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ORIGINAL ARTICLES
Mental Illness In U.S. Presidents Between 1776 and 1974
A Review of Biographical Sources
Jonathan R. T. Davidson, MD, Kathryn M. Connor, MD, and Marvin Swartz, MD
Abstract: Numerous historical accounts suggest the presence of
mental illness in US Presidents, but no systematic review has been
undertaken for all holders of this office. We reviewed biographical
sources regarding mental illness in 37 US Presidents from 1776 to
1974. Material was extracted by one of the authors and given to
experienced psychiatrists for independent review of the correspon-
dence of behaviors, symptoms, and medical information in source
material to DSM-IV criteria for Axis I disorders. Levels of confi-
dence were given for each diagnosis. Eighteen (49%) Presidents met
criteria suggesting psychiatric disorder: depression (24%), anxiety
(8%), bipolar disorder (8%), and alcohol abuse/dependence (8%)
were the most common. In 10 instances (27%), a disorder was
evident during presidential office, which in most cases probably
impaired job performance. Mental illness in heads of state is a topic
deserving further attention. Methodological limitations of using
biography to determine psychopathology are discussed.
Key Words: Presidents, mental illness, biographical sources.
(J Nerv Ment Dis 2006;194: 47–51)
The success or failure of political leaders is determined, in
part, by their state of health. Mental health problems in a
head of state may be significant for different reasons. Firstly,
there is the possible threat to effective government, as well as
to national and even international security. A historical ex-
ample of incapacitating psychosis in a ruling monarch, which
led to the appointment of a regent, can be found in King
George III (MacAlpine and Hunter, 1969). Secondly, char-
acteristics embodied in a particular head of state invariably
personify, at some level, values and visions held of a country
by its population. Thus, people saw in Calvin Coolidge “the
fine simplicities, the sturdy patriotism, the firm unpretentious
character, the spirit of New England . . . he inspires a deep
nationwide confidence that all will go well with the country
while he is in the White House” (Stoddard, 1927). After he
developed overwhelming grief and depression in office, it is
doubtful if he would have still symbolized these values.
The presence of psychiatric disorder among politicians
has already been noted by Post (1994), who reported high
rates of depression (41%), somatoform disorder (33%), and
anxiety (22%) in a nonrandomly chosen sample of 50 world
famous politicians. Furthermore, Freeman (1991) observed
that political leadership has become increasingly stressful
over the past several decades (e.g., the spread of nuclear
weapons, rise of global terrorism, the need to be available on
a ’round-the-clock basis, being subject to almost constant
scrutiny, and the power of the media). Lyndon Johnson
described the work of the presidency as “demanding and
unrelenting . . . always there to be done.” He went on to
describe that he rarely slept for more than 4 or 5 hours and
that “it became a question of how much the physical consti-
tution could take” (Johnson, 1971). The need for resiliency
among our Chief Executives is imperative.
From George Washington to Richard Nixon, there have
been a total of 37 US Presidents, some of whom are widely
acknowledged to have exhibited major mental illness, e.g.,
John Adams and Abraham Lincoln. Although a few individ-
ual psychiatric portraits exist (Freud and Bullitt, 1999; Sotos,
2003), we are unaware of any systematic psychiatric review
of all who have held office as US President. We therefore
undertook such a survey, drawn largely from historians’
secondary accounts, and then applied current DSM-IV diag-
nostic criteria (American Psychiatric Association, 1994) to
the extracted information for all US Presidents between
Washington and Nixon, covering the period from 1776 to
1974. We assessed (1) the likely level of confidence that a
psychiatric disorder was present, (2) type of disorder, and (3)
whether it was evident during the presidential term of office.
METHODS
Material was obtained from a variety of secondary
sources, including biographies, narrative accounts, medical
books, and journals (Barber, 1972; Bruenn, 1970; Bumgarner,
1994; Caro, 1990a, 1990b, 2003; Cerinchiari et al., 2000;
Coolidge, 1931; Deppisch, 1997; Deppisch et al., 1999;
DiGregorio, 2002; Fieve, 1981; Gilbert, 1998; Goodwin and
Jamison, 1990; Hersh, 1983; Levin, 2001; Marx, 1960;
McCullough, 2001; Nichols, 2003; Russell, 1968; Sobel,
1998). Relevant material was extracted by one of the authors
(J. R. T. D.) and then independently reviewed by two separate
raters (K. M. C., M. S.), who each evaluated the likelihood of
a psychiatric disorder and its type.
Department of Psychiatry, Duke University Medical Center, Durham, North
Carolina.
