Presidential Infirmity and the "Bartlett" Scenario

I’ll give some background below for anyone interested, but the short of it:

**I’m interested in the hypothetical here-if a real sitting President was revealed to have a neurodegenerative disease, one that can sometimes impact “executive function” (meaning your brain’s ability to make decisions) is there any realistic chance that President would be reelected? Would he be impeached? Would he be removed from power by the 25th amendment? **

Due to a slate of very old candidates (Trump and Hillary are near the end of the bell curve for Presidential ages, and Sanders would be the oldest person ever to enter the office) I’ve been thinking about the consequences of Presidential physical and mental infirmity.

FDR was able to manage physical infirmity pretty well, but the Presidency (while mentally demanding no doubt during the Great Depression and WWII) was a different job back then in terms of the physical demands. The President was super important but was “less a celebrity”, and FDR did a lot of his reaching out to the people through radio that he could record in his office.

Woodrow Wilson suffered grave infirmity at the end of his presidency due to a debilitating stroke. His wife sought to conceal this, and several important aides were complicit in this act. They even fabricated an interview with a reporter to make Wilson seem okay. He was bedridden for weeks. Even today we don’t fully know the impacts on his mental function, due to the desire to hide the scope of his condition. His Presidency continued on for 1.5 years after he left office.

We know that Wilson wasn’t truly a vegetable or anything, he gave some addresses/speeches even in retirement, and participated in certain civic activities with his wife. We know that his physical infirmity continued and he never truly recovered from that, strokes are complex even today. There are people who have strokes and suffer limb paralysis but who still maintain all of their cognition, but without Wilson having been subjected to any high level of scrutiny or modern medical tests we will never know his condition. What I do know is that a similar situation in 2016 would’ve gone down far differently. Wilson’s condition eventually became public knowledge to the public, but it took some months for it to leak out, and again a very different world in 1920 responded to it very differently than the 24 hour news cycle would respond today.

Even without the 25th Amendment, the original text of the constitution provided for the Vice President taking over the President’s duties if the President was “incapable” but left it to Congress to hash out the details, and since there had never been a hashing out, it was unclear what would need to happen to remove Wilson from power. As it was, no one really wanted to push the issue and figure out how to certify Wilson as “incapable” and open a large constitutional can of worms.

But that is two examples of President’s suffering a degree of infirmity. The NBC series The West Wing presented another–a President with multiple sclerosis. In the NBC series the President conceals his MS diagnosis (he has early stage relapsing-remitting MS, so when he doesn’t have an attack he appears perfectly healthy, and his overall disease hadn’t progressed enough to lead to any obvious physical incapacity) before his election, and wins. But he reveals (due to a long chain of events) that he has MS a few months before “election season” starts in his first term. In the show, while he takes a drubbing in the polls right after concealing he has MS and that he lied about it, he is able to rehabilitate his image, destroys his Republican challenger in a debate and wins a landslide reelection.

How bad was Reagan’s Alzheimer’s by the end of his term? Not being a bomb-thrower here; I genuinely don’t know if he was already deeply faded at the end of his second term and they covered it up or he was fine then and only declined a few years later. IMO every ex-president sorta goes into hiding for a year or two, but IIRC Reagan’s disappearance was faster, deeper, and more thorough than most. Particularly given his adulation by his party at the time he seemed to do fewer star turns as an elder statesman than might be expected.

If indeed he was showing deterioration by the end of his term we can see that modern politics and news media may be more intrusive than in Wilson’s day, but modern covering up is equally more effective.

It all depends on the politics of the moment, how it’s revealed, and who the President faced on the other side.

If the President was politically weak, faced a very hostile Congress, lied to the American people about his health and moreover appeared to be not up to the challenges of the office, then I suppose I could see a scenario in which he would be impeached and removed from office, although it seems unlikely.

If any of those factors was missing, he’d probably stay in office but his reelection campaign would be hurt - perhaps fatally - by the revelation.

No second final T in the President’s name, by the way:

He disclosed he was diagnosed in 1994, and there’s no evidence he had been diagnosed earlier.

With Reagan, there are several anecdotal accounts that from the mid-80s on, there were incidents in which he would seem to “not be there” or he would have “episodes” of decreased alertness. Lesley Stahl interviewed him in 1986 and said for part of the interview he seemed confused and didn’t seem to know who Stahl was, but by the end of the interview he was fine.

Alzheimer’s will often progress slowly and in the earliest stages the person will have no noticeable mental defect when they’re “feeling good” but they can have bouts where they clearly get confused. These effects get more frequent and more severe which usually lead to someone going to a doctor and a diagnosis being made.

I think given anecdotes and the typical fact that most people with a “regular” progression of Alzheimer’s have it for years before it reaches a point where they go to a doctor with symptoms and get diagnosed it’s highly likely that Reagan had it during the latter half of his Presidency but also likely that “most of the time” he was “just fine.”

That being said I think with a gradual disease like Alzheimer’s there were some things at play that insulated Reagan. Like Lesley Stahl was a journalist with a responsibility to report on the health of the President, but even she wasn’t comfortable going public with the claim that the President seemed senile. It shouldn’t be much of a surprise absolutely no one in his administration felt comfortable. To this day, his doctors at the time and close aides all say that Reagan had “normal bouts of forgetfulness”, that often become more common with old age, but that were not signs of Alzheimer’s. This is possible, people do have degraded memory with age even when they don’t have Alzheimer’s, and you can certainly have age related degradation of memory and then later develop Alzheimer’s.

Reagan also made it known all the way back to the beginning of his first administration that he viewed himself as more of a “Chairman of the Board” type of President, not a “CEO” President. He intentionally kept a lot of stuff off his desk, believed in keeping a “light” schedule and not being “disturbed” outside of it except for true emergencies. The cabinet and the White House Chief of Staff were extremely powerful in the Reagan presidency, with a lot of decision making an day-to-day things being on their desks that in other Presidencies are often handled in the Oval Office. So for that reason both the impact of any infirmity and the opportunities to notice it would’ve been decreased versus say, a Bill Clinton who was super involved in the minutiae of his staff.