Is the President Fit to Serve?

The Biden presidency has already produced a number of moments when the self-labeled “gaffe machine” seemed to grope unsuccessfully for the right words to say.

Recently, President Joseph Biden appeared to forget the name of Defense Secretary Lloyd Austin.

“And I want to thank the sec … the, the ah … former general. I keep calling him general, but my, my … the guy who runs the outfit over there,” the President said at an event announcing the nomination of two new generals.

He referred to his own Vice President as “President Harris,” an error he made in several forms since his electoral victory.

When introducing a new chief for the Bureau of Alcohol, Tobacco, and Firearms (ATF), he twice referred to the department as the “AFT,” the acronym commonly used for the American Federation of Teachers.

On the campaign trail, he created a full catalogue, announcing his confidence that Democrats could “win back the House,” though the party has held a majority since 2016, referred to Super Tuesday as “Super Thursday,” and introduced himself to a South Carolina audience as “a Democratic candidate for the United States Senate.”

Prior to the Iowa Caucuses, he told a crowd that “poor kids are just as bright and just as talented as white kids.” Around the same time, he mixed up 1980s-era British Prime Minister Margaret Thatcher and the far more recent Theresa May. And he announced to an audience, “We choose truth over facts.”

President Biden’s frequent verbal challenges have been a source of amusement and occasional derision for much of his long political career. Yet, at 78, some see his verbal trip-ups plus what many see as a conscious effort to avoid contact with the media as cause for concern over his mental and physical fitness for what is likely the most powerful and demanding job in the world.

A poll by Business Insider and SurveyMonkey showed that 10.8% of responders were “not so confident” and 22.8% were “not at all confident” in President Biden’s mental fitness. A Rasmussen poll showed that slightly more than 50% of people did not feel that he was “physically and mentally up to the job.”

Not as Old as You Are

Still, many experts on aging are dismissive of suggestions that President Biden’s frequent word fumbles are a sign of deteriorating mental capacity.

“I’m not concerned at all,” said Dr. Stuart Jay Olshansky, a professor of public health at the University of Illinois at Chicago who analyzes the longevity of Presidents. “The slip-ups you see and hear happen to all of us no matter how old we are, especially to those of us that speak publicly on a regular basis. We shouldn’t be holding Biden to any different standards than we hold ourselves.”

Dr. Olshansky led a study on the mental and physical health of both President Biden and former President Donald Trump during the 2020 campaign. The study noted that, given his age, President Biden has no serious medical conditions, takes few medications, and that both of his parents lived to old age with their minds intact.

He exercises regularly, a point publicized by news stories looking into whether the President’s use of the Peloton, a stationary bicycle linked to other users via the internet, posed security risks.

The study said that these factors made the President likely to live out his full term in solid mental and physical heath.

“There are no independently verified medical records available that measured and documented the cognitive functioning of Biden. However, his appearance on the campaign trail during the past year suggests that he is currently operating at an exceptionally high level,” said the study in part.

Its conclusions on President Biden largely aligned with a three-page medical summary released in 2019 by his personal physician saying that he is a “healthy, vigorous, 77-year-old male, who is fit to successfully execute the duties of the presidency to include those as Chief Executive, Head of State and Commander in Chief.”

One driving goal of the study and Dr. Olshansky’s work on many fronts was to fight biases driven by what he sees as “ageism.”

“He’s got a lot on his plate,” said Dr. Olshansky. “The President has enormous responsibilities and if he loses his train of thought now and then, that’s nothing to be concerned about. It’s not surprising or worrying if he can’t always recall every issue in exact detail or if he has difficulty with names. Those are normal age-related challenges that begin when we are in our 30s. … I’ve talked to reporters and asked what [Biden] is like in person and everyone says that he’s lucid, whip-smart, and on target.”

Dr. Nir Barzilai, director of Albert Einstein College of Medicine’s Institute for Aging Research, was one of several geriatricians who contributed to the study. He said that a key point he feels should encourage people to look beyond concerns based on President Biden’s age is the differentiation between chronological age and what is known as “biological age,” which also accounts for a person’s general health status.

“I cannot say exactly what age he is biologically, but I think that it is younger than his chronological age,” said Dr. Barzilai. “He has longevity in his family … he seems to be interacting with his environment well; we see him take these little jogs and know he is exercising.”

