47 Arthur Koestler called this kind of executive the Commissar: Arthur Koestler, The Yogi and the Commissar, and Other Essays (New York: Collier, 1961).

48 “defined almost exclusively in terms of growth”: “In Sickness and in Power: Hubris Syndrome and the Business World,” speech by Right Honorable Lord David Owen at the Association of British Neurologists Joint Annual Meeting, Liverpool, England, June 25, 2009, written transcript, 13. As we’ll see in chapter 14, Owen thinks that poor leaders suffer from a “Hubris syndrome,” where they increasingly lose touch with reality and make harmful decisions. My view is that this outcome occurs more in the mentally healthy “normal” leader than in the mentally abnormal leader.

CHAPTER 3. HEADS I WIN, TAILS IT’S CHANCE

51 decided to test it on undergraduates: L. B. Alloy and L. Y. Abramson, “Judgment of Contingency in Depressed and Nondepressed Students: Sadder but Wiser?” Journal of Experimental Psychology 108 (1979): 441–485.

52 Ellen Langer and Jane Roth: Ellen J. Langer and Jane Roth, “Heads I Win, Tails It’s Chance: The Illusion of Control as a Function of the Sequence of Outcomes in a Purely Chance Task,” Journal of Personality and Social Psychology 32 (1975): 951–955.

53 “positive illusions”: Shelley E. Taylor and David A. Armor, “Positive Illusions and Coping with Adversity,” Journal of Personality 64 (1996): 873–898.

54 One study even quantified this principle: Robert A. Cummins and Helen Nistico, “Maintaining Life Satistfaction: The Role of Positive Cognitive Bias,” Journal of Happiness Studies 3 (2002): 37–69.

CHAPTER 4. OUT OF THE WILDERNESS: CHURCHILL

58 the “sex goddess” of Victorian England: John Pearson, The Private Lives of Winston Churchill (New York: Simon and Schuster, 1991), 68.

58 Lord Randolph’s son Winston had a different mental illness: Ibid., 130. “Mrs. Diana Churchill ‘Suicided,’” The Age (Melbourne, Australia), October 25, 1963, http://news.google.com/newspapers?id=wVARAAAAIBAJ&sjid=EJUDAAAAIBAJ&pg=5979, 4123402 (accessed February 26, 2011).

59 “For two or three years the light faded”: Baron Charles McMoran Wilson Moran, Churchill: The Struggle for Survival, 1940–1965 (Boston: Houghton Mifflin, 1966), 179.

59 “I don’t like standing near the edge of a platform”: Ibid.

59 “I don’t like sleeping near a precipice like that”: Ibid., 309.

60 His friend Lord Beaverbrook noted: William Manchester, The Last Lion: Winston Spencer Churchill; Visions of Glory, 1874–1932 (New York: Little, Brown, 1983), 24.

60 “He is a mass of contradictions”: David Owen, In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years (Westport, CT: Praeger, 2008), 41.

60 Numerous physicians who knew Churchill: Anthony Storr, Churchill’s Black Dog, Kafka’s Mice (New York: Ballantine, 1990). W. Russell Brain, “Encounters with Winston Churchill,” Medical History 44 (2000): 3–20. Owen, In Sickness and in Power.

60 “the drive and vitality and youthfulness of a cyclothyme”: Brain, “Encounters with Winston Churchill.”

60 “We are all worms”: Quoted in Lord David Owen, “Winston Churchill and Franklin Roosevelt: Did Their Health Problems Impair Their Effectiveness as World Leaders?” Churchill Lecture Series, Churchill Museum and Cabinet War Rooms, May 5, 2009, written transcript, 9.

61 “You know, that was Churchill’s idea”: Frances Perkins, The Roosevelt I Knew (New York: Viking Press, 1946), 383.

61 The course of his depressive episodes: Pearson, The Private Lives of Winston Churchill. Moran, Churchill. Martin Gilbert, In Search of Churchill (New York: Wiley, 1994).

62 “The PM was in a crazy state of exultation”: John Harvey, The War Diaries of Oliver Harvey (London: Collins, 1978), 274.

62 “great fluctuation of mood”: Owen, In Sickness and in Power, 42.

62 “He felt that everything he had done”: Pearson, The Private Lives of Winston Churchill, 416.

62 “I have achieved a great deal”: Storr, Churchill’s Black Dog, 19.

62 gave Churchill amphetamines: Richard Lovell, “Lord Moran’s Prescriptions for Churchill,” British Medical Journal 310 (1995): 1537.

62 “I have taken more out of alcohol”: Chris Wrigley, Winston Churchill: A Biographical Companion (Santa Barbara, CA: ABC-CLIO, 2002), 13.

62 His daily routine involved: www.winstonchurchill.org (accessed December 16, 2010).

63 Once, when he was hit by a car: Winston Churchill, correspondence with Dr. Otto C. Pickhardt, January 1932, http://www.christies.com/LotFinder/lot_details.aspx?intObjectID=5382265 (accessed February 26, 2011).

63 “In 1940 when all the odds were against Britain”: Storr, Churchill’s Black Dog, 4–5.

64 the Duke of Westminster: Lynne Olson, Troublesome Young Men: The Rebels Who Brought Churchill to Power and Helped Save England (New York: Macmillan, 2008), 67–69.

64 “an Austrian Joan of Arc”: Ibid., 68.

65 “a born leader”: Ibid., 69.

65 “It was no business of ours”: Ibid., 66.

65 “When Winston was born”: Martin Gilbert, Winston Churchill: The Wilderness Years (Boston: Houghton Mifflin, 1984), 155.

66 “In spite of the hardness and ruthlessness”: Robert C. Self, Neville Chamberlain: A Biography (Farnham, UK: Ashgate, 2006), 573.

66 “How could honourable men with wide experience”: Gilbert, Winston Churchill, 234.

66 “Winston has always been a ‘despairer’”: Storr, Churchill’s Black Dog, 16.

CHAPTER 5. BOTH READ THE SAME BIBLE: LINCOLN

68 Lincoln’s Melancholy: Joshua Wolf Shenk, Lincoln’s Melancholy (Boston: Houghton Mifflin, 2005).

68 “In early January 1841”: Ibid., 56.

69 “Lincoln ‘told me that he felt like committing suicide often’”: Ibid., 19.

69 “was the victim of terrible melancholy”: Ibid., 22.

69 “often got the ‘blues’ ”: Ibid., 12.

69 “His great-uncle once told a court of law”: Ibid., 12–13.

70 Regarding the course of his illness: Ibid., passim.

70 Dr. Anson Henry: Ibid., 57.

70 “The Doctors say he is within an inch of being a perfect lunatic”: Ibid., 58.

71 prescribed mercury tablets . . . also bled Lincoln: Ibid., 59.

71 “I am now the most miserable man living”: Ibid., 62.

71 “fun and hilarity without restraint”: Ibid., 23.

71 “As a nation, we began by declaring that ‘all men are created equal’”: Sean Wilentz, ed., The Best American History Essays on Lincoln (New York: Palgrave Macmillan, 2009), 139.

73 “I would like to have God on my side”: Ibid., 219.

73 “you and we are different”: Ibid., 76.

74 “Here comes my friend Douglass”: Ibid., 80.

74 Some historians think the war changed Lincoln: Ibid., 79.

75 “Whenever I hear anyone arguing for slavery”: Ibid., 81.

75 “Both read the same Bible”: Lincoln’s second inaugural address, transcript of original manuscript, http://www.ourdocuments.gov/doc.php?doc=38&page=transcript (accessed February 26, 2011).

76 General James Longstreet: William L. Richter, “James Longstreet: From Rebel to Scalawag,” Louisiana History: The Journal of the Louisiana Historical Association 11 (1970): 215–230.

CHAPTER 6. MIRROR NEURON ON THE WALL

80 the English translation . . . captures this usage: E. B. Titchener, Lectures on Experimental Psychology of the Thought Processes (New York: Macmillan, 1909).

80 Karl Jaspers made empathy central to psychiatry: Karl Jaspers, General Psychopathology (Baltimore: Johns Hopkins University Press, 1997).

80 Thomas Insel and associates at the National Institute of Mental Health: T. R. Insel and L. E. Shapiro, “Oxytocin Receptor Distribution Reflects Social Organization in Monogamous and Polygamous Voles,” Proceedings of the National Academy of Sciences USA 89 (1992): 5981–5985.

81 The next hint about empathy came from studying macaques: Reviewed in V. Gallese and A. Goldman, “Mirror Neurons and the Simulation Theory of Mind-Reading,” Trends in Cognitive Sciences 2 (1998): 493–501.

82 Psychologists divide empathy into different parts: S. G. Shamay-Tsoory, “Empathic Processing: Its Cognitive and Affective Dimensions and Neuroanatomical Basis,” 216–232, and C. D. Batson, “These Things Called Empathy: Eight Related but Distinct Phenomena,” 3–16, both in Jean Decety and Willam Ickes, eds., The Social Neuroscience of Empathy (Cambridge, MA: MIT Press, 2009).

83 It is generally estimated that at least one-half of human communication is nonverbal: Albert Mehrabian and Susan R. Ferris, “Inference of Attitudes from Nonverbal Com-Albert Mehrabian and Susan R. Ferris, “Inference of Attitudes from Nonverbal Communication in Two Channels,” Journal of Consulting Psychology 31 (1967): 248–252.

83 severely depressed patients had much higher scores: L. E. O’Connor et al., “Guilt, Fear, Submission, and Empathy in Depression,” Journal of Affective Disorders 71 (2002): 19–27.

84 patients with various psychiatric illnesses: E. Knott and L. M. Range, “Does Suicidal History Enhance Acceptance of Other Suicidal Individuals?” Suicide and Life-Threatening Behavior 31 (2001): 397–404.

85 patients’ ratings of their psychotherapists’ empathy: D. D. Burns and S. Nolen-Hoeksema, “Therapeutic Empathy and Recovery from Depression in Cognitive-Behavioral Therapy: A Structural Equation Model,” Journal of Consulting Clinical Psychology 60 (1992): 441–449.

CHAPTER 7. THE WOES OF MAHATMAS: GANDHI

87 identification with his mother: Erik H. Erikson, Gandhi’s Truth: On the Origins of Militant Nonviolence (New York: Norton, 1969), 153–158. While Erikson’s analysis is more extensive than presented here, it never engages with Gandhi’s depression.

88 “I watched day after day”: Karen E. James, “From Mohandas to Mahatma: The Spiritual Metamorphosis of Gandhi,” Essays in History 28 (1984): 5–20, http://www.lib.virginia.edu/area-studies/SouthAsia/gandhi.html.

88 “was literally praying that God should gather him”: Ibid.

88 “He was very shy and withdrawn”: Erikson, Gandhi’s Truth, 99.

89 “Our want of independence began to smart”: Mohandas K. Gandhi, Autobiography: The Story of My Experiments with Truth (New York: Dover, 1983 [1948]), 22–23.

89 “I decided at last to write out the confession”: Ibid., 23.

90 only about 2 percent of children try to kill themselves: Ronald C. Kessler, Guilherme Borges, and Ellen E. Walters, “Prevalence of and Risk Factors for Lifetime Suicide Attempts in the National Comorbidity Survey,” Archives of General Psychiatry 56 (1999): 617–626. David M. Fergusson and Michael T. Lynskey, “Childhood Circumstances, Adolescent Adjustment, and Suicide Attempts in a New Zealand Birth Cohort,” Journal of Child and Adolescent Psychiatry 34 (1995): 612–622.

90 Indeed, 90 percent of children who attempt suicide: David Shaffer, Madelyn S. Gould, Prudence Fisher, Paul Trautman, Donna Moreau, Marjorie Kleinman, and Michael Flory, “Psychiatric Diagnosis in Child and Adolescent Suicide,” Archives of General Psychiatry 53 (1996): 339–348. Fergusson et al., “Childhood Circumstances.”

90 (or possibly, given some hypersexuality, cyclothymia): Based on incomplete and debated evidence, it is also possible that Gandhi’s baseline temperament consisted of cyclothymia. Some observers report that Gandhi sometimes had a high amount of energy, as exemplified by his habit of taking long, vigorous walks (Fischer, Gandhi: His Life and Message for the World, 1954). There is also some evidence of possible hypersexuality: for instance, in his Autobiography, Gandhi describes very high libido when he first got married; he describes marked guilt because he was engaged in sexual intercourse with his wife at the very moment his father died. He felt he could not control his urges even enough to stay by his father’s deathbed. Freud once remarked that a major prohibition usually reflects a profound instinctual urge. In this sense, Gandhi’s later emphasis on celibacy may reflect a strong sexual instinct. In his later life, there was also a controversy around the fact that Gandhi slept with his young niece. Some close aides even left the Mahatma over that scandal. Gandhi claimed he was only testing his vow of celibacy, and that he was literally sleeping, not having sex. If these controversies and claims are correct, then these behaviors are not consistent with pure dysthymia but may reflect periods of high energy and hypersexuality, which would make a cyclothymic temperament more likely. I did not make that diagnosis in the text because the veracity of these claims is not entirely clear to me. At least Gandhi had dysthymic temperament, I would conclude, but he possibly had cyclothymic temperament instead. Bal Ram Nanda, Gandhi and His Critics (New York: Oxford University Press, 1994), 14–17. Jad Adams, Gandhi: Naked Ambition (London: Quercus Publishing, 2011).

90 “I was a coward”: Gandhi, Autobiography, 17.

90 “I always felt tongue-tied”: Ibid., 55.

91 “I felt the illness was bound to be prolonged”: Ibid., 407–408.

92 the unfortunate life of Gandhi’s eldest son: Chandulal Bhagubhai Dalal, Harilal Gandhi: A Life (Chennai, India: Orient Longman, 2007).

93 “My attitude towards the English”: Louis Fischer, The Essential Gandhi (New York: Vintage, 1983), 192–193.

93 “We can do nothing without Hindu-Moslem unity”: Ibid., 253.

94 “Three-fourths of the miseries and misunderstandings in the world”: Ibid., 255–256.

95 “Europe has sold her soul”: Richard Grenier, “The Gandhi Nobody Knows,” Commentary, March 1983, 59–72.

95 “Let them take possession of your beautiful island”: Ibid.

95 They repeat the conventional wisdom: This viewpoint was later repeated by Erik Erikson in conversations with Huey P. Newton, the founder of the Black Panther Party in the 1960s, and a critic of King’s nonviolence. Erik H. Erikson and Huey P. Newton, In Search of Common Ground (New York: Norton, 1973).

96 Gandhi tried to persuade Nehru and other Hindu leaders: Documents online at http://www.oocities.org/sadna_gupta/Extra6A_1940to43offersofJinnahPMship.html (accessed February 26, 2011).

96 to give Pakistan £44 million: Bal Ram Nanda, Gandhi and His Critics (New York: Oxford University Press, 1994), 109.

97 “There was a time when people listened to me”: Fischer, The Essential Gandhi, 355–356.

97 “He said, there was a time when India listened to him”: Arthur Koestler, The Yogi and the Commissar, and Other Essays (New York Collier, 1961), 267.

97 “what he had mistaken for Satyagraha”: Ibid., 266.

97 “Where do congratulations come in?”: Fischer, The Essential Gandhi, 362.

98 “The woes of Mahatmas”: Gandhi, Autobiography, 215.

98 “a dark and deadly future”: Fischer, The Essential Gandhi, 368.

