Interviews November 2002

Pulling Back the Curtain

Presidential historian Robert Dallek, the author of "The Medical Ordeals of JFK" (December Atlantic), discusses new revelations about President Kennedy's serious health problems and his efforts to keep them hidden
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Though America's thirty-fifth President served fewer than three years in office, his hold on the American popular imagination is more powerful than perhaps any other's. John F. Kennedy remains an iconic figure—emblematic of a golden era of hopefulness that was ushered in when he ascended to the presidency in 1961 and that died with him when he was assassinated. America's visceral, wistful response to Kennedy's brief presidency seems to have at least as much to do with images and impressions as it does with concrete facts about what he accomplished in office. To many Americans, he was elegance and style personified. He was the dashing young politician with the glamorous wife and beautiful children; the war hero who had saved men's lives in the South Pacific and received the Navy and Marine Corps Medal; the well-bred graduate of an exclusive New England prep school and Harvard college; and the skilled athlete who played tennis, sailed, engaged in vigorous games of touch football, and roughhoused picturesquely with his children around the White House.

Things appeared to come naturally for him. And during his presidency his aura of ease and grace seemed to shape the mood of the country as a whole. Ironically, however, given that his appealing impression of utter well-being may have been one of his most important characteristics as President, new evidence suggests that that impression was a false one. Indeed, Kennedy's private experience was almost completely at odds with the public image of ease and grace that he projected.

Earlier this year, in the course of conducting research for a book on Kennedy, the historian Robert Dallek gained permission from a committee in charge of Kennedy's White House records to read his previously unopened medical files. What he discovered there surprised him. It had long been public knowledge that Kennedy suffered from back trouble and Addison's disease (a malfunctioning of the adrenal glands), but the extent of his suffering, and of his physical limitations, had been a well-guarded secret.

In "The Medical Ordeals of JFK," (December Atlantic), Dallek describes the litany of health problems that plagued Kennedy throughout his life, and the complex medication and treatment regimens that became a regular part of his daily experience. During just the first six months of his term, Dallek writes,

Kennedy suffered stomach, colon, and prostate problems, high fevers, occasional dehydration, abscesses, sleeplessness, and high cholesterol, in addition to his ongoing back and adrenal ailments. His physicians administered large doses of so many drugs that Travell kept a "Medicine Administration Record," cataloguing injected and ingested corticosteroids for his adrenal insufficiency; procaine shots and ultrasound treatments and hot packs for his back; Lomotil, Metamucil, paregoric, phenobarbital, testosterone, and trasentine to control his diarrhea, abdominal discomfort, and weight loss; penicillin and other antibiotics for his urinary-tract infections and an abscess; and Tuinal to help him sleep.

Because his spine had become so weakened by osteoporosis (most likely a side effect of the steroids he had been taking from a young age for his intestinal problems), his range of motion was severely restricted, and the pain was extreme. At times, Dallek reports, he had to resort to crutches or other mobility aids.

Dallek discovered that Kennedy worked hard throughout his life to hide his sickliness from others. In college he tried to obtain his prescriptions in secret, and during his military service (which was made possible only by using his father's connections to persuade the military physicians to overlook his problems), he refused to report to the infirmary, even after he strained his back rescuing several of his men when a Japanese destroyer sank his boat. Later, when he went into politics, keeping his health problems a secret came to seem even more important. If the public knew how ill he really was, and how many heavy-duty medications he needed to take just in order to function normally, he feared that voters would be unwilling to take a chance on him. Thus, he took his medications in secret, avoided being seen with doctors, and concentrated on moving normally and concealing his pain when in public. When aides to Lyndon B. Johnson, his opponent for the 1960 Democratic nomination, reported to the media that Kennedy had Addison's disease, Kennedy responded by having his doctors issue a statement denying the illness, and proclaiming him to be in "excellent" health.

In all likelihood, Dallek speculates, Kennedy was correct to assume that Americans would not have voted for him if they had known the truth about his health. And it is probably also safe to assume that many would have been justifiably angry to discover that they had been misled into taking a gamble on a frail, heavily medicated candidate. But as President, Dallek points out, Kennedy proved to be an effective and inspiring leader whose performance was not discernably affected by health considerations.

It could be argued, Dallek concedes, that Kennedy's failure to be forthright about his health status represents a moral failing—an indication that he placed greater importance on his own personal ambition than on the welfare of the American people. But that same deceptiveness, Dallek suggests, can also be viewed in another light.

