Several Presidents Declined Physically or Mentally. Is This a Problem in Today's White House?

President Trump often loses focus and goes off on a tangent. A notable example occurred on March 2, 2026. Trump briefly and vaguely mentioned his decision to order attacks on Iran and then commented in detail about construction of a new ballroom and his selection of drapes for the White House. Numerous mental health professionals have expressed concern about the President’s bizarre speech patterns.

Questions arose about the mental or physical fitness of other U.S. presidents, including Woodrow Wilson, Franklin D. Roosevelt, Dwight D. Eisenhower, and Joe Biden.

Is there anything American society can do to promote healthier national leaders?

Transcript

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On March 2, 2026, the American people were eager to hear President Trump's explanation for his decision to attack Iran a short time before. But Trump said little about the matter during a ceremony. He briefly mentioned the war and then shifted to a detailed, enthusiastic discussion about construction of a new ballroom and his selection of gold drapes for the White House. It was a strange time to talk about architecture and decor. There were disturbing news stories that day. Six United States service members died from an Iranian attack. Three United States fighter jets crashed in Kuwait in a friendly fire accident. Oil and gas prices surged because of threats to shipping in the Strait of Hormuz. Stock markets dropped precipitously throughout the world. The president's strange behavior was not unusual. There had been many such incidents in which Trump lost focus and went off on a tangent. Mental health professionals noted that the president frequently gave rambling, incoherent speeches. Sometimes he could not recall basic words and names. Several medical experts suggested he was struggling with neurological problems. Some speculated that his speech and behavior showed evidence of dementia. If physical and mental difficulties are at play, the implications are serious. In the weeks and months ahead, the leader of the most powerful nation on earth needs to steer his country and the world towards satisfactory resolution of a wide-ranging military conflict. And of course, there are numerous other complex domestic and international problems that require informed and thoughtful attention. This was not the first time that an American president seemed to face health challenges. Among the most notable examples of presidential decline are the cases of President Woodrow Wilson's infirmity after the end of World War I and Joe Biden's problems in the final two years of his presidency. The health records of some other presidents also show evidence of declining health. Is there anything American society can do to promote healthier leadership in the White House? Welcome to History is Relevant. I'm Robert Brent Toplin. And here's the plan. First, we'll examine the record of Presidents Wilson and Biden's deterioration and note the impact of their health challenges on national and global affairs. Secondly, we'll identify examples of President Trump's health challenges, and we'll offer an intriguing suggestion about a specific kind of mental illness that may be affecting his job performance. Thirdly, we'll note concerns expressed about the condition of other modern presidents, Franklin D. Roosevelt, Eisenhower, Kennedy, and Reagan. And finally, we'll ask, what can be done to mitigate health challenges of the presidents? Part one, Woodrow Wilson and Joe Biden. Many years before Wilson became seriously ill, there were signs of neurological problems. Evidently, Wilson experienced moderately troubling strokes in eighteen ninety-six, nineteen oh three, and nineteen thirteen. Then in the spring of nineteen nineteen, he fell quite sick during the Great Influenza, known then as the Spanish Flu. Irvin Hoover, chief usher of the White House, was close to Wilson throughout his presidency. Hoover, who is not any relation to President Herbert Hoover, noticed a significant personality change after Wilson recovered from the pandemic. Hoover said the president was never the same after that little spell of sickness. Other observers noticed differences too. They said Wilson exhibited personal traits that had been evident years before, but in 1919 those traits appeared more severe. Wilson was irritable and rigid in his decision making. He disagreed often with AIDS, especially with his trusted and wise political advisor, Colonel Edward House. Wilson turned away from House and many other counselors, believing they had deceived him. He showed signs of paranoia. The president's obstinacy affected negotiations over the peace settlement after World War I. Leaders in the Congress wanted the president to compromise on matters related to U.S. involvement in a new international organization, the League of Nations. Wilson refused to adjust his demands. The senators must take their medicine, he insisted. Frustrated, Wilson took his case directly to the American people. He gave numerous speeches throughout the country. After an address in Pueblo, Colorado, Wilson collapsed. AIDS canceled the tour and they rushed him back to Washington. It soon became evident that the president had a major stroke. One side of his body was paralyzed. For the next eighteen months, until Wilson's presidency ended on March 4, 1921, the United States did not have an effective functioning chief executive. Woodrow Wilson's wife, Edith, and Wilson's doctor, Carrie Grayson concealed evidence about the president's frail condition. Edith managed communications with staff members and legislators, telling them what she claimed Wilson wanted. In some respects, Edith Wilson was acting like president of the USA. Woodrow Wilson's infirmities affected the course of history. When the president was ill in Paris, he was poorly prepared to challenge French and British leaders that demanded harsh punishment of the war's losers. The nineteen nineteen Treaty of Versailles especially crippled