Send reprint requests to Jonathan R. T. Davidson, MD, Duke University Medical
Center, Department of Psychiatry, Box 3812, Durham, NC 27710.
Copyright © 2006 by Lippincott Williams & Wilkins
ISSN: 0022-3018/06/19401-0047
DOI: 10.1097/01.nmd.0000195309.17887.f5
The Journal of Nervous and Mental Disease • Volume 194, Number 1, January 2006 47
Criteria used to establish the presence of a disorder are
provided in Table 1. Based on these considerations, three
levels of likelihood (i.e., confidence) were established: (1)
“high,” if all three criteria were met as set out in Table 1; (2)
“probable,” if criterion A and either B or C were met; and
(3) “possible,” if only criterion A was met. To lessen the
likelihood of false positives, we present only those cases
where all three raters concurred at a confidence level of 1 or
2. Levels of judgment were applied to the presence of a
psychiatric disorder in general, as opposed to levels of con-
fidence in a particular DSM-IV subtype. It was not always
possible, for example, to judge whether a president had five
out of nine symptoms of major depressive disorder, thereby
qualifying for a definite DSM-IV diagnosis, but it would
nonetheless be apparent that a depressive disorder was
present, persistent, impairing, and/or evident to others. For
bipolar disorder, it was rarely possible to establish the num-
ber of consecutive days in which bipolar symptoms mani-
fested. However, if other criteria were clearly met, then we
judged the individual to exhibit type I or II bipolar disorder,
depending on reported symptoms.
Source materials were reviewed for the presence of
Axis I disorders (e.g., clinical psychiatric disorders) or per-
sistent psychopathology due to obvious Axis III disorders
(e.g., general medical conditions). Therefore, Presidents who
underwent obvious major medical disorders accompanied by
brief spells of impaired lucidity or judgment (e.g., arguably
Arthur 关Bumgarner, 1994兴, Harding during his presidential
term 关Deppisch, 1997兴, and F. Roosevelt 关Bruenn, 1970兴) are
not considered to fall under the rubric of having a major
psychiatric disorder. In cases in which multiple persistent
somatic symptoms occurred in the absence of any other
known medical diagnosis of that time (as was the case with
Madison, Wilson, and Harding), we leaned more to viewing
these symptoms as psychological in origin, in keeping with
biographic accounts.
RESULTS
A summary of our assessments is presented in Table 2.
Of 37 Presidents between 1776 and 1974, 18 (49%) exhibited
features suggesting psychiatric disorder, 14 of whom experi-
enced one disorder, while four experienced two or more. In
one instance (Wilson), raters unequivocally agreed on the
existence of pathology, but disagreed as to whether it was
best classified as anxiety or depression.
The most common disorder was unipolar depression
(N⫽9), followed by anxiety (N⫽3), alcohol abuse or
dependence (N⫽3), somatoform disorder (N⫽1), bipolar I
disorder (N⫽2), bipolar II disorder (N⫽1), paranoia
secondary to cerebrovascular accident (N⫽1), and breath-
ing-related sleep disorder (N⫽1) (President Wilson was not
included in this count).
Episodes occurring during presidential office were
noted in 10 instances (J. Adams, Pierce, Lincoln, T. Roos-
evelt, Taft, Wilson, Coolidge, Hoover, Johnson, and Nixon).
In all cases except T. Roosevelt, there was evidence to
support the conclusion that symptoms interfered with effec-
tiveness or performance.
Several Presidents appear to have exhibited psychiat-
ric symptoms or were at heightened risk. For example,
Kennedy’s repeated use of inappropriately prescribed stimu-
lant drugs is well documented (Gilbert, 1998), but we found
no evidence that it led to significant paranoia or other mental
impairment. In Arthur’s case, it was difficult to determine the
impact of progressive renal failure on his mental state, al-
though one of the raters (K. M. C.) believed there to be some
evidence of depression. The source of Jackson’s unpredict-
able mood swings, irritability, and suspicion have been de-
bated inconclusively as being caused by heavy metal poison-
ing from mercury and/or lead toxicity (Cerinchiari et al.,
2000; Deppisch et al., 1999). His complex medical history,
including chronic infections and pain, makes it very difficult
to conclude that he had a primary psychiatric disorder, and
we have excluded him as well. Jefferson experienced re-
peated, stress-related headaches, which eventually remitted
late in life. Their origin is still a matter for conjecture (Pearce,
2003). Madison’s pseudoseizures appear best viewed as petit
mal epilepsy (Bumgarner, 1994), although we cannot be
certain about this.
