Spasmodic dysphonia: What RFK Jr.’s voice condition means for his campaign
Gabrielle M. Etzel
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Robert F. Kennedy Jr.‘s splash entry into the 2024 presidential field has drawn renewed attention to his rare voice disorder, spasmodic dysphonia.
The son of the late Attorney General Robert F. Kennedy and nephew of the late President John F. Kennedy has gained a marked following for a candidate challenging a sitting president within the same party. A May CNN poll, for example, found that 20% of Democrats support Kennedy over President Joe Biden.
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Here’s what to know about spasmodic dysphonia and its implications for Kennedy’s campaign.
Spasmodic dysphonia
Spasmodic dysphonia is exceedingly rare, affecting one in 100,000, according to Cleveland Clinic estimates.
The disorder affects the muscles in the larynx, colloquially known as the voice box, by preventing the vocal cords from vibrating in a way that produces a normal speech pattern.
“Spasmodic dysphonia causes voice breaks during speaking and can make the voice sound tight, strained, or breathy,” according to the National Institute on Deafness and Other Communication Disorders. “In more severe cases, spasms may occur on every word, making a person’s speech very difficult to understand.”
NIDCD identifies that the disorder is “thought to be caused by abnormal functioning in an area of the brain called the basal ganglia,” which coordinates muscle movement and language processing. Strokes and drug abuse can affect basal ganglia function.
There is no specific gene for spasmodic dysphonia, but the disorder does run in families, suggesting that familial genetic mutation patterns might be a cause.
Although there is no cure for the disorder, speech therapy and Botox injections are the most common forms of treatment.
Botox treatments for spasmodic dysphonia weaken sections of the vocal cord muscle fiber, preventing the abnormal contractions that distort the patient’s voice. After 24 hours, the injections can improve voice functioning. As new nerve cells regenerate over a period of weeks, the vocal cords return to their normal strength, causing the dysphonia to resume.
In severe cases, surgery may be an option, but treatment plans are different for each patient. “To date, there are no comparative studies pointing to a single, best treatment,” according to NIDCD.
Kennedy’s diagnosis
Time progression videos of RFK Jr.’s public appearances show that his voice began to change in the late 1990s.
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“The disease didn’t hit me until I was about 43,” Kennedy told Oprah Winfrey in an interview in 2007 widely cited as the first time he publicly discussed his disorder. At the time, he noted “it is an effort” to speak despite it not being physically painful.
Kennedy also said that he had been obtaining Botox treatments for the disorder, but his clinicians “still [hadn’t] gotten [his] dose right.” Treatment guidance from the Stanford University School of Medicine notes that “[a]ll patients are different, and therefore the amount of Botox that is needed from patient to patient is different.”
Kennedy was also open with Winfrey about his recovery from drug addiction, which he explained began “pretty soon after” his father was assassinated in 1968. Kennedy was charged with heroin possession in 1986, at which time he entered a rehabilitation program that he said was “miraculous” in curing his addiction.
In the late ’60s and early ’70s, “I don’t think any of us were aware of how damaging drugs could be,” Kennedy told Winfrey.
Although there are documented links between heroin abuse and basal ganglia impairment, it is impossible to provide a more conclusive description of the particulars of Kennedy’s condition without access to his medical records, including radiographic images of the brain.
Campaign implications
A candidate’s voice is a key indicator of success on the campaign trail. While some analysts point to the high-pitched voices of females as a reason for their underrepresentation in elected office, vocal tonality has been found to affect the viability of both male and female candidates.
An article published in Political Psychology in 2015 found that male and female voters have a greater preference for lower-pitched voices in both controlled scientific environments and real-world elections.
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Even when pitch itself might not be a factor, the health and strength of one’s voice can sway public opinion. The infamous first television debate in 1960 between JFK and Richard Nixon, during which Nixon appeared and sounded sick after having just returned from the hospital, poised RFK Jr.’s uncle for victory in large part because he “looked and sounded good” on the new media platform.
Of those who have signaled their support for RFK Jr.’s bid, 20% support him because of the Kennedy family name, hoping that he will carry on the legacy of his father and uncle. Only 12% of would-be Kennedy voters say they support his policy opinions, according to the CNN poll.