Presidential Brain Function: Should we Know Before Pull The Lever

The following is from an email I received from a colleague this week. It brought to mind arguments and conversations I have had with friends, family and colleagues for several years. I am in full agreement with Dr Amen on the topic of presidential brain health or the lack thereof and not only our right to know about a candidate's brain health, as we have a right to know about his/her physical health, but our duty, as citizens, to demand such knowledge, for the very reasons that Daniel points out.

I've learned a few things in my discussions with numerous people on this subject:

People who have a low level of education or tend to be right-wing and/or who show signs of pathology, themselves, tend to have no use for psychiatrists/psychologists and "don't believe in psychiatry/psychology," whatever that means.

People with a high education level or tend to be to the left of center or moderate, politically do "believe in psychiatry," and/or have either seen a mental health professional at some time in their lives or knows someone who has.

When I have put forward the notion that presidential candidates and vice presidential candidates, for that matter, should have to take a full battery of psychological tests and have every type of brain imaging that we know is diagnostic or gives us a picture of the brain from which we can actually draw conclusions about the brain-function of the candidate, right-wingers usually run, screaming from such an idea. Some will hang around to argue that psychology is not a science and cannot be relied upon in such a way; as in deciding about something as important as electing a president.

I find that a jaw dropping argument, but that's just me. Everyone has a right to his/her opinion. But I can't help but find it highly interesting, if not amusing, that the very people who have, for years, diagnosed, mostly without a license to do so, an entire group of people (liberals) as loony, crazy, psychotic, etc. either don't believe in psychiatry or psychology or don't believe that candidates for president should be tested for mental health or the lack thereof.

People who do "believe in psychiatry/psychology" agree that we should and could find a way to test candidates that is exploitation-proof. They also believe it would be like trying to move a mountain to make candidates submit to mental health exams just as they do physical health exams and I'm afraid I have to agree with them on that point.

After all, while people who flip burgers and work in convenience stores must submit to the "piss police" in order to be employed, we, the people, have not a clue what types of drugs, if any, the top two officials in our government are taking. Does that make sense to anyone?

As we know, the president and this vice president are very powerful people. They could quite literally destroy the world or make large parts of it uninhabitable in less than an hour. They could declare martial law and suspend the constitution for years, should they feel threatened by the people for any reason, like with impeachment for example, and I, for one, have not seen anyone in Washington willing and with the courage to stop such an act.

Actually, I began thinking about this subject during the Clinton administration. I, and most of my friends, knew that Clinton had had a problem with womanizing. Who didn't know? What everyone who voted for him should have known was that under great and/or prolonged stress he might well return to it. What none of us could have possibly known was that the man was going to be investigated constantly from day one; that he would have the constant stress of one congressional investigation on top of another and a special prosecutor dogging his every step. The Clintons were the most investigated couple in American history, with the possible exception of the Rosenbergs and that is stress, whether one is guilty of anything or not. Add to the stress of being investigated for what amounted to nothing all those years, the normal stress of being the President of the United States and we have a situation which would almost surely have led to a relapse into his favorite "coping mechanism" and a character defect he had struggled with for years and one about which we all knew, unless we were living in a cave during the 1992 election..

I have always wondered why anyone was surprised that Clinton slipped back into his old ways?

The main problem with all of that was that it distracted the country from something far more important: Osama bin Laden. This was a man with $ millions who had bombed our embassies, our ship and declared war on the U.S., but many, many Americans had not a clue who the hell he was on the morning of 9/11/01. Why? Because the news media, in particular, and the press was fixated on Clinton's sex life. It all seems so childish and silly now, doesn't it?

After the last nearly two Bush administrations, anyone who isn't concerned about the mental health of our two top leaders either hasn't been paying attention or is as whacko as the Neocons, themselves, also known as the "effing crazies." (Just ask Colin Powell)

It doesn't take a professional to see that there is something seriously wrong with George W Bush and Dick Cheney. Nevertheless, the mental health professionals in this country and other countries have probably been the most alarmed for the longest period of time.

