medicine in politics

RECENT POSTS

When Presidential Brains Go Awry: Neuro Disorders In The Oval Office

Ronald Reagan’s family is still arguing about whether he had signs of Alzheimer’s during his time in the Oval Office. Here's the official portrait of the Reagans on the White House grounds in 1988. (Wikimedia Commons)

Ronald Reagan’s family is still arguing about whether he had signs of Alzheimer’s during his time in the Oval Office. Here’s the official portrait of the Reagans on the White House grounds in 1988. (Wikimedia Commons)

By Richard Knox

Thomas Jefferson probably suffered from migraines. Woodrow Wilson had a devastating stroke while in office. FDR was known to have seizure-like blank-outs. And Ronald Reagan’s own family is still arguing about whether he had signs of Alzheimer’s during his time in the Oval Office.

The health of presidents is a perennially intriguing subject. But this Presidents Day weekend, a New York neurologist is focusing new attention on the presidential disorders that arguably matter most: those of the brain and central nervous system.

“Do we really know about the health status of our leaders and should we?” asks Dr. Nicholas Silvestri. “I think in the case of neurologic illness, we should.”

Dr. Nicholas J. Silvestri

Dr. Nicholas J. Silvestri (Sandra Kicman, University at Buffalo)

Silvestri, a history buff on the faculty of the University at Buffalo School of Medicine and Biomedical Sciences, thinks commanders-in-chief ought to undergo neuropsychological testing just as regular recruits do.

And he wonders if the 48-year-old 25th Amendment, which provides for presidential succession if a president becomes unfit to govern, is really suited to determine cognitive or mental fitness. That’s a touchy matter the Constitution currently leaves entirely in political hands.

Now, of course, too rigorous a screen could deprive the nation of a truly great (if mentally flawed) president. Abraham Lincoln, for example, famously suffered from depression.

We’ll come back to the issue of how presidential brain unfitness should be determined. But first, let’s take a journey through the surprising twists and turns of the neurological history of U.S. presidents, guided by Silvestri. He pulled that history together for a Lincoln’s Birthday seminar in Buffalo, and described its high points in an interview.

Migraine, Seizures, Strokes

First stop: migraine headache. It’s a common ailment that doesn’t disqualify anyone from a highly responsible job. But still, migraines are “an extremely debilitating collection of neurological symptoms,” as the Migraine Research Foundation puts it — possibly a matter of concern in a president who needs to function at the top of his game during a crisis.

Silvestri says there’s evidence that John Adams, Jefferson, Lincoln, Dwight Eisenhower and John F. Kennedy suffered from migraines.

James Madison and FDR probably had seizure disorders, Silvestri says. From his college years, Madison was known to have spells that temporarily paralyzed him. “He would stare off, become immobile, and not react to his surroundings,” Silvestri says. It may be a reason Madison didn’t fight in the Revolution.

Silvestri thinks Madison’s spells were probably psychogenic seizures — a reaction to stress. “It’s what Freud describes as hysteria,” he says.

Whatever it was, Madison evidently grew out of it. The disorder didn’t prevent him from coauthoring the Constitution or the Federalist Papers, nor hinder him as president. “He was the last president to lead a field army in battle, during the War of 1812,” Silvestri notes.

FDR Didn’t Have Polio? 

FDR probably didn’t suffer from polio -- the disease he has long been associated with. Instead, many researchers think the evidence points to a different cause of FDR’s paralysis -- a rarer disease called Guillain-Barre syndrome. Here he is in 1943. (George R. Skadding/AP)

FDR probably didn’t suffer from polio — the disease he has long been associated with. Instead, many researchers think the evidence points to a different cause of FDR’s paralysis — a rarer disease called Guillain-Barre syndrome. Here he is in 1943. (George R. Skadding/AP)

FDR’s health problems are well known. They include the polio he supposedly suffered at the age of 39, his subsequent lifelong leg paralysis, and the soaring blood pressure that led to a fatal brain bleed two months after the Yalta Conference that carved up post-war Europe.

Less known are the seizures he had throughout his presidency. Continue reading