American presidential candidates always have had their character and integrity attacked, and sometimes their mental health has been questioned as well. In the 20th century, candidates' mental health was scrutinized more than ever. In 1964, psychiatrists publicly assessed Republican candidate Barry Goldwater's mental health through a survey in Fact magazine, and since then candidates' mental stability occasionally has been a campaign issue.
America has a long tradition of berating presidents and candidates' character. Alexander Hamilton insistently hurled derisions at John Adams, calling him crotchety, pugnacious, quirky, whimsical, and plucky.1 Adams, the second U.S. president, used terms such as illiterate, unlearned, and unread in referring to George Washington.2 U.S. Sen. Stephen Douglas said Abraham Lincoln was “two-faced.” Lincoln responded, “I leave it to my audience. If I had another face, do you think I would wear this one?”3 Much later Lyndon Johnson referred to Gerald Ford as “a nice guy, but he played too much football with his helmet off.”2
Mental health questions
Throughout American history questions have been raised about the mental health of candidates and presidents, including their competency to remain in office. Many of us remember hearing in history classes about Lincoln's periods of depression and melancholy, as well as Ulysses S. Grant's legendary drinking. Davidson et al applied the DSM-IV criteria to biographic material on 37 U.S. presidents, concluding that 18 (49%) had experienced a psychiatric disorder at some time in their lives: 24% had depression; 8%, anxiety; 8%, bipolar disorder; and 8% abused alcohol.4 Furthermore, 10 (27%) had their episodes while in office. For example, Davidson et al cite Nixon's excessive alcohol use while dealing with Vietnam and Watergate.
The Goldwater survey. While Davidson et al conducted a retrospective analysis of deceased presidents, analyzing a current candidate's mental health caused an uproar in 1964. One month after Goldwater received the Republican nomination, Fact sent a questionnaire to 12,356 psychiatrists, asking if he was psychologically fit to be president. Twenty percent (2,417) responded: 571 said they did not know enough about him to answer the question; 657 believed he was psychologically fit to be president; and 1,189 said he was not.5 In addition to the poll results:
Excerpts from some of the responses were published, many characterizing the candidate as “immature,” “impulsive,” “megalomaniac,” “paranoid,” “rigid,” “narcissistic.” A small number offered specific diagnoses, such as schizophrenia. Many characterized him as unstable, which was more than a simple description since “emotionally unstable personality” was a diagnostic term in the DSM.6
In a 1965 article in the American Journal of Psychiatry, Gorman characterized the psychiatrists' responses as “political bias…wrapped up in pseudo-technical flagellation of Senator Goldwater.”7 Goldwater successfully sued the American Psychiatric Association (APA) for a substantial settlement.8 In the survey's aftermath, APA added Rule 7.3 to its Principles of Medical Ethics: With Annotations Especially Applicable to Psychiatry:
On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.9
The Goldwater episode marked the beginning of presidential candidates' mental health as a campaign issue. It also began a crescendo calling for full disclosure of candidates' physical and mental health,10 and disclosure became an issue just eight years later.
Thomas Eagleton's nomination. In 1972, Democrat George McGovern asked Missouri Sen. Thomas Eagleton to be his running mate. Rather rapidly the press focused on Eagleton's mental health history, although the record of his treatment had been well known both in his home state and among his associates on Capitol Hill.11 Eagleton had been treated for depression, hospitalized, and received electroconvulsive treatment (ECT). McGovern said he did not know of this history when he picked Eagleton.
The disclosure created a firestorm of negative feelings and opinions toward Eagleton. Survey respondents indicated that such a history made him unfit to be a vice-presidential candidate.12 Democratic delegates voiced concern that “Eagleton would drain votes from the Democratic ticket because of his history of mental illness.”13 Just 18 days after his selection, Eagleton withdrew from the ticket. The stigma of mental illness and its treatment was quite evident. Yet the Missouri electorate apparently did not share the national anxiety, as they reelected Eagleton to the U.S. Senate twice more (in 1974 and 1980).
Sen. Thomas Eagleton reacts while listening to Sen. George McGovern announce at a Washington news conference on August 1, 1972, that Eagleton is stepping aside as his running mate. Image by the Associated Press
One year later, Rossman and Miller examined the effects of the Eagleton episode on adolescents at the Neuropsychiatric Institute of the University of Michigan Hospital, writing that it had a significant discomforting impact on the patients: “They further speculated about their own chances for success and survival when they left the hospital in the future. They imagined that they would be treated as second-class citizens and subjected to the kind of prejudice that was directed at the Vice-Presidential nominee.” 12
The Dukakis question. On August 3, 1988, the New York Times reported, “The Presidential race drifted into the subject of mental health today, with the campaigns of both Michael S. Dukakis and Vice President Bush attesting that the candidates had never received psychiatric treatment.”14 This incident began with a “joke” by Ronald Reagan. When asked if Dukakis would make his medical record public, Reagan said with a grin, “Look, I'm not going to pick on an invalid.”15 The source of that quip was an accusation by Lyndon LaRouche that Dukakis had received psychiatric treatment.14
Ultimately, Dukakis not only released his medical records but also had his physician, Dr. Gerald Plotkin, speak to the press. Dr. Plotkin reported that Dukakis “has had no psychological symptoms, complaints or treatment.”15 The message of Dukakis's physician was clear: Presidential candidates had best be free of mental illness symptoms and treatment. As the editors of the New York Times suggested back then, perhaps it is time to break the psychology barrier for presidential candidates.16
In a bit of irony, Dukakis's wife, Kitty, acknowledged her struggle with alcoholism in her book Now You Know (1991) and her major depression requiring ECT in Shock: The Healing Power of Electroconvulsive Therapy (2006), which she spoke about at this past spring's National Council for Community Behavioral Healthcare annual conference in Boston.
