In 1972, Democratic Vice Presidential nominee Thomas Eagleton had to step down when news surfaced about his prior hospitalizations and electroshock treatment for depression. What would happen today if there was a notation about ECT, Prozac, Lithium, addiction, or the like in a candidate’s chart? Would it be disqualifying? Should it be?

Given the stigma and discrimination that still surround mental illness, it’s not surprising that very few politicians and no presidential candidates admit to struggling with or seeking treatment for psychological problems. This does not mean there haven’t been plenty of afflicted presidents; a 2006 study found that nearly half of 37 presidents whose historical records were reviewed met the criteria for psychiatric diagnoses. Some, like Lincoln, rank among our greatest presidents.

It’s a shame that stigma and discrimination discourage proactive and responsible responses to many treatable conditions. It’s not the presence or absence of a mental illness (or life circumstance) that counts, but how someone deals with it. As any therapist knows, what’s worrisome is not the person who knows something is wrong and seeks help, but the person who doesn’t.

Not all mental illnesses are the same. Nor are all jobs. Military personnel and commercial airline pilots routinely face the quandary that acknowledging significant psychological distress may derail their careers not only because of stigma, but due to legitimate concerns about risk to self and others.

What about the presidency, a high-stress, high-responsibility job if ever there was one? People often quip that you’d have to be crazy to want to be president. It’s no joking matter, though: for decades there have been serious proposals for an independent and impartial evaluation of the physical and mental health of all presidential candidates. Assuming we could find such examiners and eliminate stigma, though, diagnosis is an imperfect art and poorly predictive of performance. (Thomas Eagleton, for example, went on to have a long and distinguished career in the Senate and academia.)

Anti-social personality disorder, malignant narcissism, and paranoia have been commonly cited as conditions that ought to raise alarm, if not disqualify someone from the presidency. There is often a partisan slant to these opinions. But even if an official and impartial diagnosis could be made, why would it be persuasive when the traits and behaviors in question are already perfectly obvious for all to see? Besides, such characteristics may or may not have anything to do with a candidate’s mental health.

Perhaps we should be more concerned about the ill state of the body politic: We are too often split into polarized camps, divorced from reality, and suffering from anxiety, paranoia, withdrawal, and despair.

These problems are much more difficult to diagnose and treat.

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What are your thoughts about this?