A First-Rate Madness (23 page)

This may seem like a lot. It is.

 

 

KENNEDY'S ANABOLIC STEROID USAGE is perhaps the most complex, and most elusive, part of his medical history. (Even in 1966, in her oral history, Travell enumerated all of Kennedy's daily medications but pointedly excluded any reference to testosterone or its derivatives.) Kennedy routinely requested extra methyltestosterone injections or other extra steroid doses, along with amphetamines, before events like press conferences, state dinners, or even just on busy days. Travell seemed reluctant, but she obeyed the commander in chief and dutifully administered the shots.

After the medical coup, Burkley switched Kennedy from injections to pills: Halotestin (fluoxymesteron, an oral testosterone derivative) became the anabolic steroid of choice. These days, Halotestin is one of the most commonly abused oral anabolic steroids, especially favored by power lifters. It has nineteen times the muscular effects of testosterone. The doses used by the president (about 10 mg/day) were lower than those used by weightlifters long-term, but athletes take similar doses just before performances to make themselves more “aggressive.”

The psychiatric effects of testosterone-derived anabolic steroids are known. At least three double-blind, placebo-controlled studies show that healthy people (with no psychiatric or medical diagnoses) given these agents experience significant psychiatric effects—some beneficial (increased libido, increased energy, euphoric mood) and some harmful (anger, aggression, violent thoughts, distractability). Combining these studies, 12 percent (ten out of eighty-four) of healthy people developed enough manic symptoms to reach the severity of a full manic or hypomanic episode. If someone has bipolar disorder or an underlying susceptibility to it (like hyperthymic personality), an even higher rate should occur. Summaries of large clinical populations treated with steroids find a 6 percent risk of severe psychiatric reactions, and 28 percent risk of mild to moderate psychiatric effects. JFK may have had manic episodes, still hidden from historical documentation, or milder manic symptoms, such as heightening of his already high libido. Or maybe, paradoxically, his Addison's disease protected him from getting too manic on steroids. In studies of people with naturally low steroid levels (as in Addison's disease), steroids improve mood and cause fewer psychiatric side effects.

JOHN KENNEDY HAD many reasons to be psychiatrically ill. He may have had a family history of mental illness; Addison's disease, when severe, itself produces clinical depression; and steroids themselves can cause mania or depression. But after carefully examining the medical records in the JFK presidential archives, I found little medical comment on his mental states. Most records simply do not discuss psychiatric symptoms. There was no documentation that Kennedy ever experienced a clinical depressive or manic episode. However, I found documents that suggest he had at least one instance of depressive symptoms severe enough to warrant medical attention.

In early December 1962, Kennedy developed another viral cold, with sinus and throat symptoms (“a slight sniffle,” according to his press secretary, Pierre Salinger). On December 11, concerned about mental depression, Jackie Kennedy called both Dr. Travell and Dr. Burkley. Here is the note in Dr. Burkley's file, with “X” being his notation for the president, and “X-1” meaning the First Lady: “Received a call from Dr. Travell who stated that X had spoken to her and said that he seemed a little depressed. . . . Received a call from X-1 stating that X felt somewhat depressed and that she felt that perhaps the antihistamine drugs were responsible for this. She requested that they be discontinued. . . . I received a second call from X-1 stating that she had called Dr. Boles [Kennedy's gastroenterologist] in Boston and requested that he supply a medication which would be a mood elevator without the possibility of upsetting the gastrointestinal tract and that he had suggested Stelazine as the drug of choice.” Kennedy then received a small dose of Stelazine—which is in fact an antimanic/antipsychotic, not an antidepressant—for the next three days, after which his infection improved. This brief but somewhat intense period of depression, probably related to his underlying Addison's disease, is the only available documented instance of explicit psychiatric treatment given to John Kennedy.

Even if they didn't cause full-blown depression or mania, Kennedy's steroids could have caused moderate symptoms of those conditions. If so, the most likely candidate for steroid-induced effects might be the presidential libido. The evidence for Kennedy's hypersexuality is both medical—recurrent urinary tract infections, chronic prostatitis, and documentation of
Enterobacter cloacae
infection in June 1961—and journalistic. The most extensive journalistic work is by Seymour Hersh, who draws on the testimony of numerous independent witnesses, including Secret Service agents. According to these reports, the president had many sexual relationships—some brief, others longer, using the White House swimming pool (later filled in by Nixon) as a favored venue, an ironic usage given that contemporary media often reported how his physical exercise regimen involved daily visits to the pool. The president's schedule tended to have long empty periods in the middle of the day, usually from lunch until 3 or 4 p.m. During those times, he went to the pool, usually with his aides David Powers or Kenneth O'Donnell; the Secret Service kept all (including the First Lady) away, except female visitors, often two White House staffers nicknamed “Fiddle” and “Faddle.” Others known to have had liaisons with the president included Mary Meyer (sister-in-law to
Washington Post
editor and Kennedy friend Benjamin Bradlee), Judith Campbell Exner, and a White House intern, among others. Secret Service agents also reported that unknown women, presumed to be prostitutes, visited the president, on the road and in the White House.

I recount this libidinous activity because it is relevant to both hyperthymic personality and steroid-related psychiatric effects. Kennedy's hypersexuality was not limited to his presidential years, but also occurred in his college and congressional years, before and after marriage. JFK always had a high sex drive, probably related to his hyperthymic temperament, and later strengthened by libido-enhancing medications (anabolic steroids and amphetamines).

Kennedy's procaine injections are also a possible source of psychiatric effects. Procaine is similar to—but weaker than—cocaine. In animal studies where rhesus monkeys are offered cocaine or procaine, they prefer cocaine. Yet when given procaine, human cocaine addicts report euphoria and pleasurable feelings similar to those of cocaine. When Kennedy combined procaine with other agents that produce euphoria, like amphetamines and steroids, they all augmented one another, increasing his energy and libido further.

