Could America Elect a Mentally Ill President? Yes. In fact, we probably already did.

POLITICO Magazine

History Dept.

Could America Elect a Mentally Ill President?

Yes. In fact, we probably already did.

By Alex Thompson

November/December 2015

Political taboos, campaign dealbreakers and electoral glass ceilings are crumbling. Members of Congress are openly gay and bisexual, there’s a black man in the White House, and a woman may be next. Voters have accepted all sorts of behavioral warts and missteps in their political candidates, too. DUIs? A mistake of their youth. Draft dodgers? There’s a long list. Womanizers? A much longer list. Illegal drugs? In just a few short elections, we’ve gone from a president who “didn’t inhale” to one who openly admits using cocaine in his youth.

Yet one large taboo remains stubbornly fixed—mental illness. Sure, it’s part of the conversation, in that pundits these days can, and do, speculate casually about whether Donald Trump has narcissistic personality disorder, Joe Biden has slid into depression, Hillary Clinton is clinically paranoid or Jeb Bush will be undone by a Freudian sibling tangle. But here’s the really sick thing: For a politician to admit to seeing a psychiatrist would likely be far more politically damaging than any of the possible symptoms of actual mental illness.

For a president or a candidate, it’s the “kiss of death,” says Burton Lee, George H.W. Bush’s presidential physician. It would “create a crisis of confidence” in the country, says David Axelrod, former senior adviser to President Barack Obama. “I’d like to believe I’m wrong,” he adds, but a commander in chief who disclosed a mental illness would face an almost insurmountable political problem: “Every time he said a cross word or expressed frustration, people would say, ‘He’s having one of those days.’” Instead, Axelrod wryly notes, “We just watch their hair turn gray.”

More than 40 years have passed since Thomas Eagleton, the 1972 Democratic vice presidential candidate, withdrew from the race after revealing that he had been hospitalized for depression. Since that political firestorm, the issue has remained firmly off-limits: No Democratic or Republican nominee running for president or vice president has disclosed mental illness or treatment for it ever since—to do so would be politically incurable. And as recently as the last election cycle, congressional and state-level campaigns were digging up past psychiatric treatment to bludgeon their opponents.

“Any vulnerability can be exploited by people and will be,” explains Newt Gingrich, the former speaker of the House and presidential candidate, whose late mother had bipolar disorder. “That’s just the nature of a very rough-and-tumble-type business.”

As a result, the notion of politicians merely consulting with a mental health professional remains the topic of only hushed conversations or forceful denials. When President Bill Clinton admitted to infidelity and impeachment loomed, talking to a psychiatrist remained a political nonstarter. Aides told reporters that Clinton was seeking the counsel of Christian ministers but was “not under any medical treatment for any psychiatric or mental condition.” Even two decades later, “crazy” remains a politically acceptable epithet, whether it’s Obama taunting Republican opponents or Representative Trey Gowdy quipping that he did not want to wrangle members of the House in a leadership position because he did not “have a background in mental health.”

Yet, a review of the historical record finds that past commanders in chief, even well-regarded ones, struggled with mental health problems throughout their presidencies. “It’s a cliché that you have to be nuts to run for president,” says Evan Thomas, the journalist and historian whose latest book is an intimate biography of President Richard Nixon. “Like most clichés, it’s at least partly true.”

Nixon and John F. Kennedy clandestinely filled their medicine cabinets with psychotropic drugs, recently uncovered documents reveal. In fact, Kennedy aide and historian Arthur Schlesinger Jr. suggested in his journals that several modern presidents were mentally unbalanced; he recorded top aides arguing whether President Lyndon Johnson was clinically paranoid or a manic-depressive, and fretted that there was no constitutional “procedure for dealing with nuts.”

In other words, mental illness is surely more common in Washington than the public knows or wants to believe. In 2006, after an embarrassing car accident, Representative Patrick Kennedy, JFK’s nephew, became a rare politician to announce he would seek treatment for his addiction and bipolar disorder. Soon, Kennedy says, several congressional colleagues privately revealed their own illnesses to him—but would not make them public. After interviewing more than three dozen people for this article, I found only one current member of Congress who has been open while in office about struggling with mental health: freshman Arizona Representative Ruben Gallego, an Iraq War veteran who suffers from post-traumatic stress disorder.

