A Call for Immediate Medical Evaluations of Presidential Candidates

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

The so-called Goldwater Rule presents an ethical principle for members of the American Psychiatric Association to not use their professional knowledge to speak publicly about public figures without their permission, such as our current Presidential nominees. However, it does not prohibit discussing the process involved in our system, which is the focus of today’s column.

In the July 2 New York Times article, “Biden’s Lapses Are Said to Be Increasingly Common and Worrisome,” various health concerns were raised about both current Presidential candidates.¹ In that article and many other media reviews of the recent Presidential debate, the reported lapses and confusion of President Biden were discussed. The New York Times noted that the White House physician Kevin C. O’Connor reported back in February that “despite minor ailments like sleep apnea and peripheral neuropathy,” tests turned up “no findings which would be consistent with” Parkinson disease and that Biden was still fit for duty.

On the other hand, back in February, special counsel Robert K. Hur characterized him as a “well-meaning man with a poor memory.” I have recently heard about other medical possibilities, some of which could have increased over the last 5 months: a transient ischemic attack on the brain, emerging Alzheimer disease, and rare forms of migraines like confusional migraine or ocular migraine among them. How episodic vs ongoing are the symptoms, treatable or not, and how severe vs mild, all in terms of the job requirements?

That same New York Times article also commented about Trump, another aging elder, noting that “he often confuses names and details and makes statements that are incoherent.” His campaign has only released a brief health summary. Previously, multiple psychiatrists made multiple diagnoses as discussed in the second edition of the book edited by Bandy Lee.² Self-disclosure: I cowrote a chapter on the environmental policies of his administration, but refused to try to diagnose him.

What these diagnostic questions about both current nominees raise for me is the growing need for anybody running for such societally important leadership positions to have an objective and independent complete medical evaluation, including neurological and psychiatric aspects, and that there is a summary released to the public. Likely, there would be resistance to releasing any adverse findings, but a normal report could be reassuring. The goal would be a reasonable projection for the next 4 years medically speaking, including the potential strengthening of wisdom. Here we have a medical ethical challenge of weighting risk to the public vs a patient’s right to confidentiality.

Given the questions about both nominees, I would recommend nothing less than such an evaluation be done before the upcoming party conventions. We in psychiatry know how common it is for individuals to avoid diagnosis of their mental health problems out of fear and denial, and know some ways to overcome it. When risk to self and others is high, commitment is possible, but for the less severe it takes finding the right motivation. Sometimes an intervention can work, especially in a repetitive substance abuse problem.

Potentially, there is even a more complex and challenging legal process, the Twenty-Fifth Amendment, which allows a President who is “unable to discharge the powers and duties of his office” to resign or be removed. However, there is only 1 President at a time, so that does not apply to both nominees. There is also the challenging task of assessing the strength and weaknesses of the supporting staff of each.

After I completed the first draft of this column, I noted the article “Dr. Sanjay Gupta: It’s time for President Biden to undergo detailed cognitive and neurological testing and share his results.”³ As far as I can tell, adequate cognitive testing has not even been done for either candidate, let alone the results released, yet it is recommended as part of any annual Medicare physical and well-being exam for those over 65. Dr Gupta is a neurosurgeon and CNN’s Chief Medical Correspondent.

Democracy depends on the people’s knowledge, reliable information, and ability to appropriately dissent. Cultish thinking, psychological denial, or even waiting to hear from God usually limits that possibility. Medical science, though it has its own limits as knowledge develops, can provide some of the answers if it is used, shared, and believed.

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. Baker P, Sanger DE, Kanno-Youngs Z, Rogers K. Biden’s lapses are said to be increasingly common and worrisome. The New York Times. July 2, 2024. Accessed July 8, 2024. https://www.nytimes.com/2024/07/02/us/politics/biden-lapses.html

2. Lee B, ed. The Dangerous Case of Donald Trump: 37 Psychiatrists and Other Mental Health Experts Assess a President. St. Martin’s Griffin; 2019.

3. Gupta S. Dr. Sanjay Gupta: it’s time for President Biden to undergo detailed cognitive and neurological testing and share his results. CNN. July 5, 2024. Accessed July 8, 2024. https://www.cnn.com/2024/07/05/health/gupta-biden-cognitive-testing-analysis/index.html