The silence regarding his health [can be viewed] as the quiet stoicism of a man struggling to endure extraordinary pain and distress and performing his presidential (and pre-presidential) duties largely undeterred by his physical suffering. Does this not also speak to his character, but in a more complex way?

What Kennedy gave the American people was an image of perfection that buoyed them up and inspired them. It took enormous effort to maintain that façade, but by reserving his suffering for himself alone, he was able to create for America the Camelot that it seemed to want and need.

Robert Dallek is a history professor at Boston University and the author of Franklin D. Roosevelt and American Foreign Policy, 1932-1945, which won the Bancroft Prize; Lone Star Rising: Lyndon Johnson and His Times, 1908-1960; Hail to the Chief: The Making and Unmaking of American Presidents; and Flawed Giant: Lyndon Johnson and His Times, 1961-1973. He is currently at work on An Unfinished Life: John F. Kennedy, 1917-1963, which will be published next fall by Little, Brown.

I spoke with him recently by telephone.

—Sage Stossel

You write that a lot of the information you present in the article just became available this year when a committee of Kennedy Administration friends and associates agreed to open up a collection of papers. Why were those files under the control of that particular group, and why did they decide to open the papers now?

The Kennedy Library is the only presidential library in the country that has donor committees, which means that the papers are controlled by committees who determine whether there should be access to them. The papers about Kennedy's medical history had been in the library for a number of years, and a number of earlier biographers had tried to gain access but were summarily turned down.

I think the reason that access was given now is because of what always happens with presidential material—the passage of time. After all, it's thirty-nine years this month since Kennedy died, and more than forty years since he came to the White House.

To request access I sent a letter to the chair of the material, Burke Marshall, who was in the Justice Department under Robert Kennedy and John Kennedy. He decided that the committee (which included a man named Samuel Beer, who is a professor at Harvard, and Ted Sorenson, who was Kennedy's counsel and speechwriter) should first of all find out whether other presidential libraries had opened up their medical histories. They found that a lot of them had. Then they decided that they should review the records. So they brought in a Boston physician—I don't know his name—who spent a year or more looking over the materials. As I was told, his judgment was that the papers would end up making John Kennedy look heroic. So the committee decided to go ahead and open the collection.

Were you surprised by what the papers revealed?

There's always been a lot of speculation, and some pretty good evidence, that Kennedy had a series of medical problems. Most prominently, his Addison's disease and his back problems. What we didn't know—but what is shown by the records—is the depth, extent, and degree of suffering he experienced from these problems, and how much he struggled with them. The records show, for example, that between the spring of 1955 and the fall of 1957, he was hospitalized nine times! Once he was hospitalized for nineteen days, and twice for a week at a time.

These hospitalizations were for a variety of illnesses that he had. First of all, he had colitis, now called irritable bowel syndrome. According to the records, during his White House period he would wake up in the morning with cramps and abdominal pain. So some of the medications they were constantly giving him were antispasmodics to calm down his stomach and inhibit the diarrhea he had from spastic colitis. He was also on testosterone. In the White House records there was an almost daily charting of his weight, because he had difficulty keeping it up. The testosterone was given to him by a physician to bulk him up.

A second problem was the difficulties he had with his back. It seems likely that he began taking something for his colitis called DOCA (which is a corticosteroid) in 1937 when it first became available. Back then they didn't know how to dose. It's been speculated that his back problems were the consequence of a football injury and of an incident in the Pacific theater of war during his Navy service in World War II. But what seems more likely is that the steroids caused the problems. There's a naval record of his back surgery in 1944 which shows that when the surgeons got in there they found that it wasn't some kind of disk problem but that the bone in the lower back had softened terribly. My medical friends tell me that taking those kinds of steroids can bring about osteoporosis.

He also had prostatitis, an inflammation infection of the prostate, and urethritis, an infection of the urethra, both of which had to be treated with massive doses of antibiotics. There's speculation that these were the consequence of some kind of venereal disease he may have contracted in 1940. A letter in the files from a urologist he consulted indicates that the first episode of his urethritis occurred in 1940, and that it was repressed with sulfite drugs. After that it was a recurrent problem.

And of course, he had Addison's disease, which is a malfunctioning of the adrenal glands. My medical friends tell me this could have been another consequence of his taking steroids. There might also have been an inherited component, because his sister Eunice has Addison's disease, too.