When it comes to their mental health, however, politicians, including the one with the nuclear launch codes, are “just like everybody else,” Lee says. Some diagnoses are dangerous, but others are manageable with treatment. For instance, he says, “A president can function very well if he has a mild anxiety disorder or obsessive compulsive [disorder].”

Which raises the question: When roughly a fifth of American adults use medication and millions go to talk therapy for their mental health, why shouldn’t the people governing the country be able to as well?

It would be hard for any public figure afflicted by the most severe mental illnesses—with symptoms like psychosis, hallucination and catatonic behavior—to evade notice or fully carry out his or her duties. But most people in psychiatric care do not have such debilitating disorders. Still, American politicians have historically grappled with milder symptoms—powerful mood swings, depression and anxiety—while serving in office, including the White House. Those afflictions can be exacerbated by the job. While scientists are still trying to understand the underlying medical causes of most mental illnesses, they are at least partly environmental; high stress can cause completely rational feelings of grief, concern and disappointment to become something more unstable. In the White House, Axelrod says, “The pressures are beyond anything that human beings are designed to handle.”

During the 1960 race, an aide misplaced Kennedy’s medication. “Find that bag,” he instructed. In the hands of his opponents, he said, “it would be murder.”

Yet the presence of such ailments, particularly at the highest levels of government, remains little known and little discussed. Asked whether Obama has ever consulted a psychiatrist, a White House official declined to discuss the president’s medical care. While the White House occasionally releases summaries of the president’s health, presidents and their doctors have lied and obfuscated in the past. Even after a president leaves office, medical records are considered private, not public record. As a result, the little we know about presidents’ mental health comes from sporadic glimpses at diaries or health records released only under rare circumstances.

Abraham Lincoln was famously melancholy, experiencing periods of such deep depression throughout his lifetime that he contemplated suicide and spent weeks at a time bedridden. The future president even tried the 19th-century version of an antidepressant: “blue mass” pills that, unfortunately for Lincoln, were a poisonous combination of ground mercury, rosewater and honey. (“The opposition researchers of today would have been very eager to discover Lincoln’s propensity for depression,” says presidential historian Michael Beschloss. “If they had, we might have lost perhaps our greatest president.”)

When some of the first effective psychotropic medications hit the market in the 1950s, they soon made their way into the White House. Medical records newly uncovered by historian Irwin Gellman for his book The President and the Apprentice show that then-Vice President Richard Nixon, complaining of “tension,” began taking a small cabinet of such drugs. His dosage included the amphetamine-barbiturate combo drug Dexamyl, which claimed to relieve “mental and emotional stress”; half a Doriden, a prescription medication for insomnia that the federal government decades later labeled a Schedule II drug because it could cause chemical dependency; and three pills a day of meprobamate, also known as Miltown or Equanil, the popular anti-anxiety medication that helped inspire the sobriquet “mother’s little helper.” Nixon’s presidential medical files remain mostly sealed, but his osteopath’s diary from that time records that Nixon began taking Valium, a successor to meprobamate, regularly in 1973, as Thomas’ book about Nixon recently revealed.

“All and all, it’s clearly a regimen to ameliorate his psychological foibles and enhance his mental performance in critical situations,” says Jeffrey Lieberman, psychiatrist-in-chief of Columbia University Medical Center and former president of the American Psychiatric Association.

Nixon’s opponent in the 1960 election, Kennedy, had an even fuller medicine cabinet; Lieberman, author of the recent Shrinks: The Untold Story of Psychiatry, calls the regimen “more extensive and reckless” than Nixon’s. More than a decade ago, a committee of longtime Kennedy associates began allowing select historians, including Robert Dallek and James Giglio, access to many of the president’s medical records. The antispasmodics, hydrocortisone and painkillers for Kennedy’s physical ailments attracted much of the attention, but there were also several prescriptions to treat the president’s mental health. Like Nixon, Kennedy had a daily prescribed meprobamate dosage, as well as less regular prescriptions for Dexamyl, the stimulant Ritalin, the anti-anxiety medicine Librium and Stelazine—a powerful tranquilizer normally used to treat schizophrenia and psychotic disorders that could also be prescribed for severe anxiety.

