Psychiatric Taboo in Presidential Health

DANIEL S. GREENBERG

December 08, 1992|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- The recent recurrence of cancer in Paul Tsongas has revived the issue of medical disclosure by presidential aspirants, with Mr. Tsongas conceding some shortfall of candor about his health while pursuing the Democratic nomination.

No excuse for that. But the understandable concern with presidential health among press and public has followed a barren course, focusing on physical health, while ignoring the real danger, psychiatric disorder.

How easily we find confidence in the easy measurables of physical examinations, even if the predictive value of the check-up is slight for any particular individual. Sudden death or serious illness occurs among people with all the right check-up results, while sickly people often live long and productive lives.

The relationship between physical illness and performance and longevity is by no means certain. By reasonable measures of physical status, John F. Kennedy was a very poor prospect for the rigors of the presidency. For political survival, he fudged his affliction with Addison's disease and concealed the miseries of his seriously injured and chronically painful back. He suffered, but without evident effect on his presidential performance.

The more dreadful consequences of presidential infirmity are likely to originate in the mental condition of the person who occupies the oval office.

Mental condition, however, is forbidden territory in politics. By silent agreement, all candidates are assumed to be in tip-top psychiatric condition. Nothing else is permissible and therefore the topic is excluded from the candidates' customary medical disclosures. The silence is reinforced by awareness that a sure exit from candidacy is guaranteed by disclosure of having undergone psychiatric treatment.

The psychiatric taboo was vividly demonstrated in 1972 when the Democratic vice-presidential candidate, Sen. Thomas Eagleton, was dropped from the ticket after it became known that he had been treated for depression. In the 1988 campaign, Michael Dukakis emphatically disputed reports that he had received psychiatric treatment. Given the choice of revealing whether they had consulted a psychiatrist or an astrologer, there's no doubt which the candidates would choose.

Everyone has known a person in authority who was slightly disturbed or worse. Why ignore the same possibility in presidential candidates, while concentrating on blood pressure, weight, cholesterol level and commonly recognized measures of physical health? There's no reason to assume that presidents are immune to depression, hallucinations, fears of persecution, distorted perceptions, or any of the many other afflictions of the human mind.

For reasons of cultural squeamishness, psychiatric status is out of bounds in reporting the health status of presidential candidates. It will be argued that medicine knows more about the body than about the mind and that any attempt to assess the psychiatric condition of candidates would become bogged down in professional disputes and political exploitation.

In reality, however, medicine is riddled with disputes about the value of physical check-ups for detecting hidden health problems. Controversy rages about the significance of cholesterol levels. The patchy state of medical agreement on physical treatments is evident in a recent article in the Journal of the American Medical Association which observed that ''over 60 percent of the practitioners of unproven treatments for cancer hold an M.D., a Ph.D., or both from an accredited medical school or graduate school.''

Since any brush with psychiatry is a political kiss of death, politicians will either shun treatment or conceal it. No seeker of office, high or low, will acquiesce to assessment by a board of mental-health specialists. Too risky, too susceptible to ridicule and political misuse. Imagine the field day for political cartoonists if the public report of the president's annual physical exam included a psychiatric section.

The danger of mental disturbance in high office is as real as the danger of heart disease and other serious physical ailments. But the consequences of mental disturbance could be far greater.

Given the state of psychiatry and public attitudes about it, there's no feasible formula for adding psychiatric condition to our expectations for presidential medical disclosure.

But, let's face it: the political process is ducking a serious issue.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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