Mental Status of United States Presidents

Sturgeon Moon, 28 August 2026

Those observing the actions of the two most recent presidents of the United States might well wonder – why does the United States electoral process seem to select (and retain) mentally unstable or deficient presidents? And why is it so difficult to constrain their erratic behavior or remove them from office? These are issues well worth considering as several current regional wars threaten to coalesce into a world war.

First, of course, I must define my terms. The easy, convenient, yet unhelpful action here is to apply the label “mentally ill”. I do not like using this term. Much of contemporary debate lapses into medicalization, describing erratic or undesirable behavior as a sickness. This amounts to name-calling and avoids addressing the matter at hand.

Second, in passionate debate, it is easy to lapse into the false equivalency of “I dislike something” equaling “mental illness”. This amounts to saying “Anyone who disagrees with me must be crazy”. Again, this amounts to name-calling and avoids addressing the crux of disagreement.

Third, the position of president is demanding. Anyone who occupies that office is under constant stress. Even the strongest man or woman will falter at times. We cannot condemn a president who occasionally nods off to sleep during a meeting.

That being said, I would like to point out three specific instances each for Presidents Doanld Trump and Joe Biden that should leave an objective observer wondering whether these men are or were mentally capable of discharging their duties.

For Donald Trump, I would single out:

For Joe Biden, I would single out:

In his “Dear Jonas” letter, Donald Trump demanded the annexation of Greenland, declared that he prevented more than 8 wars, and, being snubbed regarding the Nobel Peace Prize, no longer felt an obligation to pursue peace. His letter was so concerning that the Prime Minister of Norway made it public.

Donald Trump’s prosecution of war against Iran for the sake of Greater Israel could be the subject of many posts. But his profanity-laced threat on Truth Social calls into question his mental stability. In this post, he threatened to destroy Iran’s infrastructure, a war crime. When Pope Leo XIV countered this with advocacy for peace, Trump lashed out at him.

Donald Trump has been relentless in personally mocking and attacking former political allies (Tucker Carlson, Thomas Massie, Marjorie Greene, Alex Jones …) who raised reasonable objections to Trump’s policies. His attacks are especially cruel in that these people supported his presidential candidacy when he was an underdog.

Joe Biden’s performance during the June 2024 presidential debate made it clear to the American public that he was mentally deficient - long pauses, meandering sentences, and an inability to effectively counter Trump's attacks. It was so bad that his wife thought that he was having a stroke.

Special counsel Robert Hur interviewed Joe Biden regarding the illegal retention of classified documents. He concluded, conveniently, that a jury would likely view the president as a "sympathetic, well-meaning, elderly man with a poor memory". In other words, non-guilty by reason of mental incompetence.

Joe Biden’s behavior at a July 2024 NATO conference was particularly concerning for the assembled European leaders. He introduced Ukrainian President Volodymyr Zelenskyy as President Putin. Later in the meeting, he referred to Donald Trump as his vice president.

I think that these six instances are enough to cause concern to both Americans and non-Americans alike. In doing research for this post, I encountered the additional testimony of many witnesses who described other instances of mental instability or deficiency.

So why is this happening? One obvious issue is the advanced age of the two men. The stresses of the presidency weigh more heavily on a 75-year-old than a 45-year-old. But we need to pursue this causal chain further. Why are such elderly men installed as president?

One reason is the gradual accretion of power. It takes money, favorable publicity, and personal contacts to ascend to the presidency, and the longer one lives, the more such resources accrue. The acquisition of power favors the elderly. The United States Senate is a prime example of this, where the average age is 65.

Another reason for the ascendancy of the gerontocracy is the rigidity of the electoral system itself. The so-called two-party system has held sway over United States politics for centuries, and this has locked out independent voices.

Advanced age is not the only cause. Another cause could be described as institutionalized narcissism. The president is surrounded by sycophants, men and women telling him that he is the most powerful and important person on the planet. Men and women who tell the president what he wants to hear, else be banished from the inner circle. It takes an exceptional man to resist this flattery and seek out contrary opinions.

This is not the first time that United States politics has been in turmoil due to the mental incapacity of its chief executive. Woodrow Wilson suffered a debilitating stroke in 1919. Rather than select a new president, Edith Wilson, his wife, became acting president by restricting who had access to her husband.

Ronald Reagan showed symptoms of cognitive decline while president. Computational studies of Reagan’s speeches showed a reduced rate of unique words, increased use of filler words, and greater repetition.

Some of the difficulty here can be attributed to the Constitution of the United States. One of the pillars of the Constitution is the separation of legislative and executive powers. The President can act independently of Congress, unlike parliamentary democracies where the parliament selects the prime minister. A mentally deficient prime minister can easily be replaced.

There should be a middle ground here. There are benefits in keeping the legislative and executive branches of the government separate. The United States Constitution allows for impeachment, but that is too drastic a mechanism. A vote of no confidence, however, sets the bar too low. A stronger Congress could remedy this situation. But Congress, as an institution, is an even greater disappointment than the Presidency.

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