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While President Kennedy campaigned as if he was in the perfect health that was very far from the truth. He suffered from Addison’s disease, which forced him to take cortisone constantly. His back problems were getting more severe all the time. He was constantly in pain and at times could hardly walk. All of this was kept secret at the time. The other aspect of the Kennedy presidency that the public did not learn about was his social escapades. There can be little doubt that Kennedy had many encounters outside of his marriage.
John F. Kennedy suffered from health problems throughout his life. As a child, John seemed to have more than the average number of colds and childhood ailments. Once he became a teenager, his health problems became considerably more pronounced. At the age of 13, during his year at Canterbury Academy, John was tired much of the time. He did not grow as much as was expected for a boy his age. In the spring, John collapsed from stomach pains. He was then diagnosed and treated for appendicitis.
At Choate the next year, John's health was slightly improved, though he still suffered periods of fatigue. John remained generally frail, weighing a mere 117 lbs. In his second year at Choate, his health seemed to get worse as he suffered from various illnesses. In his third year, John was rushed to the hospital. At one point, doctors feared that Kennedy had leukemia. Though that diagnosis was found to be incorrect, doctors were not able to pinpoint the cause of his ailments.
His frail health followed him to college. When John withdrew from Princeton, he spent almost two months in hospitals as doctors tried to get a handle on his mysterious medical problems. His father enlisted the services of some of the most eminent physicians in the US, both at the Mayo Clinic and at Harvard, but none could agree on what was the root cause of John's medical problems.
In 1940, Kennedy began to experience serious back problems. His chronic back pain may have been a byproduct of treatments for his other medical conditions. Ongoing back pain would plague JFK for the remainder of his life.
Jack's health problems precluded him from passing his physical exam for induction into the military. With a war approaching and despite his poor health, Jack insisted that he wanted to serve. Through his father's connections, Jack arranged for the Navy €˜to look the other way€™ and induct him nevertheless. During his naval service, Jack continued to suffer from various medical maladies. After the ordeal of the sinking of his PT boat and the rescue of Kennedy and his crew, Kennedy's health seemed to worsen.
By that time most of those serving in the Pacific were suffering from many different ailments. Jack's illnesses, however, were often noticeably worse than the illnesses of others. Finally, when he collapsed with excruciating stomach pain, Kennedy was hospitalized and diagnosed with a gastric ulcer, which proved to be his ticket out of the Pacific theater and back to the States.
Once at home, Jack was diagnosed with a series of several conditions, including malaria. His doctors suggested he undergo back surgery. Kennedy initially resisted the surgery, but ultimately agreed. He was admitted to New England Baptist with a diagnosis of a ruptured disk. The next day, when surgeons operated they did not find a ruptured disk. They found abnormally soft cartilage, which they removed. Jack slowly recovered from the back surgery, after a protracted and difficult period of convalescence. He continued, however, to suffer from abdominal pain. On March 1, 1945 Jack was retired from the Navy. Finally, in September 1947, Kennedy was diagnosed with Addison's disease. It was unclear whether the disease was precipitated by the hormone therapy he had been taking since his youth, or whether the disease had an hereditary component. The diagnosis, however, could not have been timelier since doctors had, by then, developed successful cortisone replacement therapy.
Jack's back problems became worse. Doctors recommended a complicated and dangerous operation to alleviate his suffering. They believed if JFK did agree to the surgery, he would eventually be crippled. The operation was deemed to have only a 50/50 likelihood of success. On October 10, 1953 Senator Kennedy entered New York's Hospital for Special Surgery to undergo the procedure. Over the next few months, Kennedy underwent two operations. At one point, an infection left him hovering near death. By June, however, he was well enough to return to the Senate. Kennedy was concerned that widespread knowledge of his health problems would hurt his political career. That seemed not to be the case as his courage in facing his health problems only increased Kennedy's popularity.
But what the public did not know was that between the continued treatment for his Addison's disease and ongoing treatment for his painful back, Kennedy was taking a powerful cocktail of different medications during his first year in office. In the fall of 1961, the official White House physician, Admiral George Buckley, was greatly concerned about the large number of drugs the President was taking as well as their apparently diminishing effectiveness. After obtaining outside advice, Buckley convinced Kennedy that his current path was untenable. Buckley recommended that Kennedy engage in a vigorous routine of exercise, in place of drugs. Kennedy accepted Buckley's recommendations. In the fall of 1961, he began to exercise three or four time a week. The exercise proved successful and the President's health began to improve. Much has been written about President Kennedy's extra marital affairs. He governed in a different time in our country. During that time, the public and the media held the belief that what people did in their personal lives was not for public consumption. Therefore, reporters did not write what they might have known. They did not spend time investigating the facts regarding the private lives of politicians. The rumors about JFK are legendary. They include a rumor that the President had an affair with Marilyn Monroe. I chose not to write more than I am writing here on this matter, which is very little. Having gone through the President's schedule day-by-day, there is no doubt that the opportunity existed for Kennedy to engage in extra curricular activity. However, the actual proof of any impropriety is limited, and ultimately irrelevant. Whatever President Kennedy did, or did not do outside the confines of his marriage, there is no evidence whatsoever that anything he might have done impacted the work he did has President.
Biography of John F. Kennedy, 35th President of the U.S.
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John F. Kennedy (May 29, 1917–Nov. 22, 1963), the first U.S. president born in the 20th century, was born to a wealthy, politically connected family. Elected as the 35th president in 1960, he took office on Jan. 20, 1961, but his life and legacy were cut short when he was assassinated on Nov. 22, 1963, in Dallas. Though he served as president for less than three years, his brief term coincided with the height of the Cold War, and his tenure was marked by some of the biggest crises and challenges of the 20th century.
Fast Facts: John F. Kennedy
- Known For: First U.S. president born in the 20th century, known for the fiasco of The Bay of Pigs early in his term, his highly praised response to the Cuban Missile Crisis, as well as his assassination on Nov. 22, 1963.
- Also Known As: JFK
- Born: May 29, 1917 in Brookline, Massachusetts
- Parents: Joseph P. Kennedy Sr., Rose Fitzgerald
- Died: Nov. 22, 1963 in Dallas, Texas : Harvard University (BA, 1940), Stanford University Graduate School of Business (1940–1941)
- Published Works: Profiles in Courage
- Awards and Honors: Navy and Marine Corps Medal, Purple Heart, Asiatic-Pacific Campaign Medal, Pulitzer Prize for Biography (1957)
- Spouse: Jacqueline L. Bouvier (m. Sept. 12, 1953–Nov. 22, 1963)
- Children: Caroline, John F. Kennedy, Jr.
- Notable Quote: "Those who make peaceful revolution impossible make violent revolution inevitable."
John F. Kennedy
The image most people had of John F. Kennedy was one of youth and vitality. And, that was on purpose. JFK in fact lived in near-constant pain, but his poor health was kept a closely guarded secret for fear of damaging his political career. He had allergies, stomach troubles and suffered from chronic back pain, which was aggravated by his WWII service and required numerous surgeries. The back injury allegedly happened in 1937 while he was a student at Harvard, and it initially disqualified him from military service (his father later used his connections to get JFK into the Naval Reserve). He𠆝 been ill before the injury, too. As a child he suffered from gastrointestinal issues which were later diagnosed as Addison’s disease, an endocrine disorder. In a strange twist of fate, one of the symptoms of Addison’s as well as a symptom of the steroids used to treat it is hyperpigmentation, which may be responsible for JFK’s perpetual “tan,” something viewers of his televised debate with Richard Nixon definitely noted.
Franklin Roosevelt in his wheelchair with his dog and Ruthie Bie, the daughter of the Hyde Park caretaker. (Credit: Corbis via Getty Images)
John Kennedy and Civil Rights
John F Kennedy is not automatically associated with civil rights issues as Kennedy’s presidency is more famed for the Cuban Missile Crisis and issues surrounding the Cold War. Also, no obvious civil rights legislation was signed by Kennedy. However, Kennedy did have a major input into civil rights history – though posthumously.
JFK with Lyndon Johnson
John Kennedy came from a rich and privileged Irish-American family. Even so, the family had to leave Boston, the city they are most famously associated with, and moved to New York. In Boston, the family had been held at arms length by those rich families who saw their Irish background as vulgar and the family’s wealth as lacking ‘class’. The Kennedy’s hoped that the more cosmopolitan New York would allow them to access high society. This introduction to bigotry and discrimination should have given Kennedy some kind of empathetic understanding of what life was like for African Americans. However, the opposite would appear to be true.
Kennedy put political realism before any form of beliefs when he voted against Eisenhower’s 1957 Civil Rights Act. The route from bill to act nearly served to tear apart the Republicans and the Democrats were almost united to a politician in their opposition to the bill/act. Kennedy had aspirations to be the Democrats next presidential candidate in the 1960 election. If he was seen to be taking the party line and demonstrating strong leadership with regards to opposing the bill, this would do his chances no harm whatsoever. This proved to be the case and Kennedy lead the Democrats to victory over Richard Nixon in 1960.
However, during the presidential campaign and after he was nominated for the Democrats, Kennedy made it clear in his speeches that he was a supporter of civil rights. Historians are divided as to why he was ‘suddenly’ converted. Some saw the opposition to the 1957 Act as understandable from a political point of view. Others have adopted a more cynical view which is that Kennedy recognised that he needed the ‘Black Vote’ if he was to beat Nixon. Hence why he said in his campaign speeches that discrimination stained America as it lead the west’s stance against the Soviet Union during the Cold War. He also said that a decent president could end unacceptable housing conditions by using federal power. His call of sympathy to Martin Luther King’s wife, Coretta, when King was in prison was well publicised by the Democrats.
Now as president, Kennedy could either ignore discrimination or he could act. He had promised in his campaign speeches to act swiftly if elected. The 1960 report by the Civil Rights Commission made it very plain in clear statistics just how bad discrimination had affected the African American community.
57% of African American housing was judged to be unacceptable
African American life expectancy was 7 years less than whites
African American infant mortality was twice as great as whites
African Americans found it all but impossible to get mortgages from mortgage lenders.
Property values would drop a great deal if an African American family moved into a neighbourhood that was not a ghetto.
Regardless of his promises, in 1961 Kennedy did nothing to help and push forward the civil rights issue. Why? International factors meant that the president could never focus attention on domestic issues in that year. He also knew that there was no great public support for such legislation. Opinion polls indicated that in 1960 and 1961, civil rights was at the bottom of the list when people were asked “what needs to be done in America to advance society ?” Kennedy was also concentrating his domestic attention on improving health care and helping the lowest wage earners. Civil rights issues would only cloud the issue and disrupt progress in these areas. Kennedy also argued that improving health care and wages for the poor would effectively be civil rights legislation as they would benefit the most from these two.
What did Kennedy do to advance the cause of civil rights?