It is time to seriously discuss the importance of the degree of brain health in our leaders and our right to know before we exercise our duty to vote.

If there is anything we all should have learned in these last years it is that we can not afford, as a nation, to have leaders who with questionable mental health, not to mention psychopathology recognizable for miles.

GETTING INSIDE THEIR HEADS

By Daniel G. Amen MD
LA TIMES Op-Ed
December 5, 2007

What do Rudy Giuliani’s messy personal life, John McCain’s temper and Hillary Clinton’s inability to seem authentic have in common? Maybe nothing. They just may be overblown issues in the otherwise normal lives of candidates under the political microscope. Such symptoms, however, may mean a lot — such as evidence of underlying brain dysfunction. Sometimes people with messy personal lives have low prefrontal cortex activity associated with poor judgment; sometimes people with temper problems have brain damage and impulse control problems; sometimes people who struggle with authenticity have trouble really seeing things from someone else’s perspective.

Is the brain health of a presidential candidate a fair topic in an election year? Certainly Dick Cheney’s heart condition wasn’t off-limits in 2000, nor have questions about McCain’s age been considered out of bounds. The White House issues a complete medical history of the president each year — detailing everything from his seasonal allergic rhinitis to his adenomatous colon polyps. Clearly we care about the health outlook for our elected leaders. Should we go so far as to do brain scans? Of candidates for the Oval Office? Some people might consider discussing brain health a ridiculous idea. Not me.

As a neuropsychiatrist and brain-imaging expert, I want our elected leaders to be some of the “brain healthiest people” in the land. How do you know about the brain health of a presidential candidate unless you look? The brain is involved in everything humans do: how we think, how we feel, how we get along with others, how we negotiate, how we pay attention in meetings and how we turn away the advances of White House interns or decide to invade a country based on contradictory intelligence.

Three of the last four presidents have shown clear brain pathology. President Reagan’s Alzheimer’s disease was evident during his second term in office. Nonelected people were covering up his forgetfulness and directing the country’s business. Few people knew it, but we had a national crisis. Brain studies have been shown to predict Alzheimer’s five to nine years before people have their first symptoms.

President Clinton’s moral lapses and problems with bad judgment and excitement-seeking behavior — indicative of problems in the prefrontal cortex — eventually led to his impeachment and a poisonous political divisiveness in the U.S. The prefrontal cortex houses the brain’s supervisor, involved with conscience, forethought, planning, attention span and judgment.

One could argue that our current president’s struggles with language and emotional rigidity are symptoms of temporal lobe pathology. The temporal lobes, underneath your temples and behind your eyes, are involved with language, mood stability, reading social cues and emotional flexibility.

A national leader with brain problems can potentially cost millions of people their lives. Slobodan Milosevic and Saddam Hussein give us recent historical examples. Both of Milosevic’s parents committed suicide, he had serious bouts of depression and reportedly drank heavily — all signs that point to brain problems. He was found to be unreasonable and unreliable in negotiations and heartless as a political leader. Hussein was described as paranoid and without empathy, also symptoms pointing to poor brain function. His mother suffered severe bouts of depression and attempted suicide while pregnant with him, which is known to affect a baby’s developing brain. He was physically and emotionally abused by his stepfather. All of these stresses must have been involved in shaping his paranoid brain into a mind that could torture dissenters, murder relatives and launch chemical attacks that killed thousands.

Functional scans, such as Single Photon Emission Computed Tomography, provide a window into the brain. Doctors can now see healthy or dysfunctional brain patterns, much as we can assess the strength of a heart or measure hormone levels, and recognize trouble. All doctors might not agree on the interpretation, but there is a growing body of scientific literature establishing what these scans mean, such as a Attention Deficit Disorder or a predisposition for Alzheimer’s.

Ensuring that our president has a healthy brain may be more than an interesting topic of conversation. It can be important information to put into the election equation. A president with brain problems could wreak havoc on the U.S. and the world at large. Maybe we shouldn’t leave the health of our president’s brain to chance. We have the tools, shouldn’t we look?

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