Language is tightly bound up with what it means to be a person and it is integral to how we function in the world. It can describe and enlighten, but it can also confuse and deceive. It’s just so… human. Although it feels innate, it’s actually a cultural legacy that we inherit from previous generations. It is the single greatest meme we’ve ever created (in your face, Grumpy Cat), yet we take it for granted. Language is so central to our lives that it doesn’t even occur to most of us that it can be taken away. But it can.
Aphasia is a language disorder that affects language processing. It is common in people who have experienced a stroke; 20% to 40% of acute stroke patients develop aphasia. Because stroke is so common (it is the third leading cause of death in industrialized countries1), that amounts to 40-60 people out of every 100,000 every year3.
There are several types of aphasia, and the condition can have a variety of symptoms, potentially affecting all areas of language. It can impact a person’s ability to both speak and understand the speech of others, as well as their ability to read and write3. Lots of factors influence recovery, including age, gender, environment, as well as the type of stroke3. Unfortunately, total recovery is rare. Most patients are left with some impairment. The experience of aphasia patients illustrates the downside of our dependence on language, and it is a stark reminder of the importance of language. Studies have found that aphasia reduces the chances of a patient returning to work and social activities, and (likely because of this) also significantly reduces their quality of life3.
But it’s not all bad news. Patients usually experience some gradual spontaneous recovery from aphasia, with the greatest amount occurring within the first 3 months. This type of recovery generally plateaus around a year after the stroke1. Recovery depends on the return of normal blood flow to the parts of the brain impacted by the stroke. After that, the neural circuitry responsible for language must be rebuilt. Because the brain is plastic, neural connections can be formed and reformed throughout our lives (to a certain extent, anyway). The brain can literally heal itself, allowing us to survive adversity by giving us a nearly infinite capacity for change.
What could be more human?
Cause: Aphasia most commonly results from a stroke3. Stroke is caused by depleted blood flow to the brain from either blood loss (through a burst or leaky blood vessel) or the blockage of a blood vessel by a blood clot. With decreased blood flow comes a reduction in oxygen, which leads to brain cell death and can impact brain function2.
Consequence: Aphasia affects all aspects of language processing, including speech comprehension and expression, and reading and writing ability. Adding another layer of complexity, the severity of these symptoms also varies3.
Cure: There is no cure for aphasia. Aphasia is predominately treated with speech therapies, and the type, time started, duration, and intensity of therapy may significantly affect recovery3. Although some medications have been suggested to treat aphasia, their use is still controversial1.
Even presidents get sick. This should come as no surprise, given the circumstances.
First of all, despite the energetic arm waving and sweet campaign jams (whether endorsed by the artists or not) US presidents are− by and large− old. The average age of a president at election is nearly 55. That may not sound old, but bear in mind that’s the average from 1789 to 2008; for most of that period, life expectancy was well below 55. As recently as 1900, the overall (male and female) life expectancy was about 49.8 The current life expectancy for American men is around 76.4 (When we finally elect a female president, she’ll have until 81.4) Add the long hours, extended travel and stress of being Commander-in-Chief, and you have the perfect recipe for ailment.
Acute (sudden and severe) illness has cut several presidencies short; four presidents have died from sickness while in office. Many more have suffered in silence, laboring with the burden of chronic (long-lasting, non-infectious) disease. With one exception (I’m looking at you, Woodrow), illness did not affect the president’s cognitive or leadership abilities, but was concealed nonetheless. At times, extreme measures were taken to minimize the appearance of illness, sometimes covering it up entirely.
Calling in sick to the (oval) office
At least two presidents have had major medical procedures to treat chronic illness while in office: Grover Cleveland and Dwight D. Eisenhower.
In what has to be one of the most amazing medical maneuvers of all time, Grover Cleveland underwent a clandestine surgery to treat mouth cancer near the beginning of his second term in 1893. To pull it off, he arranged for his surgery to take place on a friend’s yacht in Long Island Sound, using the cover story of a month-long fishing trip. The surgery took place in the refurbished saloon of the boat, where he had several teeth and part of his jaw removed. To ensure there was no noticeable difference in either his appearance or speech, he was fitted with a prosthesis and continued to cultivate his trademark mustache. He never relapsed and the surgery was not officially acknowledged until 1917, nine years after Cleveland’s death.1,5
Dwight D. “Ike” Eisenhower had a massive heart attack in 1955, about midway through his first term. It was likely the result of chronic heart disease; it may not have been his first, or even his first as president. The public was informed, but the severity of his condition was substantially downplayed. In fact, efforts to keep Ike’s condition secret may have actually endangered his life: his doctor waited a full day to seek outside medical assistance, for fear of political repercussions. Ike also suffered chronic gastrointestinal issues throughout his military and political career. Intense intestinal pain brought Eisenhower back for a second surgery in 1956. The public was told that the results were normal, but that was far from true. The surgery revealed adhesions suggestive of Crohn’s or inflammatory bowel disease.3
Two of the most beloved (and boldly initialed) American presidents, FDR and JFK, also suffered from serious chronic illness that they attempted to conceal. JFK had a slew of troublesome medical conditions that he publically denied, including Addison’s disease, colitis, ulcers, and a degenerative back issue.2 Roosevelt contracted polio in 1921, and the disease left him paraplegic. He initially tried to hide his condition, but it was eventually leaked to the press. In response, the president underwent a medical exam to dispel fears about his health. Despite the fact that his condition had become public knowledge, FDR never allowed media photographers to take his picture while he was in his wheelchair. Instead, photo ops and public events were carefully planned so that he used a seat that was not reminiscent of his condition, like his iconic convertible7.