Germany. It imposed huge reparations, took away territory, forced disarmament, and required the Germans to sign a humiliating war guilt clause. Adolf Hitler later stirred German resentment of that treaty. Wilson's refusal to make a deal with U.S. Senators also had an impact. The president squelched chances to commit the U.S. to membership in the League of Nations, an organization that aimed to promote international cooperation and prevent wars. On to Joe Biden. Confidence concealed information about the severity of Joe Biden's physical decline. That conspiracy also made an impact. Biden's deterioration became quite noticeable by 2023, yet members of his family and key aides and friends concealed evidence of it. They encouraged Biden to run for a second term, and he was happy to take their recommendation. Biden's slippage became strikingly evident in his disastrous debate performance in 2024. Several Democratic leaders wanted Biden to announce he would not run for a second term. But the ailing president announced he was staying in the race and he thought he could win. In May 2025, much later, details about a cover-up came to light in a best-selling book by CNN anchor Jake Tapper and Axios reporter Alex Thompson. The title was Original Sin: President Biden's Decline, Its Cover-up, and the Disastrous Choice to Run Again. Tapper and Thompson described a protective cocoon that hid evidence of Biden's frailty. A striking example of the president's memory lapses occurred at a fundraiser co-organized by movie star George Clooney. Clooney had known Biden for 15 years and had worked closely with him to raise money for Darfur in Africa. Yet Joe Biden didn't recognize Clooney at the event. The cover-up had major consequences. It took extraordinary efforts by Democratic leaders to get the obstinate president to step aside and allow the party to name a competitive candidate. Then Biden compounded his party's problems by naming Kamala Harris as his choice for the nomination just a few minutes after announcing that he would not run again. Harris campaigned energetically and worked very hard to win, but she operated with a huge disadvantage. As vice president, she inherited the public's disappointment with Biden's leadership. The original sin Tapper and Thompson identify in their book is a cover-up that enabled Donald Trump to return to the White House. Now people in the United States and around the world are dealing with a mess that Biden helped to create. Part two, Donald Trump. Trump's public comments, which often deviate from principal themes in his speeches, have alarmed many observers. For instance, during a cabinet meeting that Trump called to discuss the flooding tragedy in Texas, global tariffs, and wars in Gaza and Ukraine, the president went off on a 13-minute monologue about his decorative choices for the cabinet room. Trump boasted that he selected the paintings. He said, look at those frames. You know, I'm a frame person. Sometimes I like frames more than I like the pictures. At a meeting with the European Commission's president, Trump abruptly switched from discussing immigration to ranting about windmills. He claimed windmills drive wells loco, and he said wind energy kills the birds. Trump veered off topic at another public event by claiming that 28,000 people die annually from a snake bite in Peru. Fact checkers reported that only a few people succumb from these bites. In another situation, the president talked about sharks and electrocution. He discussed a hypothetical situation in which he would have to choose between being eaten by a shark or being electrocuted by a sinking boat's electric battery. These examples and many others are concerning. Especially since 2025, the president has frequently seemed to be going off the rails. What can we make of Trump's tendency to lose his train of thought? Often, when speaking about an important subject, the president devotes a few sentences to that topic and then shifts into lengthy and bizarre commentary on obscure matters. When critics question his mental acuity, Trump defends his verbal meandering as the weave. He praises himself for skill in discussing multiple things simultaneously. Trump claims that these diverse topics eventually, as he says, all come back brilliantly together. Some psychologists and psychiatrists have another explanation. They suggest Trump's behavior reflects lugaria, a condition characterized by excessive talking. When losing the thread of a discussion, the speaker shifts to talking about familiar, comforting topics. Richard A. Friedman, a professor of clinical psychiatry and the director of the psychopharmacology clinic at the Cornell Medical College, says these digressions could indicate a health problem. Dr. Friedman said, if a patient presented to me with the verbal incoherence, tangential thinking, and repetitive speech that Trump now regularly demonstrates, I would almost certainly refer them for a rigorous neuropsychiatric evaluation to rule out cognitive illness. Numerous mental health professionals have made related statements about the president's bizarre speech patterns. Part three, the case of some other modern presidents. Wilson, Biden, and Trump are not the only presidents in modern times that dealt with physical or cognitive challenges. Franklin D. Roosevelt was in poor health when he ran for a fourth term in 1944. And by early 1945, several people who observed him, including his doctor, sensed he did not have long to live. FDR died a short time later in April 1945. President Dwight D. Eisenhower suffered major health crises while in office, including a severe heart attack in 1955 and a stroke in 1957. These events, along with others, aroused significant concern about the president's ability to carry out his duties. Eisenhower responded by establishing a private written agreement with Vice President Richard Nixon. That document outlined procedures for transferring power if the president became incapacitated. John F. Kennedy had suffered health problems since childhood, and he used numerous drugs, including