No documentation has been released to suggest that Kennedy’s successor got treatment for mental illness. But from 1965 to late 1967, when Johnson had ramped up America’s troop presence in Vietnam from 15,000 to nearly half a million, his eccentricities began to seem worrisome. “It was a pronounced, prolonged depression,” Johnson press secretary Bill Moyers told Dallek. “He would just go within himself, just disappear—morose, self-pitying, angry. … He was a tormented man.” Moyers said he fielded alarmed phone calls from Secretary of State Dean Rusk and others “deeply concerned” about the president, who seemed “very depressed.” Johnson’s behavior had taken a “huge leap into unreason,” Richard Goodwin, Johnson’s special assistant, later wrote. Goodwin and Moyers—independently of each other—sought out three psychiatrists to discuss the president’s conduct. “All three doctors offered essentially the same opinion: that Johnson’s behavior—if the layman’s descriptions we provided were accurate—seemed to correspond to a textbook case of paranoid disintegration,” as Goodwin wrote. Moyers said in an interview that he does not know whether Johnson ever consulted a psychiatrist. “Lady Bird often acted as his therapist,” he says.

Richard Nixon, shown in 1970, and John F. Kennedy, in 1961, clandestinely filled their medicine cabinets with psychotropic drugs while in office. Top aides argued if Lyndon Johnson, pictured in 1965, was clinically paranoid or a manic-depressive. | Getty

At a time when mental health care often still meant asylums and lobotomies, there’s evidence that Kennedy, for one, understood the risk he ran by seeking treatment, hinting why he and other politicians kept their medication secret, or tried to: During the 1960 race, an aide misplaced Kennedy’s small medical bag at a campaign stop in Connecticut. The then-senator called his friend and the state’s governor, Abe Ribicoff, and, according to an oral history with Ribicoff, instructed him to “find that bag.” In the hands of his opponents, Kennedy said, “it would be murder.”

It wasn’t long before Kennedy was proven right, but the political consequences awaited someone else.

In 1964, Johnson’s campaign mischievously had transfigured the slogan of the Republican presidential candidate, Barry Goldwater—who faced a smear campaign about his mental health—into “in your guts, you know he’s nuts.” But it was Missouri Senator Thomas Eagleton who erased any doubt that mental illness, and treatment, could have devastating political consequences. After the Democratic Party nominated the 42-year-old for vice president in July 1972, he became the first American politician on a national ticket to publicly disclose psychiatric treatment. Unbeknownst to presidential nominee George McGovern when he selected the senator as a running mate, Eagleton had been treated for depression with electroconvulsive therapy at least twice in the previous 12 years. Anonymous tips about Eagleton’s medical history made their way to newspaper and campaign offices. After Eagleton confirmed his treatment, the New York Times editorialized that Eagleton should withdraw from the ticket because “there can be no flight from the demands of the office when decisions of fateful importance need making.” Running for reelection, President Nixon cited his own performance in “stern crises” and told the unwitting press corps, “I don’t think anyone would question the state of my health.”

Eighteen days after his selection, Eagleton abdicated the vice presidential spot, and a chaotic McGovern campaign ultimately lost 49 states to Nixon. “What finally tipped Senator McGovern over and forced the decision the other way was the Cold War,” explains Gary Hart, McGovern’s campaign manager, who would go on to serve in the Senate and twice run for president himself. “The campaign had to face the reality that there would be an unending barrage from the White House and from the Nixon campaign about a finger on the button. Namely, do you want a person one step away from controlling nuclear weapons who has had serious mental problems?”

The campaign had to face the reality that there would be an unending barrage ... Namely, do you want a person one step away from controlling nuclear weapons who has had serious mental problems?”

While Hart remains skeptical that Eagleton could have handled the pressures of the presidency, McGovern later said he would have kept Eagleton on the ticket. “I didn’t know a damn thing about mental illness and neither did anyone around me,” he told the New York Times in 2005. Before his death in 2012, the former presidential candidate told the Dallas Morning News, “A lot of people have suffered from depression, including me.” Eagleton served in the Senate until 1987, overcoming the stigma of his illness in his home state, where voters rallied around him after his unceremonious dumping. In 1983, he privately received a diagnosis of bipolar II disorder, and a psychiatrist at George Washington University, later interviewed by historian Giglio, prescribed lithium—a drug that, if it had been approved in the 1960s, might have been easier to keep hidden than electroconvulsive therapy. “Eagleton’s disability ended any aspiration of his for high office,” says Giglio, who has written the most comprehensive biography of the senator, “but it never seemed to affect his performance in the Senate.”

