He was shouting at me! He looked crazy!”, my 95 year old mother exclaimed about President Biden’s State of the Union speech. “He looked angry and just shouted,” her eyes wide. Indeed, I had been present at eight State of the Union speeches by Presidents Clinton and Bush and I had not seen anything quite like the partisan speech Biden gave. I watched it with a fellow retired physician who is a Democratic and President Biden’s demeanor was so out of character that we both wondered if he’d taken a stimulant. My wife is a retired family physician, has treated dementia and stroke patients with Adderall and Ritalin, and wondered the same.
Other physicians I know think similarly. A few comments from them: “If you look at how Biden usually is—slow and stumbling—compared to how he was during the State of The Union--fiery and angry—these are signs that are typical for someone taking Adderall or any amphetamine,” and "Adderall or Provigil are the GO pills used by Military Air Force--next day was running for Congress again," and "Absolutely yes. I considered modafanil which the military has used for years." An anesthesiologist tells me, " I absolutely was thinking they pumped him up with either adderall, ritalin or modafanil. He also appeared to be very “edgy.” I have taken modafanil previously for a sleep disorder and that’s exactly how I would describe how I felt." Dr Carol Lieberman, a California psychiatrist speculated elsewhere that in light of Biden’s signs of dementia with his episodes of aggression to reporters and Iowa caucus voters, inability to remember critical things, and repeated mental lapses in his special counsel interview, he may have been given a stimulant to keep him alert and focused in his address.
Of course, Biden’s main job during the address was to show energy and not make any huge gaffes. Though he did muff Laken Riley’s name, he largely succeeded with the political class on CNN and MSNBC. Joe Scarborough, with whom I served in Congress when he was a Republican, said Biden gave, “his best speech of his presidency by far. . .strongest speech, and most importantly, for people that were thinking, “’Oh, he’s too old.’. . .he gave a lot more than he got.” CNN’s Stephen Collinson wrote that Biden, “projected vigor and forcefulness” and “was a trenchant master of the chamber of the House of Representatives, effectively wielding the theatrics of the presidency and commanding an hour of unfiltered prime time television.” The next day in public Biden, maybe without his medication, was his old bumbling self.
However, for many like my mother the president’s comportment did not come off as strength but instead as weirdly hyper aggressive. They feel that vigor and yelling aren’t the same thing. The post-speech polls like the ABC News, Ipsos poll show that a plurality thought he did better than expected (very low pre-speech expectations) but that his approval ratings did not improve. Two thirds of Americans continue to disapprove of Biden’s handling of immigration (66%), inflation (68%), the Israeli/Hamas war (65%) crime (62%) and the economy (60%). A CBS News poll produced largely the same results, the Yahoo News/YouGov's poll headline warned, "No State of the Union bump for Biden. In fact, not only did Biden see no bump, but it was Trump who did.” So Biden’s SOTU speech hasn’t done much to help him on the issues but his angry visage is going to hurt him in the long run. Most people after hearing SOTU speeches don’t parse it like the politicians or Washington pundits. They are just left with an impression and the image in many minds is of an old man looking very angry and shouting.
When I studied political science in college, I read the works of communications analyst and philosopher Marshall McLuhan who wrote on the substantive and stylistic differences between radio, print and television. He wrote about “hot’ and “cool” media. He argued that Nixon did not play well in the 1960 televised debates because he was a “hot” personality in a “cool” new television medium. Nixon’s tiredness, sweaty upper lip and shifty eyes made him look untrustworthy and unsteady. Conversely, Kennedy won the TV debates because he was “cool” and projected calm confidence. Interestingly, people thought Nixon won the radio broadcast, a hotter medium, due to his grasp of details and more resonant vocal delivery.
One can see the difference in comparing live speakers at conferences to their performance on Zoom platforms. Some speakers who excel in live venues seem too loud in a video environment while those with a more intimate, soft spoken delivery seem right at home. I suspect that Senator Britt was trying for this effect in her GOP response to the State of the Union speech though her delivery seemed too staged for some. President Obama had a “cool” television persona, but in person seemed laid back and not as forceful. On the other hand, Howard Dean's “scream” on winning the Democrat caucus in Iowa in 2004 was amplified by television and ended his campaign. It even earned its own Wikipedia entry, "The Scream."
The best TV image for politicians is “cool” not “hot.” Whatever you think of President Biden’s policies and the accuracy of his claims that the state of the Union is good, he left many people with the image of an angry face screaming at his political opponents. Will his State of the Union speech become his Howard Dean "Scream"? He would have been wiser to have learned the lesson of Marshall McLuen, “the medium is the message” and toned it down. A little bit of bi-partisanship wouldn’t have hurt, either.
Greg Ganske, MD, is a retired surgeon who cared for women with breast cancer, children with cleft lips, farmers with hand injuries and burn patients. He served Iowa in the U.S. Congress from 1995-2003.