Kennedy put pressure on federal government organisations to employ more African Americans in America’s equivalent of Britain’s Civil Service. Any who were employed were usually in the lowest paid posts and in jobs that had little prospect of professional progress. The FBI only employed 48 African Americans out of a total of 13,649 and these 48 were nearly all chauffeurs. Kennedy did more than any president before him to have more African Americans appointed to federal government posts. In total, he appointed 40 to senior federal positions including five as federal judges.
Kennedy appointed his brother (Robert) as Attorney General which put him at the head of the Justice Department. Their tactic was to use the law courts as a way of enforcing already passed civil rights legislation. No southern court could really argue against laws that were already in print – though they were very good at interpreting the law in a cavalier way !! The Justice Department brought 57 law suits against local officials for obstructing African Americans who wished to register their right to vote. Local officials from Louisiana were threatened with prison for contempt when they refused to hand over money to newly desegregated schools. Such a threat prompted others in Atlanta, Memphis and New Orleans to hand over finance without too many problems – few if any were willing to experience the American penal system which had a policy of punishment then as opposed to reforming prisoners.
Kennedy was very good at what would appear to be small gestures. In American football, the Washington Redskins were the last of the big teams to refuse to sign African Americans. Their stadium was federally funded and Kennedy ordered that they were no longer allowed to use the stadium and would have to find a new one. The team very quickly signed up African American players.
Kennedy created the CEEO (Commission on Equal Employment Opportunity). Its job was to ensure that all people employed with the federal government had equal employment opportunities it also required all those firms that had contracts with the federal government to do the same if they were to win further federal contracts. However, the CEEO was only concerned with those already employed (though it did encourage firms to employ African Americans) and it did nothing to actively get employment opportunities for African Americans. The CEEO was concerned with those in employment within the federal government…….not the unemployed.
Did Kennedy voluntarily pursue the goal of full civil rights in USA or was he ‘pushed’ into action ?
In many senses, Kennedy’s hands were tied by both national and international events. The reaction of the KKK to the Freedom Rides of 1961 was shown on national television and clearly shocked the public. However, 63% of people polled stated that they believed that the Freedom Rides should not have taken place as they were provocative (even though federal law was on the Riders side). Kennedy himself condemned the Riders for their lack of patriotism at a time of international tension over the Berlin Wall, Cuba and the Bay of Pigs fiasco. For many Americans the world scenario was of much greater importance than specific ‘home difficulties’. Involvement in the Freedom Riders affair would have been politically sensitive especially as Kennedy did not have a sizeable public mandate to initiate major change after the narrowest of victories against Nixon.
In 1961, the Interstate Commerce Commission ruled that transport terminals and interstate bus seating should be desegregated – as the 1948 ruling had already ordered. But if the 1948 Supreme Court decision had been flagrantly ignored over the years, why would people suddenly start obeying the Commission’s ruling in 1961 especially when 63% of the people seemed to be against what the Freedom Riders were attempting to achieve ?
In terms of voter registration, Kennedy’s administration did nothing in its first year in office. On the advice of his Attorney-General brother, Bobby, Kennedy claimed that it was the duty of the states to reform this area and that it was not a federal issue. Here Kennedy was no doubt attempting to win the support of those who believed that federal power was too big and trespassing in too many areas – especially the right of states to govern themselves as laid out in the Constitution.
In the violence seen at Albany in 1961, Kennedy again did nothing as he believed that the trouble had been precipitated by SNCC who were referred to as “sons of bitches” by the president.
In the 1950’s little was seen of black militancy. Progress, albeit on paper, had been made under both Truman and Eisenhower. The lack of obvious improvements under the Kennedy administration saw the start of black militancy. The Nation of Islam had been in existence in the era of Eisenhower, but its real inroads into northern inner cities came in the early 1960’s when little if anything from the federal government was seen to be advancing the cause of African Americans.
Kennedy only became voluntarily active when James Meredith forced his hand. In September 1962, James Meredith applied to a white-only college (the University of Mississippi) to do a doctorate. He was turned down. Here was a man who had served in the US Air Force for 10 years being rejected because of his colour. Meredith got legal add from the NAACP and fought his case. The Supreme Court found in his favour. When he went to enrol, Bobby Kennedy sent 500 marshals to ensure that law and order was maintained. It was not. Nearly 200 of the marshals were injured and two were shot by those who were adamant that Meredith would not go to college. To maintain law and order, something the state government could not do, John Kennedy federalised the Mississippi National Guard and sent federal troops to the university. Meredith did enroll to the university.
But would Kennedy have done anything if Meredith had not taken out legal action against the university? If Meredith had simply accepted his rejection – as illegal as it was – would Kennedy have taken such drastic action ? If Meredith had not existed, would Kennedy have hunted out those educational establishments that were blatantly breaking the law ?
Kennedy was further provoked into action by the 1963 Birmingham affair. The actions ordered by Bull Connor “sickened” Kennedy. The Justice Department was ordered to Birmingham by Bobby Kennedy and improvements quickly took place. Public facilities were desegregated and employment prospects for African Americans in Birmingham did improve somewhat.
Alabama was the last state to have desegregated universities. Kennedy sent in federal troops and federalised the National Guard to enforce the law. Did the events in Birmingham convert him to the civilrights cause? Cynics comment that it may well have been a more concerted attempt by the president to target black voters for the 1964 election.
The 1963 March on Washington was initially opposed by Kennedy as he believed that any march during his presidency would indicate that the leaders of the civil rights campaign were critical of his stance on civil rights. Kennedy also felt that the march could antagonise Congress when it was in the process of discussing his civil rights bill. A march might have been viewed by Congress as external pressure being put on them. Kennedy eventually endorsed the march when it was agreed that the federal government could have an input into it. Malcolm X criticised King’s decision to allow this as he believed that Kennedy was attempting to take over and orchestrate the march. Malcolm X was to nick-name the march “The Farce on Washington”. Historians now view the march as a great success for both King and the federal government as it went well in all aspects – peaceful, informative, well organised etc. The rumours that federal representatives would cut off the PA system if the speeches became too rabble-raising have not been proved.
Was Kennedy a keen civil rights man? In the immediate aftermath of his death, only praise was heaped on the murdered president. To do otherwise would have been considered highly unpatriotic. However, in recent years there has been a re-evaluation of Kennedy and what he did in his presidency. For a man who claimed that poor housing could be ended with the signing of the president’s name, Kennedy did nothing. His Department of Urban Affairs bill was rejected by Congress and eventually only a weak housing act was passed which applied only to future federal housing projects.
Kennedy was a politician and he was acutely aware that Democrats were less than happy with a disproportionate amount of time being spent on civil rights issues when the Cold War was in full flight with Vietnam flaring up and the world settling down after the problems poised by Cuba.
Kennedy was also aware that southern Democrats were still powerful in the party and their wishes could not be totally ignored if the party was not to be split apart – or if Kennedy was not to get the party’s nomination for the 1964 election. However, there is no doubt that the violence that occurred in the South during his presidency horrified and angered him.
For all the charisma that was attached to Kennedy’ name, he had a poor relationship with Congress and without their support nothing would become an act. Kennedy himself said:
“A good many programmes I care about may go down the drain as a result of this (his relationship with Congress) – we may all go down the drain.”
Kennedy had to tread a very fine line in the South. His popularity by September 1963 showed that his support had dropped to 44% in the South. It had been 60% in March 1963. At this time, the South was a traditional stronghold of the Democrats. Now in 2001, it is all but Republican to a state – and the move started in the presidency of Kennedy and grew from it almost certainly as a rejection of the stance taken by a Democrat president.
He was also losing support in the north where it was felt that the administration was too concerned with the African Americans and forgetting about the majority of the people – the whites.
In many senses Kennedy was damned if he did and damned if he did not. If he helped the African Americans in the South, he lost the support of the powerful Democrats there. If he did nothing he faced world-wide condemnation especially after the scenes vividly seen in Birmingham. Even civil rights leaders in the South criticised Kennedy for doing too little. In the north, the majority population was white. This group felt that its problems were being ignored while the problems of the African Americans were being addressed. The militant African Americans of the north as seen in the Nation of Islam condemned Kennedy simply because he epitomised white power based in Washington.
Disastrous Consequences Follow
Nobody asked Rosemary if she was willing to undergo this procedure. Her father decided for her, and at 23 years old, she underwent a lobotomy. Dr. Freeman drilled two holes into her skull and inserted a couple of small spatulas to cut the link between the brain and the prefrontal cortex.
Mrs. Rose Kennedy (c) with their daughters Kathleen and Rosemary. Photo by Hulton-Deutsch Collection/CORBIS/Corbis via Getty Images
Rosemary had not been given any anesthesia during this procedure. She was awake, and she continued to talk to the doctors and nurses. However, once the process was completed, she never spoke again.
Unlike the old New Deal, which was a response to a severe financial and economic calamity, the Great Society initiatives came during a period of rapid economic growth. Kennedy proposed an across-the-board tax cut lowering the top marginal income tax rate in the United States by 20%, from 91% to 71%, which was enacted in February 1964, three months after Kennedy's assassination, under Johnson. The tax cut also significantly reduced marginal rates in the lower brackets as well as for corporations. The gross national product rose 10% in the first year of the tax cut, and economic growth averaged a rate of 4.5% from 1961 to 1968. 
GNP increased by 7% in 1964, 8% in 1965, and 9% in 1966. The unemployment rate fell below 5%, and by 1966 the number of families with incomes of $7,000 a year or more had reached 55%, compared with 22% in 1950. In 1968, when John Kenneth Galbraith published a new edition of The Affluent Society, the average income of the American family stood at $8,000, double what it had been a decade earlier. 
Johnson's first public reference to the "Great Society" took place during a speech to students on May 7, 1964, at Ohio University in Athens, Ohio:
And with your courage and with your compassion and your desire, we will build a Great Society. It is a society where no child will go unfed, and no youngster will go unschooled. 
He later formally presented his specific goals for the Great Society in another speech at the University of Michigan in Ann Arbor, Michigan, on May 22, 1964.
We are going to assemble the best thought and broadest knowledge from all over the world to find these answers. I intend to establish working groups to prepare a series of conferences and meetings—on the cities, on natural beauty, on the quality of education, and on other emerging challenges. From these studies, we will begin to set our course toward the Great Society. 
Almost immediately after the Ann Arbor speech, 14 separate task forces began studying nearly all major aspects of United States society under the guidance of presidential assistants Bill Moyers and Richard N. Goodwin.  In his use of task forces to provide expert advice on policy, Johnson was following Kennedy's example, but unlike Kennedy, Johnson directed his task forces to work in secret.  His intent was to prevent his program from being derailed by public criticism of proposals that had not yet been reviewed.  The average task force had five to seven members and generally was composed of governmental experts and academics. 
After the task force reports were submitted to the White House, Moyers began a second round of review. The recommendations were circulated among the agencies concerned, and strategies were developed for getting the proposed legislation through Congress.  On January 4, 1965, Johnson announced much of his proposed program in his State of the Union Address.
