Reagan’s Brain: Was Alzheimer’s a Cause or an Effect?

When Ronald Reagan revealed, in 1994, that he had been diagnosed with Alzheimer’s disease — a finding many already suspected — I felt no compassion towards him whatsoever.

That’s not totally true. Actually, what I did was that I celebrated. It felt like cosmic retribution for his willful ignorance of the HIV/AIDS crisis, the classification of ketchup as a “vegetable” for low-income schoolchildren, and the thousand other casual cruelties that defined his time in office.

Now, I’m not sure how I feel. Don’t get me wrong; I still think he was a rotten president, even measured against the ones that have followed.

But recent insights into the workings of the brain, and the role emotions play in our physical health, have forced me to reconsider — very reluctantly — my antipathy towards the Gipper. While it’s generally thought that Alzheimer’s causes a characteristic emotional and cognitive disconnect, it seems increasingly plausible that the disease that clouded the last years of his life wasn’t the cause of his disconnection, but a symptom of it.

It’s an uncomfortable reckoning, but it’s one I can’t ignore. If I accept that Reagan was born into a family system so traumatic that it led him to deny his very emotions, can I deny him the compassion every child deserves?

The Acting President

All leaders are actors to some degree, but Reagan was the first American President to make it explicit. When he was a working actor, in the 1940s and ’50s, he tended to lean on the shortcut of sentimentality rather than drawing upon his own emotions, assuming they were available to him.

Psychologists sometimes define “sentiment” as the distortion of ideas by emotion. Put another way, it’s the perception that some emotions — typically simpler ones, like patriotism, or love of your hometown team — are intrinsically better than others. Feeling a tug at the heartstrings while watching an honor guard salute the flag is good; wondering whether Russians love their country in the same way we do is perhaps less good.

Ronald Reagan was, objectively, not much of an actor. So it’s all the more perplexing that his performance — pretty much limited to projecting resolve and steadfastness — worked so well on the national stage. If in Hollywood he was relegated to playing second banana to a chimp, in politics his ability to generate an emotional response without experiencing actual emotions himself was a potent tool.

Reagan was hardly the first person to leverage policy pitches with this prybar, but he possessed a special gift for it. And he was an uncannily perfect match for America as it staggered out of the 1970s: A nation stung by the revelations of Vietnam and Watergate, uncertain how to redeem itself, or if it even required redemption.

As a nation, we had crested a hill and couldn’t see what lay ahead: The promise of the Civil Rights Era fading in the rearview mirror, the car filling so subtly with the poison gas of a growing income gap that we mistook it for oxygen. The end of the American Century lay ahead of us, but we were unwilling to relinquish the wheel. Ronald Reagan told us that we didn’t have to, that we were above all an essentially right and good people, that the real threats to our well-being lay outside our borders. Sweeping away Jimmy Carter’s principled severity with chuckles and one-liners, Ronald Reagan was a salesman who could sell anything, but had nothing to sell.

Morning in America

I remember the election of 1980, or flashes of it. Stiff, doomed Jimmy Carter laughed out of town for his austerity and his high-mindedness; independent challenger John Anderson — who even then seemed clear-eyed and sane to me — never standing a chance. Instead we got Ronald Reagan, the B-movie actor, cheered by throngs of white people, the kind who had “values.” They loved his folksy ways, his get-tough stance on the Soviet Union, his embrace of terrifying weapons like the neutron bomb. “Let’s make America great again,” he said, and suddenly it sounded like a grand and inspiring idea.

But if Reagan had a gift for projecting America’s power abroad, there were less visible repercussions closer to home. In 1980, a month before the election, President Carter had signed into law the Mental Healthcare Systems Act, providing grants to community mental health centers. Although the board overseeing the bill provided little guidance, the MHSA was at least an acknowledgement that the need for mental health care was critical and only growing.

But immediately upon taking office, Reagan cancelled the MHSA. Caring for the mentally ill was not deemed a priority for the Republicans’ brand of compassionate conservatism, and the allocated funds were simply released to the states to do with as they wished. Simultaneously, many residents of wards like Washington’s St. Elizabeth’s — a truly Dickensian asylum — were released from care. From there it was typically a very short journey to homelessness.

