A First-Rate Madness (22 page)

Travell had just injected Kennedy with intravenous steroids and antibiotics, given along with high-dose oral steroids. She consulted with the president's endocrinologist, Dr. Eugene Cohen, who told her to also give more steroids intramuscularly. This was followed by more oral steroids later that night.

His doctors had already guessed that there was a systemic infection, which had begun in his urinary tract. Because of his Addison's disease, any infection—whether initially in his bladder, throat, or even ears—could become life-threatening. When he became sick, the infection would spread over his whole body. Untreated, high fever would be followed by low blood pressure (“septic shock”), coma, and death. Doctors then gave even more steroids to help his immune response. And without antibiotics there was no hope of overcoming the infection, so he received plenty.

From June 22 to July 3, he also received higher doses of oral steroids, amphetamines, and his usual daily dose of testosterone. All the penicillin and steroid injections produced great pain in the gluteal and thigh regions, with “marked oozing at puncture sites and ecchymotic [bruising],” for which he received doses of the narcotic codeine. He had also received up to five tablets daily of the narcotic painkiller Darvon.

The press was told that the president had a “mild viral infection.”

 

 

JUNE 22 WAS the turning point. The president could have died. But at some point all the steroids and penicillin kicked in. He came back to life.

That Kennedy and his aides hid his severe illness is not the point of this story. Kennedy thought the American people wanted a healthy president. He might have learned from FDR that the American people could handle, even admire, a sick president. Despite the cover-up, Kennedy deserves respect for all the suffering he endured, for his mere survival in the face of long odds—for his remarkable resilience. Most normal people with half his medical problems and a fraction of his wealth would have retired to a quiet, easy life.

On June 26, 1961, four days after the president began his turnaround, urine culture finally confirmed the cause of his infection:
Aerobacter cloacae
(today more commonly called
Enterobacter cloacae
). This is a dangerous bug. Even now, fatal in 20 to 40 percent of cases (high mortality in the antibiotic era), it mainly infects those who are immu-nocompromised, like the hospitalized elderly or small children. John Kennedy, neither elderly nor a baby, was immunocompromised by Addison's disease and chronic steroid treatment.
E. cloacae
is found primarily in hospitals, but Kennedy hadn't been in any hospital recently. Outside hospitals,
E. cloacae
is mainly found in the vaginal flora; it is a sexually transmitted disease.

It's unusual for a middle-aged man to have recurrent urinary tract infections and chronic prostatitis, as Kennedy did. Without anatomic abnormalities of the kidney and bladder (which he didn't have), such infections are sexually transmitted. In the president's medical records, with multiple urinalyses and cultures, I found only two recorded instances of bacterial infections (
E. cloacae,
as described, and
E. coli,
a fecal bacterium that causes UTIs in women). We can't tell whether other documented cultures were absent or removed. (His urologist's records are silent on sexual habits, which urological evaluations typically record in detail.)

Probably JFK was infected repeatedly through sexual intercourse, and after frequent doses of antibiotics he developed resistant bacteria, which almost killed him during his first year in the White House.

 

 

SO WE HAVE HERE a story of a lifelong illness, one that was terminal until modern medicine happened upon a lifesaving treatment just when the disease was about to claim a young congressman as its next victim. The young man got a second chance, and he made the most of it, and he did so despite the disease continually coming back and attacking him again and again, not only as he strove to rise in political life, but even after he had reached the presidency. Like his hero Winston Churchill and his predecessor Franklin Roosevelt, John Kennedy never gave up. And all three men were greatly abetted in this perserverance by their manic symptoms, part of their hyperthymic personalities. (Churchill also had recurrent severe depressive episodes, though Kennedy had few of the latter, at least after steroid treatment, and Roosevelt never appears to have had severe depression; they all had hyperthymic cyclothymic personality outside of any depressive periods, however.)

Even while he was alive, many noticed the parallels between the story of John F. Kennedy and that of Franklin Roosevelt. Both men were highly sociable, liked to be liked, were popular with their peers, friendly, attractive, charismatic, witty. They were highly energetic (except when in the throes of an acute medical crisis, such as Addisonian crises or the immediate aftermath of the onset of polio); they were unceasingly thinking, planning, reading, talking. They were movers and shakers, literally, not just in the sense of the cliché. They were very high in the personality trait of openness to experience, which goes along with hyperthymia: they were curious, interested in others, listeners as well as talkers, skeptics of the conventional wisdom. (The man who coined that term, John Kenneth Galbraith, worked for and admired both presidents and saw their similarities.) One can see these traits in other presidents and politicians, who also may have had hyperthymic personality: Bill Clinton and Newt Gingrich come to mind in recent years; more distantly, Theodore Roosevelt fits the bill nicely; Thomas Jefferson scored highest in a psychological study of openness to experience as a personality trait (see chapter 14 endnotes). But Kennedy and Franklin Roosevelt set the standard.

One man knew them both very well, Joseph P. Kennedy Sr. In a sadly ironic comment made a year into the Kennedy presidency, the father remarked on his son's luck and resilience:

Their story lines could hardly be closer. A young scion of wealth, marked for glory, is almost felled by illness, and in the process changes for the better. The key difference between them is that whereas Roosevelt was granted more years as president than any other man, Kennedy was given, as was said in his memorials, many gifts from God, except length of years.

But the story is not complete: there is another lesson here beyond the resilience of hyperthymic personality. There are the steroids. The drugs that saved John Kennedy's life would prove a dangerous cure; their mind-altering effects would almost ruin his life, as well as his presidency. Without them, he would never have lived to fail or succeed. With them, he almost failed, and then succeeded spectacularly.