CHAPTER 8. PSYCHIATRY FOR THE AMERICAN SOUL: KING

99 “For several minutes, Gandhi and his guests discussed Christianity”: Lerone Bennett, What Manner of Man: A Biography of Martin Luther King Jr. (Chicago: Johnson Publishing Company, 1964), 3–4.

100 American black leaders had become deeply interested in satyagraha: Vijay Prashad, “PropaGandhi Ahimsa in Black America,” Little India, 2002, http://www.littleindia.com/march2002/PropaGandhi%20Ahimsa%20in%20Black%20America.htm (accessed January 17, 2011).

100 “The black workers led by young, educated ministers”: William Edward Burghardt DuBois, W. E. B. DuBois: A Reader (New York: Macmillan, 1995), 92.

100 “The American Negro is not yet free”: Ibid.

101 An edited collection of his papers, published after his death: Clayborne Carson, ed., The Autobiography of Martin Luther King Jr. (New York: Warner Books, 1991).

101 Time magazine reported in its 1963 “Man of the Year” article: Available at http://www.time.com/time/subscriber/personoftheyear/archive/stories/1963.html (accessed September 3, 2010).

101 “The first incident occurred”: Bennett, What Manner of Man, 18.

102 Jesse Jackson recalls: Jesse Jackson, online oral interview, http://www.thehistorymakers.com/programs/dvl/files/Jackson_Jessef.html (accessed January 17, 2011).

102 This MLK was too radical for many: Vincent Harding, Martin Luther King: The Inconvenient Hero (Maryknoll, NY: Orbis Books, 1996).

103 “By 1968, King was working at a frenzied pace”: Stephen B. Oates, Let the Trumpet Sound: A Life of Martin Luther King, Jr. (New York: Harper and Row, 1982), 440.

103 “‘Bayard,’ King said [to Rustin]”: Ibid., 444–445.

104 “After the Meredith march, there were fewer marches”: Author interview with Alvin Pouissant, Boston, January 29, 2010.

104 “What I have been doing is giving, giving, giving”: David Garrow, Bearing the Cross: Martin Luther King, Jr., and the Southern Christian Leadership Conference (New York: HarperCollins, 2004), 125.

105 Dr. Poussaint . . . gave me a firsthand assessment: Author interview with Alvin Pouissant, January 29, 2010.

107 some of King’s aides urged their leader to get psychiatric help: Oates, Let the Trumpet Sound, 440.

107 “Psychologists would say that a guilt complex”: The King Papers Project, Stanford University, http://mlk-kpp01.stanford.edu/primarydocuments/Vol4/27-Oct-1957_InterviewByAgronsky.pdf (accessed September 3, 2010).

107 “put our outrage into perspective”: Andrew Young, A Way Out of No Way (Nashville: Thomas Nelson, 1994), 63.

107–108 Bevel’s insight was hard earned: Les Carpenter, “A Father’s Shadow: A Civil Rights Hero and the Daughter He Abused,” Washington Post Magazine, May 27, 2008, available at http://www.washingtonpost.com/wp-dyn/content/discussion/2008/05/22/DI2008052202148.html (accessed February 27, 2011).

108 “By nonviolence, we were trying to cure”: Author interview with Alvin Poussaint.

108 “a sort of aesthetic or romantic love”: Martin Luther King, Strength to Love (Minneapolis: Fortress Press, 1977), 52.

109 “What do nonviolent fighters do”: Bennett, What Manner of Man, 210–211.

109 The answer, as King would later tell Poussaint: Author interview with Alvin Poussaint.

110 “war without violence”: Krishnalal Shridharani, War Without Violence: A Study of Gandhi’s Method and Its Accomplishments (New York: Harcourt, Brace and Co., 1938).

110 “My creed of nonviolence is an extremely active force”: http://www.mkgandhi.org/nonviolence/phil8.htm (accessed September 3, 2010).

110 “The nonviolent resister is just as opposed to the evil”: http://mlk-kpp01.stanford.edu/index.php/encyclopedia/documentsentry/non_aggression_procedures_to_interracial_harmony/ (accessed September 3, 2010).

110 King did not reject violence per se: From his 1957 interview with Martin Agronsky:

[Agronsky:] Gandhi, Dr. King, dramatized and defined the technique of nonviolence. And yet, he also said that the only alternative to fear is violence. And that if that were the alternative, he would have to choose violence. Do you subscribe to that judgment of Gandhi, or would you disavow violence under any condition?

[King:] Well, I think I would have to somewhat interpret Gandhi at this point. I don’t think he was setting forth violence as the—as an alternative. I think he was emphasizing, or rather, trying to refute, an all-too-prevalent fallacy. And that is, that the persons who use the method of nonviolence are actually the weak persons, persons who don’t have the weapons of violence, persons who are afraid. And I think that is what Gandhi was attempting to refute. Now in that instance, I would agree with Gandhi. That if the only alternative to violence—to fear is violence, and vice versa, then I would say fight. But it isn’t the only alternative.

The King Papers Project, Stanford University, http://mlk-kpp01.stanford.edu/primarydocuments/Vol4/27-Oct-1957_InterviewByAgronsky.pdf

(accessed September 3, 2010). 110 in a 1967 New York Times Magazine article: Alvin Poussaint, “A Negro Psychiatrist

Explains the Negro Psyche,” New York Times Magazine, August 20, 1967.

111 Another black political leader: Frantz Fanon, The Wretched of the Earth (New York: Grove Press, 1965).

111 He called it “constructive assertiveness”: Poussaint, “A Negro Psychiatrist Explains the Negro Psyche.”

111 Shortly afterward, when King visited Boston: Author interview with Alvin Poussaint, January 29, 2010.

111 the coming together of... Frantz Fanon and Martin Luther King: Years later, Erik Erikson, who had published a careful study of Gandhi, made this connection as he tried to understand the ideas of the leader of the Black Panther Party, Huey Newton. Erikson wrote, “There is a relationship between violence and nonviolence which is rarely considered by those who have not studied the question. . . . [Gandhi’s] point . . . was that nonviolence doesn’t just mean abstention from a violence which one would not have the means to carry through anyway, but the renunciation of armed tactics one would well know how to use. In this sense, the meaningful opposition is not that of arbitrary violence versus fragmented nonviolence, but that of disciplined violence versus disciplined nonviolence.” Erik H. Erikson and Huey P. Newton, In Search of Common Ground (New York: Norton, 1973), 49–50.

112 “Martin always felt that anger was a very important commodity”: Oates, Let the Trumpet Sound, 274.

112 “Many people fear nothing more terribly”: King, Strength to Love, 21.

113 “you have to be a little crazy”: Available on iTunes: http://deimos3.apple.com/WebObjects/Core.woa/Browse/new.duke.edu.1293697282.01293697292.1874801640?i=1201849001 (accessed July 15, 2010).

CHAPTER 9. STRONGER

118 “good outcomes in spite of serious threats”: Ann Masten, “Ordinary Magic: Resilience Processes in Development,” American Psychologist 56 (2001): 227–238.

118 a “steeling” effect: Michael Rutter, “Implications of Resilience Concepts for Scientific Understanding,” Annals of the New York Academy of Sciences 1094 (2006): 1–12.

120 Harry Stack Sullivan: Helen Swick Perry, Psychiatrist of America: The Life of Harry Stack Sullivan (Cambridge, MA: Belknap Press, 1982). M. S. Allen, “Sullivan’s Closet: A Reappraisal of Harry Stack Sullivan’s Life and His Pioneering Role in American Psychiatry,” Journal of Homosexuality 29 (1995): 1–18.

120 “low-grade morons,” “psychopaths”: Ben Shephard, A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century (Cambridge, MA: Harvard University Press, 2000), 199.

120 By 1943, 112,500 enlisted men had been discharged: Ibid., 201.

120 “To the specialists”: Ibid., 202.

121 This is the case with all hysteria: Paul McHugh, The Mind Has Mountains (Baltimore: Johns Hopkins University Press, 2006).

121 In a classic example from medical history: Edward Shorter, From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era (New York: Free Press, 1992).

122 most people who experience trauma do not develop PTSD: Ronald C. Kessler, Amanda Sonnega, Evelyn Bromet, Michael Hughes, et al., “Posttraumatic Stress Disorder in the National Comorbidity Survey,” Archives of General Psychiatry 52 (1995): 1048–1060.

The above study is the largest and most definitive U.S. community psychiatric diagnostic study. It documented a lifetime PTSD rate of 7.8 percent, twice as high in women (10 percent) as in men (5 percent). If one includes other traumas besides physical and sexual abuse (such as crime, war, major auto accidents), about half of the American population experienced a major traumatic event (60.7 percent of men and 51.2 percent of women). Thus only about 10 percent of individuals who experience a major trauma later develop PTSD.

These are averages. With more severe trauma, such as repeated and intense childhood sexual abuse, as opposed to one occurrence, the PTSD rates rise. In the aftermath of September 11, 2001, the general PTSD rate in New York City was 6–8 percent; but if persons had been physically injured during the attack, it was 26 percent. Among Vietnam veterans, chronic PTSD appears to be present in 9 percent; in those with the most combat exposure, it is 28 percent. Studies rarely find full PTSD present in more than one-third of any sample, even with the most severe trauma. Milder PTSD symptoms that may not meet the full definition (“subsyndromal” PTSD) occur, but still only in a minority. For instance, after September 11, 2001, with syndromal PTSD present in 6–8 percent of the population, subsyndromal PTSD symptoms were found in another 17 percent. (S. Galea et al., “Psychological Sequelae of the September 11 Terrorist Attacks in New York City,” New England Journal of Medicine 346 [2002]: 982–987.) In sum, with typical traumas, even under the worst conditions, at least one-third of persons have no PTSD symptoms at all—ever. (G. A. Bonanno and A. D. Mancini, “The Human Capacity to Thrive in the Face of Potential Trauma,” Pediatrics 121 [2008]: 369–375.)

The same holds in the absolute human trauma—death. Each of us must face the deaths of loved ones, and, eventually, ourselves. Grief after the death of a beloved person is a universal human experience. Chronic grief, however—a grief of such severity that it involves long-term depression and PTSD-like symptoms—only happens in about 10 percent of persons. (W. Middleton, P. Burnett, B. Raphael, and N. Martinek, “The Bereavement Response: A Cluster Analysis,” British Journal of Psychiatry 169 [1996]: 167–171.) Even when a death is unexpected and especially painful, chronic PTSD-like grief does not occur in most persons.

122 Bonanno identifies four major types: George A. Bonanno, “Loss, Trauma, and Human Resilience,” American Psychologist 59 (2004): 20–28.

122 they recovered repressed memories: This is what Freud’s first patient famously called “the talking cure”—a staple of Freudian dogma. All sorts of unconscious emotions exist within us, some related to childhood trauma; our current neuroses, anxieties, and depressive symptoms flow from those repressed unconscious emotions. This view has not been without controversy: feminists later attacked Freud for repressing the theory of repression, fearing the consequences of revealing the sexual abuse of young girls in a male-dominated Victorian world; others see the whole concept of repression as a fabrication, mere suggestion by psychotherapists with their own ideologies (sometimes fantastically so, as in the theory of sexual abuse by aliens from outer space). The repressed memory debate has led to lawsuits and delirium, with some probable unjust accusations, and some legitimate cases dismissed as unprovable.

124 strong social supports: Michael Rutter, “Resilience in the Face of Adversity: Protective Factors and Resistance to Psychiatric Disorder,” British Journal of Psychiatry 147 (1985): 598–611.

124 Some psychologists call this “ordinary magic”: Masten, “Ordinary Magic: Resilience Processes in Development.”

124 In an uncommon project: Stephan Collishaw et al., “Resilience to Adult Psychopathology Following Childhood Maltreatment, Child Abuse and Neglect 31 (2007): 211–229.

124 psychologist Dean Keith Simonton found: Dean Keith Simonton, Greatness: Who Makes History and Why (New York: Guilford, 1994).

125 are usually set by age three or so: A. Caspi and P. A. Silva, “Temperamental Qualities at Age Three Predict Personality Traits in Young Adulthood,” Child Development 66 (1995): 486–498.

125 Adults who have higher neuroticism scores experience more PTSD: Lee et al., “A 50-Year Prospective Study.”

125 one study examined . . . terrorist attacks in Russia: V. S. Yastrebov, “PTSD After-effects of Terrorist Attack Victims,” in The Integration and Management of Traumatized People After Terrorist Attacks, ed. S. Begec, 100–107 (Amsterdam: IOS Press, 2007).

126 study of forty-six college students: Barbara L. Frederickson, Michael M. Tugade, Christian E. Waugh, and Gregory R. Larkin, “What Good Are Positive Emotions in Crisis? A Prospective Study of Resilience and Emotions Following the Terrorist Attacks on the United States on September 11th, 2001,” Journal of Personality and Social Psychology 84 (2003): 365–376.

126 in young adults with childhood sexual abuse: Bonanno, “Loss, Trauma, and Human Resilience.”

126 Genetic studies with identical versus fraternal twins: Kenneth Kendler and Carol Prescott, Genes, Environment and Psychopathology (New York: Guilford, 2006).

126 George Vaillant . . . concluded: George Vaillant, Adaptation to Life (Boston: Little, Brown, 1977).

127 followed children of the Great Depression: Rutter, “Implications of Resilience Concepts for Scientific Understanding.”

127 a project . . . with which I was associated, at Massachusetts General Hospital: Mark H. Pollack et al., “Persistent Posttraumatic Stress Disorder Following September 11 in Patients with Bipolar Disorder,” Journal of Clinical Psychiatry 67 (2006): 394–399.

127 a study of well-being in two thousand adults: M. D. Seery, E. A. Holman, and R. C. Silver, “Whatever Does Not Kill Us: Cumulative Lifetime Adversity, Vulnerability, and Resilience,” Journal of Personality and Social Psychology 99 (2010): 1025–1041.

127 in seventy-eight women who had experienced a serious life event: Allison S. Troy, Frank H. Wilhelm, Amanda J. Shallcross, and Iris B. Mauss, “Seeing the Silver Lining: Cognitive Reappraisal Ability Moderates the Relationship Between Stress and Depressive Symptoms,” Emotion 10 (2010): 783–795.

128 Resilience grows out of exposure to . . . risk: Rutter, “Implications of Resilience Concepts.”

CHAPTER 10. A FIRST-CLASS TEMPERAMENT: ROOSEVELT

130 “Get down, you fool!”: Alexander Woollcott, “Get Down, You Fool,” Atlantic Monthly 161 (1938): 169–173.

131 “blow your trumpet” and “give the order to charge”: G. Edward White, Justice Oliver Wendell Holmes: Law and the Inner Self (New York: Oxford University Press, 1995), 470.

131 “A second-class intellect, but a first-rate temperament”: The aide thought Holmes was referring to FDR, and this is the standard view; but some historians now claim the statement referred to Theodore Roosevelt. Paul Boller, Not So! Popular Myths About Americans from Columbus to Clinton (New York: Oxford University Press, 1996), 102–103. This phrase has been repeated in various combinations: “second-rate mind,” “second-class mind,” “first-class temperament.” The most commonly cited original usage appears to be what is in the text, and the original source was the aide, Thomas Corcoran, who reported it verbally afterward.

