Many of Our Elected Officials Are Unfit to Serve. Medical Problems Are Sometimes the Cause.

By Henry I. Miller, MS, MD — Jun 01, 2023
Many of our national leaders appear to suffer from some sort of cognitive impairment or other mental disorder. Should they undergo periodic intelligence and mental status testing?
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Two U.S. senators recently became incapacitated – John Fetterman (D-PA), with severe depression (following a stroke last year) that required a months-long hospitalization and whose outcome is uncertain; and Diane Feinstein (D-CA), who had a shingles infection that developed into encephalitis, from which she has not fully recovered. (And at age 89, she is unlikely to.)  Marked by inflammation and swelling of the brain, post-shingles encephalitis can leave patients with lasting memory or language problems, sleep disorders, bouts of confusion, mood disorders, headaches, and difficulty walking.

Senator Feinstein was absent from Washington and unable to fulfill her political responsibilities for months, leaving me and other Californians without half our Senate representation.  She has returned to Washington but is confused and seemingly bewildered, even denying her prolonged absence. The New York Times described Senator Feinstein’s return this way on May 18: “The grim tableau of her re-emergence on Capitol Hill laid bare a bleak reality known to virtually everyone who has come into contact with her in recent days: She was far from ready to return to work when she did, and she is now struggling to function….”

This isn’t the first time that such situations have arisen, of course. Sen. Pete Domenici (R-NM) was sufficiently forthright to reveal in 2007 that he had been diagnosed with frontotemporal lobar degeneration – an inexorably progressive, incurable disease characterized by the wasting away of the frontal and temporal lobes of the brain. Because of the behavioral changes and dementia that accompany this condition, Domenici announced that he would not seek reelection the following year.

I had great sympathy for Mr. Domenici, but should the people of New Mexico have been represented for another year by a senator who admitted to suffering from progressive dementia? I believe he should have resigned at the time his illness was diagnosed.

Senator Strom Thurmond (R-SC) retired at 100, his longstanding, profound dementia an open "secret" on Capitol Hill.

It’s a given that as we age, most of us lose some intellectual acuity, but many clueless or confused elected officials can’t use that excuse. It's not surprising that the intelligence of members of Congress has so often been spoofed.

"Suppose you were an idiot, and suppose you were a member of Congress. But I repeat myself," quipped Mark Twain.

Milton Berle observed, "You can lead a man to Congress, but you can't make him think."

Will Rogers addressed the consequences of these deficiencies: "When Congress makes a joke, it's a law, and when they make a law, it's a joke."

There are numerous examples of the joke being on us. A friend of mine was seated at a banquet table with the family of then-Rep. Dan Glickman (D-KS). The family expressed relief at his having entered politics because none of them thought Dan was smart enough to enter the family business. (Automobile and appliance shredding and scrap metal.)

Former US Congressman John Salazar (D-CO) related this anecdote: "When I was debating what became the 2008 Farm Bill, I had a member of the Agriculture Committee actually ask me if chocolate milk really comes from brown cows. I asked if he was joking, and he assured me he wasn't."

He has plenty of company.

Representative Hank Johnson's (D-GA) expressed concern during a hearing that stationing 8,000 US military personnel on Guam would cause the small island to "become so overly populated that it will tip over and capsize."

Congresswoman Sheila Jackson Lee (D-TX) once proclaimed that the US Constitution was 400 years old. And as a member of the House Science Committee, Lee, during a visit to the Mars Pathfinder Operations Center, asked a NASA scientist whether the Pathfinder probe had photographed the flag that astronaut Neil Armstrong left behind in 1969, apparently unaware that Armstrong had left the flag on the moon.

And in 2010, Representative Lee proclaimed on the House floor that “victory had been achieved” by the United States in the Vietnam War and that “today, we have two Vietnams: side-by-side, north and south, exchanging and working.” Worse still, Lee was a member of the House Foreign Affairs Committee when she made that statement. She is currently Ranking Member of the House Appropriations Subcommittee on State, Foreign Operations, and Related Programs. I wonder whether she's planning to visit the US Embassy in Saigon.  

And then there’s the inimitable Representative Marjorie Taylor Greene (R-GA), who claimed that California forest fires were deliberately set by space-based laser beams controlled by the Rothschilds to clear land for rail stations (which were never intended to be built). She also called for a “national divorce,” with red states separating from blue states. She might not realize that that sort of experiment was tried and failed rather spectacularly in the 1860s.

I attended a conference at which Representative Tom Bliley (R-VA), then chairman of the powerful House Commerce Committee, spoke by teleconference. As he recited from a prepared statement, he included the "stage instructions" – such as "pause for emphasis" – that had been inserted by his speechwriter. And where one line had been inadvertently duplicated, Bliley read it a second time.

Carelessness? Stupidity? Intoxication? Senility? Don't voters have a right to know?

As a voter, taxpayer, and physician, I worry about whether such people were, or are, fit to serve. Maybe dissatisfaction with our representation should sometimes be treated as a medical, rather than a solely political, issue.

How? Ask candidates and incumbents (including the president and vice president) to undergo periodic intelligence and mental status testing. After all, we often demand to know whether a candidate has recovered from open-heart surgery, cancer, or a stroke, and many states require elderly drivers to be relicensed periodically. With the latter requirement in mind, maybe we should at least require testing for high-level politicians above a certain age. Recall that commercial airline pilots are forced to retire at age 65 and air traffic controllers at age 56.

A mental status exam by an expert offers an assessment of cognitive abilities, memory, and quality of thought processes. It includes assessments of alertness, speech, behavior, awareness of the environment, mood, affect, the rationality of thought processes, appropriateness of thought content (presence of delusions, hallucinations, or phobias), memory, ability to perform simple calculations, judgment ("If you found a letter on the ground in front of a mailbox, what would you do with it?"), and higher reasoning, such as abstractly interpreting proverbs ("A stitch in time saves nine.").

An intelligence test measures various parameters thought to correlate with academic or financial achievement. Every politician need not be a genius, but I'd like the ones who represent me to as smart as the average person on the street.

The journalist and satirist H.L. Mencken observed, "Congress consists of one-third, more or less, scoundrels; two-thirds, more or less, idiots; and three-thirds, more or less, poltroons."

Testing might help us to weed out a few idiots. Getting rid of the scoundrels and poltroons will have to wait.

Note: An earlier version of this article was published by Issues and Insights.

Henry I. Miller, MS, MD

Henry I. Miller, MS, MD, is the Glenn Swogger Distinguished Fellow at the American Council on Science and Health. His research focuses on public policy toward science, technology, and medicine, encompassing a number of areas, including pharmaceutical development, genetic engineering, models for regulatory reform, precision medicine, and the emergence of new viral diseases. Dr. Miller served for fifteen years at the US Food and Drug Administration (FDA) in a number of posts, including as the founding director of the Office of Biotechnology.

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