The current run for the White House. Mental health issues still matter. In 2002, the Depression and Bipolar Support Alliance commissioned a study of 1,200 adults to see if the attitudes directed toward Eagleton persisted 30 years later.17 Twenty-four percent said they would not vote for a candidate with a mood disorder, and 25% indicated that such people were unstable, dangerous, and incapable of having a long-term relationship. Astonishingly, 19% said that people with a mood disorder should not have children!
In this election cycle, questions about Sen. John McCain's age and his prisoner of war experiences are frequent.18 Some would argue that McCain's strength in the face of severe torture and testing indicates a resiliency against stress-related decompensation. Others might feel that a POW background would make a president susceptible to post-traumatic stress disorder, even more than 40 years later. Despite these questions, McCain has refused to release his mental health records to the public.18
As far as Sen. Barack Obama's mental health, primary care physician David T. Scheiner, MD, said in a one-page letter released by the campaign that he “‘has been in excellent health’ during the past 21 years and is ‘in overall good physical and mental health needed to maintain the resiliency’ required of presidents.”19 As of this writing, neither McCain or Obama had announced his running mate, but we can be sure that all of the potential vice-presidential candidates' mental health histories were vetted by the campaigns—and the media.
In a provocative opinion piece in the Los Angeles Times late last year, neuropsychiatrist Daniel G. Amen suggested the candidates have PET scans to look for early evidence of Alzheimer's disease or structural changes in the frontal lobes, which might indicate a predisposition toward impulsivity, for example. As our understanding of mental illness becomes more biologically based, predictions from existing lab studies and imaging grow more meaningful. Yet Amen's suggestion that PET scans be ordered purely for predictive value in individuals with normal neuropsychiatric exams and histories does not represent excellent or even standard medical practice, and the idea is likely to remain on the shelf, at least until a candidate decides to do it and publicize the results.20
Stephen M. Soreff, MD, is President of Education Initiatives in Nottingham, New Hampshire. Stephen M. Soreff, MD, is on the faculty of Metropolitan College at Boston University, Fisher College, Worcester State College, and Southern New Hampshire University.
Patricia H. Bazemore, MD, is an Associate Professor in the Departments of Psychiatry and Family Medicine and Community Health at the University of Massachusetts Medical School in Worcester. Patricia H. Bazemore, MD, is a member of the medical staff at Worcester State Hospital.
To contact the authors, e-mail firstname.lastname@example.org.
- Chernow R. Alexander Hamilton. New York:Penguin Press; 2004.
- Foot R.Tossing insults a time-honoured political sport. Ottawa Citizen. Apr. 15, 2008:A8.
- Lamb C, ed. I'll Be Sober in the Morning: Great Political Comebacks, Putdowns, & Ripostes. Charleston, S.C.:Frontline Press; 2007.
- Davidson JR, Connor KM, Swartz M. Mental illness in U.S. Presidents between 1776 and 1974. J Nerv Ment Dis 2006; 194 ( 1 ): 47–51.
- Romano J. Reminiscences: 1938 and since. Am J Psychiatry 1990; 147 ( 6 ): 785–92.
- Pinsker H. Electoral history lesson. Psychiatr News 2008; 43 ( 6 ): 29.
- Gorman M. Psychiatry and public policy. Am J Psychiatry 1965; 122:55–60.
- Ethics reminder offered about ‘Goldwater Rule’ on talking to media. Psychiatr News 2007; 42 ( 10 ): 2.
- The Principles of Medical Ethics: With Annotations Especially Applicable to Psychiatry. 2008 ed. Arlington, Va.:American Psychiatric Association; 2008.
- Ostow M. Mental health in office; psychoanalyst points out flaws in predictive criteria. New York Times. Oct. 11, 1964:E12.
- Naughton JM. Eagleton illness known to associates. New York Times. July 26, 1972:20.
- Rossman PG, Miller D. The effects of social prejudice on hospitalized adolescents. Am J Psychiatry 1973; 130 ( 9 ): 1029–31.
- Lynn F. Delegates in 3 states say Eagleton should quit race. New York Times. July 30, 1972:1 ,38.
- Toner R. Candidates' health discussed. New York Times. Aug. 3, 1988:A10.
- Rosenthal A. Dukakis releases medical details to stop rumors on mental health. New York Times. Aug. 4, 1988:A1 ,D20.
- The psychology barrier. New York Times. Aug. 5, 1988:A24.
- Bender E. With politics and mental illness, the more things change…. Psychiatric News 2002; 37 ( 21 ): 10.
- Benjamin M. What's in John McCain's medical records? Salon. May 22, 2008. http://www.salon.com/news/feature/2008/05/22/mccain/.
- Hitti M. Obama in “excellent health,” says doctor. WebMD Health News. May 29, 2008. http://www.webmd.com/news/20080529/obama-in-excellent-health-says-doctor.
- Amen DG. Getting inside their heads….really inside. Los Angeles Times. December 5, 2007.
Behavioral Healthcare 2008 September;28(9):22-21