The vitriolic Harris-Trump rhetoric on mental health trivializes a larger issue

One of the reasons the 2024 presidential campaign has become one of the most extraordinary in American history is the way Vice President Kamala Harris and former President Donald Trump are waging direct and unrelenting violent attacks on each other’s mental health. Personal vitriol obscures and trivializes the suffering of millions of Americans with mental health issues.

Trump began the attack last summer when he called Harris “stupid as a rock,” “crazy Kamala,” “if you ever see her laugh, she’s crazy,” and a “lunatic.” At a recent rally, he called her “mentally impaired” and “mentally disabled.” He reportedly said at a private dinner that Harris was “r——ed.”

Larry Hogan, the anti-Trump Republican governor of Maryland who is currently running for Senate, told CBS that Trump’s comments were “an insult not only to the vice president, but to people who are actually mentally disabled.”

Harris, for his part, didn’t hold back. She questioned Trump’s suitability for the Oval Office, saying he was “increasingly unstable and unhinged.” Her comments echo those of critics who question Trump’s mental stability. After Trump bizarrely danced to music for 30 minutes during a town hall meeting while health workers in the audience responded to two medical emergencies, Harris posted on social media: “I hope he’s OK,” in an Oct. 13 letter Signed by 238 health professionals and organized by the group Doctors for Harris, the petition, meanwhile, said Trump “displayed alarming features of declining vision” when demanding he release his medical records.

Trump denied the allegations against Harris and demanded that she undergo cognitive testing. On October 14, he wrote on his platform Truth Social: “I believe it is very important that Kamala Harris passes a cognitive endurance and agility test.”

The nominees have submitted summaries from their doctors certifying that they have the mental health to successfully carry out the duties of the presidency. Harris’ doctor said: “She has the physical and mental resilience necessary to successfully carry out the duties of the presidency.” He did not address whether she had undergone a mental screening such as the mini-test in Montreal, which Trump underwent his first physical exam as president in 2017. Although Trump said during a campaign rally in December 2023 that he “passed with flying colors” a cognitive exam during a recent investigation, he has provided no evidence to support the claim.

Since this country’s earliest years, politicians running for office have used scathing rhetoric to target their opponents and occasionally draw attention to the physical ailments of their rivals.

But what we are seeing in this campaign – one candidate’s sustained, frontal and central attacks on another’s mental health – is unprecedented. The last time a candidate’s mental health received such attention was 1972, the first year I covered the health of political leaders for The New York Times. This year, Missouri Senator Tom Eagleton was forced to resign as the Democratic vice presidential candidate because he deliberately concealed from presidential candidate George McGovern the fact that he had been hospitalized three times for depression and had received electroshock therapy for two of those stays. Back then, it wasn’t just about the stigma of mental illness, but also about trust. How could McGovern be sure that Eagleton would be open in future conversations between the two or with the public?

An issue that received less attention occurred in the 1988 presidential campaign when President Reagan, responding to a question about rumors that Democratic nominee Michael S. Dukakis was suffering from depression, said, “Look, I’m not going to pick an invalid.” About 20 minutes later, Reagan returned and told reporters: “I was trying to make a joke. … I don’t think I should have said what I said.”

Although the current hate attacks are receiving more attention, this campaign has often addressed the broader issue of improving access to mental health care. Vice President Harris has championed the Biden administration’s efforts to fund more mental health counselors in schools and enforce rules that require insurance companies to cover the cost of behavioral health care equal to the cost of physical care. Additionally, her campaign has committed to increasing mental health resources for veterans. In response to Trump’s attacks on her cognitive abilities, she also said in a podcast in September that the lack of mental health care is “probably one of the biggest public policy failures in our country.”

Trump hasn’t talked specifically about improving access to behavioral health care. However, he has campaigned extensively on related mental health issues, such as child welfare following Covid-19 lockdowns, substance abuse and managing chronic illness. He has also pledged to ban gender-affirming care for children, as pediatricians and mental health organizations warn it could jeopardize patients’ psychological well-being.

Trump has also referenced mental health when discussing gun control issues. As president, he said the country should build more mental health facilities to “get mentally disturbed and dangerous people off the streets,” which he says is both true — the U.S. needs more beds for people with serious mental illnesses — and offensive to suggest storage rather than treatment. As president, he also signed legislation creating the suicide and crisis hotline 988 and issued an executive order to prevent veteran suicides.

On Monday, as 2024 nominees questioned each other’s mental health on the campaign trail, the National Academy of Medicine dedicated its annual meeting in Washington to a range of mental health issues. Attendees did not address the nominees’ allegations about their mental health. Rather, they spoke about issues such as the need to remove the stigma of mental illness, dementia, preventing youth suicides, the longer-term impact of Covid on families and increasing wages for trained mental health professionals.

During a break in the meeting, Eric Larson, a professor of medicine at the University of Washington who studies age-related diseases such as dementia, said the idea that people with cognitive problems are the last to notice “is true, but not always.” .” . ” Many people seek medical help because they notice their mind failing, Larson said, but many others are unaware of the changes or are in denial about them.

“If we live long enough, most of us will have dementia,” he said, citing statistics showing that “about a third of these 85-year-olds have symptoms of dementia, about half by age 90 and two-thirds to three quarters at the age of 90.” Age 95.”

Most voters “make their own decisions about the insight issues, but of course we want to have leaders who have full control of their own abilities,” Democratic Rep. Donald S. Beyer Jr. of Virginia said in an interview after speaking at the meeting had spoken. But Beyer said “the more important issue” is the mental health crisis in the U.S., particularly suicide prevention among young people. The American system for supporting the needs of people with mental health problems is “incredibly broken.”

Linda Fried, dean of Columbia University’s Mailman School of Public Health, said the nominees “aren’t talking about the mental and physical health of Americans.” She criticized “the lack of attention given to finding ways to improve the physical and mental health of Americans, who have fallen to the bottom of 36 peer nations over the past 30 years.”

According to the Centers for Disease Control and Prevention, about one in four Americans currently lives with a mental health problem, but the workforce is woefully inadequate to meet their needs, experts said at the meeting. (Full disclosure: I am a member of the National Academy of Medicine, formerly known as the Institute of Medicine, but had no role in the meeting.)

Psychiatrists and society need to “do a much better job of figuring out how to leverage the resources we have for the current workforce and recruit and train new workers,” said Ann Garland, a psychiatrist at the University of California, San Diego. This requires an increase in compensation for frontline mental health workers, she said, noting that “in San Diego County, the average wage for a fast food worker is higher than the average wage for a community health worker, and that is.” demoralizing.”

These are all mental health issues that deserve policymakers’ attention. Many people become mentally ill or suffer from cognitive decline at some point in their lives, or have a loved one who experiences the same thing. However, the vitriolic back-and-forth between Trump and Harris has distracted from the urgent mental health crisis in the United States

If you are thinking about suicide or worried about a loved one, call or text 988 Suicide and Crisis Lifeline or visit www.988lifeline.org.

Timmy Broderick and Sarah Owermohle contributed reporting.

Lawrence K. Altman is a physician, clinical professor of medicine at New York University, and former New York Times reporter and “The Doctor’s World” columnist. He researches and writes a book about the health of political leaders.