Leadership’s Aging and Health Dilemma
By Michael A. Genovese, Loyola Chair of Leadership and Professor of Political Science at Loyola Marymount University. He is the author of 17 books, most recently, Memo to a New President, Oxford University Press.
As the presidential contest comes down to the two major party nominees, hard questions must be asked of both presidential aspirants. Democratic Party frontrunner Barack Obama’s youth and inexperience are legitimate issues for the Republicans to raise, as are the age and health issues of John McCain.
McCain will soon be 72 years old. Should he win in November, he would be the oldest U.S. president taking office, three-and-a half-years older than Ronald Reagan at the beginning of his presidency. The senator suffered terribly at the hands of his captors during the Vietnam War and in August 2000, his doctors removed melanomas, the most serious form of skin cancer, from his face and arm. Fortunately, these cancers have not returned.
Senator McCain has dealt with the age issue with self-deprecating humor. And while David Letterman compares McCain to “a Wall-Mart greeter,” the senator deflects the issue with comments such as “I’m as old as dirt.” Yet, the public may not be buying the McCain strategy. A recent Washington Post/ABC News poll found that more than a 25 percent of respondents said they were less likely to support McCain because of the age question.
While this issue may be sensitive for some, there is good reason to get it out in the open. We are after all, electing someone to what is commonly referred to as the most powerful office in the world. We need all the information we can gather to make an informed judgment about who will lead us. In a nuclear age and an age of terrorism, where the threats are so grave, we must demand full physical and mental health disclosure from all our presidential candidates.
The president may be called on at any time to make fateful decisions in a crisis, decisions that will impact the safety and security of the nation. Responding to sudden threats has become one of the most important challenges for a president. We have every right to demand that the person at the wheel of history is both physically and mentally prepared, competent and fully capable of responding rationally to all threats. Presidents must be and appear to be strong, prepared and in control.
Three types of mental or physical problems should concern us. The first is the Acute Disability such as a stroke or heart attack. Woodrow Wilson suffered a stroke and was debilitated for months, leading to the defeat of the proposed League of Nations; Eisenhower suffered heart attacks while in office and was incapacitated for months. This type of challenge is obvious, impossible to conceal and demands that the 25th Amendment be invoked and the vice president temporarily take over the wheel of government.
A second type of threat is the Secondary Disability, less obvious, easier to conceal, yet also quite threatening to the functioning of government. President John Kennedy’s concealed illnesses and the medications he was taking fall into this category.
Perhaps most dangerous and easiest to conceal is the Insidious Disability, one whose onset is gradual, hard to notice and difficult to fully recognize. Denial is the most common response to the onset of such challenges. Ronald Reagan’s early stages of Alzheimer’s disease may be such a case.
Many presidents faced serious mental and physical difficulties while in office. A recent study published in 2006 in The Journal of Nervous and Mental Disease found that nearly half of our presidents suffered from a mental illness at some time in their lives, and more than half of those disorders occurred while in office. This study suggests that both Theodore Roosevelt and Lyndon Johnson may have suffered from bipolar disorder. We may think of our presidents as supermen, yet in reality they are all too human, with warts, mental illnesses and physical challenges, just like the rest of us.
Thus, if history is to be our guide, there is reason to pause. When confronted with a 72-year-old candidate, it is reasonable to ask what impact physical and mental health and aging might have on governing.
Leaders face an especially difficult road where aging is concerned. As Jerrold M. Post and Robert S. Robins write in, “When Illness Strikes the Leader” (1993): “Not only are leaders prey to the illnesses that afflict us all, but for some the pressures of high office exact a special toll.” Even if we exclude those who were assassinated, American presidents “have had a substantially lower life expectancy than their fellow citizens of the same age.” Likewise, as John Moses and Wilbur Cross note in “Presidential Courage” (1980): “Paradoxically, this congregation of human beings who have been voted into the
Nation’s highest post has a history of disease, dementia, and disability – not to mention violence – higher in proportion than that of almost any other professional body on record.”
And their chilling conclusion? “From a purely statistical viewpoint, the chances are overwhelming that in the ranks of the next 10 presidents, two will suffer heart attacks; one will be hit by a disabling cerebrovascular accident; one will require surgery, radiation or chemotherapy for cancer; one will suffer a critical accident; one will develop serious emotional problems that will be partially or totally disabling; and several will require radical general surgery. This sobering medical profile does not take into account the statistic that one out of every 10 presidents is assassinated.”
A great deal of research points to a link between stress and illness. And there in no more stressful job than being president. Robert Gilbert notes in, “The Mortal Presidency” (1992) that in spite of having greater access to good medical care than most of us, two-thirds of our presidents died before reaching their life-expectancy. In short, the job of being president is dangerous to one’s health, politically, physically and mentally. And the impact of presidential illness – physical or mental – can be devastating, from emboldening adversaries to sending the stock market into a plunge to a president taking imprudent actions.
Rose McDermott, in her newly published book “Presidential Leadership, Illness, and Decision Making” (2007), examines the dangers presented by four presidents, as they faced serious foreign policy challenges while confronting almost debilitating illnesses: Woodrow Wilson’s stroke at the end of the First World War, FDR approaching death towards the conclusion of World War II, JFK’s use of potentially dangerous medications while in the midst of the Cuban Missile Crisis and Nixon facing a changing world in the throes of mental instability. McDermott makes a strong case that we faced enormous risks when our leaders were debilitated by physical and mental problems in crises.
Given the potential for a president’s age or illness to adversely affect the nation, it is legitimate, even necessary that we confront these questions openly. The office of president is too important for the nation and the world to allow what some may think is a question of tact or courtesy to interfere with the public getting information essential to making a reasoned decision about who will be the next president.
Posted 4-4-08