At the time of the Eagleton debacle, the science of psychiatry was still nascent. Several studies exposed psychiatric diagnoses as fantastically unreliable, and it would not be until 1974 that psychiatry officially stopped diagnosing homosexuality as a form of mental illness. The American public largely remained skeptical of psychiatry. Many Americans still shared the sentiment of first lady Nancy Reagan, who in 1981told Family Circle magazine, “Getting psychiatric treatment means that you are not really trying to get hold of yourself. It’s sloughing off your own responsibilities.”

Soon enough, painting political opponents with the Eagleton brush became a regular tactic. During the 1988 presidential election between Governor Michael Dukakis and Vice President George H.W. Bush, rumors circulated that Dukakis had received psychiatric treatment for depression. At the Democratic National Convention in July, fliers appeared under reporters’ hotel doors asking, “Is Dukakis the New Senator Eagleton?” Conservative columnists Rowland Evans and Robert Novak reported that Bush’s campaign manager, Lee Atwater—who once said a Democratic congressional opponent had been hooked up to “jumper cables,” a crudely memorable moniker for electroconvulsive therapy—had been “trying to spread” the rumors “without leaving any vice presidential fingerprints.

In August 1988, President Ronald Reagan took a question about the gossip and quipped: “Look, I’m not going to pick on an invalid.” Dukakis’ mental state and medical records then became the topic of endless media speculation. The former Massachusetts governor today remembers, as the polls of the time show, that “it certainly slowed us down. For about a week, all I was doing was trying to respond to questions about this foolishness.” The attacks weren’t the only reason Dukakis, who maintains he had never received psychiatric treatment, lost, but mental illness had clearly become a go-to campaign weapon.

In the years after Prozac received FDA approval in 1987, a medley of other moneymaking, benignly branded drugs—Zoloft, Paxil, Wellbutrin, Luvox, Effexor, Serzone, Remeron, Cymbalta, Lexapro—hit the market. Unlike the drugs of earlier eras that doctors prescribed to Nixon and Kennedy, Prozac and its successors promised fewer side effects and better-targeted treatments. By 1990, it was the country’s most commonly prescribed antidepressant and was heralded on the cover of Newsweek as “a breakthrough drug for depression.”

But even as doctors increasingly wrote prescriptions for such drugs, the idea that elected leaders might require them provoked tough attacks. Just three years after Prozac’s arrival, Lawton Chiles became the first nationally recognizable political figure to come forward about mental illness and Prozac drug use, during Florida’s 1990 gubernatorial race. As a popular three-term Democratic U.S. senator, Chiles had unexpectedly announced his retirement three years earlier because he had “not the blues but the blacks, the black blacks,” as he later put it. He received a prescription for Prozac and, by the spring of 1990 he was back, declaring his candidacy for governor.

Anticipating political attacks, Chiles immediately disclosed his prescription and had his physician release a statement that the candidate had “completely resolved” his depression and—against the doctor’s private wishes—would stop taking the drug. Soon, however, “the blacks” crept back. In the midst of the campaign that summer, Chiles, pressed by a reporter, publicly acknowledged that he had resumed taking Prozac. His opponents—Democratic Representative Bill Nelson and incumbent Republican Governor Bob Martinez—pounced. “I don’t want to have a suicide during [Chiles’] term of office or during the election,” Nelson’s running mate, Tom Gustafson, told reporters in August. Nelson added that Chiles’ renewed Prozac use “raises serious questions about his ability to perform the duties of governor.” Martinez made sure to remind voters that Chiles “made a highly visible statement when he said he no longer needed it.”

In late August, a poll conducted by three of Florida’s largest newspapers found that while nearly 75 percent of Florida voters knew about Chiles’ anti-depressant use, only 15 percent said it made them less likely to vote for him. Sure enough, he prevailed in the 1990 primary and general election—and then again in 1994 against Jeb Bush. Buddy MacKay, who served as Chiles’ lieutenant governor, maintains that Chiles, who died of a heart attack in 1998, always remained “functional” in office despite an occasionally “difficult mood swing problem.” (Asked today about his campaign rhetoric regarding Chiles’ mental illness, Nelson, now a U.S. senator, emailed through a spokesman: “Knowing what I know now, I never would have said such a thing about [Chiles] or anyone else.”)

The disclosure requirements in a political campaign only come down to a simple issue: Does [withholding] it hurt you electorally?”

