3.
DOCTORS EVERYWHERE
The Ushers’ Room at the White House, circa 1915. Oct. 2, 1919, 8:50 a.m.[35] A telephone rang in the Ushers’ Room at the White House. There were two telephones perched on a roll-top desk in a corner of the room. One went through the White House switchboard; the other was a private line directly to the president. Ike Hoover, the Chief Usher, answered the call on the private line. It was the First Lady, who told Hoover, “Please get Dr. Grayson, the president is very sick.”
Hoover’s account is graphic and shocking.
. . . I waited up there until Doctor Grayson came, which was but a few minutes at most. A little after nine, I should say, Doctor Grayson attempted to walk right in, but the door was locked. He knocked quietly and, upon the door being opened, he entered. I continued to wait in the outer hall. In about ten minutes Doctor Grayson came out and with raised arms said, “My God, the President is paralyzed!”
. . . The second doctor and nurse arrived and were shown to the room. The employees about the place began to get wise to the fact that the President was very ill, but they could find out nothing more. Other doctors were sent for during the day, and the best that could be learned was that the President was resting quietly. Doctor Davis of Philadelphia and Doctor Ruffin, Mrs. Wilson’s personal physician, were among those summoned. There were doctors everywhere.
. . . The President lay stretched out on the large Lincoln bed. He looked as if he were dead. There was not a sign of life. His face had a long cut about the temple from which the signs of blood were still evident. His nose also bore a long cut lengthwise. This too looked red and raw. There was no bandage.
The Lincoln Bedroom, the White House, circa 1915. . . . Soon after, I made confidential inquiry as to how and when it all happened. I was told — and know it to be right — that he had gone to the bathroom upon arising in the morning and was sitting on the stool when the affliction overcame him; that he tumbled to the floor, striking his head on the sharp plumbing of the bathtub in his fall; that Mrs. Wilson, hearing groans from the bathroom, went in and found him in an unconscious condition. She dragged him to the bed in the room adjoining and came out into the hall to call over the telephone for the doctor, as I have related.
. . . For the next three or four days the White House was like a hospital. There were all kinds of medical apparatus and more doctors and more nurses. Day and night this went on. All the while the only answer one could get from an inquiry as to his condition was that it “showed signs of improvement.” No details, no explanations. This situation seemed to go on indefinitely. It was perhaps three weeks or more before any change came over things. I had been in and out of the room many times during this period and I saw very little progress in the President’s condition. He just lay helpless. True, he had been taking nourishment, but the work the doctors had been doing on him had just about sapped his remaining vitality. All his natural functions had to be artificially assisted and he appeared just as helpless as one could possibly be and live.[36]
Wilson’s personal physician, Admiral Cary T. Grayson, took elaborate notes and kept a day-to-day log of the president’s condition. Grayson’s papers are now housed at the Woodrow Wilson Presidential Library in Staunton, Va. [37]
Here are Grayson’s notes from the week following the president’s stroke:
Courtesy of the Woodrow Wilson Presidential Library and Museum, Staunton, Virginia; Graphic by Steven Hathaway
Excerpts of Grayson’s notes following Wilson’s stroke of Oct. 2, 1919. On October 11th the President was extremely ill and weak and even to speak was an exertion. He had difficulty in swallowing. He was being given liquid nourishment and it frequently took a great deal of persuasion to get him to take even this simple diet. On the day in question Mrs. Wilson and I were begging him to take this nourishment, and, after taking a couple of mouthfuls given to him by Mrs. Wilson with a spoon, he held up one finger and motioned me to come nearer. He said to me in a whisper:
“A wonderful bird is the pelican,
His bill will hold more than his bellican,
He can take in his beak, enough food for a week,
I wonder how in the hell-he-can.”
The notes, written on yellow foolscap, contain an assortment of limericks and anecdotes, drifting into seeming nonsense.
