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.