DISCUSSION
We found that 49% of US Presidents exhibited features
suggestive of mental illness at some stage in their life, a
figure that is in line with national prevalence rates (Kessler et
al., 1994), although the rate of depression seems high for a
male population. Broadly, we can define two emergent pat-
terns: (a) Presidents with disorders in early adult life but who
had apparently recovered well before their presidential terms,
and (b) those with persisting or recurrent problems that were
sometimes exacerbated during the course of office. A third
pattern almost certainly exists, in which late life psychopa-
TABLE 1. Guidelines Used to Assess for Presidential
Psychiatric Disorders
Criteria for Assessment
A. Persistent (i.e., at least some weeks)
or recurrent (i.e., not transient)
B. Symptoms classifiable by DSM-IV,
either as:
(a) Meeting full criteria, or
(b) Meeting subthreshold criteria
C. Presence of at least one of the
following attributable to the
condition:
(a) Alteration in personality
(b) Alteration in relationships
(c) Impairment or deterioration in
work capacity
(d) Treatment by either self or a
medical professional
(e) Evident to others
Level of confidence
1. High Meets criteria A, B, and C
2. Probable Meets 2 of 3 criteria (of
which one must be A)
3. Possible Meets criterion A only
Davidson et al. The Journal of Nervous and Mental Disease • Volume 194, Number 1, January 2006
© 2006 Lippincott Williams & Wilkins48
thology emerges, e.g., dementia or neurocognitive changes
due to a general medical condition, as recently exemplified by
Ronald Reagan. However, from the source material upon
which this paper is based, we have come across almost no
information on the mental decline of aging presidents, except
possibly for Pierce and Hayes. Belonging to pattern (a) are
Madison, J. Q. Adams, Grant, Hayes (Marx, 1960), Garfield
(DiGregorio, 2002), Harding (Deppisch, 1997; Marx, 1960),
and Eisenhower (Barber, 1972). To contemporaries well
acquainted with Madison, Hayes, Grant, and Wilson, it must
have appeared that, as young men, these individuals were
doing very little with their lives, with Grant, in particular,
unable to hold down even the most simple employment on
account of alcohol problems.
Ten (27%) Presidents exhibited psychopathology dur-
ing their presidential terms, which, in a number of instances,
produced untoward or unexpected changes evident to others.
In some cases (e.g., Pierce), associates commented that he
was not the person who had victoriously campaigned for
office. Other notable examples in this category are Taft,
Wilson, Coolidge, and Hoover.
Bereavement occurred often enough to bear further
discussion. Two Presidents, Pierce and Coolidge, tragically
and unexpectedly lost favorite sons either immediately before
assuming office (Pierce) or during administration (Coolidge),
with significant untoward effects upon their effectiveness in
office. Interestingly, neither President was renominated for
a second term. In Pierce’s case, while he sought renomina-
tion, his party repudiated him, while in the other instance
(Coolidge), to the surprise of the country and prominent
observers (Stoddard, 1927), he chose not to run for a second
term. Neither President was able to commit himself effec-
tively to the task of leadership following such tragic loss:
traumatic bereavement may have left each one poorly
equipped to discharge the demanding responsibilities of of-
fice. Pierce’s loss was particularly traumatic, in that he and
his wife saw their son decapitated in front of their eyes in a
railway accident. Whether Pierce suffered from posttraumatic
stress disorder is unclear, although one of us (K. M. C.)
believed there was evidence of intrusive, numbing, and hy-
perarousal symptoms. That he suffered from traumatic grief
is incontestable: “In these two months he can be said to have
lost his son, his wife, and his capacity to command success”
(Nichols, 2003, p. 536); “. . . disorganized and numbed by
personal tragedy, he seemed to understand little of the forces
outside himself which were combining with his inward inse-
curity to make him one of democracy’s most unfortunate
victims” (Nichols, 2003, p. 546).
