What do Rudy Giuliani's messy personal life, John McCain's temper and Hillary Clinton's inability to seem authentic have in common? Maybe nothing. They may be just overblown issues in the otherwise normal lives of candidates under the political microscope.
Such symptoms, however, may mean a lot -- such as evidence of underlying brain dysfunction. Sometimes people with messy personal lives have low prefrontal cortex activity associated with poor judgment; sometimes people with temper problems have brain damage and impulse control problems; sometimes people who struggle with authenticity have trouble really seeing things from someone else's perspective.
Is the brain health of a presidential candidate a fair topic in an election year? Certainly Dick Cheney's heart condition wasn't off-limits in 2000, nor have questions about McCain's age been considered out of bounds. The White House issues a complete medical history of the president each year -- detailing everything from his seasonal allergic rhinitis to his adenomatous colon polyps. Clearly we care about the health outlook for our elected leaders. Should we go so far as to do brain scans? Of candidates for the Oval Office? Some people might consider discussing brain health a ridiculous idea. Not me.
As a neuropsychiatrist and brain-imaging expert, I want our elected leaders to be some of the "brain healthiest people" in the land. How do you know about the brain health of a presidential candidate unless you look? The brain is involved in everything humans do: how we think, how we feel, how we get along with others, how we negotiate, how we pay attention in meetings and how we turn away the advances of White House interns or decide to invade a country based on contradictory intelligence.
Three of the last four presidents have shown clear brain pathology. President Reagan's Alzheimer's disease was evident during his second term in office. Nonelected people were covering up his forgetfulness and directing the country's business. Few people knew it, but we had a national crisis. Brain studies have been shown to predict Alzheimer's five to nine years before people have their first symptoms.
President Clinton's moral lapses and problems with bad judgment and excitement-seeking behavior -- indicative of problems in the prefrontal cortex -- eventually led to his impeachment and a poisonous political divisiveness in the U.S. The prefrontal cortex houses the brain's supervisor, involved with conscience, forethought, planning, attention span and judgment.
One could argue that our current president's struggles with language and emotional rigidity are symptoms of temporal lobe pathology. The temporal lobes, underneath your temples and behind your eyes, are involved with language, mood stability, reading social cues and emotional flexibility.
A national leader with brain problems can potentially cost millions of people their lives. Slobodan Milosevic and Saddam Hussein give us recent historical examples. Both of Milosevic's parents committed suicide, he had serious bouts of depression and reportedly drank heavily -- all signs that point to brain problems. He was found to be unreasonable and unreliable in negotiations and heartless as a political leader. Hussein was described as paranoid and without empathy, also symptoms pointing to poor brain function. His mother suffered severe bouts of depression and attempted suicide while pregnant with him, which is known to affect a baby's developing brain. He was physically and emotionally abused by his stepfather. All of these stresses must have been involved in shaping his paranoid brain into a mind that could torture dissenters, murder relatives and launch chemical attacks that killed thousands.
Functional scans, such as Single Photon Emission Computed Tomography, provide a window into the brain. Doctors can now see healthy or dysfunctional brain patterns, much as we can assess the strength of a heart or measure hormone levels, and recognize trouble. All doctors might not agree on the interpretation, but there is a growing body of scientific literature establishing what these scans mean, such as attention deficit disorder or a predisposition for Alzheimer's.
Ensuring that our president has a healthy brain may be more than an interesting topic of conversation. It can be important information to put into the election equation. A president with brain problems could wreak havoc on the U.S. and the world at large. Maybe we shouldn't leave the health of our president's brain to chance. We have the tools; shouldn't we look?
Daniel G. Amen, a neuropsychiatrist and director of the Amen Clinics, is the author of "Change Your Brain, Change Your Life."Copyright © 2014, Los Angeles Times