A First-Rate Madness (19 page)

He could never be left alone, except when he slept. This complete absence of privacy, he once said, was the worst aspect of his disability.

 

 

POLIO CHANGED FRANKLIN ROOSEVELT in ways that went well beyond the physical. He remained energetic and motivated, but he carried a different attitude. Pre-polio FDR was “an untried rather flippant young man,” according to one political friend. Roosevelt was
disciplined
by his illness, future Supreme Court justice Robert Jackson remarked. Frances Perkins had known Roosevelt since 1910, and was close to him throughout his presidency until his last days. She was well positioned to know him before and after polio, and she was convinced there was a huge change: “Roosevelt underwent a spiritual transformation during the years of his illness. I noticed when he came back that the years of pain and suffering had purged the slightly arrogant attitude he had displayed on occasion before he was stricken. The man emerged completely warmhearted, with humility of spirit and with a deeper philosophy. . . . I saw Roosevelt only once between 1921 and 1924, and I was instantly struck by his growth. He was young, he was crippled, he was physically weak, but he had a firmer grip on life and on himself than ever before.”

Before polio, he was a successful patrician: secretary of the navy in Wilson's administration, vice presidential candidate in 1920, poised to run for senator or governor. After three years of seclusion, he returned to the national limelight at the 1924 Democratic convention, leaner, older, wheelchair-bound, speaking not as a candidate, as many had expected pre-polio, but as Smith's campaign manager. After hours of mediocre, self-serving speechifying, interspersed with tepid applause, Roosevelt held the delegates spellbound for seventeen minutes with an address that would become famous as the “Happy Warrior” speech. Describing Smith, Roosevelt cited lines from Wordsworth: “This is the Happy Warrior; this is he that every man in arms should wish to be.” The delegates gave him a twelve-minute standing ovation, followed by an hour of singing, cheering, and clapping.

Four years later, running against the New York City Democratic machine of Tammany Hall, Roosevelt won the New York governorship, and four years after that, the presidency. FDR's hyperthymic personality steeled him for the challenges that his polio and later his presidency would make him face. And his polio seems to have given him a degree of empathy that we've seen in other leaders who endured depression. This combination of nature and circumstance made him unusually fit for the unprecedented series of crises that would mark his years in the White House.

Without hiding his disability, Roosevelt never used it to garner sympathy. It was, if anything, a political handicap. Some wondered, when he first ran for governor, whether a paralyzed man was fit to govern. (Al Smith responded, “A governor does not have to be an acrobat. We do not elect him for his ability to do a double back flip or a handspring.”) In 1932, a rumor spread that polio eventually would affect the brain, making Roosevelt insane. FDR responded by authorizing three physicians to fully examine him and his medical records. Their report was frank in describing his physical disability, and his psychological strength: “Ten years ago, Governor Roosevelt suffered an attack of acute infantile paralysis, the entire effect of which was expended on the muscles of his lower extremities. There has been progressive recovery of power in the legs since that date; this restoration continues and will continue.”

 

 

IN SUM, hyperthymic personality is key to Roosevelt's psychology. It made him open to new ideas, and charismatic, but also, in the face of polio, hyperthymia helped him to be resilient, to rise above and better understand human suffering. This psychological evolution may have helped him handle the huge crises of economic depression and world war. His mind was agile and he did not recoil from the most terrible of decisions. He had imbibed the pragmatic philosophy that Justice Holmes had helped invent—the view, as Perkins put it, that “nothing in human judgment is final. One may courageously take the step that seems right today because it can be modified tomorrow if it does not work well.” She thought this attitude freed Roosevelt to act. Indeed it did. But it was not just a philosophical judgment that FDR made; rather, this approach was part of his hyperthymic temperament, the always active mind that would never have given him the option of standing still. (In contrast, normal, mentally healthy leaders like George W. Bush make decisions, but refuse to modify them when they do not work well. This inflexibility, I hold, is a feature of not being hyperthymic, that is, of
not
being mentally abnormal, as we'll see.)

