A First-Rate Madness (21 page)

In all, nine of thirty-six members of the Kennedy clan—exactly 25 percent—experienced at least one of the following: mental illness, substance abuse, or accidental death. This is about twice the risk in the rest of the population for mental illness or substance abuse (about 12 percent: the baseline risk in the normal population of bipolar disorder is about 2 percent, for alcohol or substance abuse in the United States about 10 percent). It is about a hundredfold higher for accidental death (the rate for accidental death by airplane crash or skiing accidents and drug overdose is a fraction of 1 percent in the general population, versus 11 percent in the Kennedy family). Accidental death in particular suggests extreme risk-taking behavior, a key feature of hyperthymic personality, a diagnosis also supported by the presence of mental illness, especially bipolar disorder, somewhere in the family tree.

There is no need to invoke a metaphysical entity—a “Kennedy curse.” Nor is mere chance and coincidence statistically probable. There is no Kennedy curse. There is a Kennedy gene—for hyperthymia—that is both a curse and a blessing.

 

 

IN SUM, the young John Kennedy was hyperthymic when well, and nearly dead when ill. He had multiple serious medical problems, most of which probably reflected the myriad effects of Addison's disease: autoimmune colitis (with chronic diarrhea and weakness), back pain (mostly from muscular spasms), and repeated Addisonian crises (fever, infection, septic shock, near coma). By 1944, he weighed only 126 pounds on a six-foot-one-inch frame (a near-anorexic body mass index of 16.6). He was completely bedridden. Repeated examinations at the Mayo Clinic and Lahey Clinic (in Boston) continued to be normal. Finally, in November 1944, John F. Kennedy was deemed physically disabled and discharged honorably from the navy. (The full medical report is provided in the endnotes.)

Surprisingly, this chronically sick man decided to run for Congress. Many have credited (or blamed) his father for pushing him. Indeed, without the prodding of Joseph Kennedy Sr., John Kennedy might have lived the life of a rich invalid.

Whatever the reason, after an intervening period of journalism and his usual alternation between hyperactivity and hospitalization for physical illness, John Kennedy entered politics. He did well; in fact, his greatest enemy was his illness rather than other candidates. On June 17, 1945, a hot and steamy final primary campaign day, Kennedy walked five miles in a Boston parade, and at the end collapsed. Observers thought he had experienced a heart attack. His skin turned yellow and blue. He was taken home and received medical attention. The newspapers wrote nothing about it. (This event is still rarely mentioned in Kennedy biographies.) The next day, he won the primary, and later the general election.

A year later, on a visit to London, he probably suffered another infection, and became so weak he couldn't get out of bed. He called his friend Pamela Churchill, Winston's daughter-in-law, who arranged a visit by the physician Sir Daniel Davis, who in turn arranged hospitalization. This is when Kennedy was first officially diagnosed with Addison's disease. Unfortunately, the medical records at that time have never been evaluated by scholars, and the exact means by which Kennedy was diagnosed with this condition is not known, though it was probably not by laboratory tests. The usual view is that Davis made the diagnosis based on the clinical syndrome: repeated episodes of sudden exhaustion associated with fever, infection, near coma, and low blood pressure, along with chronic physical symptoms of bronzing of the skin, facial pallor, and low weight.

John Kennedy received another death sentence: He “hasn't got a year to live,” Davis confided to Pamela Churchill.

We don't know how Kennedy reacted to this diagnosis. Maybe he felt relieved to have an explanation for his lifelong travails. Even though there was a risk of death, there was also a new treatment: deoxycorticosterone acetate (DOCA), a steroid, given as pellets implanted under the skin every three months. Kennedy took DOCA the rest of his life. At the time, though, this treatment for Addison's disease was thought to prolong life for only five to ten years.

In 1950, John Kennedy's death sentence was again commuted. Cortisone, a new steroid pill, arrived; within a decade it became rare to die from Addison's disease. John Kennedy's life finally had been saved.

Despite this progress, he was not a happy man in the early 1950s. It is possible, if not probable, that JFK had clinical depressive episodes more than once in the 1950s, either related to Addison's disease, or due to his genetic susceptibility to bipolar disorder, or both. During this period of chronic depression, he appears to have been suicidal. He was “deeply preoccupied with death,” his friend Congressman George Smathers recalled. “He was always talking about dying, about ways of dying, how drowning would be good.” He resented his reliance on steroids and was somewhat self-destructive; on a trip to Indochina, for instance, he did not bring cortisone, and soon fell ill with a 106-degree fever. To avoid such future life-threatening negligence, his father arranged for DOCA pellets to be placed in bank safe deposit boxes around the world.

By age thirty, after two decades of serious illness, John Kennedy finally received the correct diagnosis, and even the right treatment. He would spend the rest of his life hiding both. In the meantime, despite steroids, he had a few more near-death episodes to survive before he could become president.

IN 1952, running for Senate, Kennedy was healthier than he had ever been. The underdog against a well-ensconced, wealthy incumbent (Henry Cabot Lodge) in a state that had been consistently Republican for a century, Kennedy campaigned strenuously. Using a state map in campaign headquarters, aides placed a pin in every town he visited. For over a year, he did not stop until the map showed at least two pins in every town. He went everywhere, for anything—Rotary Clubs, school assemblies, church groups. Kennedy was indefatigable. Without steroids, this pace would have been impossible. Family money helped his chances of election, but the other side had plenty of money too; Kennedy won in a Republican state, in a Republican year, mainly because of intrepid campaigning.

