The newly elected Representative from Long Island, New York, George Santos, has been criticized for lying about his education, business experience, athletic achievements, religious affiliations, family history, etc. If he had merely lied about a few items, those who care about politicians being honest might have objected, but the general public would have shrugged and noted there was nothing remarkable about a politician wandering outside the truth.  As Matt Gaetz, the representative from Florida, observed, candidates for public office routinely “embellish” their resumes to get elected.  If mendacity disqualified men and women from running for public office, our legislatures would be lonely places. What made George Santos an instant celebrity on arrival in the nation’s capital was not that he had lied during his campaign and apparently in a variety of business matters prior to his campaign for Congress, but that he seemed incapable of telling the truth even when discussing life events and activities that would have no bearing on his getting elected.

He said he was Jewish (or Jew-ish) but was raised as a Roman Catholic.  He claimed he was a volleyball champion in college, but he did not actually attend the colleges at which he allegedly exhibited this athletic prowess. He recounted the struggles of his family during the Holocaust, a complete fabrication (the struggles, not the Holocaust).  He told of his anxiety on 9/11/01 for his mother in lower Manhattan: She was in Brazil. The fabrications, misrepresentations, misappropriations, and lies are interminable and unfathomable. If George Santos is not merely a conventional scoundrel, snake oil salesman, or con man, it may be that he simply does not know what the truth is. We may well be observing a neurologic disorder classically referred to as Korsakoff psychosis.

There are several neurologic conditions which render a person incapable of perceiving reality. The most common is what is called phantom limb pain. In that situation, a person who has lost a limb complains of intractable pain in the missing extremity. They may complain of a burning, cramping, or a crushing sensation in a missing hand or foot. Routine painkillers, including morphine and codeine, do not blunt the pain, and the discomfort may persist for years or decades. The pain recognition areas in the brain are simply not equipped to “delete” the input from a limb that no longer exists. The brain fills the void with misinformation. Unfortunately, this misinformation is usually miserable information.

A similar phenomenon occurs in some individuals who have lost their vision because of an injury to the part of the brain (the occipital cortex) responsible for sight. In that case, referred to as Anton’s Syndrome, the blind person believes they can see. They describe a variety of scenes and activities ongoing in those delusional visions. In this situation, the brain fills in missing information with familiar objects and phenomena. The brain simply rejects the possibility that it cannot see.

There is a similar phenomenon involving memory.  This is called Korsakoff psychosis or syndrome, but it is not a psychiatric disorder in the familiar sense. Those problems we attribute to most psychiatric phenomena are distinct from thought (cognitive) or mood (affective) disorders that arise from brain damage. People with Korsakoff psychosis have damage to parts of the brain responsible for short term or long term memory.  It can appear in individuals with vitamin deficiencies or malabsorption problems or more exotic diseases.

That the affected individual is incapable of harnessing the truth may be inapparent at first. A colleague described an encounter he had with a charming, elderly man that he was asked to evaluate for neurologic disease. The elegantly dressed gentlemen joined him in his medical office and described at length his numerous adventures and achievements. My colleague was truly captivated by this remarkably accomplished man’s life story until the gentleman pulled out his pocket watch and announced, “I believe we are passing through New Haven now.” His stories, like George Santos’s, were pure fabrication. 

This raises a legitimate concern regarding our elected officials. If they lie compulsively, should they be checked for neurologic damage? If significant neurologic or psychiatric problems are evident, should they have limited responsibilities? Does George Santos have Korsakoff Syndrome?

We have had numerous members of all three branches of the Federal government with drug and alcohol problems, as well as neurologic complications of those conditions, that should have barred them from responsible positions. Unfortunately, any imposition of competence tests will predictably be perverted to advance political agendas. Anyone at odds with the faction in power will be diagnosed as demented. It is ironic that low level government employees must pass civil service exams to get jobs, but their bosses are likely to have been chosen without vetting on the basis of their affability or, as a former president phrased it, their “loyalty.”

We have had presidents, legislators, and judges incapacitated by strokes, Alzheimer’s disease, and substance abuse. An amendment to the Constitution was passed to provide a mechanism for transferring power away from the highest ranking member of the government if he or she cannot perform the duties of the President, but it is unlikely that we shall ever see that action taken for longer than it takes to manage a gunshot wound or complete a colonoscopy.

George Santos has been embraced (figuratively and literally) by the House majority and has been appointed to Congressional committees that will decide the direction our country takes over the next few years. We may take comfort in his being only one vote out of 435 in the House of Representatives, but it is well to remember that Senator Joseph McCarthy of Wisconsin was only one vote in the 1950s when as Chairman of the Permanent Subcommittee on Investigations into Government Operations he led a campaign of character assassination that destroyed the lives of many Americans.  He used ever-expanding lies and misrepresentations to advance his career but had no reply when his colleagues asked, “Have you no sense of decency, sir?” We already know what George Santos would reply to that question. He would recount the time he single-handedly captured more than 100 German mercenaries in the battle of Long Island while winning the volleyball championship for Baruch College…or something more bizarre.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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