To the Editor.
—The discussion about the attempted assassination of President Reagan focused on the implications of presidential disability due to major medical illness.1 However, the role of psychiatric illness in presidential disability was conspicuously absent from this discussion.Psychiatric illnesses such as anxiety disorders, mood disorders, and alcohol and substance abuse are a common source of morbidity and disability in the US population; the president too is vulnerable to psychiatric illness. Unfortunately, there is strong recent evidence from the Epidemiologic Catchment Area survey sponsored by the National Institute of Mental Health that only 28% of Americans with a mental disorder receive any treatment.2Unrecognized and untreated psychiatric illness in the president can have profound adverse domestic and international political effects, aside from personal morbidity. For example, a president suffering from depression may experience significant cognitive deficits, lack of motivation, and disabling fatigue.Dementias like Alzheimer's disease and
Friedman RA. Presidential Disability and the Twenty-fifth Amendment. JAMA. 1995;274(10):797-798. doi:10.1001/jama.1995.03530100037025