131 FDR’s first-rate temperament . . . was hyperthymic: In what follows I describe symptom evidence for hyperthymia, but I did not come across in my research evidence for full manic episodes or for clinical depressive episodes. The closest evidence for a possible clinical depression comes toward the end of FDR’s life, when he had suffered from severe hypertension for years and was about to die of a massive stroke. Alen Salerian, an FBI psychiatric consultant, has suggested that Roosevelt might have been clinically depressed during the Yalta conference in 1945. David Owen, reviewing medical records of the time, could not confirm this impression. In any case, depression at that time would most likely be attributable to Roosevelt’s cerebrovascular disease, especially since there is no evidence of a prior pattern of depressive episodes throughout his life. David Owen, In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years (Westport, CT: Praeger, 2008), 47.

131 “Obviously that man has never had indigestion”: John Gunther, Roosevelt in Retrospect (New York: Harper and Brothers, 1950), 23.

131 the State Department asked him to brief the president: Ibid., 24–28.

132 “FDR’s extreme loquaciousness”: Ibid., 55.

132 “My own method”: Ibid.

132 “The simplest way to get at the President”: Ibid.

132 “asking somebody who had never been in Latin America”: Ibid., 56.

132 after Pearl Harbor: Ibid., 31.

132 “His vitality was . . . practically unlimited”: Ibid., 63.

132 he made 399 trips by rail: Ibid., 139.

132 “The Roosevelt family is completely superhuman”: Marion Elizabeth Rodgers, Mencken: The American Iconoclast (New York: Oxford University Press, 2005), 434.

133 TR needed only six hours’ sleep: Gunther, Roosevelt in Retrospect, 8.

133 he had only two sleepless nights: Ibid., 32.

133 “He was often restless”: Ibid., 33.

133 He spent about a quarter of the working day on the telephone: Ibid., 125.

133 “You know, a man will do a lot of right things”: Ibid., 130.

133 “incurably sociable”: Frances Perkins, The Roosevelt I Knew (New York: Viking Press, 1946).

134 “It was here that Roosevelt was irresistible”: Robert H. Jackson, That Man: An Insider’s Portrait of Franklin D. Roosevelt (New York: Oxford University Press, 2003), 135.

134 “[Wilson] refused to see most of them”: Ibid., 135–136.

134 “There was always considerable conflict”: Ibid., 111.

135 “Roosevelt certainly was not accomplished as an administrator”: Ibid., 111.

135 not “a careful, direct-line administrator”: Perkins, The Roosevelt I Knew, 384.

135 “Mr. President, you know you’ve got to let the cattle graze”: Ibid., 135.

136 why not just shoot forty-nine thousand instead?: Jackson, That Man, 149.

136 “My fellow immigrants . . . ”: Gunther, Roosevelt in Retrospect, 67.

136 about 60 to 80 percent of newspapers opposed him: Graham J. White, FDR and the Press (Chicago: University of Chicago Press, 1979), 70.

136 “You know, we had to buy that fucking paper”: Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 172.

137 almost a thousand press conferences in all: Gunther, Roosevelt in Retrospect, 134–136.

137 “Innovations never frightened him”: Ibid., 64–66.

137 He loved to read: Ibid., 118–119.

137 After Yalta, FDR was headed to Saudi Arabia: Perkins, The Roosevelt I Knew, 88–89.

138 “You sometimes find something pretty good in the lunatic fringe”: Gunther, Roosevelt in Retrospect, 115.

138 once writing a memorandum: Ibid., 115.

138 “That fellow in the White House”: Ibid., 115.

138 “Mr. President, are you a Communist?”: Perkins, The Roosevelt I Knew, 330.

139 Roosevelt . . . read some of Kierkegaard’s works: Ibid., 146–148.

139 FDR scribbled . . . China’s coastal contours: Jackson, That Man, 13.

139 Family history provides some evidence: Gunther, Roosevelt in Retrospect, 156–161.

140 in some genetic studies of bipolar disorder: Sermin Kesebira, Simavi Vahipa, Fisun Akdeniza, Zeki Yüncüa, Müge Alkana, and Hagop Akiskal, “Affective Temperaments as Measured by TEMPS-A in Patients with Bipolar I Disorder and Their First-Degree Relatives: A Controlled Study,” Journal of Affective Disorders 85 (2005): 127–133. S. G. Simpson, S. E. Folstein, D. A. Meyers, F. J. McMahon, D. M. Brusco, and J. R. DePaulo Jr., “Bipolar II: The Most Common Bipolar Phenotype?” American Journal of Psychiatry 150 (1993): 901–903.

140 “I have one wish for you”: Gunther, Roosevelt in Retrospect, 168.

141 “It’s ridiculous to tell me”: Ibid., 238.

141 he fell, or almost fell, about five times: Ibid., 236.

142 the “ultimate humility”: Perkins, The Roosevelt I Knew, 44–45.

142 “When he reached the top”: Gunther, Roosevelt in Retrospect, 267–268.

142 was the worst aspect of his disability: Ibid., 236.

142 “an untried rather flippant young man”: Ibid., 242

142 Roosevelt was disciplined by his illness: Jackson, That Man, 171.

143 “Roosevelt underwent a spiritual transformation”: Perkins, The Roosevelt I Knew, 29.

143 “This is the Happy Warrior”: Gunther, Roosevelt in Retrospect, 245–250.

144 “A governor does not have to be an acrobat”: Ibid., 253.

144 “Ten years ago, Governor Roosevelt suffered an attack”: Ibid., 266.

144 “nothing in human judgment is final”: Perkins, The Roosevelt I Knew, 164.

145 “recovery was not enough”: Gunther, Roosevelt in Retrospect, 289.

145 a government “that cannot take care of its old”: Ibid., 289.

145 “We can’t sell the United States short in 1980”: Perkins, The Roosevelt I Knew, 294.

145 “Isn’t this Socialism?”: Ibid., 299.

145 FDR did not take a class with James: At my request, my colleague at Harvard Dr. Eugene Taylor examined the registrar’s records there for Roosevelt’s college years of 1900–1904 and documented that Roosevelt was never a student in a class taught by William James.

146 “the greatest political personality of the century”: John Kenneth Galbraith, Name Dropping (Boston: Houghton Mifflin, 1999), 43.

146 “He would certainly have been President”: Gunther, Roosevelt in Retrospect, 243.

CHAPTER 11. SICKNESS IN CAMELOT: KENNEDY

147 “If that crazy Muckers club had been mine”: Christopher Matthews, Kennedy and Nixon: The Rivalry That Shaped Postwar America (New York: Simon and Schuster, 1996), 23.

147 “I do not think it particularly helpful”: January 22, 1963, JFK Presidential Archives, Box 1, Choate School Archives.

148 an IQ of 119: Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 33.

148 “a very able boy”: James N. Giglio, “Growing Up Kennedy: The Role of Medical Ailments in the Life of JFK, 1920–1957,” Journal of Family History 31 (2006): 362.

148 At age thirteen he was hospitalized: Giglio, “Growing Up Kennedy,” 361. Dallek, An Unfinished Life, 34.

148 Robert joked that if a mosquito bit Jack: Arthur Schlesinger, Robert Kennedy and His Times (Boston: Houghton Mifflin, 2002), 13.

148 At age seventeen, he had his worst infection ever: Giglio, “Growing Up Kennedy,” 361. Nigel Hamilton, JFK: Reckless Youth (New York: Random House, 1993), 101–105. Dallek, An Unfinished Life, 35.

149 He was diagnosed with fatal leukemia: Dallek, An Unfinished Life, 77. Giglio, “Growing Up Kennedy,” 363.

149 His father, unwilling to accept this death sentence: Joseph P. Kennedy to George St. John, September 15, 1934: “About the early part of the summer we sent Jack to Mayo’s and he remained there a month. A thorough investigation of his physical condition . . . unable to find the cause of Jack’s illness during the winter. If there is the slightest tendency to a relapse he would have to be taken out of school for a year.” JFK Presidential Archives, JFK Personal Papers, Box 1. They had discovered that he had many allergies—to “animal hair, house dust, and certain foods, including lamb, pork, and to a lesser extent, whole milk, beef, and various grains.” Giglio, “Growing Up Kennedy,” 363.

149 a month of testing at the Mayo Clinic: Dallek, An Unfinished Life, 73.

149 “they have not found out anything as yet”: Giglio, “Growing Up Kennedy,” 365.

149 “Joe’s blood count was 9400”: Ibid.

149 “one of the things I am a little disturbed about”: Ibid., 367.

149 “One thing I want to be sure of”: Ibid., 368.

150 Kennedy fended off lifelong whispers of hypochondriasis: In the oral history interview between Kennedy’s close adviser Ted Sorensen and Kennedy’s personal White House physician, Janet Travell, Sorensen asks, “Did you ever feel that he complained, or did not complain but suggested maladies that perhaps weren’t something he had—that he had any tendencies toward being hypochondriac?” Travell responds, “Oh, no, he was the opposite of a hypochondriac. It was difficult to get him to state his complaints, unless they were very acute.” (JFK Presidential Archives, Oral History Collection, interview of Janet Travell by Ted Sorensen, January 20, 1966.) The association of ulcers and colitis (today called irritable bowel syndrome) with psychiatric or emotional causes is now, perhaps paradoxically, less strongly held than it was in the 1930s. Peptic ulcer disease, long considered a classic psychosomatic illness, is due in many persons to a previously unrecognized bacterial infection, and treatable with an antibiotic. Irritable bowel syndrome seems more common in those with psychiatric conditions, like depression, and improves somewhat with antidepressants, but it also occurs in persons without psychiatric diagnoses and improves with nonpsychiatric medications too. It is important to note that an autoimmune inflammatory disease of the bowel called celiac disease can mimic irritable bowel syndrome and is often misdiagnosed.

We cannot know for sure the cause of John Kennedy’s lifelong gastrointestinal illness; perhaps it was partly psychosomatic and due to his nervous and anxious and active temperament; partly, or even fully, it might have been part of a larger autoimmune disorder, which manifested a bit in his allergies, more in his irritable bowel syndrome, and even more, soon thereafter, in his near-fatal Addison’s disease.

150 evidence of hyperthymia: Hamilton, Reckless Youth, 131–133. Long before he took steroids, he was seen as extremely sociable, charismatic, and energetic, getting elected by his peers “most likely to succeed,” which was, as Hamilton notes, “a complete travesty of his record at Choate.”

150 visiting prostitutes and probably contracting venereal diseases: Ibid., 153–158, 341–342.

150 “Senator Kennedy evidently woke up each morning”: Evelyn Lincoln, My Twelve Years with John F. Kennedy (New York: Bantam, 1966), 3.

151 “When you see the President”: William Manchester, Profile of a President (London: Michael Joseph, 1967), 26–27.

151 “He usually sat in his office”: Lincoln, My Twelve Years, 25.

151 He “continued to vibrate with energy”: Manchester, Profile of a President, 26–27.

151 “Two White House chairs have collapsed”: Ibid., 144.

152 “two months after taking the oath”: Ibid., 26–27.

152 “He’s really a great gossip”: Ibid., 49.

152 would reply two hundred times per day: Ibid., 54.

152 Kennedy’s wit was famous: Bill Adler, ed., The Kennedy Wit (New York: Citadel, 1967).

153 Lyndon was doing such a great job: Lincoln, My Twelve Years, 125.

153 “I hear you’re losing Ohio”: Manchester, Profile of a President, 131.

153 “Well, the answer to the first is yes”: Helen Thomas, Thanks for the Memories, Mr. President (New York: Simon and Schuster, 2003), 23.

153 “I feel as a Catholic”: Adler, The Kennedy Wit, 40.

154 a widely read 1962 article: Eunice Kennedy Shriver, “Hope for Retarded Children,” Saturday Evening Post, September 22, 1962, available at http://www.eunicekennedyshriver.org/articles/print_article/148 (accessed February 27, 2011).

154 Rosemary received a frontal lobotomy: Ronald Kessler, “Rosemary Kennedy’s Inconvenient Illness,” http://newsmax.com/RonaldKessler/Rosemary-Kennedy/2008/06/17/id/324146 (accessed February 16, 2010). Jack El-Hai, The Lobotomist (New York: Wiley, 2005), 171. Hamilton, Reckless Youth, 409–412.

154 “agitated depression”: Kessler, “Rosemary Kennedy’s Inconvenient Illness.”

154 Freeman carefully avoided documentation about her: El-Hai, The Lobotomist, 174.

154 Rose Kennedy, in her 1974 memoir: Rose Kennedy, Times to Remember (New York: Doubleday, 1974), 286.

154 nocturnal sexual encounters: Kessler, “Rosemary Kennedy’s Inconvenient Illness.” Hamilton, Reckless Youth, 409–412. Access to Rosemary Kennedy’s personal file, within Joseph Kennedy Sr.’s personal papers at the JFK Presidential Archives, is more restricted than access to the president’s medical records. I was not able to obtain permission to see Rosemary’s file.

154 mentally ill, not just mentally retarded: Kessler interviewed Dr. Bertram Brown, who was a member of the president’s panel on mental retardation, and Dr. Brown stated that he and his colleagues at that time had believed that she had mental illness. In retrospect, he believes that the Kennedys downplayed her mental illness in reaction to social stigma being higher for that condition than for mental retardation. Kessler also found that FBI records quoted Joseph Kennedy’s Boston attorney at the time as saying that Rosemary had mental illness.

154 “Sister is insane”: The entry is by a Dr. “E. Price.” JFK Presidential Archives, Box 45, dated December 14, 1950.

155 touching Rosemary severely: It is often now stated that Rosemary worsened due to a “botched” lobotomy. There is no evidence that this was the case. Dr. Watts later described the surgery as uncomplicated. Rather than being botched, lobotomy simply did not work for those with mental illness plus mental retardation. In 1941, Rosemary Kennedy was only the sixty-sixth person in the United States to receive frontal lobotomy; hundreds of thousands would eventually get it. Unfortunately, Joseph Kennedy Sr. was too far ahead of the curve; the best medical treatment of the time, one that would receive a Nobel Prize within the decade, was disastrous: “Because of the lobotomy, she had the development of a 2-year-old. She could not wash or dress herself or put her shoes on. She had to be supervised at all times.” (Kessler, “Rosemary Kennedy’s Inconvenient Illness.”) Standing in line at Ted Kennedy’s memorial viewing at the JFK Library, I spoke with a union activist from Wisconsin. He told me that he and his family worked in the institution that housed Rosemary, and that he had observed that for years, without media coverage, Ted Kennedy quietly flew every month from Washington to visit Rosemary in the Wisconsin institution.

155 Born the son of a saloon keeper: The next three paragraphs draw from Ronald Kessler, The Sins of the Father (New York: Warner, 1996).

156 numerous affairs . . . trying his luck with the girls: Garry Wills, The Kennedy Imprisonment (Boston: Back Bay, 1994).

156 Wall Street insider trading: Kessler, The Sins of the Father.

156 an objective assessment of two generations of Kennedys: This section represents my summary of publicly known facts regarding reasons for death or substance abuse or diagnosed mental illness in the Kennedy family. It might be said that Joe Jr. died in combat. And couldn’t the other two plane crashes be attributed to the Kennedys’ access via their wealth to small-plane travel, which is more dangerous than commercial plane travel? Perhaps the same could be said for the skiing accident? Skiing is a sport associated with wealth. These many explanations could be true, but violate Occam’s razor. When we need many reasons to avoid a simpler explanation, perhaps the simpler explanation is right. Joe Jr. accepted a dangerous flying mission that he did not have to take. Kathleen agreed to fly in bad weather against her pilot’s objections and despite grounding of all commercial flights. Michael’s skiing accident occurred while playing ski football without any helmet, while skiing down Copper Bowl, a steep slope in Aspen, Colorado.