On one occasion Secretary Tumulty came in to see the President, and as he was leaving, the President said: “Why leave now?” Mr. Tumulty said: “I must go to see the King of Belgium.” The President said: “You are wrong; you should say “‘The King of the Belgians.’” Mr. Tumulty said: “I accept the interpretation.” The President said: “It is not an interpretation but a reservation.”[38]
Albert I of Belgium. Wilson was obsessed with limericks prior to his stroke, but what about the post-stroke limericks? As Grayson leaned in to hear the soft, indistinct voice of the president, was the president trying to reassure him? Were the limericks examples of light-hearted humor in the face of unblinking adversity? Or manifestations of limitless dementia? [39]
Courtesy of the Woodrow Wilson Presidential Library and Museum, Staunton, Virginia
Wilson and Grayson, 1920. In the 1970s, Edwin Weinstein, a neuropsychiatrist, was asked by Arthur Link, the editor of the Wilson papers, to survey Wilson’s medical history.
The symptoms indicate that Wilson suffered an occlusion of the right middle cerebral artery, which resulted in a complete paralysis of the left-side of the body, and a left homonymous hemianopia — a loss of vision in the left half fields of both eyes. Because he had already lost vision in his left eye from his stroke in 1906, he had clear vision only in the temporal (outer) half field of his right eye. The weakness of the muscles of the left side of his face, tongue, jaw and pharynx accounted for his difficulty in swallowing and the impairment of his speech. His voice was weak and dysarthric . . . [40]
Weinstein also wrote:
Following his stroke, the outstanding feature of the President’s behavior was his denial of his incapacity. Denial of illness, or anosognosia, literally lack of knowledge of disease, is a common sequel of the type of brain injury received by Wilson. In this condition, the patient denies or appears unaware of such deficits as paralysis or blindness . . . To casual observers, anosognosiac patients may appear quite normal and even bright and witty. When not on the subject of their disability, they are quite rational; and tests of their intelligence may show no deficit.[41] [42]
Wilson described himself as “lame” and referred to his cane as his “third leg,”[43] but otherwise he considered himself perfectly fit to be president. There was even talk of a third term. Yet his close associates noticed a change in his personality. He became increasingly suspicious, even paranoid, without having the dimmest awareness of the fact that he was perhaps becoming a different person from what he once was. Stockton Axson, his brother-in-law from his first marriage, wrote that “[Wilson] would be seized with what, to a normal person, would seem to be inexplicable outbursts of emotion.”[44] He was furious at anyone who suggested that he had physical and mental problems, and the last months of his presidency became a graveyard of fired associates. Edith Bolling Wilson, his second wife, had already deposed many of the president’s closest and most effective associates, including Colonel Edward M. House, who had played a major role at the Paris peace talks. Wilson also forced the resignation of Robert Lansing, his secretary of state, who had dared to call a cabinet meeting to discuss the president’s illness.
It was John Maynard Keynes who asked a central question: “Was Hamlet mad or feigning; was the president sick or cunning?”[45] Babinski and subsequent writers had stressed that anosognosia leaves most “intellectual and affective” faculties intact. But was this true? Or were they focused on the paralysis and the denial of paralysis, and paid scant attention to anything else? Were they anodiaphoric with respect to the anosognosia?
It is interesting to speculate about the total effect that Wilson’s illnesses had on the president’s behavior. The Oct. 2 stroke was not Wilson’s first cerebral episode. In his books and articles, Weinstein chronicles Wilson’s long history of stroke, neuritis, numbness, visual impairments and an assortment of vascular pathologies. The catastrophic Oct. 2 stroke was preceded by a stroke on Sept. 25 that left the president temporarily paralyzed on the left side, and by a severe attack of influenza in April 1909 that “suggested that he may have had another stroke.”
