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| | 1919 On October 2, 1919, Wilson suffered that stroke, and afterward, his wife Edith controlled all access to him. She screened any papers or decisions brought before him, concealing the severity of his condition from his Cabinet and the public. Edith later described her efforts as stewardship, but according to the University of Virginia’s Miller Center, Wilson had no contact beyond his doctors and family until January 1920 (months after his stroke). He did not meet with his Cabinet until April. |
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| Wilson’s story raises a question relevant to us today: What do those around the president owe the country when concerns about their ability to govern arise? Those who see what the public doesn’t may have powerful incentives to protect someone whose success is tied to their own, and loyalty sometimes makes honest assessments difficult where they are needed the most. |
| In the 1920s, limiting access would have been far easier than it is today. Escaping scrutiny, too. No cell phones, no television, and no constant press pool would have given Edith Wilson a level of control no longer available. In light of the past few weeks, that lack of photos, television coverage, or news is almost enviable. |
| President Donald Trump has never really shown a “strong restraining hand” over himself; that is a simple fact. Lately, his self-control has slipped around existing boundaries and left many in doubt about his professionalism and even his mental health. |
| In early October, he spoke about the war in Iran, saying, “Let them take out Los Angeles. Let them take out San Diego,” as part of an explanation of enduring higher gas prices. FactCheck.org examined the remarks and explained that the president’s “speeches at rallies frequently veer off on tangents before circling back to an earlier point,” as happened here, but not before causing tremendous furor and anxiety. Three days after this presidential gaffe, San Diego would welcome home the aircraft carrier USS Abraham Lincoln and its crew after more than ten months of deployment, including service in the war with Iran. |
| On October 20, The Independent’s Andrew Feinberg questioned why the new program for rewards for reporting government fraud offered smaller amounts than those under existing law. Trump responded, “I don’t know who the hell you are, but you better be careful.” Feinberg later reported that he’d introduced himself less than five minutes earlier, and when he tried to ask another question about Trump’s golf courses, the president hushed him and asked if he was a “sick person.” |
| In the past few weeks, Trump has crossed lines in discussing or describing the physical characteristics of those he admires. He has repeatedly discussed Senator Jon Husted's jawline, shoulders, hands, and buttocks. At a Michigan rally on October 25, he focused on Nicki Minaj, praising her “beautiful ass” and demanding she stand so the crowd could admire it. |
| The next evening, he posted over 1,300 words on Truth Social, all attacking comedian Bill Maher, who had discussed his recent visit to the White House on his HBO talk show. Maher had criticized Trump’s politics, but also noted that the president had been calm and willing to listen. Trump strongly disputed Maher, describing him as being drunk, a “coward,” and a “major POTHEAD.” |
| These are just a few examples from the previous few weeks. They aren't isolated incidents, and many have grown accustomed to these outlandish behaviors. Each one generates headlines, social media attention, TV clips, and a lot of arguments before the next arrives. When put together, they deserve sustained scrutiny. |
| Wilson’s documented stroke doesn’t provide us with a strong argument for diagnosing, or forcing evaluation of, Trump. Only two senators went to see Wilson for themselves in the period after his disappearance from the public eye. The visit was carefully arranged and concealed his limitations; they left reassuring the press that his mind was clear. None understood the extent of his disability or Edith’s remarkable role. |
| Wilson’s example illustrates the potential consequences of allowing any president’s inner circle to control the information and the response. Americans, and others around the globe, have started “diagnosing” Trump from information available. From those wondering about his odd vocalizations, apparent bouts of nodding off or staring into space to his late-night social media tirades, and his unprofessional conduct, the list of behaviors that can be validly described as questionable keeps growing and raising deep concern. The public deserves serious answers about his health, judgment, or ability to do his job. |
| Lest we forget, Joe Biden’s experience offers a useful standard. Following his debate performance in June 2024, concerns about his fitness intensified. Pressure from within the Democratic Party increased and helped end his reelection campaign within a month of the debate. No Democrats questioned his ability to remain president. They questioned whether he should seek another four-year term. |
| Trump deserves similar scrutiny. His ability to dominate a room isn’t going to settle any concerns about judgment. Nor does his skill at projecting a specific brand of energy prove he can do the job. A president requires consistent scrutiny, which means examining what they can actually do, what has changed over time, and what reliable evidence supports conclusions about them. |
| While cognitive and mental health matter, the president's physical health also deserves examination. Trump’s May 2026 medical tests described normal cardiac and neurological findings, a cognitive screening score of 30 out of 30, and fitness to perform his duties. What’s questionable is that an earlier report had identified chronic venous insufficiency after observers had noted leg swelling and hand bruising (the administration said aspirin use and frequent handshaking were to blame). |