Was he the only one of his siblings to have had so many different kinds of health problems throughout his life?

Yes, as far as we know. Apparently Eunice had other difficulties as well, but I don't have a close knowledge of her medical history. But Ted, for example, and Bobby—they never manifested the kinds of problems John had. His problems really began, as we understand it, with the colitis. He was sent to the Mayo Clinic at the age of seventeen in 1934. The Mayo Clinic records still remain closed, but we do have letters that he wrote to his prep school pal, LeMoyne Billings. He describes in these letters the treatments he was getting and the study of his problems—that they were looking at his bowels and intestines.

It all sounds sort of vague and mysterious. Did they rule out any sort of eating disorder or hypochondria?

They couldn't rule anything out, because it was thought in those days that that sort of irritable bowel trouble was a product of inherited traits, or psychological tension. They were never able to pin anything down with exactness, and they had no real treatment for it. That's why in 1937, when DOCA became available, it's our impression that they began giving it to him.

The litany of all the different symptoms he had—fatigue, diarrhea, ulcers, and back pain—make it sound as if he should have been curled up in fetal position, whimpering. But he played tennis and football, and everyone's heard the stories about his sexual exploits.

Well, you see, they were fostering an image of vigor. And they did a brilliant job of covering his problems up. One question that people constantly ask me is how he was able to perform these supposed Herculean feats as a sex machine, given the fact that he had serious back problems and so many illnesses. The answer may be that he carried on quite a bit in the White House swimming pool and (it's alleged) in the bathtub, and that he would practice sex in a supine position—taking the bottom position. This may explain somewhat how he was able to acquire such a reputation as a sexual athlete.

But the bottom line, I think, to so much of what I discuss in the article, is that he was really quite heroic—that he had extraordinary determination. He made a bet with himself that he could be President. Of course, one of the problems I see with this is that he did not share the gamble with the public. It could well have turned out that if the public knew about how ill he was, he never would have been elected. This is what the Kennedys themselves feared, so they made a systematic effort to hide the fact that he had so many illnesses. It was a kind of cover up.

Do you see Kennedy as having forged a successful political career for himself in spite of his problems? Or were his health problems part of what drove him to seek the kind of universal validation politics can provide in the first place?

I think it could have been both. I think his problems could have spurred him on to prove something to himself, and at the same time that he managed to become a successful politician in spite of his problems. Both points are well taken.

I tried to coordinate my study of his medical problems with some of the major crises he confronted as President—the Bay of Pigs, for example, and the Cuban Missile Crisis. What the record shows is that when he faced these crises, his dosages of cortisone and salt tablets were increased in order to allow him to cope effectively with the stress that he was under. He was also on sleeping pills.

You mention that he took so many drugs that they had to start using a chart to keep them all straight. Some of them were clearly essential—like the painkillers for his back and the antispasmodics for his colitis and the antibiotics for his urinary-tract infections. But some of them, like the sleeping pills and the amphetamines, seem like they might have been gratuitous. I was wondering whether his taking them might suggest that he felt that drugs could somehow make him into something better than he naturally was.

My guess is that the sleeping medication was necessary. The medical records show that at least one time he woke up at five o'clock in the morning with terrible abdominal cramps, probably from the spastic colitis. And his back pain was so severe that they often had to inject procaine, which is a form of novocaine, into trigger points in his back. I don't think he could have functioned effectively without these various medications because the pain was so severe. The records reveal that he couldn't turn over in bed at night, he couldn't pull a sock and shoe onto his left foot, he couldn't reach across a table and pull papers to himself. At times the pain and difficulty were so severe that he had to be on crutches. What's amazing is how effective these measures were in creating an image of vigor and good health.

Do you have a sense of what effect it may have had on him psychologically to be secretly so dependent on all these doctors and medications and crutches?

I think what it did was buoy him up. Psychologically and physically he was dependent on a significant number of medications. They gave him the psychological wherewithal to function. So I do think there was a kind of dependence on the drugs. But I don't think it was because of some psychological need to begin with. The dependence began, I think, with the medical problems. In a way I guess it did then become a psychological crutch and was essential to his successful functioning as President.

Do you think that some Kennedy worshippers might be as put off by your intimate account of his physical problems as they were by Seymour Hersh's account of his moral lapses?