Woodrow Wilson: A Medical and Psychological Biography, Edwin A. Weinstein
Diagram of carotid circulation indicating sites of vessel narrowing and occlusion.With such massive impairments, was Wilson still “there?” Grayson tells us that Wilson knew that King Albert was “King of the Belgians,” but how comforting is that?
The subsequent role played by the president’s doctors, his family and political friends was complex. But it is clear that they were involved in a coverup. Since the president was actually impaired — at least physically — what do you tell the Washington news corps? Or do you deny it to yourself and others? A determined group of gatekeepers intervened: Ike Hoover, Dr. Grayson and Edith Bolling Wilson, Wilson’s second wife, who became the de facto president of the United States.
Their actions leave open the further question: when does out-and-out prevarication shade off into self-deception and denial? Did the president’s immediate advisers convince themselves that Wilson was in possession of all his faculties despite evidence to the contrary? Did Edith Wilson cynically decide to grab power; was she in denial; or did she become anosognosic, as well, truly believing that there was nothing wrong with her husband?
I had read a number of books about the last years of the Wilson presidency — both first-hand accounts (Hoover, Edith Wilson and Grayson) and secondary sources — but there was a pair of books which stood out from the others: Edith Bolling Wilson’s autobiographical account of her marriage to Woodrow Wilson, “My Memoir,” and Phyllis Lee Levin’s “Edith and Woodrow” — two books that paint incompatible pictures of what was happening in the White House.
In Edith Wilson’s account of Oct. 2, she takes great pains to discredit Ike Hoover’s account.
Then came a knock at the door. It was locked; the President and I always locked our doors leading into the hall . . . The knock was Grayson’s. We lifted the President into his bed. He had suffered a stroke paralyzing the left side of his body. An arm and one leg were useless, but, thank God, the brain was clear and untouched . . .
So far as was possible I checked my recollections with the data of Dr. Grayson, before his lamented death in 1938. I did this because of a rather remarkable account of the events which appears in the posthumously published “diary” of Mr. I.H. Hoover, the White House head usher. For example, the late Mr. Hoover is represented as seeing a long cut on the President’s temple, which late that afternoon, still showed signs of blood; also a cut lengthwise on the nose. Dr. Grayson and I did not see such things. [46]
Mr. Hoover is “represented as seeing . . .” But who is doing the representing? It’s Hoover’s first person account that includes the observation, “The whole truth, of course, can be told by only one person in all the world, Mrs. Woodrow Wilson . . . [And] I doubt that she will ever tell the world just what happened.”[47]
Edith Bolling Wilson has been dead for nearly 50 years, but Phyllis Lee Levin, formerly a columnist and reporter for The New York Times and a feature writer and editor at Harper’s Bazaar, Mademoiselle and Vogue, is very much alive and living in Manhattan. In addition to her book on Wilson’s second marriage, she has also written an outstanding biography of Abigail Adams, the wife of John Adams, and now, at almost 90, she is working on a biography of John Quincy Adams.
It is now nearly a decade since the publication of “Edith and Woodrow.” I was surprised by her anger, and her conviction that the coverup of Wilson’s mental impairment that started in the White House continues to the present day.
PHYLLIS LEE LEVIN: I had no idea what I was getting into. My daughter gave me a copy. She was at camp, and there was a copy of Mrs. Wilson’s memoir. And so, I read it. I just found it so unbelievable that they would have toyed with the fate of this country, the welfare of this country, these two irresponsible people, certainly this lady was. Perhaps, we could excuse Mr. Wilson a little bit, that he really had no idea of how sick he was. The doctor came out and said that he was irreversibly damaged. And then that was dismissed. There’s such denial. I’m just being very, very honest with you. And there’s such denial at Princeton. They’re quite silly on this subject. The editor of the Wilson Papers [Arthur Link], when I first called to see him said, “There is nothing in Dr. Grayson’s letters. Nothing.” I finally got up enough courage to say, “Well, that should be for me to decide.” It took me a lot of courage to say that to this nice man. The papers were hidden. I went to see Dr. Grayson’s son, who lived in Virginia. And he is the one who gave the papers over. I dare say there were more there. I was quite shocked by the whole affair. When they said Woodrow Wilson wrote something to Tumulty [Wilson’s secretary, essentially his chief of staff], there’d be a little tiny asterisk. And then, at the bottom, you would find, in the tiniest possible print, “in the hand of Edith Wilson.”
