A First-Rate Madness

by Nassir Ghaemi

  150 “Senator Kennedy evidently woke up each morning”: Evelyn Lincoln, My Twelve Years with John F. Kennedy (New York: Bantam, 1966), 3.

  151 “When you see the President”: William Manchester, Profile of a President (London: Michael Joseph, 1967), 26–27.

  151 “He usually sat in his office”: Lincoln, My Twelve Years, 25.

  151 He “continued to vibrate with energy”: Manchester, Profile of a President, 26–27.

  151 “Two White House chairs have collapsed”: Ibid., 144.

  152 “two months after taking the oath”: Ibid., 26–27.

  152 “He’s really a great gossip”: Ibid., 49.

  152 would reply two hundred times per day: Ibid., 54.

  152 Kennedy’s wit was famous: Bill Adler, ed., The Kennedy Wit (New York: Citadel, 1967).

  153 Lyndon was doing such a great job: Lincoln, My Twelve Years, 125.

  153 “I hear you’re losing Ohio”: Manchester, Profile of a President, 131.

  153 “Well, the answer to the first is yes”: Helen Thomas, Thanks for the Memories, Mr. President (New York: Simon and Schuster, 2003), 23.

  153 “I feel as a Catholic”: Adler, The Kennedy Wit, 40.

  154 a widely read 1962 article: Eunice Kennedy Shriver, “Hope for Retarded Children,” Saturday Evening Post, September 22, 1962, available at http://www.eunicekennedyshriver.org/articles/print_article/148 (accessed February 27, 2011).

  154 Rosemary received a frontal lobotomy: Ronald Kessler, “Rosemary Kennedy’s Inconvenient Illness,” http://newsmax.com/RonaldKessler/Rosemary-Kennedy/2008/06/17/id/324146 (accessed February 16, 2010). Jack El-Hai, The Lobotomist (New York: Wiley, 2005), 171. Hamilton, Reckless Youth, 409–412.

  154 “agitated depression”: Kessler, “Rosemary Kennedy’s Inconvenient Illness.”

  154 Freeman carefully avoided documentation about her: El-Hai, The Lobotomist, 174.

  154 Rose Kennedy, in her 1974 memoir: Rose Kennedy, Times to Remember (New York: Doubleday, 1974), 286.

  154 nocturnal sexual encounters: Kessler, “Rosemary Kennedy’s Inconvenient Illness.” Hamilton, Reckless Youth, 409–412. Access to Rosemary Kennedy’s personal file, within Joseph Kennedy Sr.’s personal papers at the JFK Presidential Archives, is more restricted than access to the president’s medical records. I was not able to obtain permission to see Rosemary’s file.

  154 mentally ill, not just mentally retarded: Kessler interviewed Dr. Bertram Brown, who was a member of the president’s panel on mental retardation, and Dr. Brown stated that he and his colleagues at that time had believed that she had mental illness. In retrospect, he believes that the Kennedys downplayed her mental illness in reaction to social stigma being higher for that condition than for mental retardation. Kessler also found that FBI records quoted Joseph Kennedy’s Boston attorney at the time as saying that Rosemary had mental illness.

  154 “Sister is insane”: The entry is by a Dr. “E. Price.” JFK Presidential Archives, Box 45, dated December 14, 1950.

  155 touching Rosemary severely: It is often now stated that Rosemary worsened due to a “botched” lobotomy. There is no evidence that this was the case. Dr. Watts later described the surgery as uncomplicated. Rather than being botched, lobotomy simply did not work for those with mental illness plus mental retardation. In 1941, Rosemary Kennedy was only the sixty-sixth person in the United States to receive frontal lobotomy; hundreds of thousands would eventually get it. Unfortunately, Joseph Kennedy Sr. was too far ahead of the curve; the best medical treatment of the time, one that would receive a Nobel Prize within the decade, was disastrous: “Because of the lobotomy, she had the development of a 2-year-old. She could not wash or dress herself or put her shoes on. She had to be supervised at all times.” (Kessler, “Rosemary Kennedy’s Inconvenient Illness.”) Standing in line at Ted Kennedy’s memorial viewing at the JFK Library, I spoke with a union activist from Wisconsin. He told me that he and his family worked in the institution that housed Rosemary, and that he had observed that for years, without media coverage, Ted Kennedy quietly flew every month from Washington to visit Rosemary in the Wisconsin institution.

  155 Born the son of a saloon keeper: The next three paragraphs draw from Ronald Kessler, The Sins of the Father (New York: Warner, 1996).

