Does It Matter If Newt Gingrich Is Bipolar?

He wouldn't be the first president with a mental illness.

A couple weeks ago I wrote a strongly worded blog post responding to Gail Sheehy’s Daily Beast piece about Newt Gingrich’s family history, in which she suggested he could have bipolar disorder. The commenters on that post included someone who has the illness herself, a person with family members with bipolar disorder, another person who has friends with bipolar disorder … none of them was offended by Sheehy’s suggestion. In fact, they ended up reading my post by accident after doing a Newt-and-bipolar web search.

That gave me pause. Was my response to Sheehy’s article that of a kneejerk advocate? Was I being defensive? In truth, if you listen carefully to people who talk about Gingrich and who have known him for many years, you hear a lot of coded language that implies inconsistent behavior on a rather grand scale. No one comes out and says, “Newt’s mentally ill,” but they come close. Reading about Gingrich is an exercise in reading between the lines.

The question that inevitably follows: Does it matter if he has bipolar disorder?

First, let’s define our terms. What does it mean when we say someone “has bipolar disorder”? Does it mean someone who’s been diagnosed and treated? Or someone who has mood swings that, due to the imprecision of common parlance, get read as “bipolar disorder”?

From a practical perspective, our current system compels health-care providers to choose a diagnosis code from the Diagnostic and Statistical Manual of Mental Disorders upon provision of services. This allows for reimbursement. Were it not for this financial imperative, most psychiatrists would not immediately assign a fixed diagnosis; they know the picture they initially have of a patient will inevitably get more complex as they move forward. Many psychiatrists practice reverse-diagnosis: trying different medications and then confirming a diagnosis based upon the patient’s response to the drugs. (A positive response to Lithium, for example, might be a good indicator that a person is dealing with bipolar mania.) Still, they have to use a code from Day 1, so sometimes all a diagnosis means is that a doctor had to get paid.

Then there are further questions: What type of bipolar disorder—bipolar I or bipolar II? And what about the à la carte menu: cyclothymia, rapid cycling, hypomania, psychotic depression … Someone who “has bipolar” doesn’t just have an uncomplicated problem with mood. It’s a variegated diagnosis with overlapping symptoms and episodes. Sometimes the diagnosis means a lot of different things.

Now let’s say Newt Gingrich has been diagnosed with bipolar disorder I. Is he still a viable candidate for president? No, but it’s not about the diagnosis. It’s about the behavior.

A diagnosis—of any kind—becomes a problem for a public servant when it intrudes upon the performance of daily activities. Some argue Ronald Reagan was affected by Alzheimer’s disease while he was in office. Others deny it. But the key issue in that argument is whether he was affected, not whether he had the diagnosis.

Reagan aside, this country has had many presidents with … issues. A Duke University study published in the Journal of Nervous and Mental Disease in 2006 claimed that 46 percent of U.S. presidents were “afflicted” by mental illness. Has that (rather slippery) fact mattered to the development of the republic? That depends. Abraham Lincoln suffered from depression, but he did all right. Richard Nixon was (in the lingua franca of the time) “neurotic.” In his case, it probably mattered.

Bipolar disorder is like any other chronic illness. It can be controlled by medication and lifestyle choices. Some people are lucky—they can go for years without major episodes. Others struggle with symptoms on a regular basis but can manage them. Still others are incapacitated. Everyone is different. But the president is our chief executive. Ideally, he should be the calm at the center of the storm, as trustworthy as a good ship’s captain. The people around the chief executive should not be responsible for controlling him, helping him think clearly, hiding his mistakes, making excuses for him and structuring his day so he doesn’t lose it. Ideally, the president shouldn’t need babysitters. He shouldn’t need to be monitored so he doesn’t do or say anything “crazy.” If anything, the president should err on the side of boring. I think the Founders even used the word “boring” at one point.

So if we’re going to elect a president who’s been diagnosed with a mental illness, we need to be sure the illness is under meticulous control. That excludes Newt Gingrich. Politicians, pundits, journalists and even friends describe him with words like grandiose, erratic, crazed, intemperate, inconsistent, unreliable, narcissistic, self-deluded, exaggerated … the list goes on. We simply can’t elect a person whose behavior has caused him to be perceived that way. But the diagnosis alone wouldn’t exclude him from consideration.