When my friend Paul Costello left the Carter Administration, he wrote a funny New York Times article suggesting a special course for departing staffers:
There ought to be an "outward bound" course for White House employees facing exile.
Must we face this cruel and unusual punishment cold turkey?
Maybe people were tougher back then - I personally would have collapsed five minutes into the first day of the course. My experience is not unusual: White House jobs are hazardous to your health.
As our own Bill Dement, MD, PhD, would likely predict, one of the fundamental strains on the health of staffers is a lack of sleep, both in terms of quantity and quality. My worst night personally was when I was a point person on an internal policy debate that required input from staffers who were in California, Washington, Belgium and China. As one would finally go to sleep, another would wake up in the next time zone and begin calling and sending me e-mail. I ended up lying in my bed with my Blackberry wedged between my ear and a pillow, waking up every 10 minutes or so each time it buzzed.
The next morning I stumbled to the airport for a flight to London, during which I had planned to sleep but couldn't because I had too much work to do. That night, after speaking at Parliament, I was suddenly aware of an MP asking me a question and realizing that I had lapsed into microsleep and not heard it. The audience in the packed room looked at me expectantly, so I bluffed by asking, "Upon what specific aspect of this important issue do you wish me to comment?" The MP repeated the entire question and saved my bacon. We became friends later, and he told me he was not fooled at the time, but having been in the same situation himself, treated me with mercy.
The other major strain on White House staff is the 24-hour news cycle and rough-and-tumble of politics, which keep most people in flight-or-fight mode all the time. Lacking a time of true, deep relaxation, the body begins to break down. Lots of people get headaches, back aches and almost everything-else aches. Above is a photo I took of my friend Howard Koh, MD, the Assistant Secretary of Health. We were headed in to a reception for the AIDS strategy writers with President Obama for what should have been a laid back evening of music, good food and mutual congratulations. But just right after we checked our coats, he got an urgent call and turned away, deeply engaged in a crisis that couldn't wait until the next morning. I'm not actually sure he ever got to go the remaining 50 feet into the East Room for the fun.
Lack of sleep and high stress drives many people to endure wild oscillations in weight. I gained over a pound per month. In one of those weird Star-Trek-like-conservation-of-mass effects, my boss lost over a pound a month. I often had less than five minutes for lunch, so I would inhale a burrito and a liter of Coke to keep myself going. Other people simply never got around to eating when they should and thinned out accordingly.
Because the work is always pressing and always seems more important, many people give up long-established exercise regimes. They also don't get to the doctor when they should, even though there is one on site all the time. You could make a good living being a dentist for senior White House aides as long as you charged for last-minute appointment cancellations. You might not even have to ever see a patient.
On my last day, I looked at the White House mess menu and ordered a salad and a glass of water - a symbolic new start. Within eight weeks of returning to California, I lost 15 pounds. I slept 10 hours a night for several weeks as I paid off that debt. I bench pressed my weight at the gym for the first time in a year last week. I think I'm finally ready for that Outward Bound course.
Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences and addiction expert. He recently returned to Stanford after a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.