TCS Daily


Presidential Head Games

By Sydney Smith - September 10, 2004 12:00 AM

Medical innuendoes are starting to fly in the Presidential campaign. Rumors about George Bush's drug abusing past are circulating again, and former Dukakis aide, Susan Estrich suggested in a syndicated column that Bush is unfit for office because he's an alcoholic:

"Is any alcoholic ever really cured?... What if Bush were to fall off the wagon? Then what? Has America really faced the fact that we have an alcoholic as our president?"

Others have raised concerns about John Kerry's mental health, suggesting that he may have a sleep disorder, or at the very least, a post-traumatic stress disorder, if his wife's account, reported in the Washington Post, is accurate:

"When Kerry is asked about the nightmares that haunted his sleep for years after he returned from Vietnam, he shrugs. 'I don't think I've had a nightmare in a long time,' he says. But then Heinz begins to mimic Kerry having a Vietnam nightmare.

"'Down! Down, down!' she yells, patting her hands down on her auburn hair.

"'I haven't gotten slapped yet,' she says. 'But there were times when I thought I might get throttled.'

"Kerry quivers his right foot and steers the discussion to the counseling programs he has supported for Vietnam veterans. Asked if he has been in therapy himself, he non-answers. 'It doesn't bother me anymore, I just go back to sleep.'

"Heinz presses him. 'Not therapy for the dreams, therapy for the angst,' she says, and looks quizzically at him, awaiting an answer. Kerry shakes his head 'No.'"

To some extent, the medical condition of a candidate is fair game. Voters should know if a candidate has terminal cancer, or a serious heart condition, or a history of strokes. On the other hand, we really don't need to know about every hemorrhoid and mole they might have had treated.

A candidate's mental health record is a dicier call, however. Severe mental illness can certainly be as detrimental to a candidate's ability to perform in office as a physical illness. No nation can afford a leader who is paralyzed by depression or anxiety, or whose judgment is distorted by substance abuse. Mental illnesses tend to be chronic and unpredictably recurrent. Alcoholics can relapse. One-third of post-traumatic stress disorder patients never fully recover. But mental illnesses are not necessarily life sentences. Many post-traumatic stress disorder patients do successfully recover. Depression and anxiety can be overcome. Alcoholics can and do stay sober.

Unfortunately, a history of mental illness lends itself much more easily than physical illness to smear campaigns. A whiff of a physical illness reminds us of a candidate's mortality. A whiff of mental illness makes us question his strength of character. We shouldn't be so quick to judge. There's compelling evidence that Abraham Lincoln suffered from depression, even before the Civil War. By today's standards, Winston Churchill would be considered an alcoholic. Yet they're both rightly admired for their leadership during some of history's darkest days.

Does it matter that George Bush is an alcoholic? Would it matter if John Kerry has post-traumatic stress disorder? It depends on how well they handle it. We know that Bush is an alcoholic, he freely admits it. And that admission is the first and foremost step in the successful treatment of any mental illness. We don't know if John Kerry left Vietnam with lasting psychic wounds. He only evades the question when asked. And that evasion is the most disturbing aspect of the Teresa Heinz-Kerry anecdote. It suggests that he has yet to come to terms with the question himself.

Sydney Smith is a TCS contributor. A family physician who has been in private practice since 1991, she is board certified by the American Board of Family Practice, and is a Fellow of the American Academy of Family Practice. She is the publisher of MedPundit.


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