Ironically, when he came into office, Ronald Reagan actually had some experience with mental health care. Long before he became President, he was a devotee of the SoCal culture that equated psychology with Communism. As governor of California, he had presided over the large-scale deinstitutionalization of the mentally ill, forcing them out of state care and into shoddy, for-profit group homes. This was no coincidence: Several board members of at least one of the firms running these homes had close ties to Reagan and his fundraising apparatus (See “Ronald Reagan’s Shameful Legacy,”

Deinstitutionalization was an unprecedented windfall for these companies, but disastrous for the patients. As the former inmates filtered into the homeless population, the tenor of homelessness itself began to change.

Lack of shelter had been recognized as an issue of national importance for at least a century, but now those persons forced from their homes by the “usual” factors — bankruptcy or substance abuse, for example — were joined by a flood of the seriously mentally ill. Violence — including a number of high-profile murders — spiked. What’s more, released from clinical care, now former patients had access to street drugs such as heroin and PCP.

This phenomenon took place against a larger backdrop of urban disorder. It was the era of White Flight, when cities were being abandoned en masse by the middle class. The human cost of this reordering was more or less invisible where I lived, outside of my family’s occasional detours through other neighborhoods. I’ll never know whether our family’s excursions to run-down sections of D.C. were deliberate teachable moments or the result of my father’s poor sense of direction.

But these brief glimpses into other lives changed me. The stirring chapters in American history I was learning about in grade school and what I saw around me didn’t appear to be connected. If the talk of better times ahead from the President’s mouth sounded like they were meant for all Americans, it was abundantly clear that not everyone was invited to partake. What I sensed, but couldn’t yet name, was that Reagan wasn’t the man he claimed to be. What I couldn’t yet have guessed was that his obliviousness might have resulted from an act of self-protection against the bitter disappointment of a traumatic early life.

Brain Chemistry

For most of my life, I was content to regard Reagan’s shallowness as a character flaw rather than a medical condition. It made it far easier to heap righteous scorn on Ronnie the cowboy, the shallow, jocular cardboard cutout of a man who would evict tens of thousands of the mentally ill and threaten nuclear war just to prove how tough he was.

Then, six years after he left office, the former President revealed his Alzheimer’s diagnosis. At the time, it was thought that aluminum from cooking utensils, cans — perhaps even the water supply — was causing dementia in otherwise healthy individuals. But the presence of trace amounts of aluminum in the brain is a red herring. It appears that our understanding of the causality of this disease could actually be reversed: Alzheimer’s might be the result of emotional disengagement, not its cause.

In his 2003 book When the Body Says No, Dr. Gabor Maté, a palliative-care physician, reframes Alzheimer’s as an autoimmune response to emotional trauma. Like many diseases, its physiological precursors are evident in a scarily high proportion of us, but whether or not they actually progress into a diseased state may hinge upon our ability to express emotions.

Maté cites a study, published in 2000 but started nearly 15 years before, on a group of elderly nuns. By studying the journals the nuns had kept as young women and then tracking their health during the end stages of their lives, researchers discovered some startling patterns.

The nuns who displayed an ability to access their emotions more fully in their youth — admittedly, a subjective assessment — were less likely to succumb to Alzheimer’s or dementia as they aged, and they lived longer and — again, subjectively — happier lives.

But what isn’t subjective is the fact that they resisted the symptoms of Alzheimer’s even when autopsies revealed all the pathological markers of the disease in their brains. In other words, based on the physical evidence, nearly all the nuns should have had Alzheimer’s; in reality, only those with diminished emotional expression developed it.

By all accounts, Ronald Reagan learned how to suppress his emotions at a young age. The child of an alcoholic, philandering father and an emotionally disengaged mother, the future President adopted a tranquil and unflappable affect rather than face the discomfort and grief of such an upbringing. As the actress Patricia Neal would later recall, she was “touched by the despair behind his incessant, nervous jocularity.”

