As the Biden administration approaches its conclusion and transitions into its legacy phase, the events surrounding his health and cognitive vitality will undoubtedly leave a lasting impact on the historical narrative.
President Biden’s cognitive decline, initially apparent during the debates and ultimately costing him the presidential nomination, continues to raise significant questions about who is and who was making the decisions in the White House.
The challenge is that the obfuscation of President Biden’s age and health represents a potential betrayal of democratic principles, depriving the electorate of the transparency essential to informed governance. Such concealment consolidates power among unelected operatives, erodes public trust, and shakes the foundational tenets of accountability and constitutional leadership.
Has something like this ever happened before?
It has—and under even more dramatic circumstances. In 1919, President Woodrow Wilson suffered a catastrophic stroke, a debilitating event meticulously concealed from the American public. The resulting opacity in leadership profoundly and irreversibly altered the trajectory of United States history in the 20th century.
President Biden’s Age and Hidden Cognitive Decline.
Those who watched the debates witnessed it firsthand—President Biden’s cognitive decline could no longer be concealed. Yet, efforts to obscure the reality were ongoing well before June 27, 2024. President Biden had become increasingly unavailable, relied heavily on scripted remarks, declined meetings and assumed a diminished role in governance according to The Wall Street Journal in an article led by Annie Linskey. This troubling pattern culminated in a debate performance that laid these concerns bare. Far from mere speculation, these claims are substantiated by thorough reporting in The Wall Street Journal, drawing on 50 interviews with individuals closely acquainted with the administration.
Negative stories were buried. The inner circle blockaded the President. Key members of Congress didn’t have contact with Biden. Pivotal roles were played by unelected staff members. Even now, the Democratic leadership continues to assert that everything was fine in Camelot. Senate Minority Leader Charles Schumer maintained, as recently as last week, that Democrats did not gaslight the public.
Political leanings may influence whether one perceives or declares this as a scandal or not. But, at its core, this issue left the nation confronting a potential leadership vacuum. Tangible examples provided in the The Wall Street Journal piece include the chaotic withdrawal from Afghanistan, where truncated or skipped Cabinet meetings highlighted the potential absence of decisive executive direction. The question it raises is both unavoidable and urgent: who was—and who is—truly governing the country?
This scenario is not without a sobering precedent.
Woodrow Wilson’s Hidden Stroke of 1919
A little over a century ago, the nation was confronted with a president demonstrably unfit to govern, though this reality was assiduously concealed from the American people. The repercussions shaped the trajectory of U.S. foreign policy in the 20th century.
In 1919, President Woodrow Wilson, in an exhausting bid to rally public support for U.S. entry into the League of Nations, embarked on an arduous speaking tour. On September 25, 1919, Wilson collapsed, and by October 2, he had suffered a debilitating right-sided stroke. This catastrophic event, his fourth, rendered him hemiplegic—unable to move his left hand or leg. The president, incapacitated, became dependent on others for the most basic activities of daily living, such as feeding himself. Even the act of signing his name presented an insurmountable challenge.
This was hidden from the American public and even Congress.
At the center of this unfolding drama was Dr. Cary Grayson, Wilson’s White House physician and confidant. Grayson, bound by a combination of professional ethics and profound personal loyalty, acted with extraordinary secrecy. His relationship with Wilson extended well beyond the clinical; he had introduced Wilson to his second wife, Edith, tended to Wilson’s sister during a medical emergency and accompanied the president to the Paris Peace Conference in 1919. Grayson had a truly meteoric ascent. In a short time, he went from Assistant Surgeon Lieutenant to Medical Director and eventually Rear Admiral. This had inextricable ties to his proximity to the president.
Could a man so enmeshed in his patient’s personal and political fortunes truly render an objective diagnosis? In 1919, as in 2024, the question of whether loyalty can override duty to the public takes on a pressing urgency.
That question became acute when, four days after Wilson’s catastrophic stroke, his Cabinet convened to deliberate the nation’s course. Then-Secretary of State Robert Lansing invoked Article II, Section 1 of the Constitution, which provides for the vice president to assume presidential duties in cases of incapacity. Yet Grayson refused to endorse or sign any documentation attesting to Wilson’s disability, effectively quashing discussions of a transfer of power.
For the next 17 months, the reins of the presidency were, in practice, held by Edith Wilson. Acting as an intermediary, she filtered all communication to and from the bedridden president. Her role as de facto steward of executive power has been the subject of considerable historical debate, yet the fact remains that this extraordinary arrangement kept the true extent of Wilson’s condition hidden from Congress and the public.
What Were the Consequences Of Woodrow Wilson’s Hidden Stroke
The consequences altered the history of the United States. The League of Nations, bereft of U.S. support, languished into impotence, and only in the aftermath of World War II did the United States begin to approximate Wilson’s vision of a Pax Americana. Still, the ethical questions remain stark: Grayson, as my colleagues and I noted in a Journal of Neurosurgery paper, allowed patient-physician confidentiality to supersede national security at a critical juncture in history. This decision, framed by loyalty and political considerations, obscured the president’s infirmity at a moment of pivotal international consequence.
Charitably interpreted, Grayson’s actions ignite a debate about the intricate interplay of professional ethics, personal loyalty, and the bonds forged through years of medical care. Less generously, they suggest a pernicious entanglement of political ambition and institutional inertia—a reluctance of those governing to relinquish power, even when the governed are ill-served.
What Are and What Will Be The Consequences of President Biden’s Cognitive Decline?
History will tell us.