  156 numerous affairs . . . trying his luck with the girls: Garry Wills, The Kennedy Imprisonment (Boston: Back Bay, 1994).

  156 Wall Street insider trading: Kessler, The Sins of the Father.

  156 an objective assessment of two generations of Kennedys: This section represents my summary of publicly known facts regarding reasons for death or substance abuse or diagnosed mental illness in the Kennedy family. It might be said that Joe Jr. died in combat. And couldn’t the other two plane crashes be attributed to the Kennedys’ access via their wealth to small-plane travel, which is more dangerous than commercial plane travel? Perhaps the same could be said for the skiing accident? Skiing is a sport associated with wealth. These many explanations could be true, but violate Occam’s razor. When we need many reasons to avoid a simpler explanation, perhaps the simpler explanation is right. Joe Jr. accepted a dangerous flying mission that he did not have to take. Kathleen agreed to fly in bad weather against her pilot’s objections and despite grounding of all commercial flights. Michael’s skiing accident occurred while playing ski football without any helmet, while skiing down Copper Bowl, a steep slope in Aspen, Colorado.

  Could it be that excessive risk-taking, an aspect of hyperthymia, lies behind some of these unfortunate happenings? A Time article noted on the death of Michael Kennedy, “As a teenager, Michael jumped off a 75-ft. cliff above the Snake River in Wyoming during a rafting trip. Brother Robert, while at Harvard, leaped 10 feet between two six-story dorms on a dare. He was arrested in 1983 for heroin possession. Joe II drove his jeep off the road in 1973, paralyzing family friend Pam Kelley. Brother David died in 1984 of a drug overdose.” http://www.time.com/time/magazine/article/0,9171,987634-3,00.html#ixzz1FCPl6rMg (accessed February 27, 2011).

  157 the baseline risk . . . of bipolar disorder . . . for alcohol or substance abuse . . . for accidental death: Ronald C. Kessler, Olga Demler, Richard G. Frank, Mark Olfson, Harold Alan Pincus, Ellen E. Walters, Philip Wang, Kenneth B. Wells, and Alan M. Zaslavsky, “Prevalence and Treatment of Mental Disorders, 1990 to 2003,” New England Journal of Medicine 352 (2005): 2515–2523.

  157 a fraction of 1 percent in the general population: National Vital Statistics Report 59, no. 2, http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_02.pdf (accessed February 27, 2011).

  158 The full medical report: Here I present, verbatim for the first time, important extracts from Kennedy’s medical records. Although they are now available for study by scholars, the JFK Presidential Library does not allow photocopying of John Kennedy’s medical records. Furthermore, they are open to study only by scholars who are physicians or who are accompanied by physicians. I personally transcribed the full medical report of Kennedy’s naval discharge. I believe this is the first time that the verbatim transcript of the following report has been made publicly available. The same holds for other verbatim transcriptions of Kennedy’s medical records, such as his back X-ray reports (see pages 298–299) and nursing notes on his near-fatal 1961 infection in the White House (see pages 300–301).

  US Naval Hospital Chelsea Mass 16 October 1944

  Report of Medical Survey

  Diagnosis: Hernia, intervertebral disc

  Disability is not the result of his own misconduct and was incurred in line of duty

  Existed prior to enlistment: No

  Present condition: Unfit for Duty. Probable future duration: Indefinite

  This 27-year old Lt., USNR, was admitted to this hospital on 11 June 1944 with the complaint of pain in the lower back referred down the left leg. This dated from a fall aboard ship on 1 August 1943. In addition he had lower abdominal pain increased on defecation. By permission of the BuMed & S he was granted leave to report to the Lahey Clinic.
While there an oxygen spinogram was interpreted as demonstrating a herniation of the fifth lumbar intervertebral disc. On 23 June 1944 an operation was performed by Dr. James L. Poppen at the Lahey Clinic in which some of the abnormally soft disc interspace material was removed and it was noted that there was very little protrusion of the ruptured cartilage present.

  Investigation of the gastro-intestinal complaints by Dr. Sara M. Jordan of the Lahey Clinic revealed on x-ray examination spasm and irritability of the duodenum without a definite ulcer crater but . . . suggestive of a duodenal ulcer scar. Spasm of the colon was also demonstrated. Anti-spasomodic medication was prescribed.

  He returned to this activity on 4 August 1944. The pain in the back and in the left leg continued as did the lower abdominal pain. The neurosurgeon at this hospital did not feel that the operation had corrected the condition and that some other cause might underlie the neuritis of the left sciatic nerve. An orthopedic consultant injected procaine into the left sciatic nerve with considerable relief of symptoms. Review of the films from the Lahey Clinic by the roentgenologist here failed to reveal any definite abnormality of the G.I. tract or in the spine.