With the exception of the Civil Rights Act of 1964,  the Great Society agenda was not a widely discussed issue during the 1964 presidential election campaign. Johnson won the election with 61% of the vote, and he carried all but six states. Democrats gained enough seats to control more than two-thirds of each chamber in the Eighty-ninth Congress, with a 68–32 margin in the Senate and a 295–140 margin in the House of Representatives. 
Johnson won a large majority of the Jewish vote, a liberal constituency that gave strong support to the Great Society. 
The political realignment allowed House leaders to alter rules that had allowed Southern Democrats to kill New Frontier and civil rights legislation in committee, which aided efforts to pass Great Society legislation. In 1965, the first session of the Eighty-Ninth Congress created the core of the Great Society. It began by enacting long-stalled legislation such as Medicare and federal aid to education and then moved into other areas, including high-speed mass transit, rental supplements, truth in packaging, environmental safety legislation, new provisions for mental health facilities, the Teacher Corps, manpower training, the Head Start program, aid to urban mass transit, a demonstration cities program, a housing act that included rental subsidies, and an act for higher education.  The Johnson Administration submitted 87 bills to Congress, and Johnson signed 84, or 96%, arguably the most successful legislative agenda in US congressional history. 
The Naked Society is a 1964 book on privacy by Vance Packard. The book argues that changes in technology are encroaching on privacy and could create a society in the future with radically different privacy standards. Packard criticized advertisers' unfettered use of private information to create marketing schemes. He compared a recent Great Society initiative by then-president Lyndon B. Johnson, the National Data Bank, to the use of information by advertisers and argued for increased data privacy measures to ensure that information did not find its way into the wrong hands. The essay led Congress to create the Special Subcommittee on the Invasion of Privacy and inspired privacy advocates such as Neil Gallagher and Sam Ervin to fight what they perceived as Johnson's flagrant disregard for consumer privacy. Ervin criticized Johnson's domestic agenda as invasive and saw the unfiltered database of consumers' information as a sign of presidential abuse of power. Ervin warned that "The computer never forgets".  Jerry M. Rosenberg dedicated a chapter of his 1969 book The Death of Privacy to the National Data Bank. 
Civil rights Edit
Historian Alan Brinkley has suggested that the most important domestic achievement of the Great Society may have been its success in translating some of the demands of the civil rights movement into law.  Four civil rights acts were passed, including three laws in the first two years of Johnson's presidency. The Civil Rights Act of 1964  forbade job discrimination and the segregation of public accommodations.
The Voting Rights Act of 1965 assured minority registration and voting. It suspended use of literacy or other voter-qualification tests that had sometimes served to keep African-Americans off voting lists and provided for federal court lawsuits to stop discriminatory poll taxes. It also reinforced the Civil Rights Act of 1964  by authorizing the appointment of federal voting examiners in areas that did not meet voter-participation requirements. The Immigration and Nationality Services Act of 1965 abolished the national-origin quotas in immigration law. The Civil Rights Act of 1968 banned housing discrimination and extended constitutional protections to Native Americans on reservations.
Johnson recognized the benefits and costs of passing civil rights legislation. His support for the 1964 Civil Rights Act was despite his personal opinions on racial matters, as Johnson regularly articulated thoughts and disparaging language against racial minorities, including against African-Americans and Asians.  Scholar and biographer Robert Caro suggested that Johnson used racially charged language to appease legislators in an effort to pass civil rights laws, including adapting how he said the word 'negro' based upon where the legislator's district was located. 
The "War On Poverty" Edit
The most ambitious and controversial part of the Great Society was its initiative to end poverty. The Kennedy Administration had been contemplating a federal effort against poverty. Johnson, who, as a teacher, had observed extreme poverty in Texas among Mexican-Americans, launched an "unconditional war on poverty" in the first months of his presidency with the goal of eliminating hunger, illiteracy, and unemployment from American life. The centerpiece of the War on Poverty was the Economic Opportunity Act of 1964, which created an Office of Economic Opportunity (OEO) to oversee a variety of community-based antipoverty programs.
Federal funds were provided for special education schemes in slum areas, including help in paying for books and transport, while financial aid was also provided for slum clearances and rebuilding city areas. In addition, the Appalachian Regional Development Act of 1965 created jobs in one of the most impoverished regions of the country. [ citation needed ] The Economic Opportunity Act of 1964 provided various methods through which young people from poor homes could receive job training and higher education. 
The OEO reflected a fragile consensus among policymakers that the best way to deal with poverty was not simply to raise the incomes of the poor but to help them better themselves through education, job training, and community development. Central to its mission was the idea of "community action", the participation of the poor in framing and administering the programs designed to help them.
The War on Poverty began with a $1 billion appropriation in 1964 and spent another $2 billion in the following two years. It gave rise to dozens of programs, among them the Job Corps, whose purpose was to help disadvantaged youth develop marketable skills the Neighborhood Youth Corps, established to give poor urban youths work experience and to encourage them to stay in school Volunteers in Service to America (VISTA), a domestic version of the Peace Corps, which placed concerned citizens with community-based agencies to work towards empowerment of the poor the Model Cities Program for urban redevelopment Upward Bound, which assisted poor high school students entering college legal services for the poor and the Food Stamp Act of 1964 (which expanded the federal food stamp program). 
Programs included the Community Action Program, which initiated local Community Action Agencies charged with helping the poor become self-sufficient and Project Head Start, which offered preschool education for poor children. In addition, funding was provided for the establishment of community health centers to expand access to health care,  while major amendments were made to Social Security in 1965 and 1967 which significantly increased benefits, expanded coverage, and established new programs to combat poverty and raise living standards.  In addition, average AFDC payments were 35% higher in 1968 than in 1960, but remained insufficient and uneven. 
The most important educational component of the Great Society was the Elementary and Secondary Education Act of 1965, designed by Commissioner of Education Francis Keppel. It was signed into law on April 11, 1965, less than three months after it was introduced. It ended a long-standing political taboo by providing significant federal aid to public education, initially allocating more than $1 billion to help schools purchase materials and start special education programs to schools with a high concentration of low-income children. During its first year of operation, the Act authorized a $1.1 billion program of grants to states, for allocations to school districts with large numbers of children of low-income families, funds to use community facilities for education within the entire community, funds to improve educational research and to strengthen state departments of education, and grants for the purchase of books and library materials.  The Act also established Head Start, which had originally been started by the Office of Economic Opportunity as an eight-week summer program, as a permanent program.
The Higher Education Facilities Act of 1963, which was signed into law by Johnson a month after becoming president,  authorized several times more college aid within a five-year period than had been appropriated under the Land Grant College in a century. It provided better college libraries, ten to twenty new graduate centers, several new technical institutes, classrooms for several hundred thousand students, and twenty-five to thirty new community colleges a year. 
This major piece of legislation was followed by the Higher Education Act of 1965, which increased federal money given to universities, created scholarships and low-interest loans for students, and established a national Teacher Corps to provide teachers to poverty-stricken areas of the United States. The Act also began a transition from federally funded institutional assistance to individual student aid.
In 1964, basic improvements in the National Defense Education Act were achieved, and total funds available to educational institutions were increased. The yearly limit on loans to graduate and professional students was raised from $1,000 to $2,500, and the aggregate limit was raised from $5,000 to $10,000. The program was extended to include geography, history, reading, English, and civics, and guidance and counseling programs were extended to elementary and public junior high schools. 
The Bilingual Education Act of 1968 offered federal aid to local school districts in assisting them to address the needs of children with limited English-speaking ability until it expired in 2002. 
The Great Society programs also provided support for postgraduate clinical training for both nurses and physicians committed to work with disadvantaged patients in rural and urban health clinics. 
The Social Security Act of 1965 authorized Medicare and provided federal funding for many of the medical costs of older Americans.  The legislation overcame the bitter resistance, particularly from the American Medical Association, to the idea of publicly funded health care or "socialized medicine" by making its benefits available to everyone over sixty-five, regardless of need, and by linking payments to the existing private insurance system.
In 1966 welfare recipients of all ages received medical care through the Medicaid program. Medicaid was created on July 30, 1965 under Title XIX of the Social Security Act of 1965. Each state administers its own Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs and establishes requirements for service delivery, quality, funding, and eligibility standards.
A number of improvements were made to the Social Security program in terms of both coverage and adequacy of benefits. The Tax Adjustment Act of 1966 included a provision for special payments under the social security program to certain uninsured individuals aged 72 and over. The Social Security Amendments of 1965 included a 7% increase in cash benefits, a liberalization of the definition of disability, a liberalization of the amount a person can earn and still get full benefits (the so-called retirement test), payment of benefits to eligible children aged 18–21 who are attending school, payment of benefits to widows at age 60 on an actuarially reduced basis, coverage of self-employed physicians, coverage of tips as wages, liberalization of insured-status requirements for persons already aged 72 or over, an increase to $6,600 the amount of earnings counted for contribution and benefit purposes (the contribution and benefit base), and an increase in the contribution rate schedule. 
The Social Security Amendments of 1967 included a 13% increase in old-age, survivors, and disability insurance benefits, with a minimum monthly benefit of $55 for a person retiring at or after age-65 (or receiving disability benefits), an increase from $35 to $40 in the special age-72 payments, an increase from $1,500 to $1,680 in the amount a person may earn in a year and still get full benefits for that year, monthly cash benefits for disabled widows and disabled dependent widowers at age 50 at reduced rates, a liberalization of the eligibility requirements for benefits for dependents and Survivors of women workers, and an alternative insured-status test for workers disabled before age 31. 
Additionally, new guidelines for determining eligibility for disability insurance benefits, additional non-contributory wage credits for servicemen, broadened coverage of clergy and members of religious orders who have not taken a vow of poverty, and an increase in the contribution and benefit base from $6,600 to $7,800, beginning in 1968. In addition, the Social Security Amendments of 1967 provided the first major amendments of Medicare. These social security amendments extended the coverage of the program to include certain services previously excluded, simplified reimbursement procedures under both the hospital and medical insurance plans, and facilitated the administrative procedures concerning general enrollment periods. 
The Food Stamp Act of 1964 made the program permanent, while the Social Security Amendments of 1967 specified that at least 6% of monies for maternal and child health should be spent on family planning. By 1967, the federal government began requiring state health departments to make contraceptives available to all adults who were poor. Meal programs for low-income senior citizens began in 1965, with the federal government providing funding for "congregate meals" and "home-delivered meals."  The Child Nutrition Act, passed in 1966, made improvements to nutritional assistance to children such as in the introduction of the School Breakfast Program. 
The arts and cultural institutions Edit
Johnson promoted the arts in terms of social betterment, not artistic creativity. He typically emphasized qualitative and quantitative goals, especially the power of the arts to improve the quality of life of ordinary Americans and to reduce the inequalities between the haves and the have-nots. Karen Patricia Heath observes that, "Johnson personally was not much interested in the acquisition of knowledge, cultural or otherwise, for its own sake, nor did he have time for art appreciation or meeting with artists." 