Could it be that excessive risk-taking, an aspect of hyperthymia, lies behind some of these unfortunate happenings? A Time article noted on the death of Michael Kennedy, “As a teenager, Michael jumped off a 75-ft. cliff above the Snake River in Wyoming during a rafting trip. Brother Robert, while at Harvard, leaped 10 feet between two six-story dorms on a dare. He was arrested in 1983 for heroin possession. Joe II drove his jeep off the road in 1973, paralyzing family friend Pam Kelley. Brother David died in 1984 of a drug overdose.” http://www.time.com/time/magazine/article/0,9171,987634-3,00.html#ixzz1FCPl6rMg (accessed February 27, 2011).

157 the baseline risk . . . of bipolar disorder . . . for alcohol or substance abuse . . . for accidental death: Ronald C. Kessler, Olga Demler, Richard G. Frank, Mark Olfson, Harold Alan Pincus, Ellen E. Walters, Philip Wang, Kenneth B. Wells, and Alan M. Zaslavsky, “Prevalence and Treatment of Mental Disorders, 1990 to 2003,” New England Journal of Medicine 352 (2005): 2515–2523.

157 a fraction of 1 percent in the general population: National Vital Statistics Report 59, no. 2, http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_02.pdf (accessed February 27, 2011).

158 The full medical report: Here I present, verbatim for the first time, important extracts from Kennedy’s medical records. Although they are now available for study by scholars, the JFK Presidential Library does not allow photocopying of John Kennedy’s medical records. Furthermore, they are open to study only by scholars who are physicians or who are accompanied by physicians. I personally transcribed the full medical report of Kennedy’s naval discharge. I believe this is the first time that the verbatim transcript of the following report has been made publicly available. The same holds for other verbatim transcriptions of Kennedy’s medical records, such as his back X-ray reports (see pages 298–299) and nursing notes on his near-fatal 1961 infection in the White House (see pages 300–301).

US Naval Hospital Chelsea Mass 16 October 1944

Report of Medical Survey

Diagnosis: Hernia, intervertebral disc

Disability is not the result of his own misconduct and was incurred in line of duty

Existed prior to enlistment: No

Present condition: Unfit for Duty. Probable future duration: Indefinite

This 27-year old Lt., USNR, was admitted to this hospital on 11 June 1944 with the complaint of pain in the lower back referred down the left leg. This dated from a fall aboard ship on 1 August 1943. In addition he had lower abdominal pain increased on defecation. By permission of the BuMed & S he was granted leave to report to the Lahey Clinic. While there an oxygen spinogram was interpreted as demonstrating a herniation of the fifth lumbar intervertebral disc. On 23 June 1944 an operation was performed by Dr. James L. Poppen at the Lahey Clinic in which some of the abnormally soft disc interspace material was removed and it was noted that there was very little protrusion of the ruptured cartilage present.

Investigation of the gastro-intestinal complaints by Dr. Sara M. Jordan of the Lahey Clinic revealed on x-ray examination spasm and irritability of the duodenum without a definite ulcer crater but . . . suggestive of a duodenal ulcer scar. Spasm of the colon was also demonstrated. Anti-spasomodic medication was prescribed.

He returned to this activity on 4 August 1944. The pain in the back and in the left leg continued as did the lower abdominal pain. The neurosurgeon at this hospital did not feel that the operation had corrected the condition and that some other cause might underlie the neuritis of the left sciatic nerve. An orthopedic consultant injected procaine into the left sciatic nerve with considerable relief of symptoms. Review of the films from the Lahey Clinic by the roentgenologist here failed to reveal any definite abnormality of the G.I. tract or in the spine.

. . . On 3 October 1944 his back and leg pain had improved but there was continuation of the abdominal pain. . . . Because of continued symptoms and the necessity of further time to regain strength and weight lost while on combat duty, the Board recommends that he be retained for further study and treatment.

P. P. Henson, Comdr. MC V (S) USNR, P. B. Snyder Lt. Comdr. MC V (S) USNR, W. J. Jinkins, Jr. Lt. MC V (S) USNR

158 hospitalization for physical illness: After resting in Arizona for a few months, Kennedy felt better and decided to work as a journalist, first in San Francisco at the United Nations conference, then in Berlin for the Potsdam conference, and later in England, where he covered the elections that ousted Churchill. Kennedy was back to his old self: energetic, active, sexual. But as usual, he had another relapse. His pattern seemed to be one serious illness episode per year, lasting about two to three months, followed by six to nine months of normal health and heightened energy. In London, Kennedy had his usual high fever, malaise, and gastrointestinal pain. He was hospitalized for two days. Giglio, “Growing Up Kennedy,” 374.

158 walked five miles in a Boston parade: Lee Mandel, “Endocrine and Autoimmune Aspects of the Health History of John F. Kennedy,” Annals of Internal Medicine 151 (2009): 350–354.

158 a visit by the physician Sir Daniel Davis: Some biographers assume that Dr. Davis was an expert in Addison’s disease. He was not. He appears to have been simply a successful physician, with relationships with many members of the British upper classes. Giglio, “Growing Up Kennedy,” 375. Dallek, An Unfinished Life, 105.

159 chronic physical symptoms: It is clear, though, that all of Kennedy’s Lahey Clinic doctors and his later doctors accepted and concurred with the Addison’s disease diagnosis. Sara Jordan, for instance, wrote a 1952 letter clearly saying so and explaining the condition to Joseph Kennedy; she made it clear at that time that John Kennedy’s main medical problem (all the previous gastrointestinal diagnoses notwithstanding) was Addison’s disease of the adrenal glands. (Giglio, “Growing Up Kennedy,” 376.) I could not find any evidence that Kennedy was ever rediagnosed with laboratory tests in the 1950s, but such testing would likely not have been definitive anyway since he constantly received steroid treatment throughout the rest of his life.

159 “hasn’t got a year to live”: Giglio, “Growing Up Kennedy,” 375.

159 Kennedy took DOCA the rest of his life: Giglio, “Growing Up Kennedy,” 375–376. Dallek, An Unfinished Life, 76.

159 “deeply preoccupied with death”: Matthews, Kennedy and Nixon, 48.

159 on a trip to Indochina: JFK always traveled with a medical bag including his steroids. Once in the 1960 election, his bag was lost and Kennedy went to great lengths to contact political allies so as to find it. Giglio, “Growing Up Kennedy,” 377.

160 aides placed a pin in every town: Kenneth P. O’Donnell and David F. Powers, Johnny, We Hardly Knew Ye (Boston: Little, Brown, 1972), 78–80.

160 Without steroids, this pace would have been impossible: Before his Senate run, Kennedy put out a press release attributing his hospitalizations to malaria. He had already begun treatment with his first endocrinologist, Dr. Elmer Bartels of Boston, who had started to treat him with DOCA and later cortisone, as noted earlier in the text. Bartels warned Kennedy that despite such treatment, he would always be prone to Addisonian crises triggered by infections of any sort. Giglio, “Growing Up Kennedy,” 376.

160 Six months later, he was back in the hospital: JFK Presidential Archives, Medical Records, John F. Kennedy Personal Papers (hereafter PP), Box 45. Giglio, “Growing Up Kennedy,” 377.

160 noting throughout his medical chart that he was already diagnosed with Addison’s disease: JFK Presidential Archives, Medical Records, PP, Box 45.

160 X-rays repeatedly showed mostly normal bone structure: Ibid. My assessment of these medical files conflicts with the conclusion drawn by Robert Dallek and his medical collaborator that Kennedy had some osteoporosis, which would be expected with long-term steroid use. (Dallek, An Unfinished Life, 81.) As late as 1962, Kennedy’s back X-rays did not show osteoporosis or osteoarthritis or any other bony explanation for his pain. Here is a summary by Dr. George Burkley, White House physician, who concluded from this evidence that most of the president’s back pain was due to muscular spasm, not bony arthritis: “The lumbar-sacral X-rays were examined in New York and were found to show very little difference from those taken in 1958. In other words no increase in the lesion in the left sacral iliac region and there was no evidence of any change in the intervertebral spaces, no evidence of osteoarthritis in any area. The X-rays indicate that there has been no bony change since 1958. I recommend that the exercise be continued as they are done now and to be increased in the judgment of Dr. K.” JFK Presidential Archives, Medical Records, PP, Box 48, March 19, 1962.

Here is the full report on the back X-ray from 1962, located in JFK Presidential Archives, Medical Records, PP, Box 45:

Xray: Lumbar spine and pelvis, 14 March 1962, by John H. Cheffey and L. T. Brown, Captains MC USN. “The available projections demonstrate the distal three thoracic and the upper four lumbar vertebrae to be normal. Interspaces between these vertebrae have been well maintained; the interspace between L4 and L5 is normal. The interspace between L5 and S1 is narrow. Contiguous bony surfaces are increased slightly in density at L5-S1 except for the posterior-inferior half of L5 where loss of clarity of the surface is apparent. There appears to be minor subchondral dissolution of bone at L5-S1. In oblique projections, apophyseal joint space between L5 and S1 [is] incompletely obliterated but definite loss of clarity exists, especially on the left. Evidence of fusion is shown posteriorly between L5 and the upper sacrum. . . . The fusion is solid. . . . The right sacroiliac joint is slightly narrowed. The left sacroiliac joint is irregular in contour. Particularly in the middle portion of the joint contiguous bony surfaces present pronounced sclerosis. Several irregular areas of radiolucency are shown in this region, apparently in the sacrum particularly. Changes demonstrated in this region are compatible with those to be seen following operative intervention and are not inconsistent with findings to be seen with bone infection. . . . Hip joints as shown in a single frontal projection are normal in appearance. Soft tissues and other bony structures as they are seen are within normal limits.”

160 His father concurred: Giglio, “Growing Up Kennedy,” 377.

161 a three-hour operation: Ibid., 377–378.

161 “Lincoln recalled Nixon racing into Kennedy’s office”: Matthews, Kennedy and Nixon, 99.

161 large enough to fit a man’s fist up to the wrist: O’Donnell and Powers, Johnny, We Hardly Knew Ye, 114–116

161 “We came close to losing him”: Giglio, “Growing Up Kennedy,” 378.

162 seven hospitalizations: JFK Presidential Archives, Medical Records, PP, Box 45.

162 “It is not a killer”: Giglio, “Growing Up Kennedy,” 379. Dallek, An Unfinished Life, 300.

162 a contemporary movie portrayed a person with Addison’s disease: Giglio, “Growing Up Kennedy,” 385.

162 This episode is documented in his medical records: JFK Presidential Archives, Medical Records, PP, Box 45. This matter is ignored increasingly by historians. One of the first Kennedy books (Hugh Sidey, John F. Kennedy, President [Greenwich, CT: Fawcett, 1964]), written just one year after Kennedy’s death, discusses the matter at reasonable length (one page, 98), describes real concern about Kennedy’s condition among journalists and politicians (one Republican commented, “Now we’ve got an invalid for a President”), and even describes Travell’s treatment with intravenous steroids and antibiotics. Sidey had been taking notes for something like an authorized biography of JFK for six years, and thus his records on this event were likely shared with the president. Travell herself, in her 1966 oral history, near the end of the medical part of her interview with Ted Sorensen, volunteered the June 1961 crisis as an important part of Kennedy’s medical history, and considered it the most serious episode of illness during his presidency. “Interesting,” Sorensen commented, and then the interview went in a different direction. Robert Dallek (An Unfinished Life) received much praise for being the first biographer to gain access to more medical records, and to write a biography greatly built around Kennedy’s illnesses. Yet he did not refer to this episode at all. Richard Reeves (President Kennedy: Profile of Power [New York: Simon and Schuster, 1993]), who wanted to describe what it was like to be president on a day-by-day basis, titled his chapters by dates, usually within days or a week of each other. In this period, he jumps from June 17 to July 19, skipping altogether the weeks of Kennedy’s near-fatal illness, without comment. Evelyn Lincoln (My Twelve Years with John F. Kennedy) does not mention it at all in her diary of the Kennedy years, even though she was an active participant in JFK’s health care. The Travell files are full of notes describing how extra steroid or amphetamine doses were given to “Mrs. L” to give to the president.

163 “The President slept later than usual this morning”: JFK Presidential Archives, Medical Records, PP, Box 45, typed memorandum dated June 16, 1961.

163 Travell had just injected Kennedy: IV solucortef 100 mg given with 1.8 million units penicillin + tetracycline, hydrocortisone 40 mg orally. JFK Presidential Archives, Medical Records, PP, Box 45, June 16, 1961.

163 give more steroids intramuscularly: Cortisone acetate 50 mg IM. JFK Presidential Archives, Medical Records, PP, Box 45.

163 more oral steroids later that night: Hydrocortisone 10–20 mg. Ibid.

163 From June 22 to July 3: In the week of June 22–29, he received intramuscular doses of 600,000 units of procaine penicillin twenty-seven times. He also received oral steroids (hydrocortisone 10 mg in the morning and 20 mg in the afternoon daily; 0.125 mg daily of Florinef), amphetamines (2–4 tablets of dextroamphetamine, “Dexatabs,” daily), and his usual daily dose of testosterone (10 mg daily of methyltestosterone tablets). Ibid.

164 received doses of the narcotic codeine: Codeine phosphate 750 mg, and codeine sulfate 500 mg. Ibid.

164 “mild viral infection”: Ibid., June 22, 1961.

164 He came back to life: Ibid. Dr. Travell’s handwritten note on June 21, 1961, was ominous, describing a fever of 104.5 and “shivering,” blood cultures being drawn at 3:15 a.m., and symptoms of being “very chilly” and “perspiring profusely.” The next morning, his personal nurse’s neatly handwritten notes were unfiltered (edited below only for clarity and repetition; we have no available nurse’s notes for the nights of June 21 and into the early morning of June 22):

June 22 830 AM—perspiring moderately. Complete sponge bath given. Pajamas and linen changed.

9 AM—seen by doctors

920 AM—influsion of 500 cc 5% dextrose and saline [solucortef omitted] started in right hand by Dr T

930 AM—president asleep

10 AM—another infusion started . . . perspiring moderately

1010 AM—P asleep

1020 AM—P awake. Examined by Drs. [four physicians, Dr. Preston Wade, an orthopedic surgeon from New York, Cohen, Travell, and George Burkley, a naval physician who conducted the president’s laboratory tests and filled in for Dr. Travell as needed]

1030—seen by Mrs Kennedy

1100—infusion running

1120—President still awake. Appears to be feeling more comfortable.

1125—Dozing lightly

1130—Turned to left side.

1135—President asleep

1205—President awake. Stated he was cold. . . . Perspiring moderately

1210—Patient appears to be sleeping.

