The Reagan Diaries Reconsidered

When The Reagan Diaries were published in 2007, three years after the former president’s death, I was surprised by the lucidity of the language and the prosody of the former president’s prose [1]. Like many Americans, I remembered an aging Reagan, who was ultimately diagnosed with Alzheimer’s disease in 1994. To read The Diaries, expertly abridged and edited by the historian Douglas Brinkley, was to encounter an unexpected literary pleasure. In contrast to Reagan’s public persona in his later years, the entries from the start of his presidency reveal a writer firmly in command of language, his text, and himself.

These early entries, however, lay in contrast with those from his second term which I believe show evidence of an incipient dementia. Reading the diary as an internist and clinical ethicist often at the center of cases involving questions of decision-making capacity and patient self-determination, I made margins notes of what I felt was diagnostic evidence of cognitive decline. Although I casually shared my observations with some colleagues and friends, and even approached a physician journalist who I thought might be interested in pursuing the story [2], I did not seek to publish my “literary” observations as I felt that they were too impressionistic to warrant such consideration.

That is where I left it until the recent article in the Journal of Alzheimer’s Disease comparing the linguistic content of presidential press conferences of President Reagan and his successor George Herbert Walker Bush [3]. As is well known to readers of this journal, Berisha and his colleagues found significantly decreased use of unique words and increased non-specific noun use and “conversational fillers” in the Reagan transcripts. These lexical features increased during the course of Reagan’s presidency and are important findings because they are associated with the development and the progression of Alzheimer’s disease. Notably, these findings were not found in the Bush transcripts. The study received widespread media coverage, including an article in the New York Times by the physician journalist Lawrence K. Altman, known for his coverage of presidential health[4].

The paper prompted me to return to the marginalia in my copy of the Diaries. I wondered if a close reading of the journal, using critical methods drawn from clinical ethics [5, 6] and the humanities [7, 8], might further substantiate Berisha and colleague’s hypothesis and if their published analysis made my observations more plausible. While one cannot make a diagnosis of Alzheimer’s disease by either a retrospective analysis of presidential diaries or press conferences, I concluded that it is important to consider all sources of information— including his journals— to gain a fuller understanding of Reagan’s health while he was in office.

Housed at the Reagan Presidential Library, the handwritten journals, according to Brinkley, “ …  resemble a handsome half-set of an encyclopedia …  hardcover books, 81/2 by 11, bound in maroon and brown leather with the presidential seal embossed on the center of the front …  ” Brinkley notes that he made “heavy cuts” as the published diaries constitute an abridgement which would have “filled two or three volumes”, if the full collection had been published. As editor, Brinkley reports that, “Great effort was made not to lose the rhythm of his [Reagan’s] economical prose.” [1]. He does not comment specifically if he corrected spelling or grammatical errors, but as a historian, it would be unlikely that he would seek to alter archival materials in this manner without explicitly advising his readership.

The Diaries begin in January 1981 with Reagan’s inaugural. The president wrote nightly except when hospitalized. At the outset, and through his first term, entries are snappy and coherent, even stylish in the way that we remember Reagan at the top of his game. He is a master at succinctly making his point, accessible and clear. His personality jumps from the page and his emotional repertoire is full. He is decisive when accepting the resignation of an errant Cabinet member and empathic when writing about children with special needs. A reviewer from The New York Times Book Review observed that, “One strength manifest in these diaries is that Reagan, especially in his first term, was a more active and alert chief executive than his detractors care to admit. That involvement leaps out of his descriptions time after time, whether he was balancing relations between Israel and the moderate Arab states or brokering fiscal policy within the various factionsof the Republican Party or within Congress as awhole.” [9]

However, by the second half of his presidency, there are hints that something has changed. There is demonstrably less text, his entries are shorter and his analysis (always laconic) now even more truncated, all possibly early signs of cognitive impoverishment, during this same period of his presidency covered by the study of his press conferences.

In addition to structural changes in the scope of the diaries and the nature of his prose, there are specific examples of entries that contain errors, word finding problems, evidence of spatial confusion, and what might be construed as inappropriate humor. An example of the later can be found in an entry from July 7, 1986 (page 423): “We did something unusual –we slipped out of the W.H. –no we didn’t. This time we went in the usual procession.” [1]. This was written after Reagan mentioned earlier in the entry that there had been a rumor that he had gone somewhere without the press knowing his whereabouts. While the entry may be an attempt at humor, its tone was inconsistent with earlier passages and struck this reader as perhaps disinhibited.

A more worrisome entry on August 26, 1986 suggests either memory loss and/or some degree of spatial disorientation. Flying on Marine Corps One over California, familiar territory he knew well, he became confused. He worried about what happened, “Coming down the coast in the helicopter I watched for landmarks I remembered and was a little upset when I could locate them & then couldn’t remember their names –Topanga Canyon for example.” [1] (page 433).

It is hard to know if the former president had any insight into encroaching deficits, but an entry from July 25, 1988 suggests a planning error and perhaps some degree of concern. A life-long horseman, Reagan confessed, “I forgot my spurs which I’ve never done before.” [1] (page 632).

By 1988, there were also a number of spelling errors and proper name anomias. For example, on November 8, 1988 writing of his successors after the election he wrote of, “...Bush-Quale were winners” (page 664), misspelling the Vice-President Elect’s name [1]. Similarly, on December 11, 1988, writing of the annual Christmas Show in Washington, he misidentifies the entertainer, Vicki Carr as Vicki Farr, “Then on to the annual ‘Xmas in Wash.’ Jimmy Stewart, Shirley Jones, Vicki Farr & others –a wonderful Xmas program. Then back to the W.H. for dinner in front of the T.V.” [1] (page 677). On January 13, 1989, he misidentifies his Domestic Policy Advisor and Assistant to the President for Domestic Policy, Dan Crippen as Dan Crispen [1] (page 689). Crippen was very highly placed in the administration and a key ally of White House Chief of Staff, Howard Baker.

It is impossible to reliably quantify the number of entries in the Diaries which might suggest incipient dementia or comment more fully about the length and complexity of the text without access to the full diaries. There could be other examples in the unabridged version of the diary, which may have been viewed as inconsequential and thus edited out of the published volume. The editor, Douglas Brinkley acknowledges that his “...objective was to combine both the most intriguing historical material and a healthy sampling of the more mundane, day-to-day realities...” [1]. This may be right historically, but it may be in the more “mundane” entries that medical historians might find further documentary evidence of concerning symptomatology. At the very least, my analysis constitutes a hypothesis that warrants a more comprehensive analysis of the complete diaries, most especially those materials which Professor Brinkley opted to exclude from the edited volume.

In November 1994, the former president wrote a letter to the nation reporting that he had been diagnosed with Alzheimer’s disease. His note was personal and intimate, sharing medical information often kept in the shadows. But he and Mrs. Reagan decided to disclose the news to “promote greater awareness of this condition” and “encourage a clearer understanding of the individuals and families who are affected by it.” It was a courageous acknowledgement and a valedictory public service [10].

For a life-long diarist, it was especially fitting that his letter was written in the same hand which dutifully penned the details of his most extraordinary life. After decades in politics and government service, these were meant to be the president’s final public words.

Reagan’s posthumously published diaries have proven otherwise and illustrate that former presidents are never silent. Their historical legacy grows with the discovery of new archival material, and with it their list of notable contributions. A deeper understanding of the natural history of Alzheimer’s disease, as understood through the former president’s press conferences and diaries, is now also part of the Reagan legacy.