National Endowments for the arts and the humanities Edit
In September 1965, Johnson signed the National Foundation on the Arts and Humanities Act into law, creating both the National Endowment for the Arts and National Endowment for the Humanities as separate, independent agencies. Lobbying for federally funded arts and humanities support began during the Kennedy Administration. In 1963 three scholarly and educational organizations—the American Council of Learned Societies (ACLS), the Council of Graduate Schools in America, and the United Chapters of Phi Beta Kappa—joined together to establish the National Commission on the Humanities. In June 1964, the commission released a report that suggested that the emphasis placed on science endangered the study of the humanities from elementary schools through postgraduate programs. In order to correct the balance, it recommended "the establishment by the President and the Congress of the United States of a National Humanities Foundation." 
In August 1964, Representative William S. Moorhead of Pennsylvania proposed legislation to implement the commission's recommendations. Support from the White House followed in September, when Johnson lent his endorsement during a speech at Brown University. In March 1965, the White House proposed the establishment of a National Foundation on the Arts and Humanities and requested $20 million in start-up funds. The commission's report had generated other proposals, but the White House's approach eclipsed them. The administration's plan, which called for the creation of two separate agencies each advised by a governing body, was the version that the Congress approved. Richard Nixon dramatically expanded funding for NEH and NEA. 
Public broadcasting Edit
After the First National Conference on Long-Range Financing of Educational Television Stations in December 1964 called for a study of the role of noncommercial education television in society, the Carnegie Corporation agreed to finance the work of a 15-member national commission. Its landmark report, Public Television: A Program for Action, published on January 26, 1967, popularized the phrase "public television" and assisted the legislative campaign for federal aid. The Public Broadcasting Act of 1967, enacted less than 10 months later, chartered the Corporation for Public Broadcasting as a private, non-profit corporation.
The law initiated federal aid through the CPB for the operation, as opposed to the funding of capital facilities, of public broadcasting. The CPB initially collaborated with the pre-existing National Educational Television system, but in 1969 decided to start the Public Broadcasting Service (PBS). A public radio study commissioned by the CPB and the Ford Foundation and conducted from 1968 to 1969 led to the establishment of National Public Radio, a public radio system under the terms of the amended Public Broadcasting Act.
Cultural centers Edit
Two long-planned national cultural and arts facilities received federal funding that would allow for their completion through Great Society legislation. A National Cultural Center, suggested during the Franklin Roosevelt Administration and created by a bipartisan law signed by Dwight Eisenhower, was transformed into the John F. Kennedy Center for the Performing Arts, a living memorial to the assassinated president. Fundraising for the original cultural center had been poor prior to legislation creating the Kennedy Center, which passed two months after the president's death and provided $23 million for construction. The Kennedy Center opened in 1971. 
In the late 1930s the U.S. Congress mandated a Smithsonian Institution art museum for the National Mall, and a design by Eliel Saarinen was unveiled in 1939, but plans were shelved during World War II. A 1966 act of the U.S. Congress established the Hirshhorn Museum and Sculpture Garden as part of the Smithsonian Institution with a focus on modern art, in contrast to the existing National Art Gallery. The museum was primarily federally funded, although New York financier Joseph Hirshhorn later contributed $1 million toward building construction, which began in 1969. The Hirshhorn opened in 1974. 
Transportation initiatives started during President Johnson's term in office included the consolidation of transportation agencies into a cabinet-level position under the Department of Transportation.  The department was authorized by Congress on October 15, 1966 and began operations on April 1, 1967. Congress passed a variety of legislation to support improvements in transportation including The Urban Mass Transportation Act of 1964 which provided $375 million for large-scale urban public or private rail projects in the form of matching funds to cities and states and created the Urban Mass Transit Administration (now the Federal Transit Administration), High Speed Ground Transportation Act of 1965 which resulted in the creation of high-speed rail between New York and Washington, and the National Traffic and Motor Vehicle Safety Act of 1966—a bill largely taken credit for by Ralph Nader, whose book Unsafe at Any Speed he claims helped inspire the legislation.
Consumer protection Edit
In 1964, Johnson named Assistant Secretary of Labor Esther Peterson to be the first presidential assistant for consumer affairs.
The Cigarette Labeling and Advertising Act of 1965 required packages to carry warning labels. The Motor Vehicle Safety Act of 1966 set standards through creation of the National Highway Traffic Safety Administration. The Fair Packaging and Labeling Act requires products identify manufacturer, address, clearly mark quantity and servings. The statute also authorized the HEW and the FTC to establish and define voluntary standard sizes. The original would have mandated uniform standards of size and weight for comparison shopping, but the final law only outlawed exaggerated size claims.
The Child Safety Act of 1966 prohibited any chemical so dangerous that no warning can make it safe. The Flammable Fabrics Act of 1967 set standards for children's sleepwear, but not baby blankets.
The Wholesome Meat Act of 1967 required inspection of meat which must meet federal standards. The Truth-in-Lending Act of 1968 required lenders and credit providers to disclose the full cost of finance charges in both dollars and annual percentage rates, on installment loan and sales. The Wholesome Poultry Products Act of 1968 required inspection of poultry which must meet federal standards. The Land Sales Disclosure Act of 1968 provided safeguards against fraudulent practices in the sale of land. The Radiation Safety Act of 1968 provided standards and recalls for defective electronic products.
The environment Edit
Joseph A. Califano, Jr. has suggested that the Great Society's main contribution to the environment was an extension of protections beyond those aimed at the conservation of untouched resources.  In a message he transmitted to Congress, President Johnson said:
The air we breathe, our water, our soil and wildlife, are being blighted by poisons and chemicals which are the by-products of technology and industry. The society that receives the rewards of technology, must, as a cooperating whole, take responsibility for [their] control. To deal with these new problems will require a new conservation. We must not only protect the countryside and save it from destruction, we must restore what has been destroyed and salvage the beauty and charm of our cities. Our conservation must be not just the classic conservation of protection [against] development, but a creative conservation of restoration and innovation.
At the behest of Secretary of the Interior Stewart Udall, the Great Society included several new environmental laws to protect air and water. Environmental legislation enacted included:
- Water Quality Act of 1965 of 1964 of 1966 of 1968 of 1968 of 1965 of 1965 of 1966 of 1968 of 1969
In 1964, the quality of the housing program was improved by requiring minimum standards of code enforcement, providing assistance to dislocated families and small businesses and authorizing below market interest loans for rehabilitating housing in urban renewal areas.  The Housing and Urban Development Act of 1965 included important elements such as rent subsidies for low-income families, rehabilitation grants to enable low-income homeowners in urban renewal areas to improve their homes instead of relocating elsewhere, and improved and extended benefits for relocation payments.  The Demonstration Cities Act of 1966 established a new program for comprehensive neighborhood renewal, with an emphasis on strategic investments in housing renovation, urban services, neighborhood facilities, and job creation activities.  
Rural development Edit
A number of measures were introduced to improve socio-economic conditions in rural areas. Under Title III of the 1964 Economic Opportunity Act, Special Programs to Combat Rural Poverty, the Office for Economic Opportunity was authorized to act as a lender of last resort for rural families who needed money to help them permanently increase their earning capacity. Loans could be made to purchase land, improve the operation of family farms, allow participation in cooperative ventures, and finance non-agricultural business enterprises, while local cooperatives which served low-income rural families could apply for another category of loans for similar purposes. 
Title III also made loans and grants available to local groups to improve housing, education, and child care services for migrant farm workers, while Titles I and II also included potentially important programs for rural development. Title I established the Job Corps which enrolled school dropouts in community service projects: 40% of the corpsmen were to work in a Youth Conservation Corps to carry out resource conservation, beautification, and development projects in the National Forests and countryside. Arguably more important for rural areas were the Community Action Programs authorized by Title II. Federal money was allocated to States according to their needs for job training, housing, health, and welfare assistance, and the States were then to distribute their shares of the Community Action grants on the basis of proposals from local public or non-profit private groups. 
The Public Works and Economic Development Act of 1965 reorganized the Areas Redevelopment Administration (ARA) into the Economic Development Administration (EDA), and authorized $3.3 billion over 5 years while specifying seven criteria for eligibility. The list included low median family income, but the 6% or higher unemployment applied to the greatest number of areas, while the Act also mentioned outmigration from rural areas as a criterion. In an attempt to go beyond what one writer described as "ARA's failed scattershot approach" of providing aid to individual counties and inspired by the European model of regional development, the EDA encouraged counties to form Economic Development Districts (EDDs) as it was recognized that individual distressed counties (called RAs or Redevelopment Areas) lacked sufficient resources for their own development. 
EDDs encompassed from 5 to 15 counties and both planned and implemented development with EDA funding and technical assistance, and each EDD had a "growth center" (another concept borrowed from Europe) called a redevelopment center if it was located in an RA or development center if in another county. With the exception of the growth centers, EDD counties were ineligible for assistance unless they were RAs, but they were all expected to benefit from "coordinated districtwide development planning." 
The Amendments made to the 1931 Davis-Bacon Act in 1964 extended the prevailing wage provisions to cover fringe benefits,  while several increases were made to the federal minimum wage.  The Service Contract Act of 1965 provided for minimum wages and fringe benefits as well as other conditions of work for contractors under certain types of service contracts.  A comprehensive minimum rate hike was also signed into law that extended the coverage of the Fair Labor Standards Act to about 9.1 million additional workers. 
Conservative opposition Edit
In the 1966 midterm elections, the Republicans made major gains in part through a challenge to the "War on Poverty." Large-scale civic unrest in the inner-city was escalating (reaching a climax in 1968), strengthened demand for Law and order.  Urban white ethnics who had been an important part of the New Deal Coalition felt abandoned by the Democratic Party's concentration on racial minorities. Republican candidates ignored more popular programs, such as Medicare or the Elementary and Secondary Education Act, and focused their attacks on less popular programs. Furthermore, Republicans made an effort to avoid the stigma of negativism and elitism that had dogged them since the days the New Deal, and instead proposed well-crafted alternatives—such as their "Opportunity Crusade."  The result was a major gain of 47 House seats for the GOP in the 1966 United States House of Representatives elections that put the conservative coalition of Republicans and Southern Democrats back in business. 
Despite conservatives who attacked Johnson's Great Society making major gains in Congress in the 1966 midterm elections, and with anger and frustration mounting over the Vietnam War, Johnson was still able to secure the passage of additional programs during his last two years in office. Laws were passed to extend the Food Stamp Program, to expand consumer protection, to improve safety standards, to train health professionals, to assist handicapped Americans, and to further urban programs. 
In 1968, a new Fair Housing Act was passed, which banned racial discrimination in housing  and subsidized the construction or rehabilitation of low-income housing units.  That same year, a new program for federally funded job retraining for the hardcore unemployed in fifty cities was introduced, together with the strongest federal gun control bill (relating to the transportation of guns across state lines) in American history up until that point. 
By the end of the Johnson Administration, 226 out of 252 major legislative requests (over a four-year period) had been met, federal aid to the poor had risen from $9.9 billion in 1960 to $30 billion by 1968, one million Americans had been retrained under previously non-existent federal programs, and two million children had participated in the Head Start program.
