When VIPs Have a Mental Illness

James Forrestal and the diagnosis of "exhaustion."

Posted Sep 22, 2020

For much of the 20th century, political figures or celebrities who experienced severe mental illnesses avoided mental health care for fear of being stigmatized. And if they did seek care, doctors would give them the dubious and vague diagnoses reserved for the rich and famous, “fatigue” or “exhaustion”—euphemisms for the privileged, like the old adage that if you are poor you are crazy but if you are wealthy you’re eccentric.

Of course, being tired is a valid medical complaint. But unless exhaustion is associated with a serious medical or psychiatric condition, sleep will take care of it, and you do not need to sleep in a hospital. Physicians don’t diagnose exhaustion, and insurance companies don’t reimburse for it. Yet celebrities Mariah Carey, Lindsay Lohan, Selena Gomez, Justin Bieber, Demi Moore, Kanye West—and the list goes on—have been admitted to hospitals for “exhaustion.” Amy Winehouse was hospitalized in 2007 for “severe exhaustion” just a few years before she died of alcohol poisoning.  

In an effort to hide mental illnesses from the public, here’s what happened in April and May 1949 when James Forrestal, the United States’ first secretary of defense, was admitted to Bethesda Naval Hospital in suburban Washington, DC, sick from “exhaustion.” A New York Times article described the condition in military terms as “operational fatigue,” akin to a soldier “fighting too long without respite.”[i] After seven weeks of rest, restrictions to Forrestal’s movements were loosened in an attempt to give him a sense of “normalcy.”

On Sunday morning, May 21, at 1:50 a.m., Forrestal tied his bathrobe sash around his neck and attempted to hang himself from the window. The cord broke, and he fell to his death on a third-floor landing made of asphalt and cinder rocks.

How had it come to this?

Forrestal had been troubled since childhood, physically abused and often physically ill, and insecure about his masculinity. As an adult, and at the pinnacle of his political career, he was harassed by two journalists, the muckraking Drew Pearson and the syndicated columnist Walter Winchell, who disagreed with Forrestal’s conservative political views and his links to Wall Street, Big Oil, and the military. Pearson and Winchell called him “the most dangerous man in America.” They also challenged his mental status and his masculinity.

In an account of a 1937 crime in which Forrestal’s wife was robbed of her jewelry at gunpoint outside their home, they alleged that Forrestal had witnessed the event but fled through a back door “trembling” with fear. Though most accounts indicate that Forrestal was asleep at the time, and knew nothing of the robbery until his wife entered the house, the reports broadcast in both the US and the Russian media made him look like a coward. In public, Forrestal looked anxious and weak, and President Truman, troubled by the gossip about Forrestal’s mental state, asked him to resign.

Forrestal soon told colleagues he was being followed by foreign agents and that his phone had been tapped. In one radio report, Pearson claimed that Forrestal had responded in panic to the sound of planes overhead, screaming, “The Russians are attacking us!” Radio Moscow aired Pearson’s report three times in one night.

Forrestal’s friend, the investment banker Ferdinand Eberstadt, was so worried that he arranged for him to fly to Florida to stay with friends at a seaside home near Palm Beach. Meanwhile, Eberstadt also arranged for William Menninger, the most recognized name in American mental health at the time, to come too. After hearing that Forrestal had contemplated suicide by hanging, Menninger promptly diagnosed him with a severe “reactive depression,” and admitted him to the Bethesda Naval Hospital for “a routine checkup.” Menninger believed that Forrestal and Forrestal’s wife Jo, would feel less stigmatized, and would be better protected from the media, in a general rather than a psychiatric military hospital.[ii]

Forrestal’s psychiatrist at the hospital, George Raines, diagnosed him with “involutional melancholia psychosis,”[iii] a term obsolete today but that midcentury clinicians used to describe a form of paranoid depression with psychosis. Perhaps intimidated by Forrestal’s fame, Raines admitted him to a room, with windows, on the sixteenth floor, and without placing him on a suicide watch.

Forrestal must have understood much of what was happening to him. Although it was reported that he didn’t leave a suicide note, he had in fact written something just before he fell to his death and it’s hard to imagine it as anything but a suicide note. A few minutes before Forrestal leaped out of the window, he carefully copied a portion of the ancient Greek poem “Chorus from Ajax” by Sophocles.[iv] In that chorus, soldiers from the Greek island of Salamina mourn the madness of their insane friend Ajax and wonder what misery his insanity will bring to their people, and especially to Ajax’s mother. The text suggests it is better to die than to live with the disgrace of madness.

Many blamed Pearson for Forrestal’s death. But Pearson shot back, not using the word stigma, but clearly implying it played a role: “In the end, it may be found that Mr. Forrestal’s friends had more to do with his death than his critics. For those close to him now admit privately that he had been sick for some time, suffered embarrassing lapses too painful to be mentioned here ....” He added that navy doctors “minimize psychiatric treatment, which may have been why they called Mr. Forrestal’s illness ‘nervous exhaustion’ and that illnesses like severe depression do not come all of a sudden like a fall from a horse. It begins months in advance. And such an illness cannot be pushed aside or overlooked. It must be treated.”[v]

The fact that Forrestal is today remembered largely for having committed suicide rather than for his political contributions is part of the stigma of mental illness. In fact, the diagnosis of exhaustion probably only exacerbated his shame, since he must have known it was just a genteel substitute for depression.

Sadly, even today, we too often indulge the rich and famous, with appalling consequences.

References

[i] New York Times. 1949. “The Patient at Bethesda.” April 13, 1949, p. 28.

[ii] Hoopes, Townsend, and Douglas Brinkley. 2000. Driven Patriot: The Life and Times of James Forrestal. Annapolis, MD: Naval Institute Press.

[iii] Werner, August A., et al. 1934. “Involutional Melancholia: Probably Etiology and Treatment.” JAMA: Journal of the American Medical Association 103 (1): 13–16.

[iv] Interestingly, philosopher Nancy Sherman invokes a public reading of Ajax, staged by Theater of War Productions, as an analogy for the shame, suicidality, and urge for moral repair among veterans, in her 2015 book, Afterwar: Healing the Moral Wounds of our Soldiers. Oxford: Oxford University Press.

[v] Pearson, Drew. 1949. “Pearson Replies: A Communication.” Washington Post, Editorial. May 30, 1949.