The American presidency carries immense responsibility and the health of a sitting president, both physical and mental, is a matter of national security. Yet, history reveals several instances where presidents suffered significant impairments while in office. In some cases, these conditions were hidden from the public, sometimes even from senior government officials. I thought it might be useful to look back into history and identify notable cases of presidential incapacity, the methods used to conceal them and how the country functioned during those critical periods.
Woodrow Wilson (1919–1921): The Hidden Stroke
Impairment: In October 1919, President Woodrow Wilson suffered a massive stroke that left him partially paralyzed, with impaired speech and vision. He was bedridden and, by most accounts, mentally and physically incapacitated.
Cover-Up: The public was told Wilson was simply “exhausted.” First Lady Edith Wilson took control of access to the president, filtering all communications and decisions. She later described her role as a “stewardship,” but in reality, she acted as a gatekeeper, effectively becoming the de facto chief executive.
How the Country Was Run: Cabinet members and Congress were largely shut out. Wilson’s advisors and wife ran the government in a shadow presidency, with critical decisions delayed or made without the president's input.
Franklin D. Roosevelt (1944–1945): Terminal Illness in a Time of War
Impairment: During his fourth term campaign, FDR was gravely ill with advanced heart disease, high blood pressure and fatigue. His physician, Dr. Howard Bruenn, later revealed FDR was suffering from congestive heart failure.
Cover-Up: Roosevelt’s physicians downplayed his condition. He was kept out of the public eye, photographed from angles to hide his frailty, and press access was tightly controlled. The seriousness of his illness was known to only a few insiders.
How the Country Was Run: FDR remained president during critical World War II negotiations, including the Yalta Conference, but delegated heavily to aides like Harry Hopkins. His deteriorating condition raised serious concerns, especially as he did not inform Vice President Harry Truman of key wartime strategies before his death in April 1945.
Dwight D. Eisenhower (1955–1957): Heart Attack and Stroke
Impairment: Eisenhower suffered a major heart attack in 1955, an ileitis operation in 1956 and a mild stroke in 1957. Each event temporarily impaired his ability to lead.
Cover-Up: While his health issues were disclosed, the severity was often minimized. Press releases were optimistic, sometimes misleading. White House physician Howard Snyder took the lead on messaging and was later criticized for withholding information.
How the Country Was Run: During his hospitalization, power informally shifted to top aides and Vice President Nixon. However, no formal transfer of power occurred. Eisenhower later drafted a letter allowing Nixon to act in his stead in case of future incapacitation which was a precursor to the 25th Amendment.
John F. Kennedy (1961–1963): Chronic Illness and Drug Use
Impairment: Kennedy suffered from Addison’s disease (a life-threatening adrenal disorder), severe back pain and chronic infections. He took a cocktail of medications, including painkillers, steroids, stimulants and sedatives.
Cover-Up: Kennedy’s medical records were hidden for decades. His youth and vigor were key parts of his public image, so his team, particularly Dr. Janet Travell and physician Max Jacobson (“Dr. Feelgood”), kept his treatments secret.
How the Country Was Run: Despite his illness, Kennedy maintained control, but the extent of his medication use raises questions about how it may have affected his judgment, particularly during high-stakes crises like the Cuban Missile standoff.
Ronald Reagan (1984–1988): Early Alzheimer’s?
Impairment: Reagan’s age was a concern from the start. During his second term, he showed signs of cognitive decline that included confusion, memory lapses and difficulty focusing. He was formally diagnosed with Alzheimer’s in 1994, five years after leaving office.
Cover-Up: The White House dismissed concerns. After the 1986 Iran-Contra scandal, aides increasingly shielded him. Reagan’s diary entries and testimony before the Tower Commission revealed memory gaps and detachment.
How the Country Was Run: Chief of Staff Howard Baker and others reportedly referred to a “cocoon” around Reagan. The government increasingly relied on senior staff and Vice President George H.W. Bush. Whether Reagan had early-stage Alzheimer’s while in office is still debated, but many staff quietly assumed more responsibility.
Presidential incapacity creates a governance vacuum with potentially global consequences. The Constitution, particularly via the 25th Amendment, provides a process for handling incapacity but invoking it has political costs. As a result, American history shows a pattern: concealment, internal delegation and a hope that the crisis passes before the public or adversaries notice.
The question remains: Is the nation better served by full transparency or is the impulse to shield the public a necessary, if dangerous, tradition?
My column sees the world through the lens of Americana and focuses primarily on the culture and history of the United States. It uses the latest technological innovations combined with over seven decades of personal experience to create a vehicle that helps to communicate issues that have resonated throughout the history of the American experiment. My column is free to all but also offers a modest paid subscription for those who want to support the free flow of ideas.