Interpretations of the War on Poverty remain controversial. The Office of Economic Opportunity was dismantled by the Nixon and Ford administrations, largely by transferring poverty programs to other government departments.  Funding for many of these programs was further cut in President Ronald Reagan's Gramm-Latta Budget in 1981. [ citation needed ]
Alan Brinkley has suggested that "the gap between the expansive intentions of the War on Poverty and its relatively modest achievements fueled later conservative arguments that government is not an appropriate vehicle for solving social problems."  One of Johnson's aides, Joseph A. Califano, Jr., has countered that "from 1963 when Lyndon Johnson took office until 1970 as the impact of his Great Society programs were felt, the portion of Americans living below the poverty line dropped from 22.2 percent to 12.6 percent, the most dramatic decline over such a brief period in this century." 
In the long run, statistical analysis shows that the Official Poverty Rate fell from 19.5 percent in 1963 to 12.3 percent in 2017. However, using a broader definition that includes cash income, taxes, and major in-kind transfers and inflation rates, the "Full-income Poverty Rate" based on President Johnson's standards fell from 19.5 percent to 2.3 percent over that period.  
The percentage of African Americans below the poverty line dropped from 55 percent in 1960 to 27 percent in 1968.  From 1964 to 1967, federal expenditures on education rose from $4 billion to $12 billion, while spending on health rose from $5 billion to $16 billion. By that time, the federal government was spending $4,000 per annum on each poor family of four, four times as much as in 1961. 
The Legacy of John F. Kennedy
Historians tend to rate JFK as a good president, not a great one. But Americans consistently give him the highest approval rating of any president since Franklin D. Roosevelt. Why?
Among the many monuments to John F. Kennedy, perhaps the most striking is the Sixth Floor Museum in Dallas, in the building that was once the Texas School Book Depository. Every year, nearly 350,000 people visit the place where Lee Harvey Oswald waited on November 22, 1963, to shoot at the president’s motorcade. The museum itself is an oddity because of its physical connection to the event it illuminates the most memorable—and eeriest—moment of a visit to the sixth floor is when you turn a corner and face the window through which Oswald fired his rifle as Kennedy’s open car snaked through Dealey Plaza’s broad spaces below. The windows are cluttered once again with cardboard boxes, just as they had been on that sunny afternoon when Oswald hid there.
Visitors from all over the world have signed their names in the memory books, and many have written tributes: “Our greatest President.” “Oh how we miss him!” “The greatest man since Jesus Christ.” At least as many visitors write about the possible conspiracies that led to JFK’s assassination. The contradictory realities of Kennedy’s life don’t match his global reputation. But in the eyes of the world, this reticent man became a charismatic leader who, in his life and in his death, served as a symbol of purpose and hope.
President Kennedy spent less than three years in the White House. His first year was a disaster, as he himself acknowledged. The Bay of Pigs invasion of Communist Cuba was only the first in a series of failed efforts to undo Fidel Castro’s regime. His 1961 summit meeting in Vienna with the Soviet leader Nikita Khrushchev was a humiliating experience. Most of his legislative proposals died on Capitol Hill.
Yet he was also responsible for some extraordinary accomplishments. The most important, and most famous, was his adept management of the Cuban missile crisis in 1962, widely considered the most perilous moment since World War II. Most of his military advisers—and they were not alone—believed the United States should bomb the missile pads that the Soviet Union was stationing in Cuba. Kennedy, aware of the danger of escalating the crisis, instead ordered a blockade of Soviet ships. In the end, a peaceful agreement was reached. Afterward, both Kennedy and Khrushchev began to soften the relationship between Washington and Moscow.
Kennedy, during his short presidency, proposed many important steps forward. In an address at American University in 1963, he spoke kindly of the Soviet Union, thereby easing the Cold War. The following day, after almost two years of mostly avoiding the issue of civil rights, he delivered a speech of exceptional elegance, and launched a drive for a civil-rights bill that he hoped would end racial segregation. He also proposed a voting-rights bill and federal programs to provide health care to the elderly and the poor. Few of these proposals became law in his lifetime—a great disappointment to Kennedy, who was never very successful with Congress. But most of these bills became law after his death—in part because of his successor’s political skill, but also because they seemed like a monument to a martyred president.
Kennedy was the youngest man ever elected to the presidency, succeeding the man who, at the time, was the oldest. He symbolized—as he well realized—a new generation and its coming-of-age. He was the first president born in the 20th century, the first young veteran of World War II to reach the White House. John Hersey’s powerful account of Kennedy’s wartime bravery, published in The New Yorker in 1944, helped him launch his political career.
In shaping his legend, Kennedy’s personal charm helped. A witty and articulate speaker, he seemed built for the age of television. To watch him on film today is to be struck by the power of his presence and the wit and elegance of his oratory. His celebrated inaugural address was filled with phrases that seemed designed to be carved in stone, as many of them have been. Borrowing a motto from his prep-school days, putting your country in place of Choate, he exhorted Americans: “Ask not what your country can do for you—ask what you can do for your country.”
Another contributor to the Kennedy legend, something deeper than his personal attractiveness, is the image of what many came to call grace. He not only had grace, in the sense of performing and acting gracefully he was also a man who seemed to receive grace. He was handsome and looked athletic. He was wealthy. He had a captivating wife and children, a photogenic family. A friend of his, the journalist Ben Bradlee, wrote a 1964 book about Kennedy called That Special Grace.
The Kennedys lit up the White House with writers, artists, and intellectuals: the famous cellist Pablo Casals, the poet Robert Frost, the French intellectual André Malraux. Kennedy had graduated from Harvard, and stocked his administration with the school’s professors. He sprinkled his public remarks with quotations from poets and philosophers.
The Kennedy family helped create his career and, later, his legacy. He could never have reached the presidency without his father’s help. Joseph Kennedy, one of the wealthiest and most ruthless men in America, had counted on his first son, Joe Jr., to enter politics. When Joe died in the war, his father’s ambitions turned to the next-oldest son. He paid for all of John’s—Jack’s—campaigns and used his millions to bring in supporters. He prevailed on his friend Arthur Krock, of The New York Times, to help Jack publish his first book, Why England Slept. Years later, when Kennedy wrote Profiles in Courage with the help of his aide Theodore Sorensen, Krock lobbied successfully for the book to win a Pulitzer Prize.
The Kennedy legacy has a darker side as well. Prior to his presidency, many of JFK’s political colleagues considered him merely a playboy whose wealthy father had bankrolled his campaigns. Many critics saw recklessness, impatience, impetuosity. Nigel Hamilton, the author of JFK: Reckless Youth, a generally admiring study of Kennedy’s early years, summed up after nearly 800 pages:
I. F. Stone, the distinguished liberal writer, observed in 1973: “By now he is simply an optical illusion.”
Kennedy’s image of youth and vitality is, to some degree, a myth. He spent much of his life in hospitals, battling a variety of ills. His ability to serve as president was itself a profile in courage.
Much has been written about Kennedy’s covert private life. Like his father, he was obsessed with the ritual of sexual conquest—before and during his marriage, before and during his presidency. While he was alive, the many women, the Secret Service agents, and the others who knew of his philandering kept it a secret. Still, now that the stories of his sexual activities are widely known, they have done little to tarnish his reputation.
Half a century after his presidency, the endurance of Kennedy’s appeal is not simply the result of a crafted image and personal charm. It also reflects the historical moment in which he emerged. In the early 1960s, much of the American public was willing, even eager, to believe that he was the man who would “get the country moving again,” at a time when much of the country was ready to move. Action and dynamism were central to Kennedy’s appeal. During his 1960 presidential campaign, he kept sniping at the Republicans for eight years of stagnation: “I have premised my campaign for the presidency on the single assumption that the American people are uneasy at the present drift in our national course … and that they have the will and the strength to start the United States moving again.” As the historian Arthur M. Schlesinger Jr., Kennedy’s friend and adviser, later wrote, “The capital city, somnolent in the Eisenhower years, had suddenly come alive … [with] the release of energy which occurs when men with ideas have a chance to put them into practice.”
Kennedy helped give urgency to the idea of pursuing a national purpose—a great American mission. In the 15 years since World War II, ideological momentum had been slowly building in the United States, fueled by anxieties about the rivalry with the Soviet Union and by optimism about the dynamic performance of the American economy.
When Kennedy won the presidency, the desire for change was still tentative, as his agonizingly thin margin over Richard Nixon suggests. But it was growing, and Kennedy seized the moment to provide a mission—or at least he grasped the need for one—even though it was not entirely clear what the mission was. Early in his tenure, a Defense Department official wrote a policy paper that expressed a curious mix of urgent purpose and vague goals:
This reflected John Kennedy’s worldview, one of commitment, action, movement. Those who knew him realized, however, that he was more cautious than his speeches suggested.
John F. Kennedy was a good president but not a great one, most scholars concur. A poll of historians in 1982 ranked him 13th out of the 36 presidents included in the survey. Thirteen such polls from 1982 to 2011 put him, on average, 12th. Richard Neustadt, the prominent presidential scholar, revered Kennedy during his lifetime and was revered by Kennedy in turn. Yet in the 1970s, he remarked: “He will be just a flicker, forever clouded by the record of his successors. I don’t think history will have much space for John Kennedy.”
But 50 years after his death, Kennedy is far from “just a flicker.” He remains a powerful symbol of a lost moment, of a soaring idealism and hopefulness that subsequent generations still try to recover. His allure—the romantic, almost mystic, associations his name evokes—not only survives but flourishes. The journalist and historian Theodore White, who was close to Kennedy, published a famous interview for Life magazine with Jackie Kennedy shortly after her husband’s assassination, in which she said:
And thus a lyric became the lasting image of his presidency.
White, in his memoirs, recalled the reverence Kennedy had inspired among his friends:
Friends were not the only ones enchanted by the Kennedy mystique. He was becoming a magnetic figure even during his presidency. By the middle of 1963, 59 percent of Americans surveyed claimed that they had voted for him in 1960, although only 49.7 percent of voters had actually done so. After his death, his landslide grew to 65 percent. In Gallup’s public-opinion polls, he consistently has the highest approval rating of any president since Franklin D. Roosevelt.
The circumstances of Kennedy’s death turned him into a national obsession. A vast number of books have been published about his assassination, most of them rejecting the Warren Commission’s conclusion that Lee Harvey Oswald acted alone. After the assassination, even Robert F. Kennedy, the president’s brother, spent hours—perhaps days—phoning people to ask whether there had been a conspiracy, until he realized that his inquiries could damage his own career. To this day, about 60 percent of Americans believe that Kennedy fell victim to a conspiracy.
“There was a heroic grandeur to John F. Kennedy’s administration that had nothing to do with the mists of Camelot,” David Talbot, the founder of Salon, wrote several years ago. His book Brothers: The Hidden History of the Kennedy Years, more serious than most Kennedy conspiracy theories, suggested that the president’s bold, progressive goals—and the dangers he posed to entrenched interests—inspired a plot to take his life.
