Among the reasons the 2024 presidential campaign has become one of the most extraordinary in American history is how Vice President Kamala Harris and former President Donald Trump are trading direct and unrelenting vitriolic attacks on each other’s mental health. The personal venom is obscuring and trivializing the suffering of millions of Americans with mental health issues.
Trump began the assault last summer when he called Harris “dumb as a rock,” “Crazy Kamala,” “if you ever watch her laugh, she’s crazy,” and a “lunatic.” At a rally more recently, he called her “mentally impaired” and “mentally disabled.” He is reported to have said in a private dinner that Harris was “r – – – – – ed.”
Larry Hogan, the anti-Trump Republican former governor of Maryland who is currently running for Senate, told CBS that Trump’s blasts are “insulting not only to the vice president but to people who actually do have mental disabilities.”
Harris, in turn, has not held back. She has questioned Trump’s fitness for the Oval Office, saying he “is increasingly unstable and unhinged.” Her comments echo those from critics who question Trump’s mental stability. After Trump’s bizarre dancing to music for 30 minutes during a town hall meeting while health workers responded to two medical emergencies in the audience, Harris posted on social media, “hope he’s okay.” Meanwhile, an Oct. 13 letter signed by 238 health care professionals, organized by the group Doctors for Harris, argued that Trump has been “displaying alarming characteristics of declining acuity” in calling for him to release his medical records.
Trump has thrown the accusations back at Harris, calling for her to undergo cognitive testing. On Oct. 14, on his platform Truth Social, he wrote, “I believe it is very important that Kamala Harris pass a test on Cognitive Stamina and Agility.”
The nominees have shared summary statements from their doctors attesting to their having the mental health to successfully carry out the duties of the presidency. Harris’ doctor said, “She possesses the physical and mental resiliency required to successfully execute the duties of the Presidency.” He did not address whether she had undergone mental screening like the Montreal mini-test Trump underwent during his first physical exam as president in 2017. Although Trump said during a December 2023 campaign event that he “passed with flying colors” a cognitive exam during a recent physical, he has provided no evidence to support the claim.
From the earliest years of this nation, politicians running for office have used withering rhetoric to refer to their opponents and, occasionally, called attention to their rivals’ physical ailments.
But what we’re seeing in this campaign — one nominee’s sustained, front and center attacks on another’s mental health — is unheard of. The last time a nominee’s mental health received such attention was in 1972, the first year I covered the health of political leaders for the New York Times. That year, Missouri Sen. Tom Eagleton was forced to resign as the Democratic vice presidential nominee because he had deliberately withheld from the presidential nominee, George McGovern, that he had been hospitalized three times for treatment of depression and received electroshock therapy during two of those stays. The issues at that time were not only the stigma of mental illness, but also trust. How could McGovern be sure Eagleton would be frank in future discussions between the two of them, or with the public?
An issue that drew lesser attention occurred in the 1988 presidential campaign when President Reagan responded to a question about rumors that Democratic nominee Michael S. Dukakis had depression and said, “Look, I’m not going to pick on an invalid.” About 20 minutes later, Reagan returned to tell reporters, “I attempted to make a joke. … I don’t think I should have said what I said.”
Although the current vitriolic attacks get more attention, the broader issue of improving access to mental health care has come up frequently during this campaign. Vice President Harris has championed the Biden administration’s efforts to fund more mental health counselors in schools and to enforce rules that require insurance companies to cover behavioral health care costs on par with physical care costs. In addition, her campaign has pledged to increase mental health resources for veterans. She also, responding to Trump’s attacks on her cognitive abilities, said on a podcast in September that a lack of mental health care “is probably one of the biggest public policy failures in our country.”
Trump has not spoken specifically about improving behavioral health care access. But he has campaigned heavily on related mental health issues, such as childrens’ well-being in the wake of Covid-19 shutdowns, substance abuse, and managing chronic illnesses. He has also pledged to bar gender-affirming care for children, which pediatric physicians and psychological health organizations warn could endanger patients’ mental well-being.
Trump has also referenced mental health when discussing gun control issues. While president, he said the country should build more mental health institutions to “be taking mentally deranged and dangerous people off of the streets,” which is both true — the U.S. needs more beds for people with serious mental illness — and offensive — he seems to be suggesting warehousing rather than treating. He also signed legislation creating the 988 suicide and crisis hotline as president and issued an executive order on preventing veteran suicides.
On Monday, while the 2024 nominees were questioning each other’s mental health on the campaign trail, the National Academy of Medicine was devoting its annual meeting in Washington to an array of mental health issues. The participants did not address the nominees’ mental health accusations. Rather, they spoke about issues including the need to erase the stigma of mental illness, dementia, preventing suicides among adolescents, the longer-term effects of Covid on families, and raising pay for trained mental health workers.
During a break in the meeting, Eric Larson, a professor of medicine at the University of Washington who studies ailments like dementia linked to advancing age, said the idea that those with cognitive problems are the last to realize it “is true, but not always.” Many people seek medical attention because they realize their mind is slipping, Larson said, but many others are not aware of the changes or deny them.
“If we live long enough, most of us will be demented,” he said, citing statistics showing “about one-third of those 85 have symptoms of dementia, about half at age 90, and from two-thirds to three-quarters at age 95.”
Most voters “make their own decision about the cognition issues, but clearly we want to have leaders who are in full control of their own capabilities,” Democratic Rep. Donald S. Beyer Jr. of Virginia said in an interview after speaking at the meeting. But Beyer said “the more important issue” was the crisis in mental health in the U.S., particularly suicide prevention in young people. The American system to match the needs of people with mental health issues to support is “incredibly broken.”
Linda Fried, dean of Columbia University’s Mailman School of Public Health, said the nominees “are not talking about the mental and physical health of Americans.” She criticized “the paucity of attention devoted to finding ways to improve Americans’ physical and mental health, which have declined to the bottom of the 36 peer nations in the last 30 years.”
About 1 in 4 Americans currently lives with a mental health issue, according to the Centers for Disease Control and Prevention, 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.)
Mental health professionals and society “need to do a much better job of figuring out how we can utilize the resources we have” for the current workforce and recruiting and training a new one, said Ann Garland, a psychiatrist at the University of California, San Diego. That will require increasing compensation for front line mental health care 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.”
All of these are mental health issues worthy of politicians’ attention. Many people will be mentally ill or suffer from cognitive decline at some point in their lives, or else have a loved one who is in the same position. The vitriolic back-and-forth between Trump and Harris, however, has distracted from the urgent mental health crisis faced in the U.S.
If you are thinking about suicide, or concerned about a loved one, contact the 988 Suicide and Crisis Lifeline by calling or texting 9-8-8 or visiting www.988lifeline.org.
Timmy Broderick and Sarah Owermohle contributed reporting.
Lawrence K. Altman is a physician, a clinical professor of medicine at New York University, and former reporter and “The Doctor’s World” columnist for the New York Times. He is researching and writing a book on the health of political leaders.