Library of Congress
President Woodrow Wilson with his wife, Edith Bolling Galt Wilson, in June 1920. ERROL MORRIS: Did you feel, from the very outset, that there was something inherently dishonorable about what they did? That they should have been completely transparent or forthcoming about the extent of his illness? The idea that perhaps they were preserving his policies, a chance for world peace, that it was critical to —
PHYLLIS LEE LEVIN: But, they weren’t doing anything. They weren’t executing anything at all.
ERROL MORRIS: So it was just a grab for power, power for its own sake, by Mrs. Wilson?
PHYLLIS LEE LEVIN: She was probably a very limited woman, intellectually. I’m being very kind. She wasn’t a very educated woman. And she was a very vain woman. She honestly felt that her husband was the only one in the world entitled to be president, even in the shape he was in.
ERROL MORRIS: But who was in control? Was it Wilson? Was it Edith?
PHYLLIS LEE LEVIN: It was a conglomerate of people. Republicans are always blamed for the failure of the peace pact. When the vote came there had to be compromises. But Wilson’s mind was so damaged by his illness that he had to have peace on his terms or not at all. So we didn’t have the peace pact because of him. Henry Cabot Lodge [the leader of Wilson’s Republican opposition] has been made the villain of all time for this. Whereas, he had offered a compromise. What the Wilsons did was just desperately terrible. It was really the grandest deception in the world. It’s really a very shocking story.
And then Phyllis Lee Levin asked me if I had seen the movie.
ERROL MORRIS: I didn’t know there was a movie.
PHYLLIS LEE LEVIN: “Wilson.” You ought to find it. It appears every now and then on television. Oh, you’d be so interested because it’s absolutely out of whole cloth.
“Wilson” is a curious document. Clearly a work of hagiography, it was released in 1944, was a Times Critic’s Pick, was nominated for 10 Academy Awards, and won 5 Oscars, including an Oscar for best original screenplay. [48] (In the midst of World War II, why not have a movie that celebrates a man, who through his intransigence, may have helped bring it about?) It contains yet one more sanitized version of Wilson’s stroke and anosognosia.
Dr. Grayson: His whole left side is paralyzed, but his mind is perfectly clear and untouched.
Edith: Will he recover?
Dr. Grayson: He’ll improve with time. For the present, he needs rest and quiet. Release from every disturbing problem.
Joseph Tumulty: But how’s that possible? Everything that comes to the president is a problem.
Edith: Would it be better if he resigned and let Mr. Marshall succeed him?
Dr. Grayson: No, no, no, Edith! He staked his life on getting the league ratified. If he resigns now this great incentive to recovery will be gone.
George Felton:[49] Besides his resignation would have a very bad effect on the country . . . for that matter the whole world.
Dr. Grayson: Our thought is to have everything of an official nature come to you. You can weigh the importance of each matter and in consultation with the heads of the various departments decide what he must see and what can be left to others. In this way, Edith, you can be of great service to him.
Edith: No, I can’t do it. It’s too great a responsibility.
George Felton: Even though his life may depend upon it?
Edith: In that case, there’s only one answer, I’ll try.
CUT TO:
A recovering Woodrow Wilson in a wheelchair on the porch of the White House.
Wilson (to Edith): Well, Mrs. President…
Edith: Woodrow!
Wilson: What’s on tap for today?
Edith: Don’t you dare to call me that! You know very well I never even made one decision without your knowledge and consent!
Wilson: You know it, I know it, but do our enemies know it?