TABLE 2. Psychiatric Disorders in US Presidents (1776–1974)
President Diagnosis (Identified by Raters)
a
Confidence
Level
Evident in
Office
Persistent or
Recurrent
Impaired, Evident
to Others or
Sought Treatment
DSM-IV
Criteria
J. Adams (1797–1801) Bipolar II disorder (296.89) 1 Y Y Y Y
Jefferson (1801–1809) Social phobia (non-generalized) (300.23) 2 N Y Y N
Madison (1809–1817) Major depressive disorder (296.2) 1 N Y Y Y
J. Q. Adams (1825–1829) Major depressive disorder (296.2) 1 N Y Y Y
Pierce (1853–1857) Alcohol dependence (303.9) 1 Y Y Y Y
Major depressive disorder (296.2) 1 Y Y Y Y
Lincoln (1861–1865) Major depressive disorder, recurrent, with
psychotic features (296.34)
1Y Y Y Y
Grant (1869–1877) Alcohol dependence (305.9) 1 N Y Y Y
Social phobia (300.23) 1 N Y Y Y
Specific phobia (blood) (300.29) 2 N Y ? Y
Hayes (1877–1881) Major depressive disorder (296.2) 1 N Y Y Y
Garfield (1881) Depressive disorder NOS (311) 1 N Y ? Y
T. Roosevelt (1901–1909) Bipolar I disorder (296.44) 1 Y Y Y Y
Taft (1909–1913) Breathing-related sleep disorder (780.59) 1 Y Y Y Y
Wilson (1913–1921)
a
Anxiety disorder NOS (300.0) 1 Y Y Y Y
Generalized anxiety disorder (300.02) 1 N Y Y Y
Major depressive disorder (296.3) 1 Y Y Y Y
Personality change due to stroke (310.1) 1 Y Y Y Y
Harding (1921–1923) Somatoform disorder NOS (300.81) 1 N Y Y Y
Coolidge (1923–1929) Social phobia (300.23) 1 N Y Y Y
Major depressive disorder (296.2) 1 Y Y Y Y
Hypochondriasis (300.7) (2) 2 Y Y N Y
Hoover (1929–1933) Major depressive disorder (296.2) 1 Y Y Y Y
Eisenhower (1953–1961) Major depressive disorder (296.2) 1 N Y Y Y
L.B. Johnson (1963–1969) Bipolar I disorder (296.5) 1 Y Y Y Y
Nixon (1969–1974) Alcohol abuse (305.00) 1 Y Y Y Y
a
Diagnoses given were anxiety disorder NOS (300.0) (K. C.), generalized anxiety disorder (300.02) (J. D.), and major depressive disorder (296.3) (M. S.).
The Journal of Nervous and Mental Disease • Volume 194, Number 1, January 2006 Mental Illness in U.S. Presidents
© 2006 Lippincott Williams & Wilkins 49
Other Presidents have endured grief during their ad-
ministration. Jackson entered the White House distraught
over the loss of his wife just before inauguration and spent the
remainder of his years in mourning; his inaugural speech was
one of the shortest in history. Presidents Tyler and Wilson
both lost spouses while in the White House, while Arthur lost
his wife 1 year earlier and Harrison also lost his wife. J.
Adams lost a son toward the end of his term, while Lincoln
lost his favorite son, and Kennedy a newborn child. The
success with which each person overcame his grief was
variable and no doubt was determined by a variety of factors.
Other Presidents who perhaps fell short of fulfilling
their potential include Taft and Wilson (in spite of Wilson’s
high ranking as a “great” President, as noted below). Wil-
son’s inability to lead his administration effectively has been
well documented, and questions were raised as to his suit-
ability for the job, all of which happened at a particularly
critical time in world history. The development of paranoia
and other mental changes, which could have amplified his
rigidity of character, perhaps prevented him from taking
advantage of the opportunities in his hands as President of the
world’s most powerful country after World War I (Runyon,
1982, pp. 195–196). In Taft’s case, it was “drift, drift,
drift—little attempted, nothing done” (Stoddard, 1927) and
abdication of any real interest in leadership. The fact that he
coped with the stress of the Presidency by overeating to the
point of massive obesity and obstructive sleep apnea meant
that he probably could not give full attention to the job.
We did not find that any particular historical epoch was
associated with greater or lesser likelihood of presidential
psychopathology. Three Founding Fathers fulfilled criteria
for a disorder, as did several Presidents throughout the 19th
and early 20th centuries, and three recent Presidents. Criteria
for psychiatric disorder were noted in six consecutive presi-
dents between 1908 and 1928 (T. Roosevelt, Taft, Wilson,
Harding, Coolidge, and Hoover), in four of whom we believe
that an abnormal mental state adversely impacted presidential
performance. More recently, there is the documented prob-
lematical and excessive alcohol use by Nixon during the
stresses of the Vietnam War and the Watergate scandal.
