Sunday, April 11, 2010

We Need A Psychologically-Fit President

by Dr. Prospero E. de Vera

Importance of Health Disclosure

The recent release in social networking sites like Facebook and e-groups of the alleged psychiatric evaluation of Senator Noynoy Aquino has centered public attention on the need for full disclosure of the medical condition of candidates as a basis for their fitness for public office.

Supporters of Noynoy Aquino have cried foul and accused the Nacionalista Party of orchestrating a demolition job against their candidate and paraded a letter from Father Tito Caluag stating that he never examined Senator Aquino.

Not to be outdone, ABS-CBN reports that psychiatric evaluation was released by the NP and when asked to name its sources, invoked the “confidentiality” of its sources as a defense against public disclosure.

What is being forgotten in this whole media frenzy is the fact that the medical condition of candidates running for office is a public issue that needs to be addressed. The fact that Noynoy Aquino is running for the President makes the resolution of this issue more critical.

In short, this is not about Noynoy Aquino. This is not about Ninoy and Cory Aquino’s legacy. This is about what is for the good of the nation.

Americans Monitor the Physical and Mental Health of their Presidents

People in developed countries take the mental health of their leaders seriously. In his blog entitled Mental Illness in U.S. Presidents--"Call Me Incompetent But Don't Call Me Crazy" Dr. Rick Lippin said that the mental competence of Presidents are important because: : (

1. We obviously need mentally competent Presidents of the United States
2. We need better laws to ensure such mental competency both prior to and
while holding such an important office; and
3. We need to ensure that psychiatric evaluation, diagnosis, and treatment of
Presidents are as free as possible from any influence whatsoever from
partisan politics.

Dr. Lippin's blog was based on an excellently written article in The Journal of Nervous and Mental Diseases (January 2006) which studied biographical source material in 37 presidents from 1776 to 1974 on the topic of Mental Illness in U.S. Presidents. This journal article concluded that 18 presidents (49%) met the criteria suggesting psychiatric diagnoses and in 10 instances (27%) "a disorder was evident during presidential office, which in most cases probably impaired job performance". Thankfully the authors concluded that no national calamities appeared to have occurred due to presidential mental illness. ( and (

Many American Presidents suffered from psychiatric problems. James Madison, John Quincy Adams and Franklin Pierce all suffered from major depressive disorders. Theodore Roosevelt and Lyndon Johnson were bipolar, and Woodrow Wilson suffered from a generalized anxiety disorder.

David Shribman, writing in Real Clear Politics said that “some of the presidents, to be sure, came to office with a proclivity to mental disorder, only to find that the stress of office pushed them into illness. But some – Calvin Coolidge, Franklin Pierce – developed mental disorders after their sons died tragically. Neither president was able to commit himself effectively to the task of leadership following such tragic loss". The psychiatrists who did the 2006 study concluded that "(T)raumatic bereavement may have left each one (Coolidge and Pierce) poorly equipped to discharge the demanding responsibilities of office."

Unfortunately, this landmark study only covered US presidents until Richard Nixon. I am sure that if it included the more recent occupants in the White House, the study would reveal that Ronald Reagan suffered from Alzheimer's late in life and perhaps even in the White House. George W. Bush has admitted freely that he abused alcohol in the years leading up to his 40th birthday. Bill Clinton, of course led a very colorful life before and during his presidency that produced the scandals of Jennifer Flowers and Monica Lewinsky.

The American public has consistently demanded that their presidential candidates show their physical and mental fitness for public office. One of the reasons why Senator Paul Tsongas failed to capture the Democratic Party nomination in 1992 was the public concern that his lymph node cancer that afflicted him in the mid-1980s will recur. Governor Bill Clinton went on to win the primaries and became President because of this health issue.

Later events would show that this concern was correct because a few years later Tsongas’ cancer returned and he died of pneumonia and liver failure.

More recently, Republican candidate John McCain repeatedly tried to block the release of his medical records while campaigning for the presidency against Barack Obama. He argued that his melanoma was a thing of the past and will recur if he is elected President. The concern for McCain’s health, coupled with the possibility of a Sarah Palin takeover was one of the reasons for the embarrassing Republican Party loss in 2008.

All these historical precedents bring me back to my original point. It is important, crucial, and necessary to subject all presidential candidates to psychiatric tests to determine their fitness for public office. Noynoy Aquino, because of the allegations that have surfaced, needs to squarely face this issue and not hide behind media statements.

Mental Incapacity

Filipinos hold elections sacred because they pin their hopes on elected officials to solve all of their problems. In a country deeply mired in poverty, Filipinos believe that curbing corruption, alleviating poverty, and exercising good governance can be achieved if they select the best leader from among those running for President.