Edith: I’m not concerned with what our enemies know.
In the preface to her book, Levin suggests a counterfactual history, a history with a League of Nations that included the United States. It is one of history’s great what-ifs. What if Edith Wilson had allowed her husband to hand the reins of government to his vice president, Thomas R. Marshall, in 1919? Would there have been no second world war?
Given Marshall’s reasonable temperament, is it not possible that he might have reached a compromise with Henry Cabot Lodge over the degree to which Americans ought to involve themselves in foreign wars, and have thus led the United States to membership in the League of Nations? Such great questions are central to my reconsideration, in the present book, of the role and influence of Wilson’s wife during “one of the most extraordinary periods in the whole history of the Presidency.” Edith Wilson was by no means the benign figure of her pretensions; the president far less than the hero of his aspirations. On closer examination, their lives are a sinister embodiment of Mark Twain’s tongue-in-cheek observation that he “never could tell a lie that anyone would doubt, nor a truth that anybody would believe.”[50]
What if the truth of Wilson’s condition, his anosognosia, had been more widely known? Was it just that the facts of the illness was suppressed? Or did the public want to believe that the president was healthy, that nothing was wrong. That even if the president was paralyzed, “. . . his mind was clear and untouched.” Edward Weinstein also weighed in on these questions. His view was unequivocal. The president had become intransigent, inflexible. There was no willingness to compromise and hence the Treaty [ratifying the U.S. participation in the League of Nations] was doomed.
It is the author’s opinion that the cerebral dysfunction that resulted from Wilson’s devastating strokes prevented the ratification of the Treaty.
For Levin, Wilson’s inability to perceive his own incapacity had truly devastating consequences for the nation and world he helped to lead.[51] Perhaps even more troublingly, the reaction to Wilson’s anosognosia on the part of his close associates raises the possibility of an even more problematic impairment — a social anosognosia. Can a group of people, perhaps even society at large, devolve into a state of destructive cluelessness?
Wilson expressed it best of all. On hearing the news of the Senate vote — essentially, the end of the League fight — Wilson asked Grayson to read a verse from the Bible, 2 Corinthians 4:8:
We are troubled on every side, yet not distressed; we are perplexed but not in despair.
Wilson then said, “If I were not a Christian, I think I should go mad, but my faith in God holds me to the belief that He is in some way working out his plan through human perversity and mistakes.”[52]
Amen.
Still curious about the nature of self-deception, denial and neglect, I called V.S. Ramachandran, a legendary neuroscientist at the University of California – San Diego and an expert on anosognosia. Our discussion of his experiences in treating patients with anosognosia is the subject of the next installment.
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FOOTNOTES:
[35] A little more than five years after Babinski published his first report on anosognosia.
[36] Irwin H. Hoover, “Forty-Two Years in the White House,” Boston, 1934. Hoover was sent to the White House on Oct. 24, 1891, to install the first electric lights and doorbells. He was an employee of the Edison Company. He stayed on as an electrician. During the Taft administration (which immediately preceded the Wilson administration) he was promoted to Chief Usher, the executive head of the household responsible for all social affairs and visitors. Hoover’s book, according to the Publisher’s Note that serves as a preface, was published posthumously. As the note explains, “Mr. Hoover planned to retire in 1935 and publish his reminiscences. At the time of his death he had carried his story through the Taft administration; the rest of the material, far more copious and detailed, remained in the form of isolated chapters and rough notes. In presenting this material, the publishers have simply arranged it in convenient form, supplied appropriate headings — taken when possible from the text itself — deleted repetitions and irrelevant matter, and changed the original wording only when necessary for the sake of clarity.”
[37] Dr. F.X. Dercum, a neurologist from Philadelphia, who also attended the president, ordered his notes destroyed. But a “memorandum” was found among Grayson’s papers in which Dr. Dercum provides a diagnosis of “severe organic hemiplegia, probably due to a thrombosis of the middle cerebral artery.” He also notes that when the President was visited ten days after his stroke, “. . . a Babinski sign was present as before.” (Here, we have the Babinski sign as a harbinger of things to come.)
