Alex Thompson is politics and policy editor at Vice News.

In 1919, President Woodrow Wilson suffered a devastating stroke that left him partially paralyzed, semi-blind and so fragile that his wife and doctor hid him from the public. In 1923, Wilson’s successor, Warren G. Harding, died suddenly in office from what was later determined to be congestive heart failure. The fragile mortality of the presidency was on display as at no other time in American history, and in 1928, Congress codified a new White House position: the personal physician to the president. Now, a doctor would always be on hand if the president were physically ill.

Left untouched in 1928, however, was the president’s mental health. After all, mental illness in the 1920s was most commonly associated with asylums, not the White House. But nearly a century later—and after a revolution in the science of psychiatry—we now know that anyone, even presidents, can suffer from a mental illness. The newly sworn in Congress now has a chance to strengthen the health of all future presidents by appointing a psychiatrist from the military to work alongside the presidential physician. One of the most stressful and consequential offices in human history ought to have easy access to the best medical care available, including when it comes to mental health.


This is not about assuaging the fears or stoking the jeers of those who have called Donald Trump a psychopath or a narcissist. The assumption that presidents have robust mental health was wrong long before the 45th president came along. As I have written before, at least two presidents—John F. Kennedy and Richard M. Nixon—surreptitiously took daily psychiatric medications such as Valium and other anxiety treatments while occupying the Oval Office. Another—Lyndon B. Johnson—was so emotionally erratic that his top aides consulted psychiatrists and confronted the first lady about his behavior. And Abraham Lincoln experienced such deep bouts of depression during his life that he was confined to bed and contemplated suicide.

Despite the mercurial behavior and pill-popping, there is no one employed to keep tabs on the president’s mental health. Nor has any presidential physician ever been a trained psychiatrist. Today, the presidential physician periodically releases a summary of the president’s checkups, but these reports do not contain psychiatric information. Those presidents who are known to have received psychiatric medication had to arrange for it in secret, most often from doctors without backgrounds in mental health. (We do know, however, that Nixon, while serving as vice president, received prescriptions from a psychiatrist.)

Mental health problems have been destigmatized in American culture over the past few decades, yet mental health remains fair game in the political arena—as some presidential-level politicians have learned the hard way. In 1972, reports arose that Democratic nominee George McGovern’s running mate, Thomas Eagleton, had undergone shock therapy. Eagleton eventually withdrew from the ticket, and McGovern’s judgment was called into question. President Nixon, meanwhile, kept his psychiatric medication secret by getting a Valium prescription from his and Henry Kissinger’s osteopath, as reported by Evan Thomas in his book Being Nixon. And Michael Dukakis got tagged with the psychiatric stink without even seeing a psychiatrist. As George H.W. Bush’s campaign was trying to gin up rumors about Dukakis’ mental health, President Ronald Reagan answered a question on the topic by quipping, “Look, I’m not going to pick on an invalid.” The political media went wild, and Dukakis’ large lead in the polls began to shrink.

It’s true that some mental illnesses are so severe that they would make one unable to serve as president. But the greatest governing risks—not just to the president but to the world—come from not getting treatment. Just as physical illnesses include everything from the flu to terminal cancer, mental illnesses range in severity from treatable anxiety disorders to more serious diseases like schizophrenia. “A president can function very well if he has a mild anxiety disorder or obsessive compulsive [disorder],” George H.W. Bush’s presidential physician Burton Lee told me. Indeed, some already have.

The introduction of a presidential psychiatrist would surely carry political risks. Would the president’s judgment be trusted if people knew of psychiatric sessions? What would happen if the president’s medical files were leaked and the public found out the commander in chief was on anti-depressants?

In fact, the appointment of a presidential psychiatrist would actually be the most politically prudent way for a president to receive psychiatric care. As is the current practice with the presidential physician, the president could choose to keep any or all parts of his or her psychiatric medical files private. Even appointments need not be disclosed. The leak of any medical information about the president would breach both doctor-patient confidentiality and the military chain of command, providing an extra layer of privacy to the president.

Appointing a presidential psychiatrist would also be a fitting addition to an unprecedented decade of bipartisan mental health policy reform in Congress. In 2008, Congress passed Democratic Representative Patrick Kennedy’s mental health parity law, which required health insurance companies to cover mental and physical illness equally. And just last month, Congress incorporated Republican Representative Tim Murphy’s Helping Families in Mental Health Crisis Act, which overhauled the federal bureaucracy that deals with mental health, into the 21st Century Cures Act. Back in 1928, some lawmakers didn’t like that the presidential physician would automatically be given the rank, pay and allowance of a colonel; others felt that the president should pay for his own doctor rather than charge the taxpayers. But a majority ultimately decided that the position should no longer be optional. Today, the presidential physician’s salary is less than $200,000 annually, out of the federal government’s $3.9 trillion budget—a reasonable sum for maintaining the health of the leader of the free world.

Of course, whether or not a presidential psychiatrist is good policy is very different from whether it’s good politics. Republicans don’t want to be perceived as saying their party’s president needs professional help, while Democrats have already shown a willingness to wield Trump’s psyche as a political weapon. Appearing at the Democratic National Convention in July to support Hillary Clinton, former New York City Mayor Michael Bloomberg said America should reject Trump and vote for the “sane, competent person.” David Plouffe, President Barack Obama’s former campaign manager and an adviser to Clinton’s campaign, said in August, “We basically have a psychopath running for president. I mean, [Trump] meets the clinical definition.” Plouffe went on to diagnose Trump as having a “grandiose notion of self-worth, pathological lying, lack of empathy and self-worth,” before acknowledging “I don’t have a degree in psychology.”

The media has enabled this kind of armchair psychology of the president-elect. Reporters interviewed psychiatrists throughout the campaign asking them to assess Trump’s mental health despite never having met him. The Atlantic dedicated a cover story to “the mind of Donald Trump.” The Washington Post’s Bob Woodward has told multiple audiences that a notable psychiatrist says Trump appears to be “the most classic example of narcissistic personality disorder I’ve ever seen.”

Enough psychiatrists were quoted in various publications that the American Psychiatric Association issued a statement calling such psychoanalysis of candidates “unethical” and irresponsible.” The group cited what’s known as “The Goldwater Rule,” which “prohibits psychiatrists from offering opinions on someone they have not personally evaluated. The rule is a legacy of the 1964 campaign, when 1,189 psychiatrists controversially declared Republican nominee Barry Goldwater mentally unfit to be president. Trump could very well suffer from some form of mental illness (about 18 percent of the adult U.S. population does), but the point is that none of the people saying so actually knows.

The fraught politics of mental health have clearly not gone away. But Congress could try to avoid them in the short term by quickly codifying the presidential psychiatrist position before Trump is sworn in on January 20. And in the long term, such a move could actually help to destigmatize mental health problems among politicians.

Mental illnesses are caused by both environment and genetics, and history makes clear that the Oval Office can be a psychologically unhealthy place. Far from alleviating any nagging psychoses, being elected to one of the most powerful and demanding positions in the world often brings out old gremlins to gnaw on a presidential psyche. Talking to a psychiatrist every once in a while is like preventative medicine to keep such subconscious demons at bay.

“The pressures [of the presidency] are beyond anything that human beings are designed to handle,” David Axelrod, former senior adviser to President Barack Obama, told me last year, adding that in an ideal world the president should be able to see a psychiatrist any time. Even if Trump or any of his successors doesn’t want to meet the psychiatrist, the president should have easy access in case the pressures of the job change his or her mind.