1255—President awake

100—Mrs Kennedy with patient

115—Penicillin G 600K units given in left deltoid . . . backrub given . . . per- spiration much less

130—infusion running well

135—President sleeping

200—asleep

245—President still asleep

310—P awake . . . states he feels much

better 315—Hydrocortisone tablet 1 20 mgm po taken

330—sitting up

430—President appears to be feeling much better. Shaved

530—Mrs Kennedy with president

715—Penicillin

730—Dinner—ate with hearty appetite

815—Temp 97.8

The next day, he resumed his evening barbiturate sleeping pill (Tuinal), and Dr. Travell documented the amphetamine/narcotic/steroid/testosterone regimen that he mostly continued throughout his presidency (“AM: Dexatab 2 tab, Cod[eine] s[ulfate] 2 tab = 65 mg, Testosterone 25 mg IM by request, For pm today Dexatab 2 tab, [vitamin] C 500, Fl[orinef] pink 0.1 mg, HC [hydrocortisone] 10 mg, Cod[eine] S[ulfate] 32 mg”). The president recovered and went to Hyannisport for July Fourth. On the eighth, he had a chill at four in the afternoon, then at 6:10 p.m., according to Travell’s notes, a fever of 103.2 and a high pulse of 120. At 6:30 p.m., he again received intravenous steroids and intramuscular antibiotics (“Infusion saline glucose started + solucortef 50 mg, streptomycin penicillin im given”). Two hours later, he received 25 mg of cortisone intramuscularly. The next day, his temperature was 97.0: “Slept well no complaints,” wrote Travell. Another Addisonian relapse averted.

164 urine culture finally confirmed . . . Aerobacter cloacae: Ibid. Dr. Travell’s handwritten note is as follows: “June 24—T note: Urine: aerobacter resistant to strep and pen . . . many mucus threads, much amorphous, straw hazy, rbc 2–-4 phf wbc 1–3 phf.” On June 26, a urine culture laboratory report states growth of the following organism: “Aerobacter cloacae.”

164 fatal in 20 to 40 percent of cases: Michael E. Ellis, Infectious Diseases of the Respiratory Tract (Cambridge, UK: Cambridge University Press, 1998), 140.

164 mainly found in the vaginal flora: Sebastian Faro, Sexually Transmitted Diseases in Women (Baltimore: Lippincott Williams & Wilkins, 2003), 98.

165 His urologist’s records are silent on sexual habits: JFK Presidential Archives, Medical Records, PP, Box 45, Dr. Herbst’s notes, 1954–1955.

166 Galbraith . . . and admired both presidents: John Kenneth Galbraith, Name Dropping (Boston: Houghton Mifflin, 1999).

166 Jefferson scored highest: Dean Keith Simonton, Greatness: Who Makes History and Why (New York: Guilford, 1994), 271–276.

166 “I know nothing can happen to him”: Seymour Hersh, The Dark Side of Camelot (Boston: Little, Brown, 1997), 15–16.

CHAPTER 12 . A SPECTACULAR PSYCHOCHEMICAL

SUCCESS: KENNEDY REVISITED

170 William Osler once said: William Osler, Aequanimitas (Philadelphia: P. Blakinson’s Son & Co., 1914).

171 Kennedy ingested a standard set of daily medications: Florinef 0.25 mg, hydrocortisone 20 mg, methyltestosterone 10 mg, and Meticorten 2.5 mg, Lomotil (a narcotic-derived antidiarrheal agent), thyroid hormone, and sometimes penicillin. JFK Presidential Archives, John F. Kennedy Personal Papers (hereafter PP), Medical Records, Boxes 45 and 46.

171 he also took amphetamines and barbiturates: Dextroamphetamine (Dexatabs) and Tuinal (an equal mixture of secobarbital sodium and amobarbital sodium). Ibid.

171 injections of procaine: Ibid., Box 46. David Owen, In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years (Westport, CT: Praeger, 2008), 161.

171 Kennedy took mysterious injections from Max Jacobsen: Owen, In Sickness and in Power, 164–170. Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 398–399. Richard Reeves, President Kennedy: Profile of Power (New York: Simon and Schuster, 1993), 146–147.

171 “I don’t care if it’s horse piss”: Dallek, An Unfinished Life, 399.

171 New York State investigated the doctor’s injections: Owen, In Sickness and in Power, 165.

172 injected an anabolic steroid, methyltestosterone, at Kennedy’s frequent request: JFK Presidential Archives, Medical Records, PP, Boxes 45 and 46.

172 a medical coup d’état: The medical coup d’etat was not a one-day affair. David Owen best discusses the timeline (In Sickness and in Power, pp. 176–177). The process began in October 1961, when Admiral Burkley, the naval officer assigned as the official White House physician, decided to take on Travell, Kennedy’s personal physician. Burkley had the important support of Dr. Eugene Cohen, a New York endocrinologist who was Kennedy’s prime consultant for Addison’s disease. Burkley and Cohen had decided that Travell’s many injections needed to be replaced by a physical exercise and muscle-training regimen, for which they enlisted a New York specialist, Hans Kraus, MD. Travell opposed the proposal, but, over a year, Burkley and Cohen, apparently with the support of Robert Kennedy, gained the president’s approval for the change. By October 1962, Owen notes, the medical coup d’etat was complete, and Travell, though still nominally personal physician to the president, was greatly weakened. The animosity and distrust between Travell and Burkley can be seen in a medical note in Burkley’s records: “3 February 1962 Requested the medical records on X [the president] for the last six months. Dr. Travell said she would like to straighten them up before she gives them to me. I said that this was not necessary, but she said she would like to straighten them up. . . . Within the last few days Dr. Travell has been inferring that all the recent improvement of X’s condition is due to the fact that he is now getting Gamma Globulin and injections of vitamins. Several days ago while discussing the chair for the helicopter a very obvious effort to cover information on the upper part of the sheet by covering it with an additional paper. Contents were not divulged to me” (JFK Presidential Archives, PP, Box 48). Burkley had the upper hand as the official physician, backed by the military and the White House bureaucracy; Travell had been hired by the president alone. Over time, Travell remained in the White House but was closely watched and controlled by Burkley. This is captured in a note by Jackie Kennedy to Burkley in late 1963: “Memo for Dr Burkley: August 21, 1963 I have asked Dr. Travell to put suitable bulbs and reading lights in all the places where the President and I read in the White House. So, please, let’s not get excited if you see her tip-toeing up to our floor in the elevator! JBK” (JFK Presidential Archives, PP, Box 48).

172 He still took four kinds of daily steroids: As above except methyltestosterone injections were replaced by oral Halotestin 10 mg daily.

172 Kennedy always took anabolic steroids: Later Halotestin. JFK Presidential Archives, Medical Records, PP, Box 46.

172 in 1966, in her oral history: JFK Archives, Oral History Program, interview of Janet Travell by Ted Sorensen.

173 but she obeyed the commander in chief: For example, November 14, 1961: “Hypo Testosterone aq. Susp. 37.5 mg.im right buttock . . . requested med. For trip given to Dave Powers Requested MT. 25 q.d.” Or September 21, 1961: “7:15 pm Asked me to come up . . . back still aches. More tired today . . . asks if his medication has been cut back. . . . Pulse fast very keyed up and just back from pool. Given fluorinef 0. 1 stat. Also box of codeine 32 mg. Ritalin 5 mg. to take just before leaving shortly for state dinner, or during evening.” JFK Presidential Archives, Medical Records, PP, Box 46.

After the somewhat haphazard care he had received in early 1961, culminating in his Addisonian crisis of June of that year, Kennedy’s doctors began to keep better track of his testosterone use, and they have left us monthly summaries of his total dosages for ten months from August 1961 onward. (JFK Presidential Archives, Box 46, Travell notes.) I have added up those doses, keeping in mind that for the first eight months he received methyltestosterone, and in the last two months (beginning May 1962) he was switched to Halotestin. In the first eight months, he received a total dose of 3010 mg of methyltestosterone, either orally or intramuscularly; this is about 12.5 mg of methyltestosterone daily. In the final two months tallied, he received 610 mg of Halotestin, or about 10 mg daily. These are not exceedingly high doses of anabolic steroids, but they are consistent and chronic.

173 athletes take similar doses . . . to make themselves more “aggressive”: http://www.steroid.com/Halotestin.php (accessed February 11, 2010).

173 At least three double-blind, placebo-controlled studies: F. Talih, O. Fattal, and D. Malone, “Anabolic Steroid Abuse: Physical and Psychiatric Costs,” Cleveland Clinic Journal of Medicine 74 (2007): 341–352.

173 Summaries of large clinical populations: T. P. Warrington and J. M. Bostwick, “Psychiatric Adverse Effects of Corticosteroids,” Mayo Clinic Proceedings 81 (2006): 1361–1367.

173 steroids improve mood and cause fewer psychiatric side effects: Penelope J. Hunt, Eleanor M. Gurnell, Felicia A. Huppert, Christine Richards, A. Toby Prevost, John A. H. Wass, Joseph Herbert, and V. Krishna K. Chatterjee, “Improvement in Mood and Fatigue After Dehydroepiandrosterone Replacement in Addison’s Disease in a Randomized, Double Blind Trial,” Journal of Clinical Endocrinology and Metabolism 85, no. 12 (2000): 4650–4656. E. Ur, T. H. Turner, T. J. Goodwin, A. Grossman, and G. M. Besser, “Mania in Association with Hydrocortisone Replacement for Addison’s Disease,” Postgraduate Medical Journal 68 (1992): 41–43.

174 “a slight sniffle” . . . “Received a call” . . . a small dose of Stelazine: JFK Presidential Archives, Medical Records, PP, Box 46. The Stelazine dose was 1 mg twice daily. Note of Dr. George Burkley, December 13, 1962.

175 The most extensive journalistic work is by Seymour Hersh: Seymour Hersh, The Dark Side of Camelot (Boston: Little, Brown, 1999).

176 they prefer cocaine: C. E. Johanson and T. Aigner, “Comparison of the Reinforcing Properties of Cocaine and Procaine in Rhesus Monkeys,” Pharmacology Biochemistry and Behavior 15, (1981): 49–53.

176 pleasurable feelings similar to those of cocaine: Bryon Adinoff, Kathleen Brady, Susan Sonne, Robert F. Mirabella, and Charles H. Kellner, “Cocaine-like Effects of Intravenous Procaine in Cocaine Addicts,” Addiction Biology 3 (1998): 189–196.

176 the claim made by Kennedy biographers: The first historian to see most of Kennedy’s medical records (in 2002), Robert Dallek, documented the steroid use and other medications, but concluded that Kennedy, though ill, was unaffected in his role as president. As summarized by another historian, James Giglio, “despite the potential risks, his health seemed to have had no negative impact on his presidential performance.” James N. Giglio, “Growing Up Kennedy: The Role of Medical Ailments in the Life of JFK, 1920–1957,” Journal of Family History 31 (2006): 358–385 (quote on 379).

176 has been challenged only by Dr. David Owen: Owen, In Sickness and in Power, 141–190.

177 “When you commit the flag”: Reeves, President Kennedy, 71.

177 “How could I have been so stupid?” . . . “Those sons-of-bitches” . . . “I’ve got to do something”: All from ibid., 103.

177 “The President was completely overwhelmed”: Ibid., 174.

177 “Too intelligent and too weak”: Ibid., 166.

177 “Gentlemen, you might as well face it”: Ibid., 196.

177 “Walking out on generals was a Kennedy specialty”: Ibid., 182.

178 “Does this mean Germany”: Dallek, An Unfinished Life, 624.

179 “The first advice I am going to give my successor”: Benjamin Bradlee, Conversations with Kennedy (New York: Pocket Books, 1976), 117.

179 Robert Kennedy later described the pragmatic aspect: JFK Presidential Archives, Oral History Program, interview of Robert F. Kennedy by Ted Sorensen, 1966.

179 Martin Luther King was invited to the White House: Reeves, President Kennedy, 100.

180 “In the election, when I gave my testimony”: Harris Wofford, Of Kennedys and Kings (Pittsburgh: University of Pittsburgh Press), 128–129.

181 “Negroes are getting ideas”: Reeves, President Kennedy, 357.

181 “Don’t tell them about General Grant’s table”: Ibid., 359.

181 “Go to hell, JFK!”: Ibid., 360.

181 “People are dying in Oxford”: Ibid., 363.

181 The president placed a phone call to Dr. Max Jacobsen: The role of Jacobsen is documented well by Dallek (An Unfinished Life) and Owen (In Sickness and in Power). Jacobsen first saw Kennedy in 1960. Owen documents the high likelihood that Jacobsen’s injections involved amphetamines and steroids. In fact, when the Bureau of Narcotics and Dangerous Drugs interviewed Jacobsen in 1969, it noticed track marks on his arms, and the doctor admitted to injecting himself with 25 mg of methamphetamine every two to three days (Owen, 165).

There appears to have been a gradient of medical competence. Burkley and Cohen saw Travell as incompetent, and they all thought Jacobsen was a dangerous quack. Thus, in 1961, before the break between Travell and Burkley, all the White House physicians were banding together to get a handle on Jacobsen. In the JFK Library Archives, I believe I have found the first probable documentation of this effort involving Travell and the others. The following note by Travell refers to the president; GGB stands for George G. Burkley: “April 11 1962, 6:00 pm. Went upstairs early to rest. Did not swim, and said that he was too tired to do exercises. Creep in town, left White House about 8 PM. (GGB),—also yesterday PM” (JFK Presidential Archives, PP, Box 46). If we can infer that “Creep” refers to Jacobsen, then it appears that Burkley had discovered that Jacobsen had visited the president and had informed Travell. As with the medical coup d’etat, Jacobsen was not ousted overnight because the president resisted. However, Jacobsen’s visits became less frequent and faced overt opposition by the White House medical staff, Travell included. Robert Kennedy, as in many other matters, had a major impact, and his June 1962 intervention against Jacobsen was likely the beginning of the end. Thus, though Jacobsen injected the president as late as September 1962, his injections were less frequent and thus likely influenced the president for the worse to a lesser degree than had been the case in 1961.

David Owen has reviewed Jacobsen’s unpublished memoirs and reports that Jacobsen mainly describes visits to the president on a frequent basis in the spring and summer of 1961, in the new administration’s first year, when Kennedy was at his worst politically and at his sickest physically and mentally. Jacobsen saw Kennedy less frequently in 1962, and it is highly probable that his last visit was during the Oxford, Mississippi, crisis of September 1962 (Owen, 169; Dallek, 582).

The Jacobsen story, so similar to Hitler’s relationship with Theodor Morell, which is discussed in the next chapter, first came out in the media in 1972, but many of the facts were unknown at that time. Dallek’s 2003 biography first broke the story in detail. Owen’s book in 2008 first made the link to Kennedy’s performance.

181–182 Come down here, Kennedy told him: Reeves, President Kennedy, 364.

183 “I hope that every American”: Ibid., 521.

183 He knew he would lose the southern states: Robert Kennedy was later asked in an oral history whether the Kennedys thought they would gain any political or electoral advantage with their new policy. (JFK Presidential Archives, Oral History Program, interview of Robert F. Kennedy by Ted Sorensen, 1966.) No, he recounted; they did not expect that black voting rights would change elections in the South for years to come, perhaps in the 1970s or later, but not so soon as to have any effect on JFK’s reelection. They fully expected to lose the South, even Johnson’s Texas, during the 1964 election, Robert said; they might even lose the whole election. They knew their civil rights plan would mean electoral losses to some extent, but they were also savvy enough to have Lou Harris polling in the North and Midwest, with increasing support for Kennedy’s civil rights position. JFK had made a dangerous gamble, the first Democrat since the Civil War to do so: he would enter reelection, he had decided, with a plan to win by taking all of the country except the South. In fact, with the exception of Jimmy Carter, Democrats have only won the presidency since JFK by peeling off, barely, a few southern states either because of personal roots or special circumstances. Of the ten standard southern states—Virginia, North and South Carolina, Georgia, Tennessee, Alabama, Mississippi, Louisiana, Arkansas, and Texas—Lyndon Johnson, riding a wave of post-assassination sympathy, won only five; Bill Clinton won four in 1992 and three in 1996; and Barack Obama, even with a major black turnout, won only one. Only Jimmy Carter was successful, winning all southern states but Virginia in 1976. In fact, since JFK, no white non-southern Democrat has won the presidency.