Six months later, he was back in the hospital (at George Washington University in Washington, D.C.). He had the usual signs of an Addisonian crisis: an infection (of the throat) followed by high fever, nausea and vomiting, and generalized malaise. His mental state was affected in these crises such that, though not in a coma, he was sleepy. In the presteroid era, such episodes could progress to coma and death. By 1953, the GWU doctors, noting throughout his medical chart that he was already diagnosed with Addison's disease, gave penicillin and high-dose intravenous steroids. A few days later he was alert and discharged; few noticed the new senator's brief absence.

Within a year, though, his back pain had gotten worse and was now affecting his legs as well. He was barely able to walk on crutches; the cause, in retrospect, was probably severe muscle spasms (years later his back X-rays repeatedly showed mostly normal bone structure); but some doctors, diagnosing an unstable sacroiliac joint, recommended fusion with a bone graft. Most of his doctors disagreed: few Addisonian patients had ever survived such serious surgery. His father concurred: Even if you are disabled, he argued, Franklin Roosevelt had proven that disability was compatible with political success. JFK decided otherwise, finding a willing surgeon and endocrinologist in New York. Bone was grafted, a metal plate inserted, steroids given continuously throughout a three-hour operation. Kennedy's survival itself was remarkable enough that he was anonymously described in a surgical journal as a case of a good outcome with Addison's disease. (The authors later acknowledged that the case was Kennedy.) In fact, there were many complications. As expected, his immune-compromised condition led to serious infection of the surgical wound within three days. The Addisonian crisis came, he fell into an altered mental state, and this time heavy doses of steroids did not perk him up. He went into a full coma. The last rites of the Catholic Church were administered. His father and his new wife, Jackie, watched helplessly.

Kennedy's near death was no secret. His old friend Vice President Richard Nixon, whose Senate office was across the hall, was especially distressed: “[Kennedy's secretary Evelyn] Lincoln recalled Nixon racing into Kennedy's office, an odd look on his face, wanting to know if the reports were true, that her boss lay mortally ill. ‘That poor young man is going to die,' Secret Service agent Rex Scouten would recall Nixon saying on the way home one evening, his eyes filling with tears. ‘Poor brave Jack is going to die. Oh, God, don't let him die.'”

The intravenous steroids were increased, and a few days later he woke up.

He left the hospital two months after the operation, worse than he'd been upon entry. The back pain persisted; the metal plate, continually infected, was soon removed; an open hole in his back, large enough to fit a man's fist up to the wrist, drained pus for six months. Every night, his new wife would clean the open wound. For over seven months, the newly elected senator was laid up. JFK was devastated. Suggesting the presence of severe depression, a friend later recalled, “We came close to losing him. I don't just mean losing his life. I mean losing him as a person.”

FROM 1953 TO 1957, John Kennedy had seven hospitalizations, mostly at GWU in Washington or at New York Hospital, generally for short stays of a few days, usually caused by various infections, either in the urinary tract, ear, or throat, followed by Addisonian crisis symptoms of fever, malaise, and altered mental status—and later improvement with antibiotics and intravenous steroids. His back pain and irritable bowel symptoms also flared up during these years.

Throughout this medically trying time, the world noticed only that he won the Pulitzer Prize and almost became the Democratic vice presidential nominee. At the 1956 convention, when he heard that the
New York Post
was preparing an article on his Addison's disease, Joe Sr. urged his son to come clean: “It is not a killer as it was eight years ago,” he said. Better to admit it now, he advised, and get it over with, rather than have it hang around for future campaigns. Again, JFK overruled his father on the topic of illness. He publicly denied any serious illness, saying he was “fit for anything”; the
Post
killed the story. Kennedy's concern about public misinformation wasn't completely unfounded: as one historian notes, a contemporary movie portrayed a person with Addison's disease, treated with cortisone, as becoming psychotic and then committing murder. Best to avoid the topic, Kennedy judged.

Fast-forward five years. On the night of June 22, 1961, barely five months after he first took office, President Kennedy almost died in the White House. (This episode is documented in his medical records, which have been available to scholars since 2002. No biographer, I believe, has ever written about JFK's near death in 1961. I believe I am the first psychiatrist to review his medical records.) The president and his circle engaged in what David Owen has called a medical cover-up. The stigma of sickness ruled their judgment. But, as is the theme of this book, sickness—of any kind—is no stigma. In fact, it can be a badge of honor, and knowing the depths of Kennedy's diseases only serves to reveal, by contrast, the height of his resilience.

He had been feeling quite ill for about a week, exhausted after the stressful Vienna summit in which Soviet leader Khrushchev bullied and harangued him. Soon after his return from Europe, JFK spiked a fever, stopped eating, and couldn't get out of bed. Aides canceled his appointments and scrambled for an explanation. On June 16, Pierre Salinger typed a memorandum for the press, in the name of the personal physician to the president, Dr. Janet Travell. It read, “The President slept later than usual this morning. . . . He is encouraged about his condition [his infection]. He may start walking for short periods without the crutches soon. . . . I am satisfied with the President's progress. No important facts have been concealed from the press. Janet Travell M.D.” Dr. Travell took out a blue marker and crossed out “slept later than usual this morning.” She read on and crossed out the last line, “No important facts have been concealed from the press.” She wrote on the revised letter, “You don't have to say all that.” Then she signed her name in the same blue marker.