Chiles’ victory stoked hopes that mental illness in the post-Prozac era did not portend political death. In the 1994 midterm elections, Democrat Lynn Rivers became the first openly bipolar member of Congress, and would go on to serve four terms. “There can be an individual who has a significant mental illness, struggles with it, struggles to get the care necessary and as a result is very competent, very capable, intelligent, well-spoken, all the things we tend to think mentally ill people are not,” she says now. “It became important to me then to show that face to the world.”

Yet two decades later, Chiles and Rivers remain outliers. As recently as the 2014 elections, Senate Majority Leader Mitch McConnell was surreptitiously recorded in a strategy session with his campaign team discussing the liability of the mental health history of Ashley Judd, a potential opponent who had written about depression in her memoir. In the Texas race for lieutenant governor that same election cycle, an ally of incumbent David Dewhurst leaked a court deposition revealing that his opponent Dan Patrick had been treated at a psychiatric hospital and had taken antidepressants in the 1980s. Dewhurst guilefully told the press, “My heart goes out to Dan and his family for what they’ve endured while coping with his condition.”

It’s attacks like these that prevent more politicians from coming forward—attacks suggesting that, as Rivers puts it, “somehow your condition creates such a burden that you can’t do the job you’re running for.” When candidates these days do disclose their mental health records, it’s rarely more than a defense mechanism. In the 2000 presidential race, John McCain, a former prisoner of war, felt compelled to release psychological evaluations after a whisper campaign that he was mentally unstable. The Arizonan tried to laugh it away: “Those voices in my head,” he joked to columnist Maureen Dowd. “STOP THOSE VOICES!” “The disclosure requirements in a political campaign come down to a simple issue,” says Steve Schmidt, McCain’s senior strategist in the 2008 campaign. “Does [withholding] it hurt you electorally? If so, then you have to disclose.”

During the 1964 presidential campaign, Senator Barry Goldwater, left, was the target a smear campaign about his mental health. In the midst of his 1988 presidential bid, Michael Dukakis, at right in an infamous photo op, also faced media speculation over his mental health after fliers appeared at the Democratic National Convention reading, “Is Dukakis the New Senator Eagleton?” | AP Photos

Of course, that’s not a calculation that many Americans need to make, especially not in the age of Prozac Nation, when going to therapy or getting a prescription can earn plaudits. Antidepressant use among Americans soared approximately 400 percent from 1988 to 2008, according to the Centers for Disease Control and Prevention. As of 2010, more than 20 percent of the adult American population—more than 40 million people—had at least one medication for a psychological or behavioral disorder, according to a widely cited Medco Health Solutions analysis. “The treatment of mental illness in the United States has moved from what was a generation ago primarily psychotherapy to now primarily medication, and people have accepted a more biological understanding of major mental illnesses,” says Mark Olfson, professor of clinical psychiatry at Columbia University.

Yet, Olfson adds, studies have shown that the stigma oddly lingers. Biological explanations for mental illness, he says, lead many Americans to think it “is a fixed, indelible trait that people may hold at some distance.” This prejudice may explain why mental illness in politics remains a skeleton in the closet. “As long as we consider mental health issues defects, as character flaws,” says David Axelrod, “we are going to have a situation where people cannot accept that in a position of leadership nationally.”

Therein lies perhaps the biggest danger with this taboo: Politicians with mental illnesses have to hide them to continue to serve in public office and so might not seek help, putting themselves and others at risk. In 2011, Representative David Wu of Oregon resigned under the cloud of an alleged unwanted sexual encounter with a teenage girl. During the 2010 midterms, former members of his staff and campaign team now say, they feared that Wu felt too “ashamed” to take his antidepressant medication, as he swung dramatically from confused and disconsolate to impulsive, angry and sexually aggressive. (Wu, who declined to be interviewed for this article, maintained that the encounter was consensual, and she did not press charges.)

Former Representative Brian Baird of Washington, a clinical psychologist, says that while in Congress he occasionally pulled aside a colleague and privately referred him or her to a professional. “I’ve done it. I’ve seen others do it, say to a colleague, ‘You OK? You seem a little troubled,’” he says. “The simple reality is that people in a constitutional democratic republic are still human beings.” But even Baird—who periodically sought counseling himself and considered, though decided against, going on medication for depression—sympathizes with those who demurred. “If I’m back home in my district and I’m seen at a pharmacy picking up Prozac or something, I’d be worried,” he says.

