We Need to Stop Talking About Mental and Cognitive “Fitness” of Politcians

Monday, November 13, 2017

A photo of a microphone on a stand in front of blurred American flags in the background.

Who’s fit to be president? Historically, this question has revolved around issues like matters of experience, policy positions, and ability to collaborate sympathetically across national and party lines. In 2017, the conversation has taken on another element with speculations about mental health and discussions of whether prospective presidents should be required to submit evidence of mental fitness.

In the past, sitting presidents have released information about their annual physical exams, and bipartisan lawmakers have proposed requiring such disclosure for both presidents and candidates. Discussions about fitness have also played a prominent role on the campaign trail, as when a major party candidate attacked another in 2016 when she disclosed that she was receiving treatment for pneumonia. The 3 a.m. attack ad, which has been deployed by multiple campaigns, sets up a nightmare scenario: It’s 3 a.m., the phone is ringing, and what is the president doing? Sleeping or sick in bed? Too incompetent to respond to a crisis? Such ads often play on issues of age or perceived disability — evidently no one’s heard of Franklin Delano Roosevelt, who used a wheelchair throughout his record breaking 12-year term (term limits were imposed on the presidency in 1947).

Moreover, members of the public have jested that presidents and officials should be required to take IQ tests, thereby implying that a certain level of a very specific kind of intelligence should be required to be in office. And, inevitably, numerous authorities have suggested that presidents should be required to prove that they’re mentally fit to take office via mental health screening.

The insistence that presidents, or any politicians, must prove themselves “mentally fit” for office generates a very slippery and dangerous slope that the electorate should be wary of, no matter their stance on a given politician or candidate. It’s one that can slide from legitimate concern about the public interest into discrimination, making value judgements about worth on the basis of and and/or disability status.

This may explain why this particular brand of disablism is so pervasive: Nondisabled people may view disability as a negative character trait, rather than simply part of who someone is, so they don’t understand why leveraging disability to attack people carries oppressive weight.

Questions of fitness for presidents are perhaps the most pressing in the minds of the public, given the fact that the position involves tremendously demanding tasks. Proponents of fitness evaluations say both mental and cognitive health should be a consideration in the name of national security and the best interests of the electorate. They argue that some mental health conditions could interfere with decision-making ability, make it challenging to process information, and disrupt interpersonal relationships with staffers, fellow officials, foreign leaders, and other individuals. Rhetoric about mental health often invokes slurs like “crazy,” positioning mental health conditions as inherently evil and using this to drive a call to disqualify mentally ill people from holding public office.

Mental health isn’t the only subject that attracts the attention of advocates for “fitness” rooted in disability status. Cognitive impairments like Alzheimer’s or dementia, they assert, could also compromise the president’s ability to perform the duties of the office, which is certainly true. But this ageist rhetoric is often aimed at all older adults seeking office, even though not every elder develops cognitive disabilities, and it’s also used to label people who behave “erratically” in the eyes of observers.

Many people embarking on campaigns questioning fitness to serve claim to have the best of intentions: They want the best for the United States, and for that, the nation needs a president who is able to meet the demands of a challenging job. However, there’s a suspicious correlation between attacks on fitness and failure to align with personal political views. And these conversations are approaching a very serious issue from the wrong perspective, not least because the only person who can accurately diagnose a patient is a health care provider who has a relationship with the patient that’s included multiple opportunities for evaluation, along with testing to rule out a variety of possible causes.

The assertion that someone with mental illness or a cognitive disability is unable to serve in politics is an assertion, indirectly, that all people with such conditions are incapable of leading full, active lives. We see ample evidence to the contrary, including analysis that suggests a number of past presidents may have experienced symptoms of mental health conditions. Arguing that these conditions are automatically disqualifying is manifestly unfair to people, and it’s stigmatizing.

It also serves as a disincentive for political involvement: Talented, thoughtful, excellent public servants may decide against running for fear that people will use their identities against them. It may also encourage people to defer treatment, fearing that reaching out for help may create a black mark that makes it impossible to pursue careers not just in politics, but elsewhere. For those experiencing symptoms of cognitive impairment or mental health conditions, hearing that people “like you” are unfit to lead the country suggests that asking for help, or coming out openly, could be dangerous.

Making assumptions about a person’s mental health or cognition isn’t just stigmatizing. It also misses the actual issue. Proponents of armchair diagnosis say: “This person is engaging in behavior I dislike, therefore, they must have a mental health condition or cognitive impairment.” But the actual cause of the behavior may be rooted in issues like social attitudes and pressures from political parties, not cognition or mental health status. By refusing to acknowledge that, the public gives politicians a pass on bad behavior, attributing it to something that “can’t be helped” and implying that mental illness or cognitive disabilities make people hateful — either because they don’t realize it due to their altered state, or because a disability fundamentally warps someone’s approach to the world — while failing to examine the underlying problems.

There is a way to talk about fitness, though, because these are conversations that are vitally necessary. Some politicians are indisputably unfit to serve, and it has nothing to do with their cognitive, mental, or physical health and everything to do with who they are as people.

The conversation needs to start by explicitly defining and discussing the problem behavior in question, not in vague terms but in concrete ones. By doing so, people can open up a discussion about the causes of the behavior — for example, if a president has a regressive stance on immigration policy, members of the public may say it’s “insane” or “completely unhinged,” but what does that mean?

Exploring the behavior in more detail opens up the discussion along more fruitful lines. What is the actual reason you consider a certain behavior or action to be negative? Answering that question thoughtfully and honestly opens up an actual conversation about how to address such behavior, whether it’s policy you disagree with, the way a politician treats other people, or another issue. Presenting information to articulate why the behavior is wrong may create grounds for arguing that the politician is unfit for office for reasons not related to cognitive or mental health, for those who believe that policy should be fact-based and unbiased.

This becomes particularly critical in a campaign context, when messaging is often simplified to the detriment of everyone involved. Campaigns, and advocates, need to think about how to communicate information about fitness in a clear context that people will understand, even if it doesn’t make for snappy soundbites and campaign ads. There is also, of course, a clear ethical benefit to focusing on a candidate’s actions and their consequences, rather than armchair diagnosis that stigmatizes disabled people. Providing accurate context on a candidate’s stated policy positions, their origins, and their implications should be a nonpartisan activity rooted in mutual interest in seeing the United States grow stronger and more cohesive.

Leaving the policy discussion at the door in favor of making assumptions about a politician’s health is a disservice to the United States, and to the communities who struggle with the stigma created by “fitness” rhetoric.

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