Clearly, the public vetting of politicians for mental health issues was not going to be simple. Part of the problem was that even some of the best analysts had a hard time bracketing their own politics when diagnosing public figures. Psychological profiles often read like political attacks—suggesting, for example, that Nixon bombed Cambodia because he needed to replenish his self-esteem. “We are danger of having the insights of psychotherapy,” warned the political journalist Godfrey Hodgson in a 1981 book review, “used as a tool for character destruction, certainly for libel, potentially for revenge.” Compounding the problem, people were using psychology to highlight a politician’s negative traits—such as, in Nixon’s case, his lying, his narcissism, paranoia, his rage—but rarely what one analyst called the president’s “many ego strengths and adaptations” that might explain how he had risen as high as he did.

Commentators in the media also failed to distinguish among varieties of mental distress. It was one thing to be insane or deranged; quite another to display neurotic behavior like extreme narcissism or paranoia; another to be functional yet still temperamentally ill-suited to the responsibilities of global power. And, of course, just as many perfectly sane people came to seek out therapy to cope with common neuroses or sources of suffering, so a politician might exhibit certain unhealthy tendencies while still mostly coping well in his or her job and daily life. But in the popular discourse, all of these distinctions tended to get lost.