Should heads of state and candidates to high office pass a cognitive/ mental fitness test?

Is it fair to ques­tion a pres­i­den­tial candidate’s men­tal fit­ness? (Salon):

“My heart sank as he floun­dered his way through his respons­es, fum­bling with his notes, unchar­ac­ter­is­ti­cal­ly lost for words. He looked tired and bewil­dered,” Ron Rea­gan, the son of Pres­i­dent Ronald Rea­gan, wrote of his father’s per­for­mance dur­ing the first 1984 pres­i­den­tial debate.

At the time, there had long been rumors that Rea­gan was suf­fer­ing from cog­ni­tive impair­ment — per­haps Alzheimer’s Dis­ease — and as he strug­gled dur­ing the first debate against his Demo­c­ra­t­ic oppo­nent, for­mer Vice Pres­i­dent Wal­ter Mon­dale, those con­cerns threat­ened his reelec­tion cam­paign. He recov­ered dur­ing the sec­ond debate with a mem­o­rable quip, jok­ing that he would not allow age to become an issue in the cam­paign because “I am not going to exploit, for polit­i­cal pur­pos­es, my oppo­nen­t’s youth and inex­pe­ri­ence.” The audi­ence laughed, the nation moved on… and, a decade lat­er, Rea­gan announced to the world that he had been diag­nosed with Alzheimer’s…

I must add that I am not try­ing to add to the stig­ma that sur­rounds men­tal health issues. I have writ­ten before about how men­tal ill­ness is stig­ma­tized in dan­ger­ous and unjust ways, how as an autis­tic per­son I am espe­cial­ly sen­si­tive to men­tal health-based dis­crim­i­na­tion and how I have been per­son­al­ly impact­ed by it.

At the same time: Whether one likes it or not, there is a dif­fer­ence between a pres­i­dent sim­ply hav­ing a men­tal health issue like anx­i­ety, depres­sion, bipo­lar dis­or­der or alco­holism (one 2006 study found that just under half of Amer­i­ca’s pres­i­dents had at least one of those con­di­tions, includ­ing our great­est pres­i­dent — Abra­ham Lin­coln) and a pres­i­dent being inca­pable of doing the job because of men­tal health issues.

News in Context:

• Men­tal ill­ness in U.S. Pres­i­dents between 1776 and 1974: a review of bio­graph­i­cal sources (The Jour­nal of Ner­vous and Men­tal Dis­ease). Abstract: Numer­ous his­tor­i­cal accounts sug­gest the pres­ence of men­tal ill­ness in US Pres­i­dents, but no sys­tem­at­ic review has been under­tak­en for all hold­ers of this office. We reviewed bio­graph­i­cal sources regard­ing men­tal ill­ness in 37 US Pres­i­dents from 1776 to 1974. Mate­r­i­al was extract­ed by one of the authors and giv­en to expe­ri­enced psy­chi­a­trists for inde­pen­dent review of the cor­re­spon­dence of behav­iors, symp­toms, and med­ical infor­ma­tion in source mate­r­i­al to DSM-IV cri­te­ria for Axis I dis­or­ders. Lev­els of con­fi­dence were giv­en for each diag­no­sis. Eigh­teen (49%) Pres­i­dents met cri­te­ria sug­gest­ing psy­chi­atric dis­or­der: depres­sion (24%), anx­i­ety (8%), bipo­lar dis­or­der (8%), and alco­hol abuse/dependence (8%) were the most com­mon. In 10 instances (27%), a dis­or­der was evi­dent dur­ing pres­i­den­tial office, which in most cas­es prob­a­bly impaired job per­for­mance. Men­tal ill­ness in heads of state is a top­ic deserv­ing fur­ther atten­tion. Method­olog­i­cal lim­i­ta­tions of using biog­ra­phy to deter­mine psy­chopathol­o­gy are discussed.
• Trend: With 25% of US physi­cians aged 65+, hos­pi­tals test old­er doc­tors on men­tal and phys­i­cal acuity
• Prepar­ing Soci­ety for the Cog­ni­tive Age (Fron­tiers in Neu­ro­science article)
• What are cog­ni­tive abil­i­ties and how to boost them?
• Test­ing and train­ing cog­ni­tive abil­i­ty: Key Neu­rotech Patent #16
• Study: 10-minute cog­ni­tive test MoCA helps pre­dict long-term motor, cog­ni­tive and mor­tal­i­ty out­comes after stroke
• The FDA clears two com­put­er­ized cog­ni­tive tests to assist in med­ical eval­u­a­tions fol­low­ing brain injury or concussion