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Health a chief concern for commander in chief

Job's demands, political calculations all factor in


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Being president has taken its toll on many chief executives. Nixon, for example, was all smiles in 1969 ...
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(CNN) -- Warning: Being U.S. president may be harmful to your health.

A periodic business trip may be annoying, but crisscrossing the country and world on a weekly and sometimes daily basis can be grueling. Many people balance their checkbooks, but for a president, that involves trillions of dollars -- and, with that, millions of jobs and programs that affect hundreds of millions of lives.

Presidents not only face constant scrutiny, but also death threats -- and at times, assassination attempts. As if that weren't burden enough, a commander in chief's decisions in war and peace may help decide other people's lives, and in some cases, a society's future.

Still, candidates jostle every four years to land one of the world's most prestigious -- and most stressful and physically demanding -- positions. As Sen. John Kerry's multiple bouts with laryngitis thus far this year show, life on the campaign trail can be a tough test physically -- and good training for the demanding life of a president.

"It's the ultimate 24/7 job, and presidential history will tell you that there is no way of getting relief," says Dr. Bert Brown, a former director of the National Institute of Mental Health. "It's a four-year root canal of pressure and problems."

Whoever wins in November will have round-the-clock access to some of the nation's top health care. Physicians and top-notch medical equipment and facilities follow the president wherever he goes. (Full story)

When something does go wrong, most presidents have little time to recover from injuries, improve their health or even mourn for private tragedies. Yet they have great political incentive to portray themselves as forever fit and strong, physically and mentally.

"When the president becomes ill, the entire system is affected -- the circle around him, the media, and most importantly the American public, particularly when there has been a sense of confidence reposed in the president," says Jerrold Post, a political psychologist and professor at George Washington University.

"An illness to the president is not just a personal matter. It is a devastating public crisis."

Physical strains

Presidents, like anyone else, have physical setbacks. President George W. Bush, for instance, hurt his right knee running and famously choked on a pretzel. President Clinton tore a quadriceps tendon and had a benign cyst removed from his neck.

Some presidents have suffered more severe health concerns.

President Reagan underwent four operations at Bethesda Naval Hospital as chief executive, with surgeons addressing an enlarged prostate, a cancerous growth in his large intestine, two benign polyps and a condition called Dupuytrin's contracture that had caused part of his left hand to curve inward.

President Eisenhower suffered a heart attack and a stroke while in office. Whereas Eisenhower recovered enough to work efficiently, the same might not be said of President Wilson after he had a stroke during his second term.

A president's arduous job may hinder his physical recovery, Post says.

"When a person is recovering from a major trauma or major surgery, he deserves the rest and rehabilitation that any of us mere mortals would have," Post says. "The public expectation, at times, is so high that the president [is] always on duty."

"The political situation aside, just the day-to-day demands of being president, are extraordinary," adds Capricia Marshall, President Clinton's social secretary during his administration. "He could never turn it off."

The assassination attempt against Reagan in March 1981 showed -- as did fatal attacks on Presidents Lincoln, Kennedy and others -- that presidents face near constant, sometimes all too real threats on their lives.

Dr. E. Connie Mariano, a White House physician from 1992 to 2001, recalls a discussion with Clinton on what to do if he were to become incapacitated by an illness or attack -- including the option of invoking the 25th Amendment, under which power can be transferred quickly to the vice president.

"It was very sobering," Mariano says. "Most people don't want to think about their mortality or that people are trying to kill them. But they have to know."

Severe, sustained stress

Although the record has improved recently -- Reagan lived to 93, while President Ford is 91 and President George H.W. Bush 80 -- Northeastern University professor Robert Gilbert notes that more than two-thirds of presidents have failed to reach their era's life expectancy for white males, "despite the fact that they have received the best medical care that you can imagine."

LBJ
Lyndon Johnson, like many other presidents, faced tremendous stress while president.

Post says a "certain degree of stress" can make people "more alert, more focused" during a crisis, "but the data on sustained stress shows a decrease in functioning over time, even though a person may believe he is at the height of his powers."

In the long run, Post says, "stress tends to bring out not the best in people, but magnifies the flaws that are already there."

President Coolidge, for example, suffered from severe depression after his son's death, which historians link to his administration's record.

Oftentimes, the office's many demands can impair a president's mental health.

As the Watergate crisis unfolded, several leading senators alerted Brown -- one of Washington's top mental health experts -- about President Nixon's "withdrawal of social contact" and rumors of increased drinking. Nixon showed paranoid tendencies, as did his predecessor Lyndon Johnson related to rising antiwar sentiment, "that put terrible strains on them," Boston University professor Robert Dallek says.

Looking vs. feeling good

Social stigma often associated with mental illness and a desire to portray oneself as physically fit -- implying strong leadership -- prompts presidential candidates to play down the negatives and accentuate the positives about their health.

Dallek, whose 2003 book "An Unfinished Life" revealed many new details on President Kennedy's medical problems, found that the president received treatment for Addison's disease, severe back pain, colitis and urethritis, among other ailments. Despite apparent ongoing pain, Kennedy the candidate denied any ill health or medical conditions, portraying himself as vibrant and robust.

"There was a president who was much less healthy than the public image of him conveyed," says Dallek, noting that the strains did not appear to affect Kennedy's decision-making, as during the Cuban Missile Crisis. "If [the public] knew about it in 1960, I doubt that he would have been elected."

George W. Bush and John Kerry frequently play sports in view of cameras while campaigning and extol their health. Kerry, moreover, has touted his full recovery from prostate cancer.

An emphasis on physical fitness not only helps a candidate's public image, experts say, but may also prove useful for dealing with the heavy load a president carries in office.

Woodrow Wilson once said that being president "requires the constitution of an athlete," among other qualities, because of the burdens of running the country.

The significance the public and media places on a president's health, says Gilbert, is healthy for the country.

"It's important to everyone," he says. "If [political leaders] are in good health, they do their jobs better and they live their lives better."


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