U.S. Presidents and Bipolar Disease (BPD) or Major Depression Disease (MDD)

It is tremendously difficult to search for reliable statistics about the incidence of BPD, MDD and Schizophrenia. After much effort on the internet the statistics that most jived were 0.8% for bipolar I, 1.8% for bipolar II and 1.0 % for schizophrenia. Looking for numbers for unipolar or MDD vary from developed to developing countries. For the former the average number is 7% for recurrent major depression and 8 to 15% for lifetime incidence of a single episode of a major depression episode. In this article I will be talking about recurrent major depression. So, if one adds the three diseases that have major depression, bipolar I, II and MDD the actual prevalence of major depression is 9.6%. I believe this is where in the lay literature and even in blanket statements by national mental illness organizations such as the NAMI and NIMH quote a figure of 10% for major depression. If I look at that figure alone for MDD alone it seems way too high but not if one adds the two bipolar diseases that have major depression as components. Whew.

Now as to MDD and BPD from 1776 to 1974 a major study was conducted by the psychiatry department at Duke University and published on 2006. “Mental Illness in U.S. Presidents between 1776 and 1974 – A Review of Biographical Sources.” This article can be downloaded from a pdf file from The Journal of Nervous and Mental Diseases, 2006; 194 (1): 47-51. The lead authors are J.R. Davidson, K.M. Connor and M. Swartz.

In their introduction they mention King George III of England also called the “Mad King” (even at the time) as he was frankly psychotic. You will recognize he was king during the revolutionary war. How could we lose, right!

Their sources were biographies, letters, journals, narrative accounts and medical books. This was done much as I did in my article about Abraham Lincoln and the Civil War, with MDD, and Robert Lowell, poet emeritus, with BPD.

They used criteria from the DSM-IV, section or axis I, the book used by psychiatrists worldwide major mental illnesses.  In summary they found that of the 37 Presidents, 18 exhibited psychiatric disorders. 14 suggested one disorder. 4 had two or more. In the case of Woodrow Wilson the study participants could not agree as to generalize anxiety disorder (GAD) or MDD.

In order of frequency the diseases were unipolar depression or MDD (9/18), anxiety, alcohol abuse or dependence, somatoform disorder, bipolar I or II (3/18), paranoia due to stroke, sleep apnea.

In ten of the 18, 10 occurred while in office and in all of those except Theodore Roosevelt the disorder was felt to affect performance while in office.

They propose why the incidence of the major diseases, BPD and MDD, were so much higher than that of the general population as I outlined at the beginning of this piece. They posited three groups, those who had disease early in life and had recovered before office, those with persistent disease worsened by the stress of office and late life neuropathology such as stroke or dementia (Ronald Reagan).

I would present another hypothesis why so many high functioning men went on to become Presidents. We all know that MDD, BPD and S are very often associated with high intelligence. I have referred in both my books the many famous people past present who were remarkable productive in their various fields. See Kaye Redfield Jamison’s book, “Touched with Fire: Manic –Depressive Illness and the Artistic Temperament.” (1993, Free Press) Look particularly at appendix III which lists which painter, composer, writer, poet, etc. had MDD, BPD, hospitalization, ECT or suicide. She does not even talk about all the great politicians and military figures in history.

So, my other hypothesis is not my own. Dr. Nassir Ghaemi wrote a book, “A First – Rate Madness: Uncovering the Links between Leadership and Mental Illness. “ (2011, Penguin). He calls this relationship of intelligence to the three major mental illnesses, “the inverse law of sanity.”

The book is divided into fourteen chapters. Each is devoted to a political and military figure who, again, through biographies, letters, narratives, etc. have been forensically diagnosed with MDD or BPD: William Tecumseh Sherman, Winston Churchill, Mahatmas Gandhi, Franklin D. Roosevelt, and John F. Kennedy.

At the end of the book he cites contemporary exceptions. A Freudian disciple named Roy Grinker in the 1930s coined a word (not in dictionaries) homoclite, an adjective. It describes people who follow the normal or average path through life and may sometimes slip into a leadership role. These are so-called homoclite leaders. His examples are George W. Bush, with an IQ of 120, Tony Blair, General George McClellan, and Neville Chamberlain.  Each became leaders and did not suffer from MDD or BPD. (Whew, thanks for that.) Interesting that Nixon, who Ghaemi, argues did not have a mental illness, coined the term, “Silent Majority.” He makes a case for Nixon being just stupid who turned to alcohol and pills!

In a nutshell, Ghaemi proposes that anyone who has suffered through an episode of major depression with or without mania and survived has seen what severe adversity is. They have stared down (what I call) the beast and come out the other side. So, when an external crisis arises such as WWII in Churchill’s case or the Cuban Missile Crisis in Kennedy’s case they are better able to step up to the plate, focus on the problem and make decisions. They use that intellect that comes with that genetic disease to the common good. Sherman saw that the only way to end the bloodiest war (in terms of deaths) in history was to take drastic action, the famous march to the sea to take Atlanta.

So, I have read biographies of almost all the Presidents and I am going to write an article on each of them with either BPD or MDD. I am going to start with Lyndon Baines Johnson.

Until the next time, I remain a retired physician with BPD never cured, always working with my psychiatrist to adjust medications, still having occasional morning terror and occasional being the wise-ass who pisses people off but mostly loves writing. As in doctoring I just want to know that I help folks.