 

 

The story of John Kennedy is instructive in a way that is different from all the other leaders I've discussed so far. JFK was
treated,
with steroids and other agents (amphetamines, barbiturates, cocaine analogues), not just occasionally, but consistently over many years. Those treatments greatly influenced his behavior, for worse and, as we'll see, eventually for better. So too was the case with an unlikely bedfellow, a leader with mental illness whose treatments (mainly intravenous amphetamines) markedly worsened that illness: Adolf Hitler.

John Kennedy abused anabolic steroids. He didn't just take cortisone as a replacement for his body's normal physiological needs. He abused testosterone-based anabolic steroids—literally the same drugs today used by bodybuilders—for their psychiatric effects. In so doing, Kennedy was changing his moods, probably causing manic and depressive symptoms, in a way that, for a while, harmed his ability to lead. Later, when his physicians got control of the president's misuse of anabolic steroids, his medications not only kept him alive—they enhanced his function and contributed to his successes.

Adolf Hitler abused intravenous amphetamines. He had, as we will see, bipolar disorder, with spontaneous severe depressive and manic episodes since his youth. But those mood episodes served him well in many ways, contributing to his charisma and leadership skills, until around 1937, when he began receiving amphetamines as treatment for his depressive periods. Soon he began to abuse those treatments by receiving daily intravenous injections—a practice that continued every day throughout the Second World War, worsening his bipolar disorder, with more and more severe manic and depressive episodes, while he literally destroyed the world.

The great physician William Osler once said that all medicines are toxic; it is how they're used that makes them therapeutic. If used in the wrong setting, in the wrong amounts, they always cause harm; they are dangerous; they kill and maim. The art of medicine is about knowing how and when to use medicines—and when
not
to use them. When doctors give drugs to people with underlying psychiatric illnesses, the potential for harm is exponentially higher. And if such people are political leaders, especially with despotic power, that danger can extend to entire nations, even races.

So we now need to turn to the effects of treatment for mental illness in leaders. And we'll see how those treatments can cause great harm, as well as notable success.

 

 

JOHN F. KENNEDY'S presidency had two distinct phases: early failure and late success. The early period (1961–1962) included the Bay of Pigs disaster (when Kennedy tried to implement regime change in Cuba based on an Eisenhower-planned CIA coup), a botched summit in Vienna with Soviet leader Khrushchev (in which Kennedy appeared weak), and retreat in Berlin (where Khrushchev constructed the Berlin Wall). Domestically, Kennedy waffled on civil rights and was unable to get most of his election platform passed by a Democratically controlled Congress. Few knew that throughout this time he suffered from poorly controlled Addison's disease, which almost killed him, and, as we will see, from the wayward psychiatric effects of anabolic steroid abuse.

The second phase (1962–1963) included his adroit handling of the Cuban Missile Crisis, a triumphant visit to Berlin, and vigorous support for the civil rights movement. It is this latter Kennedy—peaking in Dallas—whom we mostly recall. Few know that during those last years, Kennedy's medical treatment had vastly improved; his steroids and other treatments now enhanced his resilience rather than impaired it. These are not the only causes of Kennedy's successes. But if victory has a hundred fathers, two of the most important for JFK were his natural hyperthymic personality augmented by the manic-like effects of steroid treatments.

From inauguration day until Dallas, John Kennedy ingested a standard set of daily medications. In 1961, under the care of his personal physician, Janet Travell (consulting with Kennedy's endocrinology, urology, surgery, and gastrointestinal specialists), the president took four kinds of daily steroids (including an anabolic steroid, testosterone). Sometimes, when he requested them, he also took amphetamines and barbiturates. Travell, a specialist in muscle spasm who had treated Kennedy for about eight years, frequently supplemented the above treatments with injections of procaine, an analogue of cocaine. These injections helped his pain, but by constantly puncturing his back and buttocks they weakened his muscles in those areas.

At the same time, on his own and without informing his physicians, Kennedy took mysterious injections from Max Jacobsen, purveyor of amphetamines to a well-heeled Manhattan clientele. When this was discovered by Travell and the official White House physician assigned by the navy, George Burkley, they sought Robert Kennedy's help. The attorney general reluctantly asked the president to drop Jacobsen's injections, or at least submit a sample for DEA testing. “I don't care if it's horse piss,” JFK replied. “It works.” We now know that Jacobsen's injections probably included testosterone, amphetamines, and possibly narcotics. (In 1971, New York State investigated the doctor's injections, found them medically dangerous, and stripped him of his medical license.)

This was the period when, in physical pain and taking numerous psychoactive treatments of unknown safety, the president almost died. Travell kept up her procaine injections, and the president's muscles kept wasting away. She also injected an anabolic steroid, methyltestosterone, at Kennedy's frequent request, while Jacobsen kept injecting God-knows-what.

At this point, an important and underappreciated event happened in the Kennedy presidency:
a medical coup d'état
. Burkley and the other consultants joined together and, working with Robert Kennedy, weakened Travell and banished Jacobsen. Muscle injections were minimized and a weekly regimen of physical exercise started under a new specialist. Doses of the president's drugs were reduced.

Into 1962, the president became more stable in body and mind. He still took four kinds of daily steroids, and now was prescribed daily doses of amphetamine as well. (He also continued to receive, off and on, antidiarrhea medications, and drugs to prevent urinary tract infections). These low to medium doses of multiple steroids were still sufficient (especially with injectable anabolic supplements) to suppress any natural production of steroids in his body (suggested by gynecomastia, growth of breast tissue, a side effect of anabolic steroids), and to cause steroid-related psychiatric side effects. Few historians have clearly noted that these psychiatric risks were especially high because Kennedy always took
anabolic
steroids (methyltestosterone initially, later Halotestin)—the kinds that make athletes sometimes go crazy—not just adrenal replacement steroids.