On February 13, 2017, thirty-five physicians signed a letter to the New York Times that stated: “We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.” Even a quick glance at social media or political buttons and bumper stickers shows us that these doctors are not the only ones worried about our current POTUS and the future of our republic. Americans’ current level of concern about the mental health of the man serving in the White House goes beyond what many of us have seen in our lifetimes, but, like all concerns, this one, too has a history.

In this country, anxieties about the mental stability or instability of our leaders can be traced back to the earliest years of the republic. The founding generation worried incessantly about the possibility of irrational actors in a government premised on rationality. In opposition to ratification of the Constitution, George Clinton fretted that it would be difficult to guard against the “unbridled ambition of a bad man, or afford security against negligence, cruelty, or any other defect of mind.” Perhaps Clinton and others from the founding generation were right to worry. Could President Donald Trump be the embodiment of their fears?

As the United States emerged from the American Revolution, Americans agonized about the possible failure of their experiments in government. The new systems that arose during and after the war emphasized the social compact, linking the individual and government explicitly. As the 1780 Massachusetts Constitution stated: “The body-politic is formed by a voluntary association of individuals: it is a social compact, by which the whole people covenants with each citizen, and each citizen with the whole people, that all should be governed by certain laws for the common good.”

This relationship necessitated rationality. In his 1794 medical dissertation on insanity, Edward Cutbrush wrote that “an uninterrupted use” of reason “is absolutely necessary for the well being of all societies, both civil and religious.”  People needed to be rational enough to understand their positions and occupy them fully according to the norms. Otherwise, they created dangerous situations for themselves, their families, communities, and even the republic. Lunatics, as they were called most frequently in the late 18th century, were incapable of this kind of rationality. For many Americans, fears about lunatics intersected with anxiety over the health of the community and nation.

Americans had a reason to worry as a tendency toward madness came, according to 18th- and 19th-century physicians, from the very freedom Americans cherished. According to the medical texts, in countries ruled by despots, there was no madness. However, where there was access to political and economic power, striving for office, “an increase in the number and magnitude of the objects of ambition and avarice, and the greater joy or distress, which is produced by gratification or disappointments,” insanity was widespread. ...