[38] Wilson was right. The name of the King of Belgium is “the King of the Belgians.” Tumulty was not presenting an interpretation but rather expressing an inaccuracy; and Wilson quite reasonably expressed his reservations about it.
[39] I am reminded of the exchange in “Dr. Strangelove,” where General “Buck” Turgidson/George C. Scott briefs President Merkin Muffley/Peter Sellers. Muffley demands to see the letter that Turgidson is reading.
General “Buck” Turgidson: We’re still trying to figure out the meaning of that last phrase, sir.
President Merkin Muffley: There’s nothing to figure out, General Turgidson. This man is obviously a psychotic.
General “Buck” Turgidson: Well, I’d like to hold off judgment on a thing like that, sir, until all the facts are in.
[40] Edwin Weinstein, “Woodrow Wilson: A Medical and Psychological Biography,” Princeton University Press, 1981.
[41] Edwin Weinstein, “Woodrow Wilson’s Neurological Illness,” The Journal of American History, vol. 57, no. 2, September, 1970, pp. 324-351.
[42] This phenomenon is discussed in further detail in Oliver Sacks, “A Leg to Stand On.” “Babinski had given memorable descriptions of the bizarre, almost comic, presentation in some cases: patients in whom the first sign of a stroke was an inability to recognize one side of their body — and the feeling that it was someone else’s, or a ‘model,’ or a joke, so that they might turn to someone sitting next to them on a train, saying of their own hand, ‘Pardon me, Monsieur, you have your hand on my knee!’ or, to a nurse clearing away the breakfast, ‘Oh, and that arm there — take it away with the tray!’ . . . Babinski pointed out further that many such patients had been regarded as mad.”
[43] Weinstein, p. 356, 359.
[44] Weinstein, p. 369.
[45] But behind that question lurks another question: could it be both?
[46] Edith Bolling Wilson, “My Memoir,” p. 288.
[47] I tend to believe Ike Hoover’s account. He has no reason to lie. On the other hand, Edith Wilson has every reason to lie or to deceive herself. When she remembers looking at her husband on Oct. 2, 1919, does she see “the long cut on the President’s temple?” Or a swath of unbroken, unblemished skin?
[48] Bosley Crowther, the lead movie reviewer for The Times, produced one discordant note in an otherwise laudatory review: “There are obvious omissions in the story, some forgivable and some less so. A little less time spent on spectacle in this two-hour-and-thirty-four-minute film might have allowed for a clearer definition of Wilson’s historic battle for the League. As it now stands, the League is but a symbol of international accord, and the opposition to it — with Senator Lodge as the villain — is just an inchoate obstructive force. Wilson’s refusal to ask assistance from his Senatorial enemies in framing the peace is covered in his righteous pronouncement that ‘too many treaties have been written by practical men.’”
[49] George Felton is listed in the Wilson film notes as a “composite fictional character,” although the notes do not specify whether he was a composite of two fictional characters or of two real characters.
[50] Phyllis Lee Levin, “Edith and Woodrow.”
[51] This is a view supported by the dean of Woodrow Wilson historians, John Milton Cooper, Jr. In “Woodrow Wilson: A Biography,” Knopf, 2009, he writes, “This bad, even tragic, outcome of the League fight turned on Wilson’s stroke . . . At times in the first three months of 1920, he did seem to verge on mental instability, if not insanity. Edith Wilson, Dr. Grayson, and Tumulty did the best they could by their lights, but they were frightened limited people who should have not been trying to keep the Wilson presidency afloat. He should have not remained in office. If he had not, the League fight would have turned out differently, and the nation and the world would have been better off.”
[52] Quoted in Cooper, “Woodrow Wilson: A Biography,” p. 560.