Roosevelt never sought an overarching ideology to guide his decisions. He made each decision step by step, backing off where things did not work, forging ahead when they did. After a while, he was building a new approach to government, though he probably had not foreseen it clearly. In 1929, he saw that the Great Depression was “the end of an era” and that “recovery was not enough.” He had declared something entirely new, a philosophy that remains controversial in American politics—the notion that government had a duty to create jobs and take care of its citizens, for a government “that cannot take care of its old, that cannot provide work for the strong and willing, that lets the black shadow of insecurity rest on every home is not a government that can or should endure.”

Of all his programs, Roosevelt took the most pride in Social Security, though even there he refused to take an ideological approach. When the program was being prepared, one proposal would have covered everyone at the time, but it would have left a deficit to be handled by the U.S. government in 1980. “We can't sell the United States short in 1980 any more than in 1935,” Roosevelt objected. Still, he faced critics who assumed there must be an ulterior motive. Frances Perkins, then secretary of labor, recalled appearing before a Senate committee, where Senator Thomas Gore from Oklahoma, blind and elderly, a former progressive Democrat, asked sarcastically, “Isn't this Socialism?” “Oh, no,” Perkins replied. “Then, smiling, leaning forward and talking to me as though I were a child, he said, ‘Isn't this a teeny-weeny bit of Socialism?' ”

Franklin Roosevelt wasn't worried about any accusation, nor even of bringing about piecemeal socialism in the United States. He knew only that people were hurting; he knew what it was like to hurt; and his personality would not allow him to sit still. He tried whatever worked, and with that method he achieved astounding success. This wasn't just because of an intellectual pragmatism, as many presume. Though he studied at Harvard from 1900 to 1904 when the influential founder of philosophical pragmatism, William James, taught there, FDR did not take a class with James, and, as previously noted, he hardly read philosophy. His pragmatism was not intellectual; it was temperamental. (James had the view anyway that one's philosophy is determined by one's personality.) It was not an overstatement when, long after Justice Holmes, another elderly American statesman, John Kenneth Galbraith—a member of FDR's administration, and a later confidant of Kennedy and Johnson—could conclude that FDR was “the greatest political personality of the century.”

All this would not have happened had his hyperthymic temperament been different, as Holmes rightly saw. Nor would it have happened had he not been tried by the adversity of illness and, with his hyperthymic energy and spirit, grown from the experience. Frances Perkins saw this ability to grow, this “viability,” as the hallmark of Roosevelt's personality. So too did the president's wife. Asked years later whether FDR's polio affected his politics, Eleanor summed it up well: “He would certainly have been President,” she remarked, “but a president of a different kind.”

 

 

 

John F. Kennedy should never have survived into his thirties, much less become a great president. His success in becoming America's youngest president is in itself more remarkable than many realize. He overcame great adversity, like FDR, because of his hyperthymic personality.

Psychologically, young John Kennedy was a highly energetic, charming, hypersexual rebel—marked all over by traits of hyperthymic personality. At prestigious Choate Academy, where his brother Joe had been a star student-athlete, John posted middling grades and belonged to a misfit gang called the “Muckers,” whose rebellious antics led to his temporary expulsion, reversed after a conference between the headmaster, George St. John, and Joseph Kennedy Sr. (After getting young John to promise Mr. St. John that he would behave, Joe Sr., himself a rebel, admonished the boy privately, “If that crazy Muckers club had been mine, you can be sure it wouldn't have started with an M!”) Years later, when Choate planned a book about his school years, President Kennedy responded laconically, “I do not think it particularly helpful to go through the monthly reports, etc. It might have an adverse effect on the work of students who might think it necessary to work hard and do well at school in order to become President.” The book did not advertise that headmaster St. John had been concerned enough about the mental state of the future president that he had arranged for a psychological evaluation of the seventeen-year-old, which, besides documenting an IQ of 119, concluded that Kennedy was “a very able boy, but definitely in a trap, psychologically speaking. He has established a reputation in the family for thoughtlessness, sloppiness, and inefficiency, and he feels entirely at home in the role.”