There are many reasons to question the official version of Kennedy’s murder. But there is little concrete evidence to prove any of the theories—that the Mafia, the FBI, the CIA, or even Lyndon B. Johnson was involved. Some people say his death was a result of Washington’s covert efforts to kill Castro. For many Americans, it stretches credulity to accept that an event so epochal can be explained as the act of a still-mysterious loner.
Well before the public began feasting on conspiracy theories, Kennedy’s murder reached mythic proportions. In his 1965 book, A Thousand Days, Schlesinger used words so effusive that they seem unctuous today, though at the time they were not thought excessive or mawkish: “It was all gone now,” he wrote of the assassination: “the life-affirming, life-enhancing zest, the brilliance, the wit, the cool commitment, the steady purpose.”
Like all presidents, Kennedy had successes and failures. His administration was dominated by a remarkable number of problems and crises—in Berlin, Cuba, Laos, and Vietnam and in Georgia, Mississippi, and Alabama. Some of these, he managed adroitly and, at times, courageously. Many, he could not resolve. He was a reserved, pragmatic man who almost never revealed passion.
Yet many people saw him—and still do—as an idealistic and, yes, passionate president who would have transformed the nation and the world, had he lived. His legacy has only grown in the 50 years since his death. That he still embodies a rare moment of public activism explains much of his continuing appeal: He reminds many Americans of an age when it was possible to believe that politics could speak to society’s moral yearnings and be harnessed to its highest aspirations. More than anything, perhaps, Kennedy reminds us of a time when the nation’s capacities looked limitless, when its future seemed unbounded, when Americans believed that they could solve hard problems and accomplish bold deeds.
Second in an occasional series on how Harvard researchers are tackling the problematic issues of aging.
W hen scientists began tracking the health of 268 Harvard sophomores in 1938 during the Great Depression, they hoped the longitudinal study would reveal clues to leading healthy and happy lives.
They got more than they wanted.
After following the surviving Crimson men for nearly 80 years as part of the Harvard Study of Adult Development, one of the world’s longest studies of adult life, researchers have collected a cornucopia of data on their physical and mental health.
Of the original Harvard cohort recruited as part of the Grant Study, only 19 are still alive, all in their mid-90s. Among the original recruits were eventual President John F. Kennedy and longtime Washington Post editor Ben Bradlee. (Women weren’t in the original study because the College was still all male.)
In addition, scientists eventually expanded their research to include the men’s offspring, who now number 1,300 and are in their 50s and 60s, to find out how early-life experiences affect health and aging over time. Some participants went on to become successful businessmen, doctors, lawyers, and others ended up as schizophrenics or alcoholics, but not on inevitable tracks.
During the intervening decades, the control groups have expanded. In the 1970s, 456 Boston inner-city residents were enlisted as part of the Glueck Study, and 40 of them are still alive. More than a decade ago, researchers began including wives in the Grant and Glueck studies.
Over the years, researchers have studied the participants’ health trajectories and their broader lives, including their triumphs and failures in careers and marriage, and the finding have produced startling lessons, and not only for the researchers.
“The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health,” said Robert Waldinger, director of the study, a psychiatrist at Massachusetts General Hospital and a professor of psychiatry at Harvard Medical School. “Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation.”
"The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80,” said Robert Waldinger with his wife Jennifer Stone.
Rose Lincoln/Harvard Staff Photographer
Close relationships, more than money or fame, are what keep people happy throughout their lives, the study revealed. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes. That finding proved true across the board among both the Harvard men and the inner-city participants.
The long-term research has received funding from private foundations, but has been financed largely by grants from the National Institutes of Health, first through the National Institute of Mental Health, and more recently through the National Institute on Aging.
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Researchers who have pored through data, including vast medical records and hundreds of in-person interviews and questionnaires, found a strong correlation between men’s flourishing lives and their relationships with family, friends, and community. Several studies found that people’s level of satisfaction with their relationships at age 50 was a better predictor of physical health than their cholesterol levels were.
“When we gathered together everything we knew about them about at age 50, it wasn’t their middle-age cholesterol levels that predicted how they were going to grow old,” said Waldinger in a popular TED Talk. “It was how satisfied they were in their relationships. The people who were the most satisfied in their relationships at age 50 were the healthiest at age 80.”
TED talk / Robert Waldinger
He recorded his TED talk, titled “What Makes a Good Life? Lessons from the Longest Study on Happiness,” in 2015, and it has been viewed 13,000,000 times.
The researchers also found that marital satisfaction has a protective effect on people’s mental health. Part of a study found that people who had happy marriages in their 80s reported that their moods didn’t suffer even on the days when they had more physical pain. Those who had unhappy marriages felt both more emotional and physical pain.
Those who kept warm relationships got to live longer and happier, said Waldinger, and the loners often died earlier. “Loneliness kills,” he said. “It’s as powerful as smoking or alcoholism.”
According to the study, those who lived longer and enjoyed sound health avoided smoking and alcohol in excess. Researchers also found that those with strong social support experienced less mental deterioration as they aged.
In part of a recent study, researchers found that women who felt securely attached to their partners were less depressed and more happy in their relationships two-and-a-half years later, and also had better memory functions than those with frequent marital conflicts.
“Good relationships don’t just protect our bodies they protect our brains,” said Waldinger in his TED talk. “And those good relationships, they don’t have to be smooth all the time. Some of our octogenarian couples could bicker with each other day in and day out, but as long as they felt that they could really count on the other when the going got tough, those arguments didn’t take a toll on their memories.”
Since aging starts at birth, people should start taking care of themselves at every stage of life, the researchers say.
“Aging is a continuous process,” Waldinger said. “You can see how people can start to differ in their health trajectory in their 30s, so that by taking good care of yourself early in life you can set yourself on a better course for aging. The best advice I can give is ‘Take care of your body as though you were going to need it for 100 years,’ because you might.”
The study, like its remaining original subjects, has had a long life, spanning four directors, whose tenures reflected their medical interests and views of the time.
Under the first director, Clark Heath, who stayed from 1938 until 1954, the study mirrored the era’s dominant view of genetics and biological determinism. Early researchers believed that physical constitution, intellectual ability, and personality traits determined adult development. They made detailed anthropometric measurements of skulls, brow bridges, and moles, wrote in-depth notes on the functioning of major organs, examined brain activity through electroencephalograms, and even analyzed the men’s handwriting.
Now, researchers draw men’s blood for DNA testing and put them into MRI scanners to examine organs and tissues in their bodies, procedures that would have sounded like science fiction back in 1938. In that sense, the study itself represents a history of the changes that life brings.
Psychiatrist George Vaillant, who joined the team as a researcher in 1966, led the study from 1972 until 2004. Trained as a psychoanalyst, Vaillant emphasized the role of relationships, and came to recognize the crucial role they played in people living long and pleasant lives.
In a book called “Aging Well,” Vaillant wrote that six factors predicted healthy aging for the Harvard men: physical activity, absence of alcohol abuse and smoking, having mature mechanisms to cope with life’s ups and downs, and enjoying both a healthy weight and a stable marriage. For the inner-city men, education was an additional factor. “The more education the inner city men obtained,” wrote Vaillant, “the more likely they were to stop smoking, eat sensibly, and use alcohol in moderation.”
Vaillant’s research highlighted the role of these protective factors in healthy aging. The more factors the subjects had in place, the better the odds they had for longer, happier lives.
“When the study began, nobody cared about empathy or attachment,” said Vaillant. “But the key to healthy aging is relationships, relationships, relationships.”
The study showed that the role of genetics and long-lived ancestors proved less important to longevity than the level of satisfaction with relationships in midlife, now recognized as a good predictor of healthy aging. The research also debunked the idea that people’s personalities “set like plaster” by age 30 and cannot be changed.
“Those who were clearly train wrecks when they were in their 20s or 25s turned out to be wonderful octogenarians,” he said. “On the other hand, alcoholism and major depression could take people who started life as stars and leave them at the end of their lives as train wrecks.”
Professor Robert Waldinger is director of the Harvard Study of Adult Development, one of the world’s longest studies of adult life. Rose Lincoln/Harvard Staff Photographer
The study’s fourth director, Waldinger has expanded research to the wives and children of the original men. That is the second-generation study, and Waldinger hopes to expand it into the third and fourth generations. “It will probably never be replicated,” he said of the lengthy research, adding that there is yet more to learn.
“We’re trying to see how people manage stress, whether their bodies are in a sort of chronic ‘fight or flight’ mode,” Waldinger said. “We want to find out how it is that a difficult childhood reaches across decades to break down the body in middle age and later.”
Lara Tang ’18, a human and evolutionary biology concentrator who recently joined the team as a research assistant, relishes the opportunity to help find some of those answers. She joined the effort after coming across Waldinger’s TED talk in one of her classes.
“That motivated me to do more research on adult development,” said Tang. “I want to see how childhood experiences affect developments of physical health, mental health, and happiness later in life.”
Asked what lessons he has learned from the study, Waldinger, who is a Zen priest, said he practices meditation daily and invests time and energy in his relationships, more than before.
“It’s easy to get isolated, to get caught up in work and not remembering, ‘Oh, I haven’t seen these friends in a long time,’ ” Waldinger said. “So I try to pay more attention to my relationships than I used to.”
As an approved provider for mental health professionals, social workers, and nurses, JFK University Continuing Education offers a diverse selection of courses to meet your licensing and professional development needs. You can learn about the latest diagnostic tools and therapeutic approaches for the issues your patients face or explore a clinical area in-depth to enhance your professional expertise. Our instructors are experts in their fields who will equip you with the practical skills and tools you need. Choose courses offered online and onsite at one of our two Bay Area campuses.
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Stress is defined as a process in which environmental demands strain an organism’s adaptive capacity resulting in both psychological demands as well as biological changes that could place at risk for illness (1). Things that cause us stress are called stressors. Stress affects everyone, young and old, rich and poor. Life is full of stress. Stress is an every fact of life that we must all deal with. It comes in all shapes and sizes even our thoughts can cause us stress and make the human body more susceptible to illness. There are three theories or perspectives regarding stress environmental stress, psychological (emotional) stress and biological stress (1). The environmental stress perspective emphasizes assessment of environmental situations or experiences that are objectively related to substantial adaptive demands. The psychological stress perspective emphasizes people’s subjective evaluations of their ability to cope with demands presented to them by certain situations and experiences. Finally, the biological stress perspective emphasizes the function of certain physiological systems in the body that are regulated by both psychologically and physically demanding conditions.
The relationship between stress and illness is complex. The susceptibility to stress varies from person to person. An event that causes an illness in a person may not cause illness in other person. Events must interact with a wide variety of background factors to manifest as an illness. Among the factors that influenced the susceptibility to stress are genetic vulnerability, coping style, type of personality and social support. When we are confronted with a problem, we assess the seriousness of the problem and determine whether or not we have the resources necessary to cope with problem. If we believe that the problem is serious and do not have the resources necessary to cope with the problem, we will perceive ourselves as being under stress (2). It is our way of reacting to the situations that makes a difference in our susceptibility to illness and our overall well-being.
