Mental Illness in U.S. Presidents--"Call Me Incompetent But Don't Call Me Crazy"
- We obviously need mentally competent Presidents of the United States
- We need better laws to ensure such mental competency both prior to and while holding such an important office
- We need to ensure that psychiatric evaluation,diagnosis,and treatment of Presidents are as free as possible from any influence whatsoever from partisan politics.
I had planned to write on this topic in the future but was stimulated by a remark that Sen. Dick Durbin (D-Ill and new Senate Majority Whip) made in January of this year that our current Vice-President was "delusional" about Iraq and the daily vitriol that spews forth on a number of mostly progressive liberal blogs about the sanity of our current president and vice-president. Reflecting upon Mr. Reagan's Alzheimers disease while still in office was another stimulus to this piece.
As a physician I go out of my way NOT to tele-longdistance-diagnose anyone as was done by former Sen (Dr.) Bill Frist in now landmark Terri Schiavo case where Frist insisted she was not in a persistant vegitative state.(He then tried to recant saying he was speaking as a Senator not a Doctor?)
But back to the more to the general issue of presidential mental health
About a year ago (Jan 2006) an excellent article which studied biographical source material in 37 presidents from 1776 to 1974 was published in The Journal of Nervous and Mental Diseases on the topic of Mental Illness in U.S. Presidents... and concluded that 18 presidents (49%) met criteria suggesting psychiatric diagnoses and in 10 instances (27%)"a disorder was evident during presidential office, which in most cases probably impaired job performance". Thankfully the authors concluded that no national calamities appeared to have occurred due to presidential mental illness. Here is the abstract for the article. (Sorry folks you must cough up some bucks for a full reprint)
Presidents with mental illness provide opportunities to discuss the stigma of mental illness,the treatment of mental illnes, the possible abuse of psychiatry (see Citizens Commission on Human Rights) and issues surrounding privacy in a public figure whose privacy rights in my opinion need to be subjugated by the public's right to know the health and competency of their President who is also their Commander-in-Chief.
In 1967 the 25th Amendment to the U.S. Constitution was ratified which addresses transfer of power in cases of presidential illness or death precipitated by the tragic assasination of President John Kennedy in 1963.
The prestgious College of Physicians of Philadelphia, of which I am a fellow, under then Executive Director Dr. Marc Micozzi launched several initiatives beginning in 1996 to better understand presidential health and disability with special emphasis on improving the 25th amendment by giving it,in Dr. Micozzi's words, "operational definition by statute or regulation"
Currently,for example, the 25th Amendment does not address who makes the final medical determination that the president is unable to hold office? (That's not good)
An educational exhibit took place at the College between 1996 and 1998 entitled "When the President is Patient" which traced George Washington's thigh carbuncle/abcess to George(Papa)Bush's thyroid condition.(see NY Times Coverage)
Sen. Arlen Specter (R-PA) delivered Opening Remarks (Nov 19, 1997) at a College Forum on Presidential Diability and the 25th Amendment where he closed by stating he was very interested in whether the College "will recommend legislative action to strengthen our current system for providing for the health of The President of the United states".(now that's a positive way of saying it) But Specter also raised the issue of the nation possibly being better served if White House Physician were required to consult with an independent panal of physicians for a mandatory second opinion. ("The panal will see you now-Mr. President")
In it's final report on the College's Presidential Health Task Force chaired by Dr. William Kissick the group concluded that "the current system of providing for the health of the president of the United States has in the past failed to serve effectively the president himself and the public, and has even been exploited as a means of deceiving the public about the state of the president's health.This committee went on to propose that an Act of Congress be passed into law to create a physician panal to provide a second opinion to the White House physician. A draft bill was even prepared by this committee. (Alas, I do not know the current status of this draft legislation?)
Needless to say the College of Physicians of Philadelphia deserves significant credit for these initiatives in the late 1990s. And special thanks to Dr. Marc Micozzi for spearheading these efforts and to Sen. Arlen Specter for assisting the College.
The College did not, to my knowledge, specifically focus on Presidential mental disability in any of its activities and deliberations?
Sufficed to say that psychiatric status is often ommitted from any or most of our own health evaluations. Yet for the President of the United States - past, present and future- I would focus on that first and foremost.
In our increasingly volatile world it seems like a pretty important priority to me?
Don't you agree? Let's hear from you!
Dr. Rick Lippin