In part, the lingering stigma is cultural and generational. Patrick Kennedy, the former congressman, recalls some colleagues telling him, “I come from the buckle of the Bible Belt. In my part of the country, it’s about moral issues, not medical issues. This is about character, not chemistry.” Kennedy wrote in his recent memoir, A Common Struggle, that he believes his late father, one-time presidential candidate Senator Ted Kennedy, suffered from PTSD and often self-medicated with alcohol. As a congressman, Patrick developed his own self-medicating habits to cope with mental illness—until he could no longer hide it. At 2:45 one morning in 2006, he crashed his car into a traffic barrier near Capitol Hill. He was found with his lights off, eyes glazed over, claiming to be late for a congressional vote. “My dad used to say all I needed was a good swift kick in the ass,” Kennedy says now. “I needed that, and I needed some good treatment.”

Lawton Chiles’ Prozac prescription became a campaign issue in the 1990 Florida gubernatorial race. In 2006, Rep. Patrick Kennedy, right, gave a news conference in which he said he was entering treatment for addiction to prescription pain medication. | AP Photos

Beyond politicians’ personal health, this taboo can affect the way they govern, too, including how the federal government decides to spend nearly $1 trillion on major health programs each year. Several colleagues confided in Kennedy about their own mental illness after he announced he would get help, but in 2008, when the congressman helped the House pass a bill requiring insurance companies to cover mental and physical health care equally, he noticed that many of those same colleagues voted against the bill. “I’ve never betrayed their confidence, but of course I went up to them after the vote and I said, ‘Hey, I thought we had something where we understood what this was about,’” Kennedy says. More recently, Representative Tim Murphy, a Pennsylvania Republican who remains a practicing psychologist at Walter Reed National Military Medical Center, has been working steadily on a bill to overhaul America’s mental health care system. His efforts, he says, have been slow in part because there’s not an open dialogue around mental health. “A lot” of his colleagues, he says, “have no idea what we’re talking about and need to be educated.”

A more open discussion, and forgiving atmosphere, is precisely what some politicians and mental health professionals hope for. Saul Levin, CEO and medical director of the American Psychiatric Association, says the public should “commend” rather than punish any politician who seeks treatment for a mental illness. “If anything, I’d come out even stronger in support of them for saying, ‘I don’t want to just hide this and not take care of it,’” he says. Representative Jim McDermott, a psychiatrist by training, echoes this: “The question is not whether you’ve had the experience, it’s how you’ve dealt with it.”

Ruben Gallego’s willingness to speak candidly about his PTSD is a s

mall test of that openness. After he returned home from his 2005 Iraq War deployment, Gallego experienced heightened anxiety and couldn’t sleep. He went to the local Veterans Affairs facility, visited drop-in clinics to talk with other veterans and had support from his family to “get mentally back together” over six months. By the time he ran for Congress, he was open about the experience. How concerned was he about the effect on his public life of admitting his struggles with PTSD? “I don’t know what people think about a member of Congress who has PTSD,” he says. “And I guess at this point I don’t really care. My job is to represent the citizens of my district as much as possible and the veterans of this country.”

If I’m back home in my district and I’m seen at a pharmacy picking up Prozac or something, I’d be worried.”

For now though, Gallego is the rare, if not the only, exception in Washington. Even in the idealistic world of Aaron Sorkin’s The West Wing, the fictional President Josiah Bartlet bows to political reality and must meet a psychiatrist in secret. “A session every now and then with a psychiatrist would have been a bridge too far,” Sorkin says.

For precedent, American politicians may need to look overseas. In 1998, Kjell Magne Bondevik, prime minister of Norway, became likely the only world leader in modern history both to disclose a mental illness publicly and to seek treatment while in office. One morning, after less than a year in office and on the eve of one of the most important government meetings of the year, Bondevik woke up unable to get out of bed and ready to resign. He saw a psychiatrist, publicly disclosed his depression and announced he would take a leave of absence to mend.

When he returned to government a month later, he continued taking medication for a time, took more weekends and nights off, and stayed vigilant to maintain his mental health. He continued to serve as prime minister until 2000 and then was chosen again in parliamentary elections in 2001, serving until 2005. “It’s very hard work and a heavy burden all the time being a leader,” Bondevik said in an interview. “If you lose sleep, if things are becoming dark for you, if you feel increasing anxiety, all of these may be signals of depression. It’s important for all leaders to take the necessary measures for keeping your most physical and mental health. There, that’s my recommendation for all leaders.”


Alex Thompson is an editorial assistant at the New York Times.

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