This is an explosive mix of psychiatrically active medications: four types of steroids (including anabolic testosterone-like agents), amphetamines, intramuscular procaine, and intermittent barbiturates. It is hard to accept, biologically, the claim made by Kennedy biographers that none of these medications, nor the illnesses they were meant to treat, had any impact on the president's leadership.

This consensus has been challenged only by Dr. David Owen, the sole physician-scholar to examine the medical records and write about Kennedy's leadership. In his personal review of Kennedy's medical records, Owen concluded that two phases can be discerned. In the early years of his presidency, Kennedy's medications were a mess: the mix was higher in testosterone and frequently changing, as well as combined with Jacobsen's mysterious amphetamine/testosterone injections. This was the time of his greatest failures. In the second half of Kennedy's thousand days, though, Owen believes the reduction of Kennedy's injections and the departure of Jacobsen led to more reasonable treatment, and Kennedy became a more effective leader. Owen's insight makes medical and historical sense, as we'll see.

 

 

THE POLITICAL TRANSFORMATION of President Kennedy bears recounting in the context of his steroid treatments and the White House medical coup d'état. A few months after taking office, he faced a proposed CIA covert action in Cuba. When Cuban exiles landed in the Bay of Pigs, however, they were overwhelmed. They called for U.S. Air Force backup. Kennedy, who had been assured repeatedly by the CIA and military brass that no such military intervention would be needed, refused. CIA and military leaders were appalled; they had expected him to take the next step when defeat was the only other option. Eisenhower would not have stopped, they told him. (“When you commit the flag, you commit to win,” Eisenhower had said during the 1954 overthrow of Guatemala's government.) Kennedy was shocked. For months thereafter, while struggling to survive his Addisonian crisis, he kept repeating over and over, “How could I have been so stupid?” He brooded on how the CIA and the generals had duped him. (“Those sons-of-bitches with all the fruit salad just sat there nodding, saying it would work.” “I've got to do something about those CIA bastards . . .”)

In June 1961, reporting to Queen Elizabeth on the Vienna summit, the British prime minister, Harold Macmillan, had compared Kennedy to Neville Chamberlain: “The President was completely overwhelmed by the ruthlessness and barbarity of the Russian Chairman. It reminded me in a way of Lord Halifax or Neville Chamberlain trying to hold a conversation with Herr Hitler. . . . For the first time in his life Kennedy met a man who was impervious to his charm.” “Too intelligent and too weak” had been Khrushchev's summary conclusion. “Gentlemen, you might as well face it,” Kennedy's own secretary of state, Dean Rusk, told a White House meeting in the summer of 1961, when the president was out of the room, “this country is without leadership.” Needing extra testosterone injections even to handle state dinners, Kennedy struggled through his annus horribilis.

As his doctors got better hold on his steroid abuse in 1962, Kennedy's mental and physical state improved. By October of that year, when the Soviets placed missiles in Cuba, Kennedy was ready. Rather than rely on the military or CIA, he made decisions himself. Writes one historian, “Walking out on generals was a Kennedy specialty. ‘The uniforms' seemed incapable of listening, or understanding, and they could not stop once they swung into canned briefings. . . . ‘I don't want that man near me again,' Kennedy said once after one of his walk-outs on [air force general Curtis] LeMay. [Defense Secretary Robert] McNamara and his men learned not to bring the general's name up. ‘He has a kind of fit if you mention LeMay.' ” The president of 1962 was not going to make the same mistakes as the president of 1961.

The details of the Cuban Missile Crisis are well known: Khrushchev tested Kennedy by bringing missiles to Cuba. Kennedy ignored his generals, who advised attack; he also ignored his diplomats, who opposed any military action. With his brother Robert as his main confidant, he commenced a naval blockade. For thirteen days in which the world teetered on the precipice of nuclear war, Kennedy stared down Khrushchev. The Soviet leader famously blinked first, and after secret negotiations to remove U.S. missile bases in Turkey, Soviet ships turned back and the missiles came out of Cuba.

Prime Minister Macmillan now opined that if Kennedy did nothing else in his entire presidency, this one victory would mark him as a successful leader, for he had done what Chamberlain had failed to do: during peacetime, he stood up to a military threat, refused to give in, and thereby averted future war. About eight months after the missile crisis, Kennedy made his famous speech in West Berlin. Standing tall in front of the Berlin Wall, he was no longer the weak leader whom Khrushchev had harangued. This John Kennedy had new international stature. The people of Berlin could tell a special leader when they saw one; they reached such a frenzy that Mayor Konrad Adenauer, reminded of the Nazi rallies, murmured, “Does this mean Germany can one day have another Hitler?” These two men—Kennedy and Hitler—were complete opposites politically and personally, of course, but they had their medical similarities (as we'll see); Adenauer intuited more than he could have known.

The military presence in Vietnam, later disastrous, was a mistake made in 1961, when Kennedy was medically ill and psychiatrically erratic. By 1963, Kennedy expressed reservations about further involvement in that conflict. Had he lived, he probably would not have responded the way Lyndon Johnson did; the Kennedy of the late 1960s would not have allowed generals to dictate military policy, to pursue the standard line of adding more troops when the original plan failed, to invade another country just because we could. Kennedy had rejected all this reasoning for Havana, ninety miles from Miami; he would not logically have accepted it for Saigon, continents away. He said as much privately: “The first advice I am going to give my successor is to watch the generals and to avoid feeling that just because they are military men their advice on military matters is worth a damn.” Johnson certainly did not follow this advice.