Rather than expressing his true emotions and the vulnerability this act entails, Reagan turned to the more acceptable crutch of sentimentality as a stand-in. Later incidents — such as his blithe reception of the news of his wife’s breast cancer diagnosis — would mirror his failure to recognize the devastating implications of shuttering mental health facilities, pushing their inmates into the dismal human warehouses of for-profit care and eventually the howling exile of homelessness.

The Great Communicator Speaks

I was hardly the only one to sense the vast gulf between the President’s words and his actions. In his 1985 book The Man Who Mistook His Wife for a Hat, the late neurologist Dr. Oliver Sacks observed a group of patients who greeted a televised speech of Reagan’s with inappropriate, helpless laughter. The group consisted of aphasiacs, or those who experience “…Partial or total loss of the ability to articulate ideas or comprehend spoken or written language, resulting from damage to the brain from injury or disease.” (Thank you, internet.)

Because aphasiacs must work infinitely harder to understand spoken language, one characteristic of their condition is a heightened ability to discern other cues about a speaker’s emotions. What these patients could so plainly see was that the President’s tone, facial expressions and body language were at odds with his words. As one patient explained with uncanny precision: “Either he is brain-damaged, or he has something to conceal.”

The irony, of course, is that Reagan was often hailed as “The Great Communicator.” I doubt if he was aware that he was concealing anything, and therein lies the rub. For at the end of the day, this hollow shell of a man, who did so much to normalize institutional neglect — for the poor, for people of color, for gays and lesbians and anyone else who didn’t deserve to bask in his “Morning in America” — was every bit as trapped, emotionally starved, and bereft as the people whose lives he objectively worsened.

But the dawning truth of Reagan’s woundedness is a blazing torchlight held in my eyes. Much as I would prefer otherwise, I can’t unsee the trauma and hurt that drove a little boy to a very human response, even if it was one that would have very inhumane consequences: The self-protective but crippling denial and eventual atrophy of his emotions, undermining his essential capacity for love, and thus self-love.

Seeing the man I and many of my peers regarded as an arch-nemesis in this new light tests the limits of my own compassion. It’s so exquisitely uncomfortable, this karmic inversion. It brings me back to 1980 and the backseat of our bottle-green Chevrolet Caprice Classic, staring out at the awful sadness of Washington’s blighted streets. This separation spreads outward like a bloodstain, now enfolding not only me, but my entire family, our entire country, our entire species cut off and isolated from each other. But there it is, the realization that our misguided president was every bit as wounded as I was.

Once I saw the hurt and confused little boy inside Ronald Reagan, I could not unsee him, and I could not wish him harm any more than I could wish it for myself.

Still, my accommodation raises more questions than it answers. Reagan was unable to access his emotions, as appears to be the case with our current President, a man whose self-absorption and capacity for violence — whether expressed in his boasts of sexual assault or the physical abuse of his children and former wives — far outstrip Ronald Reagan’s.

What does this say about us?

Perhaps we should view it through the terms of the disease that claimed Ronald Reagan’s life. Faced with seemingly intractable forces like globalism and nationalism — not to mention the looming catastrophe of climate change, a threat so existential we can barely acknowledge it — maybe we’re all suffering a kind of collective Alzheimer’s. We certainly are suffering a literal one; although deaths from other major causes are in historic decline, deaths from Alzheimer’s disease have increased over 123% since 2000.

The challenges we face trigger uncomfortable emotions. They seem so unbearable, in fact, that we’re using other outlets, like politics, as a more acceptable-seeming substitute. But as a result, politics has become radioactive, a fight to the death in which every act is a personal assault to be countered or escalated. And the policies we’re choosing are killing us, no longer on a personal level but on the order of a society and a species.

The desire to shut out our more complicated emotions, to push away the discomfort — and yes, sometimes the pain — of living upon this earth is a powerful one, but it most assuredly pales compared with the looming loss of our only habitat. To access the compassion our fellow humans need is to acknowledge that we need it ourselves. But until we turn squarely to face this pain, the future looks very bleak indeed.

Based in Portland OR, I write about music, plant medicines and more. I’m at work on a book tracing my roots through the Holocaust; find more at

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