Wednesday, March 07, 2007

Mental Illness in U.S. Presidents--"Call Me Incompetent But Don't Call Me Crazy"

This is very serious subject for several reasons-

- 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


Anonymous shel said...

The issue is of interest from several perspectives, not least of which is the issue of debilitation versus disease, mental or otherwise. If, for example, we define as debilitating for specific functions of a president [or a physician] most forms of psychosis and neurosis, and if such debilitation means removal from the job, then I suggest that we would have to invent a form of government [or healthcare] in which most current and prospective incumbents could be eliminated.

The paradigm that may be heuristic is found among psychotherapists themselves, many of whom recognize the need to be analyzed, not to eliminate disorders but to bring them under control.

6:33 PM  
Anonymous Dr. Rick Lippin said...


Thanks-I don't disagree with your comment.

Of course we are all "crazy" (neurotic) to one extent or another.We are human!

I am concerned with underemphasis in all of medicine of severe emotional disorders.

I am especially concerned with Presidents who may be "protected" by a single White House physician, who in the face of diagnosing a significant disability or disease that has the potention to have a severe impact on judgement, deceives the public by witholding the diagnosis putting us ALL at risk!

That is why the "second opinion" of an independent panal idea appeals to me.

Rick Lippin

7:07 PM  
Anonymous Roman Kozlowski said...

Hi Rick

As a psychologist, I found this report interesting and agree that more needs to be done to keep a check on the mental health of our leaders.

Of course, we can all show signs
of mental instability, especially if put under pressure for long periods.

Though with W it appears to be more
of the case that he has been puppeted into power and that others are pulling his strings, hence, his coping better than Blair, particularly on the matter
of Iraq.

Modern CBT formulations at present
(research is revealing) is in the main the most effective of psychological treatments in discerning and working through deep rooted unconscious
motivations of coping mechanisms
which lead to negative thinking
generating from early established
core belief systems. And psycho-
therapists who are politically neutral,chosen to regularly carry out such psychological checks, would be the ideal to strive for.

But to have this written in as standard medical checks for both our leaders, and how do we go
about to establish this, is a nothermonster of a mountain to climb.

We can see the flaws, but oh my,
what to do? what to do? what to do?

All the best

Roman Kozlowski BPS BABCP
United Kingdom

2:34 AM  
Anonymous June said...

This is definitely an important issue that is not discussed enough, but what a nightmare to get congress to devise an assessment procedure. If the evidence for the president's mental problems is his incompetence, there already is a political solution to remove him from office: impeachment. Since the Congress can't manage to consider the tools they already have, good luck trying to get them to have his mental health assessed.

This may seem an off-topic, but what really prompted me to write was your mistake in writing: "by the public's right to know the health and competency of their President who is also their Commander-in-Chief." The President is not the Commander-in-Chief of the people; he is only the C-I-C of the Armed Forces. An understandable mistake as the President keeps wanting us to believe that he has commanding authority over all of us and is above the Congress, but this is not true according to our Constitution (not even during a time of war, nor during the undeclared unending war on terra) Yet another abuse by this adminstration of using words to mean something else and using language in a way that makes people believe something that is not true.

6:09 PM  
Anonymous Dr. Rick Lippin said...


Thanks for the input and especially for correcting my error.

You are absolutely correct about C-I-C role of President.

Be Well,

Dr. Rick Lippin

2:33 PM  
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10:14 PM  
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1:10 AM  
Anonymous ativan said...

President doing his homwork.

2:05 AM  
Anonymous Anonymous said...

Doctor Lippin provides an important perspective dramatically illustrated now only one decade since his post. The ultimate diagnosis of mental incompetency should not be a mushroom cloud.

The Office of the President is not a deity. The occupant is not above the laws of the nation. If the laws cannot protect the nation from an incompetent President then what will?

That question needs to be answered and Congress must act to provide protection not only from enemies foreign and domestic but in the Oval Office itself. How can that be achieved?

6:02 AM  

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