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Health a chief concern for commander in chief

Job's demands, political calculations all factor in

Being president=20 has taken its toll on many chief executives. Nixon, = for=20 example, was all smiles in 1969 = ...

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Explore the health = demands of=20 being commander in chief -- and the challenges = facing=20 presidential doctors -- in a one-hour "Dr Sanjay = Gupta=20 Primetime Special" premiering Sunday, October 3, = at 9=20 p.m. ET and re-airing at midnight.=20

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(CNN) -- Warning: Being U.S. = president=20 may be harmful to your health.

A periodic business trip may be annoying, but = crisscrossing the=20 country and world on a weekly and sometimes daily basis can = be=20 grueling. Many people balance their checkbooks, but for a = president,=20 that involves trillions of dollars -- and, with that, = millions of=20 jobs and programs that affect hundreds of millions of = lives.

Presidents not only face constant scrutiny, but also = death=20 threats -- and at times, assassination attempts. As if that = weren't=20 burden enough, a commander in chief's decisions in war and = peace may=20 help decide other people's lives, and in some cases, a = society's=20 future.

Still, candidates jostle every four years to land one of = the=20 world's most prestigious -- and most stressful and = physically=20 demanding -- positions. As Sen. John Kerry's multiple bouts = with=20 laryngitis thus far this year show, life on the campaign = trail can=20 be a tough test physically -- and good training for the = demanding=20 life of a president.

"It's the ultimate 24/7 job, and presidential history = will tell=20 you that there is no way of getting relief," says Dr. Bert = Brown, a=20 former director of the National Institute of Mental Health. = "It's a=20 four-year root canal of pressure and problems."

Whoever wins in November will have round-the-clock access = to some=20 of the nation's top health care. Physicians and top-notch = medical=20 equipment and facilities follow the president wherever he = goes. (Full=20 story)

When something does go wrong, most presidents have little = time to=20 recover from injuries, improve their health or even mourn = for=20 private tragedies. Yet they have great political incentive = to=20 portray themselves as forever fit and strong, physically and = mentally.

"When the president becomes ill, the entire system is = affected --=20 the circle around him, the media, and most importantly the = American=20 public, particularly when there has been a sense of = confidence=20 reposed in the president," says Jerrold Post, a political=20 psychologist and professor at George Washington = University.

"An illness to the president is not just a personal = matter. It is=20 a devastating public crisis."

Physical strains

Presidents, like anyone else, have physical setbacks. = President=20 George W. Bush, for instance, hurt his right knee running = and=20 famously choked on a pretzel. President Clinton tore a = quadriceps=20 tendon and had a benign cyst removed from his neck.

Some presidents have suffered more severe health = concerns.

President Reagan underwent four operations at Bethesda = Naval=20 Hospital as chief executive, with surgeons addressing an = enlarged=20 prostate, a cancerous growth in his large intestine, two = benign=20 polyps and a condition called Dupuytrin's contracture that = had=20 caused part of his left hand to curve inward.

President Eisenhower suffered a heart attack and a stroke = while=20 in office. Whereas Eisenhower recovered enough to work = efficiently,=20 the same might not be said of President Wilson after he had = a stroke=20 during his second term.

A president's arduous job may hinder his physical = recovery, Post=20 says.

"When a person is recovering from a major trauma or major = surgery, he deserves the rest and rehabilitation that any of = us mere=20 mortals would have," Post says. "The public expectation, at = times,=20 is so high that the president [is] always on duty."

"The political situation aside, just the day-to-day = demands of=20 being president, are extraordinary," adds Capricia Marshall, = President Clinton's social secretary during his = administration. "He=20 could never turn it off."

The assassination attempt against Reagan in March 1981 = showed --=20 as did fatal attacks on Presidents Lincoln, Kennedy and = others --=20 that presidents face near constant, sometimes all too real = threats=20 on their lives.

Dr. E. Connie Mariano, a White House physician from 1992 = to 2001,=20 recalls a discussion with Clinton on what to do if he were = to become=20 incapacitated by an illness or attack -- including the = option of=20 invoking the 25th Amendment, under which power can be = transferred=20 quickly to the vice president.

"It was very sobering," Mariano says. "Most people don't = want to=20 think about their mortality or that people are trying to = kill them.=20 But they have to know."

Severe, sustained stress

Although the record has improved recently -- Reagan lived = to 93,=20 while President Ford is 91 and President George H.W. Bush 80 = --=20 Northeastern University professor Robert Gilbert notes that = more=20 than two-thirds of presidents have failed to reach their = era's life=20 expectancy for white males, "despite the fact that they have = received the best medical care that you can = imagine."

Lyndon Johnson,=20 like many other presidents, faced tremendous stress = while=20 = president.

Post says a "certain degree of stress" can make people = "more=20 alert, more focused" during a crisis, "but the data on = sustained=20 stress shows a decrease in functioning over time, even = though a=20 person may believe he is at the height of his powers."

In the long run, Post says, "stress tends to bring out = not the=20 best in people, but magnifies the flaws that are already = there."

President Coolidge, for example, suffered from severe = depression=20 after his son's death, which historians link to his = administration's=20 record.

Oftentimes, the office's many demands can impair a = president's=20 mental health.

As the Watergate crisis unfolded, several leading = senators=20 alerted Brown -- one of Washington's top mental health = experts --=20 about President Nixon's "withdrawal of social contact" and = rumors of=20 increased drinking. Nixon showed paranoid tendencies, as did = his=20 predecessor Lyndon Johnson related to rising antiwar = sentiment,=20 "that put terrible strains on them," Boston University = professor=20 Robert Dallek says.

Looking vs. feeling good

Social stigma often associated with mental illness and a = desire=20 to portray oneself as physically fit -- implying strong = leadership=20 -- prompts presidential candidates to play down the = negatives and=20 accentuate the positives about their health.

Dallek, whose 2003 book "An Unfinished Life" revealed = many new=20 details on President Kennedy's medical problems, found that = the=20 president received treatment for Addison's disease, severe = back=20 pain, colitis and urethritis, among other ailments. Despite = apparent=20 ongoing pain, Kennedy the candidate denied any ill health or = medical=20 conditions, portraying himself as vibrant and robust.

"There was a president who was much less healthy than the = public=20 image of him conveyed," says Dallek, noting that the strains = did not=20 appear to affect Kennedy's decision-making, as during the = Cuban=20 Missile Crisis. "If [the public] knew about it in 1960, I = doubt that=20 he would have been elected."

George W. Bush and John Kerry frequently play sports in = view of=20 cameras while campaigning and extol their health. Kerry, = moreover,=20 has touted his full recovery from prostate cancer.

An emphasis on physical fitness not only helps a = candidate's=20 public image, experts say, but may also prove useful for = dealing=20 with the heavy load a president carries in office.

Woodrow Wilson once said that being president "requires = the=20 constitution of an athlete," among other qualities, because = of the=20 burdens of running the country.

The significance the public and media places on a = president's=20 health, says Gilbert, is healthy for the country.

"It's important to everyone," he says. "If [political = leaders]=20 are in good health, they do their jobs better and they live = their=20 lives better."

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