As a political science major in university, I began to understand the stark terms of how the functions of the executive branch of American government operate. After a few internships with various government offices, including being a House intern, I realized there are a lot of people working and operating the bowels of government that probably live high-stress, and arguably, paranoid lives. But it wasn’t until the presidential candidacy of Barry Goldwater in 1964 where the psychological and psychiatric consequences came to foray for Americans interested in voting for a conservative with strict libertarian ideologies about the expansiveness of government. Eventually, questions of Arizona Senator Goldwater’s mental competency arrived because of comments he had made regarding the use of nuclear weapons against American enemies. His answers to these sensitive questions appeared to many to be advocating for the casual use of low-grade nuclear weapons and the possibility of continual use for defensive purposes. The incumbent president, Lyndon Johnson, used this self-defeating rhetoric against Goldwater in a now infamous ad that ran only one time, called the “Daisy Ad.”
Goldwater, furious about the implication in the ads about his casual use of nuclear weapons that could lead to the destruction of the planet, demanded that the Johnson campaign remove the ad. Johnson’s team did, and it only aired once on television. But the damage was done, and Johnson won a landslide election.
Throughout the campaign, though, many psychiatrists (besides voters) questioned whether Senator Goldwater was mentally component to be president, given his answers to these life-or-death questions. The American Psychiatric Association (APA) eventually came up with a set of rules known as the Goldwater Rule in determining the fitness for office of presidential candidates. Until then, no major presidential candidate for office was questioned for psychological fitness for running and becoming the president.
Senator Goldwater was accused of having chronic psychosis and being a schizophrenic, and psychiatrists have largely suggested that Goldwater was mentally unstable. It has been rare since to indict presidential candidates on their psychological fitness for the presidency, until President Trump. Psychologists and psychiatrists frame the current president has exhibiting symptoms from bipolar disorder to megalomania to various personality disorders. What is interesting is that the Constitution has an amendment, created in the late 1960’s (interestingly following the Goldwater-Johnson campaigns) that established some rules on presidential disability.
Not to get into the details of the 25th Amendment, but there’s a big difference between the legal ramifications of assessing the organizational capacity of the executive branch of government and the political ramifications of assessing the mental capacity of the President of the United States as a means of transferring power. The amendment does not provide enough detail to this arrangement and much of the literature on the 25th amendment is dedicated to the work of several senators following the Kennedy assassination. But the questions that they managed to solve doesn’t address issues that have lead to larger conversations on disability and the mental capacity of individuals at-large.
As Johnson (himself exhibiting symptoms of bipolar disorder) mentioned during the ratification’s ceremony, we are still determining the extent of the term “disability” and who can adjudicate the term onto someone else. States and counties are struggling with this issue on an individual basis with patients, members of the homeless community, and people on the psychosis spectrum. The conversation of mental capacity hasn’t been addressed at the highest level of government because it is fraught with political consequences that either side does not want to address. How can society address these major high-level executive functionality concerns when it cannot address them at a local basic level for behavioral health purposes?
The options are not very attractive, but piece-by-piece members of the psychosis community, the patients themselves, are addressing these issues in a very real way. Addressing human rights concerns will improve how we address issues of institutional function and executive leadership at a constitutional level. One hope is the legacy of many politically-minded patients and sufferers of serious mental illness will lead to a greater understanding of managing executive capacity in all its forms, not just casting aspersions on presidents and political leaders we deem mentally incapable.