 

 

AFTER HIS OLDER BROTHER Joe was killed in World War II, Jack was given the family mantle to bear. But before the adult Jack could deliver, the teenage Jack had to survive. John Kennedy was sick most of his life, and almost died multiple times before he was assassinated. In his teen years, Kennedy experienced the first of many lifelong physical illnesses that, inexplicable at the time, probably reflect onset of Addison's disease and related immune system illnesses. In Addison's disease, the adrenal glands do not produce steroids, which are essential for the proper functioning of the immune system. Like other immune system deficiencies, such as AIDS, Addison's disease makes its sufferers unable to resist infections. Along with adrenal problems, other immune system abnormalities in the body can lead to inflammation in the bowels, leading to belly pain and diarrhea, or inflammation in the muscles, leading to back pain. Kennedy was to suffer all these illnesses, without ever fully realizing how they were connected.

At age thirteen he was hospitalized with severe abdominal pain, which would recur throughout his life. Because of his weak immune system, even a knee scrape would lead to severe infection, a long healing process, and the need for crutches. He had frequent colds, ear infections, and influenza. Jack was sick so often that his brother Robert joked that if a mosquito bit Jack, the mosquito would die. At age seventeen, he had his worst infection ever, with high fever, hives all over his body, very low white blood cell count (probably due to inadequate steroid levels), and jaundice. He was diagnosed with fatal leukemia and given a 5 percent chance of survival.

His father, unwilling to accept this death sentence, sought a second opinion—a month of testing at the Mayo Clinic, after which the best doctors of the era confessed that they had no idea what illness had almost killed the young man. Nevertheless, the doctors prescribed strict diet and limits on physical exertion.

Like manic-depressive illness, Addison's disease is episodic; crises are followed by natural recovery, and later relapse into another episode. Probably because of nature, rather than the doctors' advice, Kennedy improved in his final year of high school and graduated. In the next few years, though, the episodes increased in frequency and severity: on a trip to London after graduation, after entering Princeton, and following his withdrawal from Princeton. Months of hospitalization were inconclusive; tests were still mostly normal. Symptoms were nonspecific: jaundice, weight loss, fatigue, diarrhea. Kennedy knew his condition was serious, and seriously confusing. While he was at Brigham Hospital, he wrote to a friend that “they have not found out anything as yet except that I have leukemia + agranulocytosis. Took a peak [
sic
] at my chart yesterday and could see that they were mentally measuring me for a coffin.” He felt ashamed of his illnesses and weakness, it seems, competing even there with his brother Joe. “Joe's blood count was 9400,” he wrote in a letter to his brother Robert, “mine for comparison was 4000 which makes him twice as healthy.”

As psychoanalytic concepts became popular, one of Kennedy's Boston doctors, gastrointestinal specialist Sara Jordan, concluded that his problem was not a serious physical illness but an emotional malaise affecting his intestines. The death sentence was now lifted, but Jack now received a vaguer psychiatric sentence. His father was ambivalent, writing Jordan that “one of the things I am a little disturbed about is that he may get to thinking he is a sick boy—I see some signs of this—and I want him to get away from that idea as quickly as possible.” And in another note: “One thing I want to be sure of is that he doesn't develop into a hypochondriac. So, if there isn't anything seriously the matter with him let's tell him that everybody has a few disturbances now and then.” In later years, Kennedy would learn the secret of all his medical problems: he had Addison's disease (now known to be mainly an autoimmune illness in which one's adrenal glands stop producing steroid hormones). Throughout his later life, unwilling to publicly acknowledge his real illness, Kennedy fended off lifelong whispers of hypochondriasis.

 

 

ONE REASON WHY young John Kennedy kept going, despite his severe bouts of illness, was his hyperthymic temperament. Here I again will examine the four sources of evidence for a psychiatric diagnosis: symptoms, family history, course of illness, and treatment.