‘A Gaffe Machine’

President Biden’s verbal stumbles are nothing new. In 2008, as he and President Barack Obama campaigned for their first term, The New York Times ran a story titled “Biden living up to his gaffe-prone reputation.”

The story cites that on the day his candidacy for the vice presidency was announced, he referred to his running mate as “Barack America,” and that same week then-Senator Biden asked a wheelchair-using state official to stand up for the audience, before catching his error.

“He’s done it for a long time,” said Dr. Barzilai of the President’s tendency to trip on his words. “That’s Biden, but it doesn’t reflect anything about his cognitive ability.”

Some have conjectured that President Biden’s natural stutter, which he has largely overcome but which can still leave a mark on a person’s verbal expression, might play a role in his frequent awkward use of words.

The study Doctors Olshansky and Barzilai worked on said that President Biden is a “lifelong stutterer and he sometimes struggles with speech fluency; this has no relation to cognitive function.”

Hiding, But Few Seekers

Yet, as polling suggests, many remain unconvinced of President Biden’s physical and mental fitness for the presidency. Ronny Jackson, who served as White House doctor under former Presidents Obama and Trump, and who was named to several higher positions during the Trump administration, voiced concern over the matter.

“I’ve watched Joe Biden on the campaign trail, and I’m concerned, and I’m convinced that he does not have the mental capacity, the cognitive ability to serve as our commander-in-chief,” said Dr. Jackson.

Rumors and theories questioning President Biden’s mental sharpness have been fanned by what some see as his effort to minimize unscripted contact with the media and public. Citing concerns over the COVID pandemic, he largely campaigned virtually from his basement in Delaware.

After his inauguration, President Biden avoided holding a press conference for nearly two months. When it did take place, he responded largely by reading lengthy pre-prepared notes, but some other Presidents have done that as well. At one point, the President responded to a question about specific gun-control measures by launching into remarks about his infrastructure bill, but it was not clear if the cause was confusion or just a seasoned politician’s dodge of an unwelcome question.

The President has also largely avoided taking informal questions from the press at the rope-line during events — something most Presidents normally do.

Tobe Berkovitz, an associate Professor of Advertising at Boston University who has worked as a media consultant for Democratic candidates, said the President’s actions betrayed a strategy to be “insulated from spontaneous contact.”

While not commenting directly on President Biden’s mental fitness, Professor Berkovitz noted that his approach was a departure from earlier stages of his political career.

“If you look at the old Joe Biden, he never saw a microphone he didn’t want to talk to,” he said. “He reveled being on center stage. Now, he’s doing everything he can to avoid that.”

Noting President Biden’s long history of word blunders, Professor Berkovitz said that such incidents were less concerning than the frequency of statements that seem to miss the mark.

“It’s not so much the gaffes as the misstatements and grasping for concepts,” he said. “He gives these slow and clumsy answers and makes constant mistakes about facts and locations.”

An oft-repeated concern by critics of the President since his campaign was that he would largely be a figurehead while high-ranking staff set White House policy.

President Biden campaigned on “healing” the nation and touted his Senate record of bipartisanism. Yet, so far, he has pursued policy goals through executive orders and used a workaround to Senate rules to pass a COVID relief bill that was universally opposed by Republicans.

Aubrey Immelman, an associate professor of psychology at Saint John’s University in Minnesota, published a personality study on candidates in the 2020 election that identified President Biden as having a propensity toward “flexibility, compromise, and an emphasis on teamwork.” Yet it also noted that his tendency to be conciliatory leaves him “vulnerable to manipulation by pressure groups.”

Professor Immelman expressly avoided hypothesizing as to how his observations bear on the President’s mental health, but noted that his early actions were partially incongruous with the personality study.

“From my nonpartisan personality-in-politics perspective, the most puzzling aspect of President Biden’s first 100 days in office has been my observation that his political behavior has been more activist and less conciliatory than predicted by my personality profile, which is based on data collected since Mr. Biden’s run for President in 2007,” he said.

Professor Berkovitz doubted that the President had abdicated on important decisions.

“I can’t tell you how tight a control he has on the way policy is being run, but he’s been in Washington forever and he has clear ideas on what he wants,” he said.

The Golden Rule

Amid accusations from former President Trump and his supporters that then-candidate Biden was not up to the presidency, some suggested that the former Vice President should undergo a cognitive test. Yet, when asked about the matter in an interview, the candidate grew testy, saying, “No, I haven’t taken a test? Why … would I take a test?”