| These findings require accurate reporting, as do their limitations. Which cognitive screening is used, and does it require clinical interpretation? Can it independently establish a diagnosis of “fitness to perform his duties”? Useful questions should be asked and answered about his current medications, any changes since previous exams, and their impact on the president’s work. An accurate, in-depth medical briefing addressing these issues would serve the public far better than further speculation based on vague or inconsistent answers. |
| Biden faced serious questions about his health, and his administration did not meet the public’s need for fuller answers. He pointed to the demands of his daily work when pressed to undergo an independent evaluation and release the results. His last medical evaluation ran six pages and was released to the public, with a conclusion that he remained fit for duty. Biden’s assurances didn’t settle the matter; he was pressured to abandon his reelection campaign, and it left questions about presidential health and disclosure. |
| Similar questions are being asked about Trump now. In April, Rep. Jamie Raskin formally requested a comprehensive cognitive and neurological evaluation and public discussion about the findings. On June 18, he sent a follow-up letter indicating no response from the administration. Thus far, the only White House response has been to attack Raskin, calling him a “stupid person’s idea of a smart person.” |
| Of course, doing a full evaluation would mean moving past statements of alarm to sustained oversight of the president’s fitness. The vice president and Cabinet may need reminding of their constitutional responsibilities and encouragement to conduct an honest assessment of the president’s capacities. None of these duties depend on which party holds the White House. |
| Journalists can help by comparing conduct over time and following up on unanswered questions after the clips fade from circulation. And this, too, should be done in service to the office and the public interest, not the party holding the White House. |
| But such calls for scrutiny lead to the next question: What happens if a president cannot perform the duties of the office? |
| While Wilson’s administration lacked a straightforward solution, we have one now. The 25th Amendment, ratified in 1967, addresses the president’s ability to perform the job without requiring a specific diagnosis. Uncertainty about presidential capacity calls for credible evidence; unfortunately, offensive behavior alone doesn’t meet that threshold. (If it did, we’d have worn out the amendment in Trump’s first term.) |
| The amendment provides a process, though, and its use depends on people willing to make a gravely consequential judgment about the person they serve. Officials can’t responsibly examine presidential capacity while treating any questions as inherently disloyal to the president. |
| Of course, a president can voluntarily transfer authority to the vice president (in the world of “most unlikely events,” this ranks as most unlikely of all). But Section 4 of the amendment allows the vice president and a majority of the principal officers of the executive departments, or the vice president and a majority of another body established by Congress, to declare the president unable to discharge the office’s powers and duties. Under this approach, the vice president then becomes acting president. A president can contest the determination, and if the vice president and a majority reaffirm it within four days, Congress decides. Two-thirds of each chamber must sustain the transfer within the constitutional deadline. |
| Some argue that Trump’s unpredictable behaviors are more calculated than they look. At an October 10 rally in Tennessee, Trump said: “I could say the stupidest things, and you’d clap me.” The crowd did precisely that, laughing along at the “joke.” Helen Lewis wrote in The Atlantic that Trump keeps commenting on men’s bodies because his audiences respond to it. Something that seems alarming outside of a rally may bring a reliable laugh or cheer inside of the rally. Simply playing to a crowd does not make his health questionable. |
| | I could say the stupidest things, and you’d clap me. PRESIDENT DONALD TRUMP, OCTOBER 10, 2026 |
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| 32% | However, it is the wider audience where Trump should point his gaze. Reuters noted on October 24 that attendance at his rallies was uneven, with many empty seats at some. Its October 26 polls put his approval rating at 32%, just barely out of the record low a week earlier. These numbers don’t tell us if his insults cost him in approval ratings. They do show us that his pursuit of applause from those coming to see him is a poor exchange for applause from the rest of the country. |
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| Wilson’s inner circle kept the public in the dark about his condition and capacities. Today, we can watch Trump all day and still be left guessing. We can demand better than that. We can demand clear medical information, serious responses from Congress, and people around the president willing to put the country first. We don’t need a medical degree to ask if the person in charge is up to the job; giving the people who hired you a straight answer really shouldn’t be harder than clowning your way to a standing ovation. |
Faithfully,  |
P.S. I want to hear your take on this. Hit reply and share your biggest takeaway from today’s issue. (Yes, this goes straight to my inbox.) |
NOTES |
HOW DID WE DO TODAY? |