painkillers and stimulants, to treat medical conditions during his presidency. To fight the pain, Kennedy took as many as twelve medications at once, taking more during times of stress. During the Bay of Pigs fiasco in 1961 and the Cuban Missile Crisis in October 1962, Kennedy was taking steroids for his case of Addison's disease, painkillers for his back, antispasmodics for his colitis, antibiotics for urinary tract infections, antihistamines for his allergies, and on at least one occasion an antipsychotic drug to treat a severe mood change that Jackie Kennedy believed was brought on by the antihistamines. The public was not aware of much about this situation when Kennedy was president. Considerable information about JFK's medical condition and his drug regimen came to light when historian Robert Dalek published a book in 2003 called An Unfinished Life. There has been much discussion about the possibility that Ronald Reagan was showing the effects of Alzheimer's during the second term, but that matter remains disputed. An official diagnosis of Reagan's condition did not appear until 1994. Part four. Is there anything we can do to reduce the risk of leadership by unhealthy presidents? Obviously, there are no easy answers, and any effort to establish regulations for candidates would be met with strong political resistance. Yet some ideas are worthy of discussion. Thoughts about dealing more effectively with American presidents' health challenges. Four main ideas are salient. First, it's evident that age is often a factor in the cases of presidents' decline. It's time for political leaders to recognize this problem and try to advance younger individuals for the nation's top office. There will, of course, be angry responses to any effort to prioritize younger candidates. Critics will denounce age discrimination. Nevertheless, a candid discussion of the age factor is needed. Conversation about this subject has been muted much too long. Secondly, there ought to be greater transparency regarding the health of America's presidents. Wilson, Biden, and Trump were able to prevent scrutiny of their medical records. Perhaps teams of medical professionals selected by independent physicians groups can examine the president biannually and provide the public with at least a summary of their findings. The present situation in which a president such as Trump selects his favorite doctor to conduct an examination and then boasts that he received a glowing report that he is in excellent health. That's not acceptable. When medical leaders asked why Trump had MRIs and CAT scans, the president got away with simply saying that he had no idea why there was a test. The public has a right to know more about the physical and mental condition of the nation's commander-in-chief. Thirdly, the selection of vice presidents needs adjustment. Individuals are not typically selected as vice presidential candidate because they have solid experience and knowledge about public affairs or impressive leadership skills. They are not typically identified, in other words, as one of the best individuals in the country to serve the nation if the chief executive is incapacitated. Instead, a person is usually chosen to help the presidential candidate win support from important constituencies. That political calculus will likely remain common in VP selection, but there should be greater public demand for competence as well. There have been numerous situations in American history in which a vice Vice President replaced a deceased leader, or the president was so severely ill that the vice president should have stepped up to take over. It would be helpful if nominees for president and party leaders gave this question serious consideration before announcing the choice for VP. Who is well qualified to lead the nation if elevation to the presidency becomes necessary? A fourth needed change relates to a looming problem in the American political system, the huge expansion of presidential power and influence over recent decades. Since Donald Trump began his second term as president, overreach by the executive branch of the federal government has been extraordinary. Among numerous problems associated with concentrated authority is the difficulty of raising questions about a president's physical and mental condition and getting answers. Presidents can easily push back when queried about their health. As we have seen, cover-ups of president's frailty were evident in the cases of Woodrow Wilson and Joe Biden, and a cover up may be in effect in Donald Trump's situation as well. It has been relatively easy for Trump, members of his staff, and party leaders to stifle discussion about the president's health. That resistance needs to be broken. Presidents are not absolute monarchs. They are responsible to their constituents. The American people have a right to know if their elected leader has the physical and mental capacity to function effectively. They deserve answers when questions arise about the leader's bizarre behavior. Trump's remarkable soliloquy at the White House shortly after he greenlighted a war against Iran should have alarmed America's political leaders. In a moment of international crisis, the president seemed incapable of explaining why he started a war. Rather than provide Americans and millions of people around the world with a clear justification for his impactful decision, Trump used the occasion to boast about golden curtains and a new ballroom. That meandering commentary did not look like a brilliant application of the speaking style Trump calls the weave. It looked again like the affliction health professionals call logeria, excessive talking that occurs when a person with cognitive difficulties loses the train of thought and compensates by talking about simple, familiar, comforting topics. If the president continues acting in this fashion on numerous occasions, it may be time to invoke the twenty-fifth. That's the amendment to the Constitution that establishes procedures for a change in leadership when a president appears to be incapacitated.