183 “Every single person who spoke about it”: Wofford, Of Kennedys and Kings, 172.

184 The White House practically took over: Reeves, President Kennedy, 580–582.

184–185 He changed a line in . . . John Lewis’s speech . . . asked Lewis to remove an analogy: Ibid., 581–582.

185 “He’s damned good”: Ibid., 584.

185 “You made the difference”: Ibid., 585.

185 JFK “frankly acknowledged that he was responding to mass demands”: Wofford, Of Kennedys and Kings, 177.

185 “I have a dream”: Reeves, President Kennedy, 584.

185 In her 1966 oral history: JFK Presidential Archives, Oral History Program, interview of Janet Travell by Ted Sorensen, 1966:

Sorensen: Did he ever express concern that he was dependent on too many drugs or that they might have some unknown effects on his system?

Travell: These were not drugs.

Sorensen: Pills.

Travell: That’s right. . . . He really didn’t take any drugs. . . . He didn’t take sleeping pills. He wouldn’t take medication for pain. He didn’t want it. I think the record should be perfectly clear that the things that he did take were normal physiological constituents of the body, almost entirely.

186 “It is my considered opinion”: JFK Presidential Archives, Medical Records, PP, Box 45, November 29, 1963.

CHAPTER 13. HITLER AMOK

188 was advanced . . . by Hannah Arendt: Hannah Arendt, Eichmann in Jerusalem: A Report on the Banality of Evil (New York: Viking, 1963). Arendt previously had been a student and mistress of the philosopher Martin Heidegger, who later became pro-Nazi. Arendt, who was Jewish, then rejected Heidegger’s ideas and maintained close personal and intellectual ties to Jaspers.

189 the memoirs of his closest friend from young adulthood: August Kubizek, The Young Hitler I Knew (Boston: Houghton Mifflin, 1955; Norwalk CT: MBI Publishing Company, 2006).

189 Most historians accept the general veracity: Some historians express concern that Kubizek’s memoir may not be entirely valid, partly because some have claimed that it was commissioned by the Nazi Party, a claim vehemently denied by Kubizek and by his publisher Stocker Verlag. Though a party member in 1942, Kubizek had not joined in previous years and was never an active member. He also turned down Hitler’s offers of special positions throughout the Nazi period. Another critique is that Kubizek’s claim that Hitler was anti-Semitic early in his life has not been corroborated, apparently, from other sources. With such caveats, most historians accept the broad outline of Kubizek’s memoir. (Martin Kitchen, personal email communication, July 31, 2010.)

189 “He walked always and everywhere”: Kubizek, The Young Hitler I Knew, 39.

189 “I cannot remember a time when he had nothing to do”: Ibid., 62.

189 “Once he had conceived an idea”: Ibid., 105.

189 “Here he could give full vent to his mania”: Ibid., 105.

190 “When Adolf and I strolled”: Ibid., 55.

190 “I had long since known this behavior of his”: Ibid., 194.

190 “He used to give me long lectures”: Ibid., 32.

190 “Hysterically he described”: Ibid., 226.

191 “Adolf was exceedingly violent and high-strung”: Ibid., 32.

191 “Adolf stood in front of me”: Ibid., 117.

192 “In that hour it began”: Ibid., 116.

192 it is 90 percent likely . . . depressive episodes: Frederick Goodwin and Kay Jamison, Manic-Depressive Illness, 2nd ed. (New York: Oxford University Press, 2007).

192 “His mood worried me more and more”: Kubizek, The Young Hitler I Knew, 158.

192 “As the Goddess of Misery took me”: Adolf Hitler, Mein Kampf (Delhi: Jaico Publishing, 2008).

193 “the most outstanding trait”: Kubizek, The Young Hitler I Knew, 49.

193 his family history: Fritz Redlich, Hitler: Diagnosis of a Destructive Prophet (New York: Oxford University Press, 1998), 255–257. Ron Rosenbaum, Explaining Hitler (New York: Random House, 1998), 19–21. Leonard L. Heston and Renate Heston, The Medical Casebook of Adolf Hitler (New York: Stein and Day, 1980), 63–67.

194 “[Alois Hitler] often moved”: Kubizek, The Young Hitler I Knew, 54.

195 Regarding the course: Jablow Hershman and Julian Lieb, A Brotherhood of Tyrants (New York: Prometheus, 1994), 69–82. Heston and Heston, The Medical Casebook of Adolf Hitler, 67–72.

196 his classic work about Hitler’s rise to power: Alan Bullock, Hitler: A Study in Tyranny (New York: Harper and Row, 1964).

196 In 1937, Hitler began using amphetamines: Heston and Heston, The Medical Casebook of Adolf Hitler, 82–83.

196 previous attempts to “explain” him: Rosenbaum in his book (Explaining Hitler) never mentions Heston’s work. Redlich (Hitler: Diagnosis of a Destructive Prophet) discusses the amphetamine story only briefly, but never engages with it in terms of what it means psychiatrically.

196 published a complete medical study of Hitler: Leonard L. Heston and Renate Heston, The Medical Casebook of Adolf Hitler (New York: Stein and Day, 1980).

196 the man who would remain his personal physician: Robert Kaplan, “Doctor to the Dictator: The Career of Theodor Morell, Personal Physician to Adolf Hitler,” Australasian Psychiatry 10 (2002): 389–392.

197 “Herr Reich Injektion Minister”: Heston and Heston, The Medical Casebook of Adolf Hitler, 85. D. Doyle, “Adolf Hitler’s Medical Care,” Journal of the Royal College of Physicians of Edinburgh 35 (2005): 75–82.

197 Morell admitted to giving Hitler twenty-eight different treatments: Heston and Heston, The Medical Casebook of Adolf Hitler, 162. Doyle, “Adolf Hitler’s Medical Care.”

197 “Orchikrin” . . . “Prostakrimum” . . . “Cortiron”: Heston and Heston, The Medical Casebook of Adolf Hitler, 162. Transcript of interrogation of Dr. Morell by Allied investigators, November 29, 1945.

197 the narcotic given was Eukodal: Heston and Heston, The Medical Casebook of Adolf Hitler, 75.

198 a barbiturate for sleep . . . Brom-Nervacit: Ibid., 79, 162.

198 By 1971, there were over thirty-one amphetamine preparations: http://www.druglibrary.org/schaffer/library/studies/cu/cu36.html (accessed February 27, 2011). Methamphetamine was also widely distributed to German and U.S. troops during the war.

198 They were especially noted by Albert Speer: Heston and Heston, The Medical Casebook of Adolf Hitler, 72.

198 Himmler . . . began collecting a medical file: Ibid., 138.

198 repeated negative tests for syphilis: Ibid., 115.

198 the Italian king . . . wondered aloud to his court: Ibid., 138.

198 the Hestons interviewed Hitler’s valet: Ibid., 82–83.

199 “a mixture specially compounded for the Führer”: Ibid., 16.

199 Schenck . . . analyzed its chemical contents: Ibid., 85–86. Schenck’s confirmation is the most definitive documentation that Hitler took methamphetamine, which raises the question: Was Hitler simply a crystal meth addict? Is his behavior merely attributable to methamphetamine addiction? I would say no, for the following reasons: although methamphetamine is the same ingredient as in crystal meth, the pill form is quite different from the injected crystal form. Each pill of methamphetamine, called Pervitin in Hitler’s day, contained 3 mg of active drug. (Andreas Ulrich, “Hitler’s Drugged Soldiers,” Der Spiegel, 5/6/2005; http://www.spiegel.de/international/0,1518,354606,00.html, [accessed April 11, 2011]). Thus Hitler’s use added up to 15 mg/day, which is notably lower than the usual minimum composition of crystal meth (100 to 1000 mg). Also, oral use is much less addicting than intravenous. Depending on how much daily intravenous amphetamine Hitler also received, and whether it was the methamphetamine form, his usage might have begun to approach the low end of crystal meth addiction. It is more likely, though, that the harmful amphetamine effects for Hitler had to do with the fact that, especially when the drug is given intravenously, it is likely to destabilize mood episodes in bipolar disorder.

199 Schenk . . . repeated in his own memoirs: E. G. Schenck, Patient Hitler. Eine medizinische Biographie (Düsseldorf, 1989). “Hitler’s Life: Hitler’s Doctor—Interview with Ernst Günther Shenck,” http://www.onlinefootage.tv/video/show/id/4430 (accessed February 27, 2011).

199 According to Linge: Heston and Heston, The Medical Casebook of Adolf Hitler, 82–83.

200 Like Kennedy’s doctors, some of Hitler’s: Finally intervening in 1944, when Hitler was declining mentally, Hitler’s other doctors chose the wrong drug: noting that Morell’s gastrointestinal preparations included traces of strychnine, they accused Morell of trying to poison the Führer. The doses were tiny, however, and of dubious risk; Hitler dismissed Morell’s enemies. Kaplan, “Doctor to the Dictator,” 392.

200 Even oral amphetamines . . . cause mania: A. P. Wingo and S. N. Ghaemi, “Frequency of Stimulant Treatment and of Stimulant-Associated Mania/Hypomania in Bipolar Disorder Patients,” Psychopharmacology Bulletin 41, no. 4 (2008): 37–47.

201 he shouted nonstop for three hours: Heston and Heston, The Medical Casebook of Adolf Hitler, 40.

201 Himmler, convinced that Hitler had a “sick mind”: Ibid., 42.

201 several generals tried to persuade prominent psychiatrists to commit Hitler: Redlich, Diagnosis of a Destructive Prophet, 337.

202 “That pathological liar has gone completely mad!”: Charles F. Marshall, Discovering the Rommel Murder (Mechanicsburg, PA: Stackpole Books, 2002), 259.

202 “The only troops I could move”: Alan Wykes, Hitler (New York: Ballantine, 1970), 120.

202–203 Morell even publicly revised his prior diagnosis: Hershman and Lieb, Brotherhood of Tyrants, 79. Heston and Heston, The Medical Casebook of Adolf Hitler, 46.

203 The source . . . a Swedish journalist: G. T. Pihl, Germany: The Last Phase (New York: Knopf, 1944).

203 “The more inexorably events moved”: Albert Speer, Inside the Third Reich (New York: Simon and Schuster, 1997), 292.

203 Linge . . . told the Hestons: Heston and Heston, The Medical Casebook of Adolf Hitler, 46.

203 The Hestons date such brief periods: Ibid., 47.

203 “cycle” into and out of his manic and depressive episodes: Ibid., 139–140.

203 his mind already had: In addition to manic depression, it is hard to avoid another illness: Hitler is well known to have had parkinsonian symptoms in his final years, a common side effect of amphetamines, especially when used in their potent forms and intravenously, as with Hitler. Parkinson’s disease starts on average at age sixty. Onset in one’s forties is considered early, and usually due to external causes, like head trauma or drugs. Hitler’s parkinsonian symptoms began around age fifty. If it was naturally occurring, concurrent amphetamine use also may have worsened the condition. E. Gibbels, “Hitler’s Neurologic Disease—Differential Diagnosis of Parkinson Syndrome,” Fortschritte der Neurologie-Psychiatrie 57 (1989): 505–517. Original article in German.

203 Hitler heard a voice: This was first described in Mein Kampf. It has been discussed by Hershman and Lieb, Brotherhood of Tyrants, 62. Except for those authors, most historians and physicians have viewed Hitler’s experience as a metaphorical, rather than actual (and hence psychotic), “voice.” Robert George and Leeson Waite, The Psychopathic God: Adolf Hitler (New York: Da Capo, 1993), 378. This was also the conclusion of the official U.S. intelligence psychiatric profile of Hitler, conducted from a psychoanalytic perspective by Walter C. Langer in 1942–1943. He interviewed a number of sources who knew Hitler somewhat well. This was a very psychoanalytically oriented evaluation, and it applied numerous Freudian concepts to explain Hitler, such as projection and narcissism. It labeled him neurotic, not psychotic, but beyond that judgment it is not diagnostically valuable. Walter C. Langer, The Mind of Adolf Hitler: The Secret Wartime Report (New York: Basic Books, 1972). One might claim that Hitler had “overvalued ideas,” such as Aryan superiority and Jewish conspiracy, but these views, shared by many in his culture, would not meet most psychiatric definitions of delusious.

203–204 Some think his experience occurred under hypnotic suggestion: David Lewis, The Man Who Invented Hitler (London: Headline Publishing Company, 2003).

205 a “paranoid destructive prophet”: Redlich, Diagnosis of a Destructive Prophet.

205 But rejecting psychoanalytic diagnoses: We can draw from three full books about Hitler written by psychiatrists who are prominent researchers or academics but not psychoanalysts (Hershman and Lieb, Heston and Heston, Redlich). Supplementing those works with memoirs and other historical material, Hitler’s story is rather well documented. The three psychiatric writers disagree among themselves (one sees Hitler as having no mental illness but mainly affected by amphetamine-induced psychosis, another sees him as having pure manic-depressive psychosis, and a third sees him as having neither condition but rather a kind of political personality disorder of paranoid destruction). All these sources provide the same evidence, described above, which seems to show rather clearly that Hitler had manic and depressive episodes, a likely family history of manic symptoms, a typical course for bipolar disorder, and treatment for depression. The likely diagnosis of bipolar disorder seems solid.

206 apparently was treated by . . . Dr. Edmund Forster: Lewis, The Man Who Invented Hitler . Lewis presents the following story: There is some evidence that Hitler was examined and apparently treated by a psychiatrist at Pasewalk Hospital in present-day Poland, where he had been sent in late October 1918. This was a hospital known to be used for psychiatric cases, six hundred miles away from where Hitler had been involved in a mustard gas attack in France; all his other companions injured in the attack were treated at medical hospitals nearby. Hitler was sent far away, suggesting a psychiatric problem. Also, Hitler’s complete and immediate recovery from mustard gas is biologically implausible. On this evidence, it seems reasonable to conclude, as did U.S. intelligence during World War II, that Hitler suffered from something like PTSD, manifested as hysterical blindness. Naval intelligence records from 1943, declassified in 1973, report, according to Dr. Karl Kroner, who saw Hitler immediately after the blindness, that Hitler was transferred to the care of a psychiatrist, Dr. Edmund Forster. Exactly during the period when the armistice occurred, Forster treated Hitler with what might today be called a species of psychodrama, sometimes used in French and German psychiatry of the nineteenth century for hysteria (excellent examples are found in the most prominent ninenteenth-century psychiatric text written by Philippe Pinel). According to Dr. David Lewis’s book on Forster, the psychiatrist made strong hypnotic suggestions to Hitler that he had much to see and live for, including helping Germany. One week after the armistice, Hitler recovered his eyesight and was discharged from the army as unfit for duty. He never again had any difficulty with his vision. Years later, after Hitler came to power in 1933, Forster, a known anti-Nazi, took his psychiatric records to France and reportedly gave them to German exiles there, including Eduard Weiss, who, according to Lewis, later posthumously published the content in fiction form. Soon thereafter, Forster either committed suicide or was killed. After the naval report was released, Rudolph Binion, an American-German professor, tracked down some persons who were present in the reported Paris meeting with Forster, and they confirmed the events. Forster’s notes have never been found, though, leading to doubt on the part of other observers.

