The Hidden Threat to Democracy: How Presidential Health Can Shape World History

The cognitive health of a nation’s leader can have far-reaching consequences that extend beyond their term in office. A striking example of this is the case of President Woodrow Wilson, whose impairment during crucial post-World War I negotiations may have indirectly contributed to the conditions that led to World War II.

In 1918, Wilson contracted influenza during the global pandemic. This illness, coupled with a severe stroke in October 1919, left him significantly impaired during the final year of his presidency[1]. This period coincided with critical negotiations for the Treaty of Versailles, which would shape the post-war world order.

Wilson’s diminished capacity meant he was unable to effectively advocate for his “Fourteen Points” plan, which aimed for a more balanced peace[2]. Instead, harsher terms were imposed on Germany, creating economic hardship and national resentment that would later be exploited by extremist political movements[3].

The consequences of these decisions were catastrophic. World War II resulted in an estimated 70-85 million deaths worldwide[4], a scale of loss that might have been preventable had the post-WWI peace process been handled differently.

This historical example underscores the critical importance of a president’s cognitive function. Executive functions such as decision-making, problem-solving, and communication are essential for effective leadership, particularly in times of crisis or complex international negotiations[5].

One aspect of cognitive function that plays a crucial role in leadership is prosody – the rhythm, stress, and intonation of speech. Prosody is not merely about eloquence; it significantly impacts how messages are received and interpreted. Research has shown that prosodic features of speech can influence listeners’ comprehension, emotional response, and even decision-making[6].

In the context of presidential communication, prosody can affect a leader’s ability to motivate a nation, provide hope in times of crisis, and effectively convey complex policy decisions. Presidents who have been noted for their strong oratorical skills, such as Franklin D. Roosevelt and John F. Kennedy, used prosody effectively to rally public support and communicate their vision[7].

The implications of this are significant for the democratic process. When electing a president, voters are not just choosing a set of policies, but also a communicator-in-chief who must be able to lead effectively in times of national and global crisis. The cognitive health of candidates should be a key consideration in the electoral process.

It’s important to note that cognitive health is a complex issue influenced by many factors, and simplistic or discriminatory approaches should be avoided. However, given the potential long-term consequences of presidential decision-making, it is crucial that voters have accurate information about candidates’ cognitive capabilities and that robust systems are in place to ensure continuity of effective governance under all circumstances.

[1] Cooper, J. M. (2009). Woodrow Wilson: A Biography. Knopf.
[2] MacMillan, M. (2001). Paris 1919: Six Months That Changed the World. Random House.
[3] Keynes, J. M. (1920). The Economic Consequences of the Peace. Harcourt, Brace and Howe.
[4] Weinberg, G. L. (2005). A World at Arms: A Global History of World War II. Cambridge University Press.
[5] Goldstein, K. (2015). The Executive Brain: Frontal Lobes and the Civilized Mind. Oxford University Press.
[6] Scherer, K. R., & Bänziger, T. (2004). Emotional Expression in Prosody: A Review and an Agenda for Future Research. Speech Communication, 46(1-2), 180-203.
[7] Leanne, S. (2016). Say It Like Obama and Win!: The Power of Speaking with Purpose and Vision. McGraw Hill Professional.

Political Theatre turns into a Monty Python Skit

In the latest episode of political theatre, President Biden’s debate performance was deeply concerning. His responses were not merely gaffes but signs of potential cognitive decline. Speaking in a low volume, with a monotone delivery, semantic errors, and tangential content, he seemed far removed from the sharp, decisive leader we expect in a Chief Executive.

It is troubling that his closest allies dismissed this as just a “bad night.” This situation is reminiscent of Monty Python’s Black Knight, who, after losing all his limbs after a duel with King Arthur, insists it is “only a flesh wound.” Such deflection ignores the serious implications of what we witnessed.

While I am not a neurologist, but just a humble retired GI doc, I have observed patients and family with neurologic symptoms and signs, taught mental status exams  for 5 years to  medical students and watched 10 seasons of ER. While watching the debate, terms like “abnormal prosody” and “paraphrasing errors” came to mind.. Coupled with a noticeably slowed, narrow gait, vascular Parkinson’s disease may be the disease process we are witnessing. This can mimic neurodegenerative disorders and  often follows a progressive course.

The stakes are too high to ignore these signs. Ensuring that the most powerful position in the world is held by someone who is neurologically and psychologically sound is not just a matter of political strategy—it is a matter of national and global security. If we are to avoid potential tragedy, we must confront these issues with the seriousness they deserve.

The recent debate should prompt a thorough and transparent evaluation of President Biden’s capacity to fulfill the demands of his office. Anything less risks dooming not just our nation, but the world, to the consequences of impaired leadership. The time for empathy and decisive action is now, for the sake of all our futures.