The lack of medical records on President Biden’s mental agility constricts psychiatrists from evaluating his fitness based on casual observation due to a clause in the American Psychiatric Association’s (APA) ethics code known as the Goldwater Rule. In the 1960s, Arizona Senator and presidential candidate Barry Goldwater successfully sued a magazine for libel after it published a critical study of his psychiatric make-up based on spotty and selective use of source material. In the fallout of the suit, the APA barred its members from rendering opinions about the mental state of public figures to media without having conducted examinations themselves.

A psychiatrist, Brandy X. Lee, sparked controversy with a 2017 study that labeled former President Trump as “dangerous” based on her evaluation of his behavior.

Dr. John Martin Joy authored Diagnosing from a Distance, a study of the history and ethics of the Goldwater Rule. He teaches psychiatry at Beth Israel-Deaconess Medical Center and Mt. Auburn Hospital, both in the Boston area. He said that the extent to which the Goldwater rule binds psychiatrists is not clear.

“Comment on any dementia in Biden would likely run afoul of the Goldwater Rule, but the rule only applies to APA members,” he said. “Many assume the APA’s Rule is an ethics norm in the mental health professions at large; there is so much dissent about the Rule’s insensitivity to conscience and obligation to society that, in my opinion, it cannot be regarded as commanding universal support by psychiatric ethicists.”

Press Pass

While much of the mainstream media extensively covered President Trump’s missteps, many see the same outlets looking away from fumbles by President Biden and feel that they show a lack of interest in his health or fitness for the job.

Dr. Immelman said that his informal observation was that left-leaning media have indeed looked away from President Biden’s awkward moments, but that right-leaning outlets are giving them extensive coverage.

“If empirically confirmed, it would suggest that media treatment of Biden gaffes serve a political agenda,” he said.

Dr. Olshansky concurred that attention or lack thereof to the mental fitness of officials is largely a political game.

“When a Republican President got elected the Democrat-related media was looking at every wrong move he could make, but there was no evidence that Trump had any of these issues. On the flip side, if Biden trips, the media that favors the left won’t pay attention to it, and those on the right will say it’s the beginning of the end,” he said.

However, as the majority of mainstream media outlets tend to have a left of center orientation, some are concerned this lack of scrutiny does the public a disservice.

“Biden has been getting a [free pass] from the press,” said Professor Berkovitz. “They rarely dwell on his malapropisms or on his lack of exposure to the press or public. Its seems that no network wants to be the one that could potentially bring down the Biden White House, so they’re treating him with kid gloves.

“On the one hand, as someone who used to advise candidates on how the handle the media, I admire that fact that they are getting away with their strategy, but it’s deplorable for democracy, where the press has a responsibility to hold officials accountable.”

An Old Problem

The Biden presidency is hardly the first time the age of a commander-in-chief or candidate for the post has been a source of concern and political fodder.

President Ronald Reagan was the nation’s oldest President until President Biden’s election, taking office at age 69. After a poor performance in a debate with Senator Walter Mondale in 1984, many questioned the President’s mental sharpness. When asked at the next debate about whether he was physically up to another term, he responded with a quip that has since become a classic of the Reagan era.

“I will not make age an issue of this campaign. I am not going to exploit, for political purposes, my opponent’s youth and inexperience,” said President Reagan.

The crowd erupted in laughter and even Senator Mondale could not help but smile widely. The joke erased the entire issue from the campaign, and President Reagan won his second term in a landslide.

Five years after leaving office, President Reagan publicly announced that he had been diagnosed with Alzheimer’s disease. Some suggested that he had shown signs of dementia while in the White House, but these accounts were never confirmed and have largely been refuted.

In 1992, while President George H.W. Bush’s health was not at issue, the Clinton campaign and many in the media worked hard to portray him as a relic of the World War II generation and out of touch with younger Americans.

In 1996, former Majority Leader Bob Dole’s health figured prominently in his match against President Bill Clinton, and the subject was in focus again in 2008, when Senator John McCain ran against President Obama. In addition to their ages, both were cancer survivors, but they both went on to live healthily through the terms they were seeking.

Dr. Olshansky said that while he feels it is unfairly exploited, the health of public officials is indeed important, cautioning however that the public should not put undue weight on their age.

“Everybody should be concerned about the mental and physical functioning of every President,” he said. “We should all try to ensure that we have someone competent and highly functioning, but how old they are doesn’t necessarily matter.”