  . . . On 3 October 1944 his back and leg pain had improved but there was continuation of the abdominal pain. . . . Because of continued symptoms and the necessity of further time to regain strength and weight lost while on combat duty, the Board recommends that he be retained for further study and treatment.

  P. P. Henson, Comdr. MC V (S) USNR, P. B. Snyder Lt. Comdr. MC V (S) USNR, W. J. Jinkins, Jr. Lt. MC V (S) USNR

  158 hospitalization for physical illness: After resting in Arizona for a few months, Kennedy felt better and decided to work as a journalist, first in San Francisco at the United Nations conference, then in Berlin for the Potsdam conference, and later in England, where he covered the elections that ousted Churchill. Kennedy was back to his old self: energetic, active, sexual. But as usual, he had another relapse. His pattern seemed to be one serious illness episode per year, lasting about two to three months, followed by six to nine months of normal health and heightened energy. In London, Kennedy had his usual high fever, malaise, and gastrointestinal pain. He was hospitalized for two days. Giglio, “Growing Up Kennedy,” 374.

  158 walked five miles in a Boston parade: Lee Mandel, “Endocrine and Autoimmune Aspects of the Health History of John F. Kennedy,” Annals of Internal Medicine 151 (2009): 350–354.

  158 a visit by the physician Sir Daniel Davis: Some biographers assume that Dr. Davis was an expert in Addison’s disease. He was not. He appears to have been simply a successful physician, with relationships with many members of the British upper classes. Giglio, “Growing Up Kennedy,” 375. Dallek, An Unfinished Life, 105.

  159 chronic physical symptoms: It is clear, though, that all of Kennedy’s Lahey Clinic doctors and his later doctors accepted and concurred with the Addison’s disease diagnosis. Sara Jordan, for instance, wrote a 1952 letter clearly saying so and explaining the condition to Joseph Kennedy; she made it clear at that time that John Kennedy’s main medical problem (all the previous gastrointestinal diagnoses notwithstanding) was Addison’s disease of the adrenal glands. (Giglio, “Growing Up Kennedy,” 376.) I could not find any evidence that Kennedy was ever rediagnosed with laboratory tests in the 1950s, but such testing would likely not have been definitive anyway since he constantly received steroid treatment throughout the rest of his life.

  159 “hasn’t got a year to live”: Giglio, “Growing Up Kennedy,” 375.

  159 Kennedy took DOCA the rest of his life: Giglio, “Growing Up Kennedy,” 375–376. Dallek, An Unfinished Life, 76.

  159 “deeply preoccupied with death”: Matthews, Kennedy and Nixon, 48.

  159 on a trip to Indochina: JFK always traveled with a medical bag including his steroids. Once in the 1960 election, his bag was lost and Kennedy went to great lengths to contact political allies so as to find it. Giglio, “Growing Up Kennedy,” 377.

  160 aides placed a pin in every town: Kenneth P. O’Donnell and David F. Powers, Johnny, We Hardly Knew Ye (Boston: Little, Brown, 1972), 78–80.

  160 Without steroids, this pace would have been impossible: Before his Senate run, Kennedy put out a press release attributing his hospitalizations to malaria. He had already begun treatment with his first endocrinologist, Dr. Elmer Bartels of Boston, who had started to treat him with DOCA and later cortisone, as noted earlier in the text. Bartels warned Kennedy that despite such treatment, he would always be prone to Addisonian crises triggered by infections of any sort. Giglio, “Growing Up Kennedy,” 376.

  160 Six months later, he was back in the hospital: JFK Presidential Archives, Medical Records, John F. Kennedy Personal Papers (hereafter PP), Box 45. Giglio, “Growing Up Kennedy,” 377.

  160 noting throughout his medical chart that he was already diagnosed with Addison’s disease: JFK Presidential Archives, Medical Records, PP, Box 45.