Not all stress has negative effect. When the body tolerates stress and uses it to overcome lethargy or enhance performance, the stress is positive, healthy and challenging. Hans Selye (3), one of the pioneers of the modern study of stress, termed this eustress. Stress is positive when it forces us to adapt and thus to increase the strength of our adaptation mechanisms, warns us that we are not coping well and that a lifestyle change is warranted if we are to maintain optimal health. This action-enhancing stress gives the athlete the competitive edge and the public speaker the enthusiasm to project optimally. Stress is negative when it exceeds our ability to cope, fatigues body systems and causes behavioral or physical problems. This harmful stress is called distress. Distress produces overreaction, confusion, poor concentration and performance anxiety and usually results in sub par performance. Figure 1 illustrates this concept.
Eustress is the action-enhancing stress that give athletes the competitive edge
There is a growing concern about the increasing cost and prevalence of stress-related disorders especially in relation to work place. “Worked to death, drop death, work until you drop” are highlighted “work-related death” in the 21 st century. Countries renowned for their long working hours know this well enough Japan and China each have a word for death by overwork – karoshi and guolaosi respectively. Both Japan and Korea recognize suicide as an official and compensatable work-related condition (4). The estimated prevalence of stress and stress-related conditions in the United Kingdom rose from 829 cases per 100,000 workers in 1990 to 1,700 per 100,000 in 2001/2002. In that year, 13.4 million lost working days were attributed to stress, anxiety or depression, with an estimate 265,000 new cases of stress. The latest HSE (Health and Safety Executive) analysis of self-reported illnesses rate revealed that stress, depression or anxiety affects 1.3% of the workforce (5). It is estimated that 80% to 90% of all industrial accidents are related to personal problem and employees’ inability to handle stress (6). The European Agency for Safety and Health at work reported that about 50% of job absenteeism is caused by stress (7).
The morbidity and mortality due to stress-related illness is alarming. Emotional stress is a major contributing factor to the six leading causes of death in the United States: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver and suicide. According to statistics from Meridian Stress Management Consultancy in the U.K, almost 180,000 people in the U.K die each year from some form of stress-related illness (7). The Centre for Disease Control and Prevention of the United States estimates that stress account about 75% of all doctors visit (7). This involves an extremely wide span of physical complaints including, but not limited to headache, back pain, heart problems, upset stomach, stomach ulcer, sleep problems, tiredness and accidents. According to Occupational Health and Safety news and the National Council on compensation of insurance, up to 90% of all visits to primary care physicians are for stress-related complaints.
Stress and the immune system
Our immune system is another area which is susceptible to stress. Much of what we know about the relationship between the brain, the nervous system, and the immune response has come out of the field of psychoneuroimmunology (PNI). PNI was developed in 1964 by Dr. Robert Ader, the Director of the Division of Behavioral and Psychosocial Medicine at the University of Rochester. Psychoneuroimmunology is the study of the intricate interaction of consciousness (psycho), brain and central nervous system (neuro), and the body’s defence against external infection and aberrant cell division (immunology) (8). More specifically it is devoted to understanding the interactions between the immune system, central nervous system and endocrine system. Although a relatively new medical discipline, the philosophical roots of the connection between physical health, the brain and emotions can be traced to Aristotle.
Immune responses are regulated by antigen, antibody, cytokines and hormones. Lymphocytes are most responsible for orchestrating the functions of the immune system. The immune system has about 1 trillion lymphocytes. Lymphocytes that grow and mature in the thymus are called T cells other lymphocytes are called B cells. B cells secrete antibodies, chemicals that match specific invaders called antigens (humoral immunity). T cells do not secrete antibodies but act as messengers and killers, locating and destroying invading antigens (cellular immunity). Some T cells, called helpers, help activate the production of other T and B cells. Other T cells, called suppressors, stop the production of antigens, calling off the attack. The number of T and B cells must be balanced for them to perform effectively. When the ratio of T to B cells is out of balance, the immune response is compromised and does not work effectively. Other key chemicals that are produced by the immune systems are macrophages, monocytes and granulocytes. These chemicals envelop, destroy and digest invading microorganisms and other antigens. Known generally as phagocytes, they team up with more than 20 types of proteins that make up the immune system’s complement system. This system is triggered by antibodies that lock onto antigens, which cause inflammatory reactions.
Cytokines are non-antibody messenger molecules from a variety of cells of the immune system. Cytokines stimulate cellular release of specific compounds involved in the inflammatory response. They are made by many cell populations, but the predominant producers are helper T cells (Th) and macrophages. Th1 and Th2 cytokines inhibit one another’s production and function: Th1 cells stimulate cellular immunity and suppress humoral immunity, while Th2 cytokines have opposite effect. Cytokines is a general name other specific name includes lymphokines (cytokines produced by lymphocytes), chemokines (cytokines with chemotactic activities), interleukin (IL) (cytokines made by one leukocyte and acting on other leukocytes) and interferon (IFN) (cytokines release by virus-invaded cell that prompt surrounding cell to produce enzymes that interfere with viral replication).
Cytokines are produced de novo in response to an immune stimulus. They generally act over short distances and short time spans and at very low concentration. They act by binding to specific membrane receptors, which then signal the cell via second messenger, often tyrosine kinases, to alter its behaviour (gene expression). Responses to cytokines include increasing or decreasing expression of membrane proteins (including cytokines receptors), proliferation and secretion of effectors molecules. The largest group of cytokines stimulates immune cell proliferation and differentiation. Some common bacterial antigens activate complement and stimulate macrophages to express co-stimulatory molecules. Antigens stimulate adaptive immune responsiveness by activating lymphocytes, which in turn make antibody to activate complement and cytokines to increase antigen elimination and recruit additional leukocytes.
Several studies have shown that chronic stress exerts a general immunosuppressive effect that suppresses or withholds the body’s ability to initiate a prompt, efficient immune reaction (9,10). This has been attributed to the abundance of corticosteroids produced during chronic stress, which produces an imbalance in corticosteroid levels and weakens immunocompetence. This weakening of immune function is thought to be associated with general strain on the various body parts associated with the production and maintenance of the immune system. For example, atrophy of the thymus or shrinking of the thymus results in its inability to produce T cells or the hormones needed to stimulate them. This can lead to an imbalance and inefficiency of the entire immune response. This is consistence with the finding that as we get elder, we are prone to suffer from infection, cancer, hypersensitivity and autoimmunity.
In a meta-analysis of 293 independent studies reported in peer-reviewed scientific journal between 1960 and 2001 with some 18,941 taking part, it is confirmed that stress alters immunity (11). Short-term stress actually boosts the immune system as it readies itself to meet and overcome a challenge such as an adaptive response preparing for injury or infection but long-term or chronic stress causes too much wear and tear, and the system will break down especially if the individual has little control over events. The analyses (11) revealed that the most chronic stressors which change people’s identities or social roles, are more beyond their control and seem endless–were associated with the most global expression of immunity almost all measures of immune function dropped across the board. Duration of stress also plays a role. The longer the stress, the more the immune system shifted from potentially adaptive changes (such as those in fight-or-flight response) to potentially detrimental changes, at first in cellular immunity and then in broader immune function. They also found that the immune systems of people who are older or already sick are more prone to stress-related change.
The link between stress and illness
The critical factor associated with stress is its chronic effect over time. Chronic stressors include daily hassles, frustration of traffic jams, work overload, financial difficulties, marital arguments or family problems. There are, of course, many more things that can cause stress, but these are the stressors commonly encountered in daily life. The pent-up anger we hold inside ourselves toward any of these situations, or the guilt and resentment we hold toward others and ourselves, all produce the same effects on the hypothalamus. Instead of discharging this stress, however, we hold it inside where its effects become cumulative.
Research shows that almost every system in the body can be influenced by chronic stress. When chronic stress goes unreleased, it suppresses the body’s immune system and ultimately manifests as illness. One can only wonder what would happen to the body if it remained in the fight-or-flight response. Fortunately, under normal circumstances, three minutes after a threatening situation is over and the real or imagined danger is removed, the fight-or-flight response subsides and the body relaxes and returns to its normal status. During this time heart rate, blood pressure, breathing, muscle tension, digestion, metabolism and the immune system all return to normal. If stress persists after the initial fight-or-flight reaction, the body’s reaction enters a second stage. During this stage, the activity if the sympathetic nervous system declines and adrenaline secretion is lessened, but corticosteroid secretion continues at above normal levels. Finally, if stress continues and the body is unable to cope, there is likely to be breakdown of bodily resources.
In asthma, both external and internal factors are involved it is the internal factor that is most affected by acute effects of psychological stressors. Family therapy is widely incorporated in the management of asthmatic children. The improvement is attributed to minimizing the interaction with parents that produced frequent stressful situation. Additionally, asthmatics exposed to a harmless substance that they thought they were allergic would elicit a severe attack (12). A study by Gauci et al. (13) demonstrated significant positive correlations between a few of Minnesota Multiphasic Personality Inventory (MMPI) distressed-related scales and skin reactivity in response to allergens. Collectively, these data provide evidence for a clear association between stress, immune dysfunction and clinical activity of atopic and asthmatic disease. For further reference, Liu et al. (14) provided excellent evidence that stress can enhance allergic inflammatory response.
Gastrointestinal diseases such as peptic ulcer (PU) and ulcerative colitis (UC) are known to be greatly influenced by stress. PU occurs twice as often in air traffic controllers as in civilian copilots, and occurs more frequently among air traffic controllers at high-stress centers (Chicago O’Hare, La Guardia, JFK and Los Angeles International Airport) than low-stress centers (airports in less-populated cities in Virginia, Ohio, Texas and Michigan). Although stress is a risk factor in PU, more than 20 other factors are thought to be associated as well: blood type, sex, HLA antigen type, alcoholic cirrhosis, hypertension, chronic obstructive pulmonary disease, cigarette smoking, and even consumption of coffee, carbonated beverage or milk during college (12). Certain stressful life events have been associated with the onset or symptom exacerbation in other common chronic disorders of the digestive system such as functional gastrointestinal disorders (FGD), inflammatory bowel disease (IBD) and gastro-esophageal reflux disease (GERD). Early life stress in the form of abuse also plays a major role in the susceptibility to develop FGD as well as IBD later in life (15).
Ulcers are caused by excessive stomach acid, and studies of patients with gastric fistulas have shown that anger and hostility increase stomach acidity, while depression and withdrawal decrease it. Other theory correlating the effects of stress on the development of ulcers linked to the mucous coating that lines the stomach. The theory states that, during chronic stress, noradrenaline secretion causes capillaries in the stomach lining to constrict. This in turn, results in shutting down of mucosal production, and the mucous protective barrier for the stomach wall is lost. Without the protective barrier, hydrochloric acid breaks down the tissue and can even reach blood vessels, resulting in a bleeding ulcer (16). However, it has recently been discovered that many cases of ulcers are caused by a bacterial called Helicobacter pylori (H. pylori) (17). Although the exact mechanism by which it causes ulcers is unknown, it is believed that H. pylori inflames the gastrointestinal lining, stimulates acid production or both.
