What Jackie Kennedy Didn't Say—and Didn't Know

The recent release of Jacqueline Kennedy's tapes has generated much interest. Caroline Kennedy reports not editing the tapes, but the question of self-censorship still exists.

After all, Jackie Kennedy vigorously guarded the secrets of her husband, as witnessed by the scandal surrounding William Manchester's book Death of a President. John Kennedy's medical records were not made public until about a decade ago. And there is certainly more that is still not known.

Only now, half a century after his election, can we begin to get a realistic assessment of John Kennedy and his presidency.

Jackie's tapes remind us that there is much we have not known, and much still to be known.

In listening to the televised edits of those tapes, I was struck by what she said, and also what she did not say.

I base my comments here on my own personal study of John Kennedy's medical records, in the JFK Presidential Archives. I believe I am the first psychiatrist to review those records, and one of a handful of physicians. In my recent work, I have published the details of his medical records, focusing on its psychiatric aspects, more extensively than in prior published biographies. This includes verbatim transcription of important parts of his medical records that have never before been printed in full (such as his medical evaluation upon leaving the navy in 1944, xray result on his back while president, and nursing notes on a near fatal infection while president).

Here is what Jackie admits: John (and she, briefly) took amphetamines (dexedrine); JFK suffered much pain (from his back); JFK suffered greatly from abdominal pain (which she attributes to the "Kennedy nerves").

Here is what she did not say but certainly knew: The president took steroids, of many kinds and amounts, including injections of anabolic steriods (testosterone and its analogs) such as are currently used (and banned) among athletes and bodybuilders. Kennedy took these agents for near-fatal Addison's disease (lack of production of steriods by the adrenal glands), which almost repeatedly killed him, including half a dozen hospitalizations while he was a congressman and senator, some of which left him semi-comatose. He also almost died from a serious infection in mid 1961 - just when he was erratically weak in his political decisions involving the Bay of Pigs and the Vienna summit with Khruschev. This infection was hidden from the public. Its source was a sexually transmitted bacterium. Addison's disease reduces the body's ability to react to infections, hence the repeated near-fatalities.

Here is what she probably did not know: The president's lifelong recurrent diarrhea and "colitis" is now mostly seen as autoimmune, and is genetically related to the autoimmune cause of Addison's disease. His back pain was not due to a war injury; his spinal x-rays did not show major bony abnormalities, such as arthritis. (He did have the harmful evidence of prior, probably unncessary, spinal fusion). Most of his back pain was likely due to muscle spasm; this was the eventual conclusion of Kennedy's White House doctors and consultants, and, by 1963, Kennedy had improved with a conservative physical therapy treatment. Before 1962-1963, however, Kennedy's personal physician, Janet Travell, had been repeatedly injecting him with procaine (an analog of cocaine) for the muscle spasms, with probable long-term worsening due to increased muscle weakness from the repeated injections into the muscle mass.

There is a correlation between JFK, the failure, and the overuse and abuse of steroids - and JFK the success and the appropriate use of steroids. Travell and another doctor, Max Jacobsen (who was injecting Kennedy with a mixture of probable amphetamines and more anabolic steroids) were giving Kennedy a major mix of anabolic steroids throughout 1961. In 1962, after a medical coup d'etat - when Travell was displaced and Jacobsen fired - Kennedy's other doctors, led by White House physician, George Burkley, markedly reduced the president's steroid intake. The president's leadership, at the same time, improved notably - with the stunning success of the Cuban Missile Crisis, and his audacious move to propose a civil rights bill and support Dr. King's March on Washington.

This is a correlation; it is not causation; but it may not be coincidence either. The idea that all those psychoactive drugs, especially anabolic steroids, might affect one's thinking is something that cannot be easily dismissed, unless one believes that the brain is not a biological organ affected by drugs.

So Jackie said a few things we need to know, and she didn't say as much as she could have. And there were some things even she didn't know, but that we should all finally understand today if we are ever able to get a realistic appreciation of this great, and flawed, leader.