  160 X-rays repeatedly showed mostly normal bone structure: Ibid. My assessment of these medical files conflicts with the conclusion drawn by Robert Dallek and his medical collaborator that Kennedy had some osteoporosis, which would be expected with long-term steroid use. (Dallek, An Unfinished Life, 81.) As late as 1962, Kennedy’s back X-rays did not show osteoporosis or osteoarthritis or any other bony explanation for his pain. Here is a summary by Dr. George Burkley, White House physician, who concluded from this evidence that most of the president’s back pain was due to muscular spasm, not bony arthritis: “The lumbar-sacral X-rays were examined in New York and were found to show very little difference from those taken in 1958. In other words no increase in the lesion in the left sacral iliac region and there was no evidence of any change in the intervertebral spaces, no evidence of osteoarthritis in any area. The X-rays indicate that there has been no bony change since 1958. I recommend that the exercise be continued as they are done now and to be increased in the judgment of Dr. K.” JFK Presidential Archives, Medical Records, PP, Box 48, March 19, 1962.

  Here is the full report on the back X-ray from 1962, located in JFK Presidential Archives, Medical Records, PP, Box 45:

  Xray: Lumbar spine and pelvis, 14 March 1962, by John H. Cheffey and L. T. Brown, Captains MC USN. “The available projections demonstrate the distal three thoracic and the upper four lumbar vertebrae to be normal. Interspaces between these vertebrae have been well maintained; the interspace between L4 and L5 is normal. The interspace between L5 and S1 is narrow. Contiguous bony surfaces are increased slightly in density at L5-S1 except for the posterior-inferior half of L5 where loss of clarity of the surface is apparent. There appears to be minor subchondral dissolution of bone at L5-S1. In oblique projections, apophyseal joint space between L5 and S1 [is] incompletely obliterated but definite loss of clarity exists, especially on the left. Evidence of fusion is shown posteriorly between L5 and the upper sacrum. . . . The fusion is solid. . . . The right sacroiliac joint is slightly narrowed. The left sacroiliac joint is irregular in contour. Particularly in the middle portion of the joint contiguous bony surfaces present pronounced sclerosis. Several irregular areas of radiolucency are shown in this region, apparently in the sacrum particularly. Changes demonstrated in this region are compatible with those to be seen following operative intervention and are not inconsistent with findings to be seen with bone infection. . . . Hip joints as shown in a single frontal projection are normal in appearance. Soft tissues and other bony structures as they are seen are within normal limits.”

  160 His father concurred: Giglio, “Growing Up Kennedy,” 377.

  161 a three-hour operation: Ibid., 377–378.

  161 “Lincoln recalled Nixon racing into Kennedy’s office”: Matthews, Kennedy and Nixon, 99.

  161 large enough to fit a man’s fist up to the wrist: O’Donnell and Powers, Johnny, We Hardly Knew Ye, 114–116

  161 “We came close to losing him”: Giglio, “Growing Up Kennedy,” 378.

  162 seven hospitalizations: JFK Presidential Archives, Medical Records, PP,
Box 45.

  162 “It is not a killer”: Giglio, “Growing Up Kennedy,” 379. Dallek, An Unfinished Life, 300.

  162 a contemporary movie portrayed a person with Addison’s disease: Giglio, “Growing Up Kennedy,” 385.

  162 This episode is documented in his medical records: JFK Presidential Archives, Medical Records, PP, Box 45. This matter is ignored increasingly by historians. One of the first Kennedy books (Hugh Sidey, John F. Kennedy, President [Greenwich, CT: Fawcett, 1964]), written just one year after Kennedy’s death, discusses the matter at reasonable length (one page, 98), describes real concern about Kennedy’s condition among journalists and politicians (one Republican commented, “Now we’ve got an invalid for a President”), and even describes Travell’s treatment with intravenous steroids and antibiotics. Sidey had been taking notes for something like an authorized biography of JFK for six years, and thus his records on this event were likely shared with the president. Travell herself, in her 1966 oral history, near the end of the medical part of her interview with Ted Sorensen, volunteered the June 1961 crisis as an important part of Kennedy’s medical history, and considered it the most serious episode of illness during his presidency. “Interesting,” Sorensen commented, and then the interview went in a different direction. Robert Dallek (An Unfinished Life) received much praise for being the first biographer to gain access to more medical records, and to write a biography greatly built around Kennedy’s illnesses. Yet he did not refer to this episode at all. Richard Reeves (President Kennedy: Profile of Power [New York: Simon and Schuster, 1993]), who wanted to describe what it was like to be president on a day-by-day basis, titled his chapters by dates, usually within days or a week of each other. In this period, he jumps from June 17 to July 19, skipping altogether the weeks of Kennedy’s near-fatal illness, without comment. Evelyn Lincoln (My Twelve Years with John F. Kennedy) does not mention it at all in her diary of the Kennedy years, even though she was an active participant in JFK’s health care. The Travell files are full of notes describing how extra steroid or amphetamine doses were given to “Mrs. L” to give to the president.