I don't think so, and I hope not. My work is not an attempt at debunking. What I feel I've done is to try to describe as fairly, accurately, and honestly as I possibly could what was in the record. I'm hoping that people will see Kennedy as a combination of things. There was a cover up, so to speak, but this was not unusual. Other Presidents have had health problems, and they also hid them from the public. There is, as I say in the article, something of a tradition of doing that. But I think that the bottom line here is that it speaks well in many ways of Kennedy's character. There's been such an assault on his character, by Hersh, for example, who sees him as a sex maniac, or by Thomas Reeves in an earlier book called A Question of Character. But I hope this article will enlarge our picture of his character by showing the kind of strength he must have had to be able to cope with such grave, serious medical problems and yet to have performed so effectively.

And that is what I found in studying his presidency—that he did perform with great effectiveness. He was quite lucid in the taped conversations we have of the Cuban Missile Crisis, for example. He performed quite brilliantly. It took significant strength of character, I think, to do that in the face of the medical difficulties that he struggled against day in and day out.

If Kennedy had thought that any of his ailments were life threatening, or that they might have impaired his ability to fulfill his duties, do you think he would have refrained from running for office?

I do think so. I think that if he had felt he couldn't function he wouldn't have run. But he had confidence that he could do it. And as it turned out, he did carry it off. None of his doctors ever said, "You're so ill, think about giving up this run for the presidency." He consulted quite a few doctors. And as far as I know, not a single one of them told him that.

Has writing about all this affected your views about whether aspiring Presidents should have to present a complete picture of their health status before they run?

This has definitely complicated my view of it. Before I got into these medical records, I was of a mind to believe that, yes, Presidents have an obligation to tell us about their health problems. Now, after looking at all this, what I have to say is, Yeah, I do believe that Presidents should play honest pool with the public and tell us candidly what their health difficulties are. But on the other hand, if Kennedy had done that there's a good chance that he wouldn't have been President. And I think he was, by and large, a very effective and successful President.

Do you think it's important for a President to give an impression—whether it's accurate or not—of physical robustness?

Yes. This is a very good point. Not just physical robustness, but psychological optimism. See, Presidents are actors on a large stage. And what they try and do is communicate to the public and educate the public as to how effective and successful they're going to be. So for a President to say, My goodness, I've got all these physical and emotional problems…. When Edmund Muskie cried while he was running for President, it destroyed his bid. And there was a man named George Romney from Michigan who said he had been brainwashed by the U.S. military, and it killed off his bid for presidency.

So I think what the Kennedys understood, and what all successful Presidents understand, is that they need to convey a picture of good health and psychological strength.You're shooting yourself in the foot if you don't convey those two things. I remember Jimmy Carter telling the country, in essence, that he was experiencing a malaise. But Reagan, by contrast, always presented a picture of optimism and a kind of durability, and the public loved it. There's almost an unspoken, unwritten agreement that this is what the public wants to hear, and this is what Presidents will give them. So I think the blame for these kinds of cover ups, if you want to call them that, is not simply with Presidents but with the refusal of the public to take account of the fact that someone can have a certain number of medical, even emotional, limitations, and yet carry off the job in the White House. For example, with Franklin Roosevelt, the public just didn't want to know about his physical limitations. And Roosevelt didn't want them to see him as a man who was paralyzed from the waist down—who had spent his life in a wheelchair and could only walk with the help of aides or with the help of steel braces or crutches. So there's a kind of collaboration between Presidents and the public in muting these ailments.

What was it like to go back and reconstruct various aspects of Kennedy's life primarily using information that was left behind in his medical records? As medical science continues to advance, do you see this as a growing field of biographical study?

I think it's all part of a trend toward probing the private lives of presidents. Since about the 1970s, there has been more and more of an impulse to look closely at what presidents do in private—what the intimate state of their affairs is. In recent years, for example, there have been many attempts to pin down whether Thomas Jefferson had a mulatto mistress and fathered children with her. It's not something that was done so aggressively by earlier historians. But there is definitely that impulse now. I think part of it has to do with the fact that a lot of serious wrongdoing by public figures has come to light in recent years, which has fanned the flames of the desire to get behind the mask of propriety to look at any possible improprieties. After Kennedy died, Charles de Gaulle, the president of France, came to the funeral and said to somebody, "This man Kennedy was America's mask, and this man Johnson is the country's real face." It was, I think, a very insightful kind of statement.