Everybody gets sick, so why all the secrecy and subterfuge?
Well, it’s politics. Image is everything, and any display of vulnerability is an invitation for an attack. Illness− even when it is chronic and does not affect job performance− can be seen as weakness and weakness is fatal in politics. No president has wanted to be viewed, either at home or abroad, as a Patient-in-Chief− a sick old man past his prime.
But the shows of vigorous good health were not just for fellow politicians. In all of these cases, it was thought that admitting the complex reality of the President’s health would not only minimize the effectiveness of the president, but also destabilize the country. It was taken as given that the admission of chronic disease would inspire uncertainty in the public, that the people would also see illness as weakness and reject it.
We, the People
It’s reasonable to be concerned about an ill president’s capacity to perform the duties of the office. However, in the history of the American presidency only one president has been incapacitated by illness, Woodrow Wilson. Wilson had a major stroke that left him bedridden and unable to sign his own name, but neither Congress nor the American people were informed of his condition. For the next 17 months, until Wilson left office, essentially no one was allowed to see the president, and nearly all communication was relayed through his wife, Edith.6 Disconcerting, to say the least. But, in an era with TV and Twitter, repeating this maneuver would never work. (I know, never say never, but seriously: never). Not only that, there are now procedures in place for passing presidential duties on to the Vice President in such circumstances, thanks to the 25th Amendment (passed by Eisenhower, BTW).6
Instead, the evidence actually shows the opposite: chronic disease and disability do not make a person incapable of meeting the demands of the presidency. Collectively, the presidents mentioned here successfully led America through some of its most trying times: financial crises, WWI, the Great Depression, WWII, and the Cuban Missile Crisis. They were taken seriously by their peers, both nationally and internationally, and they handled some seriously challenging situations with nothing short of grace. Three (FDR, Eisenhower, and JFK) routinely rank in the top ten greatest presidents.
While it is certainly not commendable that these men concealed their health issues, it is understandable. They were combatting their own fears of disgrace and disgust by attempting (albeit misguidedly) to give the people what they (might have) wanted. They were striving to fit an unrealistic ideal of youthful experience. However, I’d like to think that their concerns too were unfounded. We will never know if honesty would have damaged or ended their careers, but I hope not. Maybe Americans would have seen the bravery and endurance these men evinced. And, when a candidate finally runs for office openly admitting a chronic condition, maybe they will see strength in his or her suffering and admire it, knowing that there is− as FDR famously said− nothing to fear but fear itself.
Cashman, EC, & C. Timon. 2011. Otolaryngology and the American presidency: a medical legacy. ORL, 73:105-109.
Dallack, R. The medical ordeals of JFK. The Atlantic, Special Issue. Web. 4 September 2015.
Gilbert, RE. 2008. Eisenhower’s 1955 heart attack: medical treatment, political effects, and the “behind the scenes” leadership style. Politics and the Life Sciences, 27: 2-21.
Life expectancy. Centers for Disease Control and Prevention. 20 January 2015. Web. 4 September 2015.
Maloney, W. 2010. Surreptitious surgery on Long Island Sound: the oral cancer surgeries of President Grover Cleveland. New York State Dental Journal, 76:42-5.
Menger, RP, CM Storey, B Guthikonda, S Missios, A Nanda, & JM Cooper. 2015. Woodrow Wilson’s hidden stroke of 1919: the impact of patient-physician confidentiality on United States foreign policy. Neurosurgical Focus, 39:E6.
Meschia, J, BE Safirstein, & J Biller. 1997. Stroke and the American presidency. Journal of Stroke and Cerebrovascular Disease, 6: 141-143.
Rosner, M. 2015. Life expectancy. OurWorldinData.org. Web. 4 September 2015.