Tuesday, October 21, 2008

Mental health and the presidency

Several years ago a teenage client of mine had her first manic episode in the middle of her school day. Her behavior was bizarre enough that most people thought she was high on meth. I ended up intervening, getting her to the hospital, insisting on a urine test which I knew would be negative, and eventually getting her the proper diagnosis and help.

Most people I know who would be diagnosed with bipolar disorder would be angry, they'd be paralyzed, they wouldn't accept the diagnosis. And they would go around for the rest of their lives, not managing the diagnosis, and likely as a result, not realizing their full potential.

Not this teen. She showed up at her next appointment with a list of names. She decided to do an Internet search to see if any famous people had been diagnosed with bipolar disorder. On her list were some remarkable names, including Abraham Lincoln and Winston Churchhill. She said to me, "I decided that if Abraham Lincoln can be bipolar and do incredible things....so can I."

And that is what this remarkable woman has done ever since her diagnosis.

Her exercise intrigued me, and I've since become interested in reading biographies of American Presidents, not so much to learn the facts of the eras in which they led, but to learn more about their personalities. I began to see that many of them, in the documents and legacies they left, left some great clues for us regarding their personalities and mental functioning.

I recently surfed the Internet to see if anyone else had written about this, and learned that a few years ago, some researchers at Duke University actually did. They propose that about half of our presidents have actually had diagnosable mental disorders, if you use the criteria in the Diagnostic and Statistical Manual of Mental Disorders. The incidence cited is about what is found in the general population, so mental illness is not anything more common or rarer in our country's leaders.

Some of the examples they provide:

Ulysses S. Grant struggled with social phobia and alcohol abuse. This combination makes sense, since if you have trouble being around people and your job has a lot of people wanting to be around you...you're going to need some self-soothing at the end of a long day.
Howard Taft had sleep apnea and often fell asleep in meetings. Sleep apnea is correlated with depression.
Abraham Lincoln is thought to have been bipolar. One account I read said his depressive bouts were so severe he would not even allow himself to carry a pocket knife.
Franklin Pierce witnessed the violent death of his son in a railway accident just before he assumed office, and he suffered from symptoms indicating depression or post-traumatic stress during his term. The study noted that his associates described Pierce of being a different person than the one who had energetically campaigned for office.
Richard Nixon abused alcohol.
Calvin Coolidge reportedly had social phobia, and experienced depression after his son died
Thomas Jefferson's behavior was consistent with social phobia.
Theodore Roosevelt and Lyndon Johnson both are believed to have had bipolar disorder. (I read both their bios last summer and was struck with (1) the amount that Roosevelt accomplished during his term and (2) the extreme behavior that Johnson was allowed to act out in such a prominent position. It was like no one knew what to do with him, and he intimidated his way all the way up to the top. Just this week Johnson's bio was on PBS. If you're interested in this topic, get a hold of a copy. It's fascinating to watch his contemporaries describe his energy, his complexity, and his mood swings in the detail they did without ever using the words "manic" or "bipolar")
John Quincy Adams had clinical depression. (I recently read this bio and throughout, his writings reflected a despair that he was not accomplishing much with his life.)
Rutherford B. Hayes, James Garfield , and Dwight D. Eisenhower all appear to have had depression.
Franklin Pierce did, too, along with alcohol issues.
Woodrow Wilson lived with generalized anxiety disorder.
Ronald Reagan had Alzheimer's disease, which may have started to manifest during his service.

Contemporaries of several of these men even expressed, likely in observing behaviors related to these conditions, early on, that they may never achieve anything noteworthy in their lives.


1. Wow! My client is part of a distinguished list of people who proved themselves to be very important to our country and our heritage. I love to use this list with clients who have not had the courage to admit their diagnosis, for fear of being stigmatized. Having a mental health diagnosis is clearly not about lacking intelligence or capability to achieve great and wonderful things. And it's important to note, mental health diagnoses do not discriminate. They reach across those party lines and affect individuals regardless of their political bent.

2. I wasn't surprised to find this article. When I worked in a treatment center there seemed to be a disproportionate percentage of our population coming from what I used to call the "Big P" professions: Performers, Politicians, Psychologists (and related therapists and social workers), and Preachers (people in ministry-related work). I can't tell you why it played out that way, except for maybe the first two categories are people who use public attention as a way to convince themselves they're really ok and a way to distract from inner turmoil...and the latter as people who seek out professions looking for answers they haven't yet found. I won't get a Nobel Prize for that theory, and honestly, I'm just surmising.

And for anyone reading this who works in one of the "Big P" professions, please take my observation as a compliment. The most intelligent, creative, inspiring people I know are my clients. I think these variations on cognitive function are what drive our inventions, our art, our newest and greatest ideas. It's when we stigmatize people who have them and make them feel something is wrong with them that we prevent them from achieving their true potential.

3. I must qualify before saying anything here, I'm seriously considering not voting for President for the first time ever since I've voted. I'm simply not enthusiastic about either option this time around...so this is not at all a hint at my political leaning. But what I must say is that it distresses me very much that the party that supposedly is mental health-friendly seems to think it is ok as part of campaign strategy to needle the other party's candidate because he is "hot-headed".

I see the same personality, but coming from someone who was a POW, my first inclination is to think it's likely part of some understandable post-traumatic stress disorder. I don't think that someone who has PTSD and isn't managing it appropriately should be given responsibilities that his level of cognitive functioning are not able to manage. However, neither do I think it is responsible, especially if you call yourself mental health-friendly, to bully someone and then use the resulting response as a weakness to capitalize on for personal gain. Especially not when respecting and taking better care of veterans, a whole host of which are returning from Iraq with PTSD, is a prominent campaign issue.

I'm not sure I want to know what our country would be like had Thomas Jefferson and Theodore Roosevelt not served us, and therefore, I choose to refrain from jumping to the gun about anyone's mental state and fitness for a job I certainly wouldn't want to have myself.

As it is clearly illustrated in this Duke article, having a mental health diagnosis does not preclude one from greatness. Having a mental health diagnosis and not appropriately managing it, or treating someone as if they are a lesser person for having one...are the problems we'd be best to work at solving.

Davidson JR, Connor KM, Swartz M. Mental illness in U.S. Presidents between 1776 and 1974: a review of biographical sources. J Nerv Ment Dis. 2006 Jan;194(1):47-51.

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