The wonderful but, of course, quite fanciful Capitol Hill Blue is reporting that Bush is taking ‘powerful anti-depressant drugs’ to control his erratic behavior, depression and paranoia.’ The source of the report is not made clear beyond citing unnamed ‘White House sources’, but the ‘powerful’ drugs have reportedly been prescribed by Presidential physician Col. Richard Tubbs MD after the July 8th debacle, which I mentioned here, in which Bush stormed off stage after reporters questioned him about his relationship with the indicted Kenneth Lay. Added details of that incident are offered:
“Keep those motherfuckers away from me,” he screamed at an aide backstage. “If you can’t, I’ll find someone who can.”
This piece suggests that the unidentified drugs “can impair the President’s mental faculties and decrease both his physical capabilities and his ability to respond to a crisis, administration aides admit privately.”
The article draws heavily on the armchair diagnosis of Bush offered by psychiatrist Justin Frank in his recent book, Bush on the Couch: Inside the Mind of the President, which I have criticized and others have more thoroughly savaged. Frank’s book and the comments of several prominent psychiatrists who share his concerns about the President’s mental stability are the closest the article comes to citing an authoritative source. But, notice, those sources have nothing to say about the drug prescriptions. All that Frank is ‘confirming’, in the words of the article, are ‘increasing concerns’ about Bush’s ‘mood swings’ and outbursts.
I will reiterate that, while I feel diagnosis of a public figure without having a treatment relationship with that individual is irresponsible and unethical, I feel that expressing concern from a professional vantage point, from which certain signs of instability may be clearly recognizable, is abidingly in the public interest. What this calls for is transparency about the mental health of a leader such as the President, much as his physical health is a matter of public record. Of course, we are vanishingly far from that transparency, and left to vain speculation.
I can say as a psychopharmacologist that, if these reports are true rather than scurrilous propaganda, the article is painting certain unwarranted and irresponsible implications. First of all, if it is really an anti-depressant that is being prescribed, these medications do not impair one’s mental faculties or ability to respond in a crisis except in very limited respects:
- Some are sedating and sleep-inducing; while the anti-depressant benefit exerts itself round the clock, the sedation only occurs for a limited time after a dose is taken. The sleep improvement and overall benefit from an effective anti-depressant actually usually enhances daytime cognitive efficiency.
- Some SSRI antidepressants have been described as causing a tongue-tied feeling or word-finding difficulties. How one would know in George Bush’s case is a real question…
- Certain anti-depressants, by figuratively giving the user a thicker skin and stopping things from getting to them quite so much, can reduce motivation in someone who is largely driven by perfomance anxiety. Do we really think it is plausible that Bush is worried by not doing a good job?
No medical professional would describe one anti-depressant as more ‘powerful’ than another; it is simply not an adjective that is usually applied to this class of medications. All are equally ‘powerful’ when used correctly. None are second-rate in comparison to othes that are first-rate. And while one should properly refrain from using other medications with addiction and abuse potential (such as anti-anxiety medications) in those with a history of alcohol abuse and other substance abuse problems such as Bush’s, this is not a concern with anti-depressants.
If the term ‘paranoia’ is being used in an accurate clinical sense, this is not something that would be benefited by an anti-depressant either. Perhaps the President is being given an anti-psychotic (instead or in addition?), which would be the proper medication to target a psychotic symptom such as frank paranoia and which would more warrant the concerns about impairing mental capacities and responsiveness. Or perhaps he is receiving a benzodiazepine (Valium-like) anti-anxiety medication, although these would tend to disinhibit rather than contain his outbursts? Or a mood stabilizer, which might benefit emotional reactivity, impulsivity, irritability and outbursts, but might also dull mental acuity at least at the outset.
In any case, my suspicion all along has been that Bush is a figurehead, a creature of his handlers. This rumor, if true, may be just the latest technique of a vast repertoire being used to manage a puppet who was never qualified to rule and has never been leading in reality. If so, we need not worry about any further impairments in his mental acuity or capacity to handle crises. They will continue to be handled by the people behind the scenes just as well as they have been since his Cabal seized power three years ago.
