economic programs, enacted civil rights legislation, and defused the Cuban Missile Crisis. (35) His heavy medications did not seem to affect his ability to behave rationally and get the job done. For the most part, he had the media and the public fooled. (36)

At the same time, there is evidence that Kennedy's presidency was in fact affected by his illness. (37) There remains a lingering question of whether he could have accomplished more. He rarely showed up at Congress, in part due to his sickness and multiple surgeries, which adversely impacted his reputation among members of the House and Senate. (38) Also, high level officials within the administration criticized Kennedy's handling of the Cuban Missile Crisis. (39)

Considering the significance of the events at play during this era, such as the Cuban Missile Crisis and the Cold War, it is shocking that most Americans at the time were unaware of Kennedy's maladies. The White House deliberately misled the public as to the state of his health, and the false exuberance he radiated in public only confirmed their story. (40) Moreover, the media was a different animal in the 1960s than it is today. White House correspondents were not particularly diligent and did not dig into the personal affairs of the president, even though they had some idea of his poor condition. (41) His many achievements have not rendered insignificant the question of whether the public had a right to know about the state of his health and the course of his treatment.

C. RECENT PRESIDENTS

In a speech prior to 2004's presidential election, George W. …

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