You're writing a book about Kennedy now. How will this article fit into the larger scheme of it? Will it be a section, or will it be a theme that's woven throughout the book?

Well, it's part of a theme that develops throughout the book. I write chronologically and look at his health problems as they arise in the historical account of his life and career. So it's not just a section. I excerpted this theme for the Atlantic article. I'll also be doing another Atlantic article out of the book, about Kennedy and the military—his handling of Vietnam, and what he might have done if he had lived and been re-elected and served out a second term. But again, this is a theme that evolved through his presidential term and that in the book is woven into the longer story.

There are so many books about Kennedy already out there. How do you hope to make yours distinctive?

Well, everybody asks me, Why another book on Kennedy? Usually I just quote the famous comment by the Dutch historian Peter Geyl who said that history is argument without end. We always reinterpret the past. Also, there is significant new material that has come to hand. I've had access to these medical records and to new material on Kennedy's foreign policy, particularly in Cuba. The new material will add something to the discussion, as will the way in which I interpret these materials—how I see them, how I judge them, how I integrate them into the story.

What's fascinating to me is to try and sort out why it is that John Kennedy, who served less than three years in the White House, still has such an extraordinary hold on the public's imagination. One can say it's because he was so young, and was assassinated. But you know, William McKinley was assassinated in 1901 at the start of his second term, and he was in his fifties, a relatively young man. But forty years later, nobody remembered who McKinley was or cared much about him.

My students, many of whom were born just twenty years ago now, have no direct experience with John Kennedy. Yet of all the modern American Presidents I talk about in my course on the American presidency, they come most alive when I talk about him. They know something about him. Obviously their parents and grandparents and aunts and uncles have been telling them about him.

Do you have a theory about his lasting appeal?

Well, there are several things I point to. Aside from the fact that he was young and charming and was assassinated, I think the existence of television was very important. Kennedy's memory is very much kept alive by the constant return to pictures of the assassination and the aftermath—John Jr. saluting his father's coffin rolling by, and so on. And then there's the family—Bobby and the famous Joe and Rose, and Jacqueline the glamorous wife. They're celebrities—it's a dynasty. I think all these things have had a hold on the public's imagination.

I also think that what's important here is that Kennedy was the first of our successful ethnic presidents—the first Catholic to win the White House. Franklin Roosevelt brought American ethnics into the mainstream by appointing Jews and Irish Catholics—really creating a coalition of Democratic ethnics to support the Democratic party. Kennedy, I think, was the first ethnic to give America's ethnics a sense of full legitimacy in American society. The fact that he was not only ethnic, but also a Harvard graduate and a genuine war hero gave not just Catholics but all sorts of other ethnics a sense of pride. I think this has survived. It probably accounts for the continuing hold he has on the public's imagination.

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Sage Stossel is a contributing editor at The Atlantic and draws the cartoon feature "Sage, Ink." She is author/illustrator of the graphic novel Starling, and of the children's books  On the Loose in Boston and On the Loose in Washington, DC. More

On Election Day in 1996, TheAtlantic.com launched a weekly editorial cartoon feature drawn by Sage Stossel and named (aptly enough) "Sage, Ink." Since then, Stossel's whimsical work has been featured by the New York Times Week in Review, CNN Headline News, Cartoon Arts International/The New York Times Syndicate, The Boston Globe, Nieman Reports, Editorial Humor, The Provincetown Banner (for which she received a 2009 New England Press Association Award), and elsewhere. Her work has also been included in Best Editorial Cartoons of the Year, (2005, 2006, 2009, and 2010 editions) and Attack of the Political Cartoonists. Her children's book, On the Loose in Boston, was published in June 2009.

Sage Stossel grew up in a suburb of Boston and attended Harvard University, where she majored in English and American Literature and Languages and did a weekly cartoon strip about college life, called "Jody," for the Harvard Crimson. From 2004 to 2007, she served as Books Editor of the Radcliffe Quarterly

After college she took what was intended to be a temporary summer position securing electronic rights to articles from The Atlantic's archive for use online. Intrigued by The Atlantic's rich history and the creative possibilities in helping to launch a digital edition of the magazine on the Web, she soon joined The Atlantic full time. As the site's former executive editor, she was involved in everything from contributing reviews, author interviews, and illustrations, to hosting message boards and producing a digital edition of The Atlantic for the Web.

Stossel lives in Cambridge, Massachusetts.

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