This is the only known official psychiatric evaluation or treatment of Hitler in his life. While Lewis and others make the mistake, in my view, of thinking that Forster’s hypnotic suggestion “invented” the grandiose Führer, the overall story of PTSD is consistent with Hitler’s many psychiatric symptoms and his high level of anxiety (which is called the personality trait of neuroticism), a well-established risk factor for PTSD.

In 1923, after the Munich putsch, Hitler was again psychiatrically examined, though this time by the chief physician of Landsberg prison, Dr. Joseph Brinsteiner, who was not a psychiatrist. Documented in a January 8, 1924, report titled “Report of the Mental Condition of Prisoner Adolf Hitler,” it was described as follows by one biographer: “The doctor, who was obviously very impressed by his prisoner, wrote very general comments stressing that he was a man of very high intelligence, extraordinary range of knowledge and great oratorical ability. At the time of his arrest, Hitler was very depressed, the doctor said, and suffering from ‘a very painful neurosis’ (sehr schmerzhaften Neurose). No details are given. The report emphasizes the ephemeral nature of the condition and that the prisoner was soon in excellent spirits.” Robert G. L. Waite, The Psychopathic God: Adolf Hitler (New York: Basic Books, 1977), 350. A prison guard, Otto Lurker, who later published in 1933 a hagiographic memoir of Hitler’s time in jail, called “Hitler Behind Fortress Walls,” reported that the painful neurosis diagnosed by Dr. Brinsteiner was due to a shoulder dislocation Hitler suffered when hurt during the melee of the putsch. Lurker quotes Brinsteiner as telling the court, while attesting that Hitler was mentally fit to stand trial, “The patient . . . has no symptoms of psychic disorders or psychopathic tendencies.” Quoted in Milan Hauner, Hitler: A Chronology of His Life and Time, 2nd ed. (London: Palgrave Macmillan, 2008). Yet the earlier possibility of psychiatric diagnosis and treatment for PTSD would be consistent with the known fact that the chairman of psychiatry at the University of Heidelberg, Karl Willmans, had stated publicly that Hitler had suffered a hysterical reaction during World War I. In 1933, Willmans was forced to resign. Ruth Lidz and Hans-Rudolph Wiedemann, “Karl Wilmanns (1873–1945) einige Ergänzungen und Richtigstellungen,” Fortschritte der Neurologie-Psychiatric 57 (1989): 161–162.

CHAPTER 14. HOMOCLITE LEADERS: BUSH, BLAIR, NIXON, AND OTHERS

211 Grinker decided to take on this task: Roy R. Grinker Sr., Roy R. Grinker Jr., and John Timberlake, “ ‘Mentally Healthy’ Young Males (Homoclites),” Archives of General Psychiatry 6 (1962): 405–453.

213 “Within the general population of the United States”: Ibid., 445–446.

213 “People like the George Williams students”: Ibid., 446.

213 “To have a population of relative stability”: Ibid., 448.

213 “I often described my subject-population”: Ibid., 446.

214 Sigmund Freud’s dictum: Ibid., 448.

214 No ideal standard of mental health works scientifically: Karl Jaspers, General Psychopathology (Baltimore: Johns Hopkins University Press, 1997). S. Nassir Ghaemi, The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry (Baltimore: Johns Hopkins University Press, 2009).

214 “Standards of health on the basis of admirable traits”: Leston Havens, A Safe Place: Laying the Groundwork of Psychotherapy (Cambridge, MA: Harvard University Press, 1989), 28.

214 “muscular Christian” normality: Grinker, “ ‘Mentally Healthy’ Young Males,” 444.

215 what happens when homoclites rule: Grinker’s work gives us a framework to understand mental health, and if applied to leaders it would head us in the direction of looking at personality and seeing whether our leaders are similar to or different from the rest of us in their personality traits. Historians and psychologists have worked out ways to do this, not only for personality traits, but also for intelligence, another psychological attribute commonly seen as important for leadership. (Dean Keith Simonton, Greatness: Who Makes History and Why [New York: Guilford, 1994].) For intelligence, this involves quantifying leaders’ achievements in childhood and early adulthood, such as grades and academic degrees, and correlating those achievements with population averages. Assuming a population IQ norm of 100, one can then infer higher or lower levels of intelligence for historical figures. This method has been used in psychology research now for over eighty years. For personality traits, historians and scholars are given biographical data—anonymized and altered enough to try to remove specifics that would identify the individuals—based on which they complete assessments of major personality traits, as in the NEO scale, which assesses the three major personality traits of neuroticism (one’s baseline level of anxiety), extraversion (one’s sociability and outgoingness), and openness to experience (one’s willingness to take risks or tendency to follow routines or habits). These estimates are then correlated with objective (number of bills passed, reelection) and subjective (consensus of historians) estimates of presidential success. (In the normal population, we all score somewhere on each of these traits, and we do so in a way that statistically is called the “normal” curve, also referred to as the bell curve. Most of us score in the middle, while 2.5 percent of us score at either extreme—very high or very low—on each trait. These traits can also be translated into the abnormal temperaments discussed previously. Thus those with hyperthymic personality will tend to be very high on extraversion and openness to experience.)

When applied to presidents (Simonton, 2006), these studies of intelligence and personality support, in my view, the idea that most presidents are homoclites, and that the most successful of them are the least homoclitic. Using the above methods, about one-half of presidents (twenty-three out of forty-three) had IQ estimates in the average, but not gifted, range (100–120). (The average college graduate has an IQ of 120, while the population norm is 90–110, above average is 110–120, gifted is 120–140, and above 140 is considered “genius” level.) Among twelve recent presidents from FDR onward, only four score in the gifted range (FDR, Kennedy, Carter, and Clinton). For those presidents considered by some as not particularly intelligent, like George W. Bush (IQ estimate 111) or Reagan (IQ estimate 118), estimated intelligence is above the population average (though not greater than the average college graduate). These are not stupid men, nor are they highly intelligent; they are just normal. (Just to show that intelligence is overrated as a measure of success, by the way, one might note that the estimated IQ for George Washington was 125, lower than Clinton or Carter.) Personality seemed a more robust predictor of presidential success. Specifically, of the three traits in the NEO (Simonton, 2006), only openness to experience correlated with presidential success, and even this was not straightforward. The three highestrating presidents for openness to experience were Thomas Jefferson, John Quincy Adams, and Lincoln; yet Adams is generally seen as ineffectual. Clinton and Kennedy ran distant seconds on this personality trait, and some presidents viewed as successful, like Reagan and Washington, scored low on it. I would turn the usual interpretation of these personality tests around. The standard view is that these studies show that neuroticism, for instance, is “irrelevant” to presidential personality. Rather, it would be more accurate to say that extremes of neuroticism, and indeed all personality traits, are not found in our presidents. They are mostly average in their personality traits, and even their intelligence. Much as we yearn for heroes, our presidents are, by and large, normal people—homoclites like you and me. And yet when one picks out those who are extreme on any of these features, whether personality or intelligence, one finds names like Jefferson and Lincoln and Franklin Roosevelt and Kennedy—those who are seen as the “best” presidents, the ones full of charisma and creativity. They are not “normal” people: they are the ones with abnormal temperaments, like hyperthymic personality, or even frank mental illness.

Most presidents, however, are normal and thus homoclites. Hence research about the psychological basis of political beliefs in the general population (who are also homoclites) might help us understand the psychology of these homoclite leaders. The classic work in this area is that of British psychologist Hans Eysenck (The Psychology of Politics [London: Routledge and Kegan Paul, 1954]), who observed that the left/right theory of politics could not account for the many similarities between communism and fascism—apparent extreme opposites. Eysenck interviewed middle-class and working-class persons in 1950s England and classified their political beliefs along the above labels; he then gave them NEO-like personality tests. (Eysenck himself was a founding father of personality research.) Statistically grouping people with similar political beliefs versus their personality traits, Eysenck found another factor besides political ideology (leftwing versus right-wing) that seemed to relate to how practical versus how idealistic people tended to be. In other words, political behavior needed to be seen on two dimensions, the first being political ideology, as is commonly accepted, and the second not being political at all, but psychological, correlating with personality traits, which (borrowing from the philosopher William James) Eysenck labeled tender-mindedness versus tough-mindedness. This produces a new two-dimensional picture, when combined with the original dimension of political ideology. Over the years, numerous genetic studies on identical twins have repeatedly confirmed that Eysenck was right: temperament is an important biological predictor of political beliefs (Lindon Eaves, Hans Eysenck, and Michael Neale, Genes, Culture, and Personality: An Empirical Approach [London: Academic Press, 1989]).

Eysenck’s thesis may help explain why apparently opposite political figures, like Bush and Blair, could find so much common ground: their personalities were similar—they were tough-minded “normal guy” leaders, taking pride in their toughness, arms swaying beside them as they strode to a press conference podium together, like two gunslingers at a shootout. Other homoclite leaders, differing in the normal range of personality traits, will be tender-minded instead, and thus likely to make different political judgments. It goes beyond available evidence to speculate how these considerations apply to other recent or contemporary leaders, like Bill Clinton or Barack Obama, but Eysenck’s theory provides testable hypotheses for historians and psychologists to assess.

216 Chamberlain was a commoner: Nick Smart, Neville Chamberlain: A Biography (London: Routledge, 2009).

216 “a good mayor of Birmingham”: George Lichtheim, Thoughts Among the Ruins (Piscataway, NJ: Transaction, 1973), 177.

216 “a nice man”: Robert C. Self, Neville Chamberlain: A Biography (Farnham, UK: Ashgate, 2006), 97.

216 “rigid competence,” “indispensable for filling subordinate posts”: Peter Rowland, David Lloyd George: A Biography (New York: Macmillan, 1976), 707.

217 “If Germany could obtain her desiderata”: Ibid., 219.

217 “In one phase men might seem to have been right”: Graham Macklin, Chamberlain (London: Haus, 2006), 97.

218 The son of a Philadelphia surgeon: Most of the material on McClellan is drawn from Stephen Sears, George B. McClellan: The Young Napoleon (New York: Da Capo, 1999).

220 “I almost think”: Ibid., 95.

220 “Shall we crush the rebellion”: Ibid., 99.

221 “One Napoleonic grand army”: Ibid.

221 “How does he think”: Ibid., 103.

221 “I am here in a terrible place”: Ibid.

222 “Cautious and weak” . . . “A psychiatrist could make much”: James McPherson, Crossroads of Freedom: Antietam (New York: Oxford University Press, 2004), 44.

222 unlike Lee, who seems to have been dysthymic: Michael Fellman, The Making of Robert E. Lee (Baltimore: Johns Hopkins University Press, 2003).

223 what about Reagan, Eisenhower, Truman?: Historians may disagree. Truman did have to deal with Korea. And at the end of World War II, he had to make the massive decision to bomb Hiroshima and Nagasaki. Whether the latter decision in particular was the correct one, and the mark of a successful crisis leader, is something about which Japanese and American readers may have differences of opinion. Reagan certainly has his fans, as did Eisenhower. I cannot and do not attempt to cover every major leader of the twentieth century in this book, and I especially try to avoid recent ones. The most recent leader I study in detail is Nixon. As for the others, I can only make tentative comments while awaiting the clarifying impact of time and distance. This all depends, of course, on historians’ having open enough minds to even consider some of these theses.

224 six books and a dozen professional journal articles: David Greenberg, Nixon’s Shadow (New York: Norton, 2004), 235.

224 “on the naked edge of a nervous breakdown”: Ibid., 256.

224 “Almost uniformly”: Ibid., 235.

224 “Each painted Nixon”: Ibid., 244–245.

224 Narcissism has never been empirically validated: The concept of narcissism was heavily used by Freud, and is a psychoanalytic belief. It is often used pejoratively. Though it can be operationalized and identified in populations (Robert Raskin and Howard Terry, “A Principal-Components Analysis of the Narcissistic Personality Inventory and Further Evidence of Its Construct Validity,” Journal of Personality and Social Psychology 54, no. 5 [1988]: 890–902), it is not validated as a distinct and separate personality trait or personality disorder or unique personality condition. By validation, I mean scientific standards as described in this book: being distinct from other conditions in the four validators of symptoms, course of illness, family history, and treatment response. In such studies, it is poorly separable from a host of other claimed personality disorders. Andrea Fossati, Theodore P. Beauchaine, Federica Grazioli, Ilaria Carretta, Francesca Cortinovis, and Maffei Cesare, “A Latent Structure Analysis of Diagnostic and Statistical Manual of Mental Disorders, Narcissistic Personality Disorder Criteria,” Comprehensive Psychiatry 46 (2005): 361–367. W. John Livesley, “Diagnostic Dilemmas in Classifying Personality Disorder,” in Advancing DSM: Dilemmas in Psychiatric Diagnosis, ed. Katharine A. Phillips, Michael B. First, and Harold Alan Pincus, 153–168 (Washington, DC: American Psychiatric Press, 2003).

225 “so outlandish as to be downright silly”: Greenberg, Nixon’s Shadow, 238.

225 “Do not inflict this Freudian horseshit”: Ibid., 253.

225 Regarding treatment: Ibid., 242–243.

226 “I cannot help thinking”: Ibid., 232.

226 “dangerous emotional instability”: Ibid., 257.

226 “crazy with rage”: Ibid.

226 “as if he were a tape”: Ibid., 258.

226 Haig . . . remove his sleeping pills: Ibid., 259.

226 “I think I’ve got a lousy personality”: Christopher Matthews, Kennedy and Nixon: The Rivalry That Shaped Postwar America (New York: Simon and Schuster, 1996), 282.

226 “cocksucker” and “damn Jews”: Greenberg, Nixon’s Shadow, 254. Rick Perlstein, Nixonland: The Rise of a President and the Fracturing of America (New York: Scribner, 2008), 353.

226 “screw” and “fuck”: Nigel Hamilton, JFK: Reckless Youth (New York: Random House, 1993), 143. Robert Dallek, An Unfinished Life: John F. Kennedy (Boston: Little, Brown, 2003), 172.

226–227 Johnson . . . favored metaphors of urination and defecation: In one of my favorites, Johnson once commented to John Kenneth Galbraith as follows: “Did y’ever think Ken that making a speech on economics is a lot like pissing down your leg? It seems hot to you, but it never does to anyone else.” John Kenneth Galbraith, A Life in Our Times (New York: Ballantine, 1981), 450.

227 McGovern told a heckler: Perlstein, Nixonland, 739.

227 Victor Frankl would have known: Said Frankl, “An abnormal reaction to an abnormal situation is normal behavior.” Viktor Frankl, Man’s Search for Meaning (Boston: Beacon, 2000), 32.

227 Nixon constantly encouraged the sick JFK: Matthews, Kennedy and Nixon, 87–102.

227 Joseph P. Kennedy Sr. sent word to Nixon: Ibid., 132.

227 Robert Kennedy . . . quietly voted: Ibid., 113.

227 “I just saw a crushed man today”: Matthews, Kennedy and Nixon, 199. Garry Wills, Nixon Agonistes (New York: Signet, 1969), 40.