Coronary Heart disease (CHD) has long been regarded as a classical psychosomatic illness in that its onset or course was influenced by a variety of psychosocial variables. Psychosocial aspects of CHD had been studied extensively and there is strong evidence that psychological stress is a significant risk factor for CHD and CHD mortality (18,19,20,21). Tennant (19) found a positive relationship between life stress and cardiac infarction and sudden death while study by Rosengren et al. (20) reported that CHD mortality was increased two folds for men experiencing three or more antecedent life events. The INTERHEART study (21) revealed that people with myocardial infarction reported higher prevalence of four stress factors: stress at work and at home, financial stress and major life events in the past year.
Although the evidences supporting an association between type A behaviour (aggressive, competitive, work-oriented and urgent behaviour) and CHD were conflicting (22) some studies found that type A individuals generate more stressful life events and were more likely than others to interpret encountered life event in an emotionally adverse way (23, 24). If type A is a risk factor it may not operate by way of long-term physiological dysfunction (leading to atherogenesis), but by way of acute life events provoking severe strain on the heart. One of the components of Type A behaviour is hostility, which may be correlated with CHD risk. Some studies (25, 26) noted that clinical CHD events are predicted by hostility and this seems to independent of other risk factors. Hostility was also found to be related to atherosclerosis in some angiography studies (27,28). Other studies found suppression of anger was associated with CHD event (29) and atherosclerosis (27,28). In review of these findings, Tennant (30) concluded that the possibility emerges that hostility (or its suppression) may have some role in CHD, although the mechanism is unclear.
The three major risk factors commonly agreed to be associated with CHD are hyper cholesterolemia, hypertension and cigarette smoking. In attempt to determine the causes of increased levels of serum cholesterol Friedman et al. (31) conducted one of the early investigations of the relationship between stress and serum cholesterol. They found that stress is one of the causes of increased levels of serum cholesterol. Other researchers who studied the medical students facing the stress of exam (32), and military pilot at the beginning of their training and examination period (33) verified the findings. Since blood pressure and serum cholesterol increases during stress, the relationship between stress and hypertension has long been suspected emotional stress is generally regarded as a major factor in the etiology of hypertension (34). One of the early evidence of this relationship came from the massive study of 1,600 hospital patients by Dunbar (35). He found that certain personality traits were characteristic of hypertensive patients for example they were easily upset by criticism or imperfection, possessed pent-up anger and lack self-confidence. Recognizing this relationship, educational programs for hypertensive patients have included stress management.
It appears that some people are hereditarily susceptible to rheumatoid arthritis (RA). Approximately half of the sufferers of this condition have a blood protein called the rheumatoid factors (RF), which is rare in non-arthritic people. Since RA involves the body turning on itself (an autoimmune response), it was hypothesized that a self-destructive personality may manifest itself through this disease (16). Although the evidence to support this hypothesis is not conclusive, several investigators have found personality differences between RA sufferers and others. Those affected with this disease have been found to be perfectionists and are self-sacrificing, masochistic, and self-conscious. Female patients were found to be nervous, moody and depressed, with a history of being rejected by their mothers and having strict fathers. It has been suggested that people with the RF who experience chronic stress become susceptible to RA (16). Their immunological system malfunctions and genetic predisposition to RA results in their developing of the condition.
Migraine headaches are the result of constriction and dilatation of the carotid arteries of one side of the head. The constriction phase, called the prodrome, is often associated with light or noise sensitivity, irritability and a flushing or pallor of the skin. When the dilatation of the arteries occurs, certain chemicals stimulate adjacent nerve endings, causing pain. Diet may precipitate migraine headaches for some people. However, predominant thought on the cause of migraine pertains to emotional stress and tension. Feeling of anxiety, nervousness, anger or repressed rages are associated with migraine. An attack may be aborted when the individual gives vent to underlying personality (8). A typical migraine sufferer is a perfectionist, ambitious, rigid, orderly, excessively competitive and unable to delegate responsibility.
There is also evidence that emotionally stressful experience is associated with endocrine disorder such as diabetes mellitus (36). Physical or psychological stressors can alter insulin needs stressors may often be responsible for episodes of loss of control, especially in diabetic children. Type II diabetes is most often affected by stress, as it tends to occur in overweight adults and is a less severe form of diabetes (12). Additionally, children who had stressful life events stemming from actual or threatened losses within the family and occurring between the ages of 5 and 9 had a significantly higher risk of type I diabetes.
Acute stress can suppress the virus-specific antibody and T cell responses to hepatitis B vaccine (37). People who show poor responses to vaccines have higher rate of illness including influenza virus infection. There are several other studies which demonstrated a relationship between psychological stress and susceptibility to several cold viruses (38,39). This is not surprising, as stress does suppress the immune system latent viruses then have an easier time resurging since the body cannot defend itself any more. Attempts to find an association between stress and disease progression in patients with acquired immunodeficiency syndrome (AIDS) have met with conflicting results (40). Analysis of the Multicentre AIDS Cohort Study failed to observe an association between depression and the decline of CD4+ T lymphocytes, disease progression or death (41), but others have found significant association between immunological parameters reflective of HIV progression and psychosocial factors, particularly denial and distress (42), and concealment of homosexual identity (43).
A large body of research in the past four decades has provided evidence that recent life events contribute to the onset of psychiatric illness (44). The association between stressful life events and psychiatric illness is stronger than the association with physical or medical illness. Vincent and Roscenstock (45) found that prior to hospitalization, patients with psychiatric disorders had suffered more stressful event than those with physical disorders. Meanwhile, Andrew and Tennant (46) failed to find the association between stress and physical illness. Although the exact relationship between stress and psychiatric illness is not clear, the final pathway is biochemical. As with medical illness, the appropriate model is one of multifactorial causations. Most life event research indicates a limit of 6 months to consider a stress having significant effect on illness. After that, the effect of stress diminishes with time.
Recent life events held to have a major etiological role in neuroses, a formative role in the onset of neurotic depression (mixed depressive illness) and a precipitating role in schizophrenic episodes (47). In other words, the association of stress with psychiatric illness is the strongest in neuroses, followed by depression and schizophrenia is the least. The correlation between neuroses and schizophrenia with stress is clearer. The weak association between stressful life events and onset of psychotic illness, particularly schizophrenia had been demonstrated in a few studies (48,49,50), in contrast with strong association between stress and neuroses (51,52, 53,54). However the degree of relationship between depressive illness and neuroses in relation to stress is rather controversial. Neither Paykel (55) nor Brown et al. (56) found the relationship between life event stress and illness is greater for neurotic depression than unipolar (endogenous) depression.
Bebbington et al. (57) found that there is an excess of life events preceding the onset of all types of psychoses, particularly in the first 3 months. In the study of recent onset of schizophrenia, schizophreniform disorder and hypomania, Chung et al. (49) found that threatening life events were significantly related to the onset of schizophreniform psychosis but not schizophrenia. They also found that threatening events might precipitate hypomanic episodes. Other study (50) found that individuals with schizophrenia do not experience more stressful life events than normal controls, but they reported greater subjective stress. A study that investigated the relationship between recent life events and episodes of illness in schizophrenia found that, initial or early episodes of schizophrenia are more likely to be associated with recent life events than are later episodes (48).
On the other hand, bipolar disorders have received less study than unipolar. In bipolar disorder, the effect of life events is generally weaker than unipolar however major life events may be important in first onset (58). Causative factors in bipolar disorders are multifactorial and complex, and genetic factor seems to influence life events exposure. Those with greater genetic loading, there were fewer stressful life events before the first episode and they had the earlier onset of the disease. A number of studies have shown that the onset of depression is often preceded by stressful life events (59,60). Stressful life events along with recent minor difficulties have also been identified as predictors of an episode of depression in a monozygotic female twin study. Kessler (61) who came with the same conclusion added that there is evidence that concomitant chronic stress enhances the effect of major life events on depression.
Cooper and Sylph (51) documented the role of life events in the causation of neurotic illness. They found that neurotic group reported 50% more stressful events than the control group. McKeon et al. (52) found that patients with obsessive-compulsive neuroses who have abnormal personality traits (obsessional, anxious and self-conscious) experienced significantly fewer life events than those without such traits. Zheng and Young (53) in comparing live event stress between neurotic patients and normal control found that neurotic patients had significantly higher level of stress and experienced more life event changes than the control group. Rajendran et al. (54) who compared the neurotic executives with healthy executives as a control group, found significant differences between normal and neurotic groups in terms of the frequency of the life events as well as the stress they experienced due to those life events.
Stress and cancer
The relationship between breast cancer and stress has received particular attention. Some studies have indicated an increased incidence of early death, including cancer death among people who have experienced the recent loss of a spouse or loved one. A few studies of women with breast cancer have shown significantly high rate of disease among those women who experienced traumatic life events and loses within several years before their diagnosis. However, most cancers have been developing for many years and are diagnosed only after they have been growing in the body for a long time. Thus, this fact argues against an association between the death of a loved one and the triggering of cancer. There is no scientific evidence of a direct cause-and-effect relationship between these immune systems changes and the development of cancer. It has not been shown that stress-induced changes in the immune system directly cause cancer. However, more research is needed to find if there is a relationship between psychological stress and the transformation of normal cells into cancerous cells. One area that is currently being studied is whether psychological interventions can reduce stress in the cancer patients, improve immune function and possibly even prolonged the survival.
Studies in animals, mostly rats, revealed the link between stress and progression of cancerous tumors. Chronic and acute stress, including surgery and social disruptions, appear to promote tumor growth. It is easy to do such research in animal, but it is harder with humans. Furthermore, the interactions of many systems that affect cancer, from the immune system to the endocrine system, along with environment factors that are impossible to control for, make sorting out the role of stress extremely difficult. In addition, researchers cannot expose people to tumour cells as they do with animals. A recent study (62) found that there was a link between stress, tumour development and a type of white blood cells called natural killer (NK) cells. Of all the immune systems cells, NK cells have shown the strongest links to fighting certain forms of the disease, specifically preventing metastasis and destroying small metastases. Although the result of this study is not definitive, it is indicates that stress acts by suppressing NK-cell activity. Other preliminary study showed the evidence of a weakened immune system in breast cancer patients who feel high level of stress compared to those experiencing less stress.
A new study shows stress and social supports are important influences in a man’s risk for developing prostate cancer. Researchers (63) at State University of New York at Stony Brook’s medical school found men with high level of stress and a lack of satisfying relationships with friends and family had higher levels of Prostate-Specific Antigen (PSA) in their blood, a marker for an increased risk of developing prostate cancer. Based on the results, the risk of having an abnormal PSA was three times higher for men with high levels of stress. Likewise, men who had felt they had low levels of support from friends and family were twice as likely to have an abnormal PSA. The findings raise the possibility that a man’s psychological state can have a direct impact on prostate disease.