While our study has revealed psychopathology in a
substantial number of US Presidents, we should acknowledge
several limitations to this report. In the first place, we may
have underestimated the burden of psychopathology inas-
much as we did not identify and review all that has been
written about presidential health. To have covered the terrain
of all primary and secondary sources (e.g., major biographies,
presidential papers and collections) was beyond the scope of
this report. Our method likely underestimates more subtle
forms of psychopathology and even within major diagnostic
categories misses certain key symptom clusters that might
appreciably change the diagnosis. For example, in several
cases there was clear evidence of depressive symptoms but
inadequate biographical detail to rule out manic symptoms.
As a result, finer-grained diagnostic precision is hard to
achieve from biography alone.
We have not entered the debate over disagreements
within the psychobiography literature, but it is certainly
necessary to acknowledge that such disagreements exist (Ru-
nyon, 1982; Schlesinger, 2004; Wills, 2004). Although the
validity of diagnosis from historical sources is unproven, it
continues as an established practice. Among the suggested
criteria for assessing psychobiography are whether (1) more
than one rater was used and (2) material is factual or inter-
pretative/speculative (Runyon, 1982). By using three inde-
pendent raters, we attempted to introduce a degree of meth-
odological rigor to this survey.
We also recognize that description of mental illness
was not usually a focus of the biographical sources and that,
moreover, any presentation of presidential behavior or emo-
tional state may have been colored by the writer’s personal
bias. Also undetermined is the effect of applying contempo-
rary criteria to a description of human behavior and health
from a time when concepts of mental illness were very
different from those in use today. However, in any culture or
period of history, evidence that a person was hospitalized or
unable to function constitutes prima facie evidence that some
form of significant health problem existed, no matter how
illness was conceptualized.
Our findings raise several interesting issues. Firstly, no
national calamities appear to have occurred due to presiden-
tial mental illness. Secondly, Presidents are seen to be human,
and if so many of them have a major psychiatric disorder,
then it could at least serve to lessen the long-standing stigma
toward mental illness. Thirdly, in situations where mental
illness has occurred, it has usually been of the type that is
readily treatable with appropriate professional help and sup-
port. Whether such episodes should be kept private or made
public is a matter for debate. The general issue of medical
cover-ups in the White House and their attendant problems
has been described elsewhere (MacMahon and Curry, 1987).
Does the public have a right to know, for example, if their
next President is likely to make crucial decisions under the
influence of alcohol or if severe psychopathology is likely to
impair decision making and judgment?
Mental illness in the President also raises important
issues of how temporary or permanent mental impairment or
incapacity should be handled. The assassination of President
Kennedy in 1963 raised questions about the process of
declaring the President incapacitated, which were addressed
in 1967 by ratification of the 25th amendment to the US
Constitution. The amendment stipulates that the Vice Presi-
dent become Acting President whenever the President notifies
the Senate and the House of Representatives that he is unable
to serve. The President may resume his duties by his written
declaration that he is fit to do so, unless contested and two
thirds of both Houses of Congress agrees that the President is
unable to discharge his duties.
Mental illness and potential loss of insight regarding
the illness also raise the specter of the President or his staff
failing to disclose or resisting a determination of incapacity.
While this provision of the 25th Amendment has never been
invoked, the Vice President and Cabinet may declare the
President incapacitated, and the Vice President then tempo-
rarily serves as Acting President unless contested by the
Davidson et al. The Journal of Nervous and Mental Disease • Volume 194, Number 1, January 2006
© 2006 Lippincott Williams & Wilkins50
President and arbitrated similarly by a vote of two thirds of
both Congressional Houses.
Understandably, the 25th Amendment sets a high
threshold for nonconsensually removing a US President due
to mental or physical incapacity. The possibility of a partisan
attempt to remove a President clearly requires careful safe-
guards. At the same time, in certain instances—for example,
President Wilson’s impairment after a stroke—attempts may
be made to conceal potential incapacity. Given the extensive
powers of the President, the apparently fairly common oc-
currence of mental illness, and the potentially devastating
impact of impaired judgment due to mental illness, perhaps
an additional mechanism to initiate a politically neutral ex-
amination of the President’s capacity should be considered.
CONCLUSION
This review of biographical sources reveals the likeli-
hood, to varying degrees of confidence, of major mental
illness in 49% of presidents; in 27%, such disorder occurred
during the term of office and, in many cases, was believed
to affect performance adversely. The occurrence of mental
illness was distributed across all historical epochs, spanning
the 18th, 19th, and 20th centuries. We have considered the
strengths and numerous limitations of our approach.
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The Journal of Nervous and Mental Disease • Volume 194, Number 1, January 2006 Mental Illness in U.S. Presidents
© 2006 Lippincott Williams & Wilkins 51