227 to invite the widow and her two children: Matthews, Kennedy and Nixon, 292–297.

228 It was 1946: What follows is based on Matthews, Kennedy and Nixon.

229 “Chotiner had two working precepts”: Ibid., 35.

229 “I understand yours was Whittier”: Ibid., 61.

230 as author Rick Perlstein puts it: Perlstein, Nixonland, 435.

231 “you’ve got to be a little evil”: Tom Wicker, One of Us: Richard Nixon and the American Dream (New York: Random House, 1991), 686.

231 “The notion of Nixon”: Greenberg, Nixon’s Shadow, 263.

231 “a study in psychiatric imbalance”: Ibid., 261.

231 In truth, Nixon was rather normal: Three authors who appear to come to similar conclusions based on journalistic and historical evidence are Wicker (One of Us), Wills (Nixon Agonistes), and Perlstein (Nixonland).

231 “How is the nation to be protected”: Greenberg, Nixon’s Shadow, 261.

231 “A man harassed, tortured, and torn” . . . “There is a delicious inconsistency”: Ibid., 262.

232 the Hubris syndrome identified by David Owen: David Owen, In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years (Westport, CT: Praeger, 2008).

233 As a young man: The material in this paragraph is drawn from Ronald Kessler, A Matter of Character: Inside the White House of George W. Bush (New York: Sentinel, 2004).

233 “He was Huck Finn and Tom Sawyer”: Ibid., 16. 2

33–234 about 15 percent of all adults . . . lose a parent or a sibling: http://www.disabledworld.com/communication/community/parent-loss.php (accessed February 27, 2011).

234 childhood parental loss . . . increases the risk of depression: Kenneth Kendler and Carol Prescott, Genes, Environment and Psychopathology (New York: Guilford, 2006).

234 some studies show that . . . losses during childhood: Norman F. Watt, James P. David, Kevin L. Ladd, and Susan Shamos, “The Life Course of Psychological Resilience: A Phenomenological Perspective on Deflecting Life’s Slings and Arrows,” Journal of Primary Prevention 15 (1995): 209–246.

234 SAT score was 1280 . . . IQ of about 120: Kessler, A Matter of Character, 23.

235 his memoir Decision Points: George W. Bush, Decision Points (New York: Crown, 2010).

235 his blood alcohol level was found to be 0.10: Kessler, A Matter of Character, 35.

235 pressured him to quit drinking . . . he apparently did: A psychiatrist colleague has told me that he knew a Bush family member who claimed that Bush continues to drink and has even been drunk at times at family meals, as recently as just before the 2000 presidential election. However, according to my colleague, that person was not willing to make that accusation publicly, and since I cannot confirm the source or corroborate the claim, I cannot present it as probably or even possibly true.

235 This history is actually the best possible outcome: George E. Vaillant, The Natural History of Alcoholism Revisited (Cambridge, MA: Harvard University Press, 1995).

237 “solved my biggest political problem”: Kessler, A Matter of Character, 54.

238 one sign of creativity is “integrative complexity”: Simonton, Greatness, 80,

238–239 “I would be at a press conference with him”: Tony Blair, A Journey: My Political Life (New York: Knopf, 2010), xiv.

239 “No one was more shocked and angry than I”: Bush, Decision Points, 262.

239 “I remembered the shattering pain of 9/11”: Ibid., 252.

239 Santayana’s dictum that fanaticism: This view does not undermine my assertion that Bush was mentally healthy. I do not see fanaticism as a type of mental illness. It occurs most commonly, in fact, in the mental health of homoclites, who do not have much integrative complexity. Grinker’s work showed this possibility in his description of how homoclites were similar to “muscular Christianity.”

240 Blair was a classic British amalgam: These pages on Blair draw mostly from his memoirs, and from Philip Stephens, Tony Blair: The Making of a World Leader (New York: Viking, 2004), 2–15.

241 a major intellectual guide: Blair, A Journey, 80–81. John Burton and Eileen McCabe, We Don’t Do God: Blair’s Religious Belief and Its Consequences (London: Continuum, 2009), 4–8.

242 “It was his manner that won us over”: Burton and McCabe, We Don’t Do God, 20.

242 became Kinnock’s posse: Alastair Campbell, The Blair Years (New York: Knopf, 2004).

242 likable persona and moderate politics: Stephens, Tony Blair.

243 “Progress in Northern Ireland”: Campbell, The Blair Years, xxix.

243 “Some indeed advocated this strategy”: Blair, My Journey, 349.

244 “The other way, the way we chose”: Ibid.

244 liberal imperialism of William Gladstone: Stephens, Tony Blair, 16.

244 “We are interventionists”: Ibid., 215–219.

244–245 “Who knows which [option] is right” . . . “All these years”: Blair, My Journey, 349.

245 “The battle is not”: Ibid., 348.

246 “Friends opposed to the war”: Ibid., 380.

247 “The world provides sources”: Shelley E. Taylor and David A. Armor, “Positive Illusions and Coping with Adversity,” Journal of Personality 64 (1996): 873–898.

249 “The difference between the TB of 1997”: Blair, My Journey, 651.

250 “normal basic personality” . . . “mystical fatalism”: Jack El-Hai, “The Nazi and the Psychiatrist,” Scientific American, January 5, 2011, available at http://www.saloforum.com/index.php?threads/the-nazi-and-the-psychiatrist-goering-and-kelley.286/ (accessed May 1, 2011). Authors have previously wondered whether Kelley committed suicide because of his desperation in realizing how the Nazi horror happened at the hands of normal, ordinary men and thus could happen again anywhere, anytime. El-Hai, who has interviewed Kelley’s son and conducted new research, notes that Kelley had alcohol problems and that he killed himself impulsively while in the midst of an argument with his wife. His son believes that Kelley swallowed the cyanide pill by accident.

250 Goering also had an IQ of 138: El-Hai, “The Nazi and the Psychiatrist.”

250 “Your excellency Major Kelly!”: John Michael Steiner, Power Politics and Social Change in National Socialist Germany (New York: Walter de Gruyter, 1976), 395. The original text of the letter is presented by Steiner in both English and German. The English translation begins, “Dear Major Kelly,” but the original German reads, “Sehr geehrter Major Kelly!” The literal translation for the German salutation is “Your excellency”; I’ve altered the English translation on this point to capture the respect in which the Nazi leaders held Dr. Kelley.

250 the Rorschach tests of the Nazi leaders . . . A follow-up analysis: Barry A. Ritzler, “The Nuremberg Mind Revisited: A Quantitative Approach to Nazi Rorschachs,” Journal of Personality Assessment 42 (1978): 344–353. Molly Harrower, “Rorschach Records of the Nazi War Criminals: An Experimental Study After Thirty Years. Journal of Personality Assessment 40 (1976): 341–351.

252 “I have yet to hear one of these men say”: Robert H. Jackson, That Man: An Insider’s Portrait of Franklin D. Roosevelt (New York: Oxford University Press, 2003), 170.

253 “You must not picture Professor Brandt as a criminal”: Robert Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide (New York: Basic Books, 1986), 116–117.

254 in prominent historical works on Hitler and the Nazis: John Lukacs, The Hitler of History (New York: Vintage, 1998).

254 as historian Martin Kitchen describes well: Martin Kitchen, The Third Reich: Charisma and Community (London: Pearson Longman, 2008). Martin Kitchen, “Hitler Bewitcher or Hitler Bewitched?” in Creativity and Madness: An Interdisciplinary Symposium, ed. J. D. Keehn, 93–108 (York, ON: University Press of Canada, 1987).

254 No Hitler, no Holocaust: Ron Rosenbaum, Explaining Hitler (New York: Random House, 1998), 348.

CHAPTER 15. STIGMA AND POLITICS

256 a deep cultural stigma accompanying mental illness: Paul Jay Fink and Allen Tasman, eds., Stigma and Mental Illness (Washington, DC: American Psychiatric Publishing, 1992).

256 physicians attach as much stigma: William R. Dubin and Paul Jay Fink, “Effects of Stigma on Psychiatric Treatment,” in Fink and Tasman, eds., Stigma and Mental Illness.

256 Even mental health professionals: David Kingdon, Tonmoy Sharma, and Deborah Hart, “What Attitudes Do Psychiatrists Hold Towards People with Mental Illness?” Psychiatric Bulletin 29 (2004): 401–406.

257 a “proud mediocrity”: Cesare Lombroso, The Man of Genius (New York: C. Scribner’s Sons, 1891), 2.

257 a “prejudice” of psychiatric “inferiority”: Ernst Kretschmer, The Psychology of Men of Genius (London: Kegan Paul; New York: Harcourt, Brace and Co., 1931), 6.

257 “It shows Winston in a completely false light”: Lord David Owen, “Winston Churchill and Franklin Roosevelt: Did Their Health Problems Impair Their Effectiveness as World Leaders?” Churchill Lecture Series, Churchill Museum and Cabinet War Rooms, May 5, 2009, written transcript, 36.

257 the Kennedy family criticized Nigel Hamilton’s . . . evidence: http://www.huffingtonpost.com/nigel-hamilton/the-kennedys_b_810465.html (accessed February 27, 2011).

257 Brendan Maher showed: Brendan Maher, “Delusional Thinking and Cognitive Disorder,” Integrative Physiological and Behavioral Science 40 (2005): 136–146.

258 mental heuristics and biases: Stuart Sutherland, Irrationality (London: Pinter and Martin, 2007).

258 identified thirty-one standard irrational thought processes: http://www.acceleratingfuture.com/michael/works/heuristicsandbiases.htm (accessed February 27, 2011).

258 the unfortunate Missouri senator Thomas Eagleton: http://chipur.com/i-want-relief/thomas-eagleton-heartbeat-depressed-president/ (accessed February 27, 2011).

259 “[Adviser David Axelrod] said to me”: Dan Balz and Haynes Johnson, The Battle for America 2008: The Story of an Extraordinary Election (New York: Penguin, 2009), 18.

260 “Character above all”: http://www.pbs.org/newshour/character/ (accessed February 27, 2011).

260 “And so, when I put my hand on the Bible”: http://www.4president.org/speeches/bushcheney2000convention.htm (accessed February 27, 2011).

260 “With Bush, there was an instant change”: http://old.nationalreview.com/interrogatory/kessler200408090855.asp (accessed February 27, 2011).

261 “Nobody died when Clinton lied”: http://www.nobodydied.com/ (accessed February 27, 2011).

261 “Public virtue cannot exist”: John Adams, Samuel Adams, and James Warren, Warren-Adams Letters (Boston: Massachusetts Historical Society, 1917), 22.

261 “It’s my experience”: Abraham Lincoln, Marion Mills Miller, and Henry Clay Whitney, Life and Works of Abraham Lincoln: Speeches and Presidential Addresses, 1859–1865 (New York: Current Literature Publishing Company, 1907), 282.

264 “to form what, for lack of a better phrase”: Matthew Joseph Bruccoli and Scottie Fitzgerald Smith, Some Sort of Epic Grandeur: The Life of F. Scott Fitzgerald (Columbia: University of South Carolina Press, 2002), 443.

EPILOGUE

266 the classic work of the psychologist Hans Eysenck: Hans Eysenck, The Psychology of Politics (London: Routledge and Kegan Paul, 1954).

266–267 Simonton . . . Westen . . . Lakoff: Dean Keith Simonton, Psychology, Science, and History: An Introduction to Historiometry (New Haven, CT: Yale University Press, 1990). Drew Westen, The Political Brain (New York: Public Affairs, 2007). George Lakoff, The Political Mind (New York: Viking, 2008).

267 Michael Fellman in his biography of Sherman: Michael Fellman, Citizen Sherman: A Biography of William Tecumseh Sherman (New York: Random House, 1995).

267 Joshua Shenk in his biography of Lincoln: Joshua Wolf Shenk, Lincoln’s Melancholy (Boston: Houghton Mifflin, 2005).

267 does not mean that illness is nothing but a social construction: S. Nassir Ghaemi, The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry (Baltimore: Johns Hopkins University Press, 2009).

268 the claims of some postmodernist historians notwithstanding: For some of my debates with postmodernist oriented colleagues, see http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=4504, http://metapsychology.mentalhelp.net/poc/view_doc.php?type=book&id=4440 , and alien.dowling.edu/~cperring/aapp/bulletin_v_17_2/21.doc (accessed February 27, 2011).

269 “split-brain” research: Michael Gazzaniga, Mind Matters: How Mind and Brain Interact to Create Our Conscious Lives (Boston: Houghton Mifflin, 1988). In some epilepsies, where seizures do not respond well to medications, as a last resort a kind of surgery is sometimes used where the fibers, called the corpus callosum, connecting the right and left hemisphere are cut. After corpus callectomy, seizures that begin on one side of the brain at least do not travel to the other side, and full-blown convulsions are thus prevented. This kind of surgery began a few decades ago, and in the intervening time researchers have observed an important thing about these patients: living with two halves of a brain no longer communicating with each other, they seem to have two brains, not one. Not much is noticeable in terms of personality or behavior; interacting on the street or in stores, one cannot tell someone with a split brain, after corpus callectomy, apart from the rest of us. With neuropsychological tests, however, important abnormalities emerge.

The right hemisphere of the brain controls the left visual field; the left hemisphere controls the right visual field. In all right-handed persons, language is fully controlled by the left hemisphere. (In left-handed persons, language is partly controlled by both hemispheres.) Thus in right-handed patients after split-brain surgery, the split between language and vision can be tested. If an image is shown to the right hemisphere (in the left visual field) of, say, a woman talking on a phone, the experimenter who asks the patient—What do you see?—will get an answer, a wrong answer, but an answer nonetheless. “I see a friend,” the subject might say. “What is the friend doing?” “Cooking dinner.” Then with a phone nearby, the experimenter can ask the subject, “Show me what you saw.” The subject will pick up the phone.

The split-brain epilepsy patient “knows” what is seen by the right hemisphere, but she cannot speak it. What is most interesting is that she does not say, “I do not know,” or “I am unsure,” or some such. Even when prompted before the experiment by the researcher saying, “Now remember, you have had split-brain surgery for your seizures, keep that in mind when you answer my questions,” patients rarely say that they do not know what they saw, or why they feel as they do about what they saw. They never admit ignorance; they always make something up. That is the way our brains operate: our brains are rationalizing machines; we are designed, by God or evolution, to come up with plausible explanations for what we experience. We never say we do not know.

269 Stephen Ambrose writes: Stephen Ambrose, “William T. Sherman: A Reappraisal,” American History Illustrated 1 (1967): 6–7.

269 decades of excellent twin studies: Kenneth Kendler and Carol Prescott, Genes, Environment and Psychopathology (New York: Guilford, 2006).

270 David Hume starkly laid out this “problem of causation”: David Hume, An Enquiry Concerning Human Understanding (Cambridge, UK: Cambridge University Press, 2007).

271 The German philosopher Wilhelm Dilthey: Rudolf Makkreel, Dilthey: Philosopher of the Human Studies (Princeton, NJ: Princeton University Press, 1992). S. Nassir Ghaemi, The Rise and Fall of the Biopsychosocial Model (Baltimore: Johns Hopkins University Press, 2009).

272 “Whilst thus many men of genius themselves”: Ernst Kretschmer, The Psychology of Men of Genius (London: Kegan Paul; New York: Harcourt, Brace and Co.), 4.