A presidential candidate must therefore show unquestioned physical and mental fitness for public office to show that he can handle the stresses of managing a nation. The traumatic loss of their sons made US Presidents Coolidge and Pierce poorly equipped to discharge the demanding responsibilities of office. If it is true that Noynoy Aquino suffers from mental incapacity BEFORE he even assumes office, imagine the danger of him experiencing the traumatic situation of Coolidge and Pierce while in office!

The issue of “mental incapacity” is important for another reason - the Constitution cites “mental incapacity” as one of the grounds for declaring the Office of the President vacant.

Article VII, Sec. VIII of the 1987 Constitution states that “In case of death, permanent disability, removal from office, or resignation of the President, the Vice-President shall become the President to serve the unexpired term…”

Article VII, Section 8 of the Constitution which deals with vacancies occurring in the Office of the President identifies four (4) specified situations, to wit: (a) death of the incumbent, (b) his permanent disability, (c) removal, or (d) resignation from Office.

Permanent disability, as constitutionalists widely agree, refers not only to physical but also mental incapacity.

Noynoy Aquino's Alleged Psychiatric Evaluation Form

Noynoy Aquino’s alleged Psychiatric Evaluation Form from the Ateneo de Manila University Department of Psychology contains the following details:

“History of Present Illness: The patient is a 36-year old single male with a history of profuse salivation and labile moods since his childhood. He was observed to be sleeping excessively, disoriented and confusing family and household member’s name. When interviewed at the time of psychiatric assessment, the patient said he had difficulty in speech, poor concentration, impaired thinking and melancholia brought about by the stresses of his work and the break-up with his flight attendant girlfriend. He also claimed he felt clumsy and uncoordinated. He also describes what appeared to be a deep sense of foreboding and feeling that the “world was coming to an end.”

“Current Symptoms:

1. Psycho motor retardation
2. Slowed gait and activity
3. Lack of initiative
4. Melancholia
5. Fatigue
6. Lack of self-confidence
7. Lack of sexual interest”

“Substance Abuse History:

Smoker Yes, up to two (2) packs a day
Drugs Yes, teen-age experimentation with Marijuana and various pills
ETOH Yes, solitary drinker”

“…when confronted with stressful or traumatic experiences they transcend into open aggression, most noticeable during the coup d’etat attempts against his mother when she was President. He wanted to execute all the rebel soldiers and their leaders. He claimed that it was these very same men who killed his father, now here they were again trying to kill his whole family.”

Tell Tale Signs?

Critics of Noynoy Aquino have raised this mental condition question as early as Septmber 2009 when news broke out that he was running for President. Despite repeated denials, his media responses, conduct in public debates, mannerisms, and interviews about his life raise many questions. For example:

• He owns a lot of guns, definitely much more than the average gun enthusiast,
as shown in a special television show about presidential candidates
• He sleeps even in places where he shouldn’t be napping, such as during the
GMA-7 Presidential Debates series.
• He did raise tantrums during a Presidential Forum when he thought Tony Lopez, the moderator, was biased in favor of the other candidates
• He laughs a lot in public; smiles even when there is no reason to smile.
• His answers during interviews are sometimes “off tangent” with the question raised.
• He walks, talks, and acts similar to the “Current Symptoms” mentioned in the Report.
• He is very “vindictive” through his pronouncements on various issues (e.g. should he be elected president, he will impeach an Arroyo-appointed Supreme Court Chief Justice,).
• He does lack initiative. He has not passed any law, not even a local law after 9 years in the House of Representatives and 3 years in the Senate. He rarely holds committee hearings in the Senate committees that he chairs, and very seldom speaks in plenary debates.

National Interest vs. Privacy Requirements

Is privacy as covered in doctor-patient privilege more important than national interest?

According to George Annas, Professor of Health Law at Boston University School of Public Health in his article in the New England Journal of Medicine entitled “The Health of the President and Presidential Candidates: The Public’s Right to Know”:

“It is a central legal and ethical principle that physicians should not disclose private medical information to people who are not involved in a patient’s care without the patient’s authorization. The doctor–patient relationship is a confidential one, and a breach of confidentiality is unethical unless it is necessary to protect the public’s health.”

The Public’s Right to Know

So should Aquino’s denial be the end of this issue? Absolutely not! It is the public’s right to know whether he, in fact, suffers from mental incapacity. He and all presidential candidates should allow themselves to undergo psychological examination.

It is in the best interest of the nation that they do. The nation cannot risk that its fate be entrusted to someone who is not psychologically fit to govern.

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