The health of our leaders is important to them - but even more so to us. But, as a new study shows, at critical times our politicians' ability to take decisions has been seriously compromised - and then covered up.
David Owen has had an unusually rich and varied career. After qualifying as a doctor he became a neurological registrar at St Thomas's Hospital. At 27, he was elected to parliament as the Labour member for a marginal seat. At 38 he was the youngest foreign secretary since Anthony Eden. In the early 1980s he was the most dynamic and original, though also the most wayward, of the Gang of Four who set up the Social Democratic Party. In 1983 he succeeded Roy Jenkins as SDP leader, and for four years he contrived, with brazen chutzpah and demonic energy, to make the tiny SDP band of MPs look like a serious political force. The collapse of the party after the 1987 election left him without a political home, but as a cross-bench peer he found a new role as a distinguished international statesman and troubleshooter.
But Owen was a doctor before he was a public figure, and his combination of political experience and medical (particularly neurological) knowledge has given him a unique perspective on the crucial role of powerful individuals in history. The first fruits came last year in a mordant, tantalisingly brief analysis of what he called the "hubris syndrome", particularly as manifested in the Iraq misadventure of George W Bush and Tony Blair. In his new book he has cast his net more widely. In Sickness and in Power is a study of the role of illness, mental and physical, in the careers of a selection of 20th-century political leaders ranging from Stalin and Hitler to JFK and the last shah of Iran. It is a major contribution to historical and political understanding that no one else could have written. I found it utterly absorbing, sometimes unexpectedly moving, and often quite frightening.
The book has four parts. The first consists of 16 short, sometimes compassionate and sometimes deadly vignettes, ranging in size from half a page to ten pages. It opens with an analysis of the bi polar disorder ("manic depression", in layman's language) that afflicted the tempestuous Republican president Theodore Roosevelt, and that helps to explain his self-destructive decision to stand as a third-party candidate in the 1912 presidential election. It ends with a brief account of Ariel Sharon's massive stroke and subsequent coma. In between, Owen throws vivid, and frequently alarming shafts of light on Woodrow Wilson's disabling stroke, Neville Chamberlain's cancer, Stalin's paranoia, Mussolini's depressions, the hardening of Franklin Roosevelt's cerebral arteries before the Yalta conference, Richard Nixon's alcoholism, and the bizarre cocktail of drugs, ranging from bulls' testicles to amphetamines and cocaine, administered to Hitler by his personal physician, Dr Morell.
The real meat of the book comes in the second and third parts. These contain substantial chapters on Anthony Eden, J F Kennedy, François Mitterrand, the shah of Iran and the deluded duo of George W Bush and Tony Blair. With a measured restraint appropriate to his medical past, Owen shows that, at crucial moments in their political lives, Eden and Kennedy were both unfit to wield the power they possessed. Eden's unfitness was displayed during the Suez crisis of 1956. Kennedy's followed suit in 1961 at the beginning of his presidency. First, he sanctioned air strikes against Castro's Cuba, followed by a disastrous landing at the Bay of Pigs by Cuban exiles. Soon afterwards he had an equally disastrous tête-à-tête with Nikita Khrushchev, who came away convinced that the new American president was weak and indecisive.
Thanks to a gall bladder operation that had gone wrong, Eden suffered from debilitating high fevers and bouts of uncontrollable shivering. (At one point his temperature soared to 106.) Kennedy had suffered from Addison's disease for 13 years before he became president, and perhaps for longer. He was also prone to severe back pain, urinary tract infections, prostate problems and chest infections. Both men took heavy doses of amphetamines, in Kennedy's case complicated by steroids, painkillers, testosterone and antibiotics. Almost certainly he used recreational drugs as well, cocaine among them. Owen leaves the reader in no doubt that both Eden's astonishing, ultimately self-destructive misjudgements during the Suez crisis and Kennedy's folly over the Bay of Pigs and mishandling of Khrushchev were partly drug-induced. Thanks to a belated outbreak of good sense in the White House, Kennedy's medical treatment and physical and mental health improved markedly before the Cuban missile crisis erupted in 1962. But if he had been as sick and irresponsible in 1962 as he was in 1961, the world might well have plunged into a nuclear war.
After these horrors, the chapters on François Mitterrand and the shah of Iran seem, at first sight, a little anti-climactic, but they have profound implications Both are variations on the theme of denial - on the unwillingness of leaders to admit that they are seriously ill, and on their insistence on covering up the truth. For years, the shah suffered a form of chronic leukaemia that eventually killed him. The Iranian people were kept in the dark, and so - more fatally - were the governments of Iran's western allies. Had the British and Americans known, Owen believes, they might have persuaded the Shah to abdicate in favour of a regency charged with overseeing a transition to democracy. That might have forestalled the revolution of the mullahs and checked the destructive growth of fundamentalism across the Muslim world.
Mitterrand's denial was more flagrant, but its consequences were less damaging. Six months into his presidency, he was diagnosed with advanced cancer of the prostate; his doctors thought he would die within three years. In fact he lived for nearly 15 years more, having won a second seven-year term in 1988. For most of his time as president, however, his cancer was treated as a state secret. Health bulletins were issued periodically over the signature of his doctor, but they were deliberately misleading. Even Mitterrand's wife was not allowed to know the truth until 1991, ten years after the cancer was diagnosed. The French people were not let into the secret until 1992, 11 years after Mitterrand had first crossed the threshold of the Élysée as president, and only four years before his death.
As well as describing the physical and mental illnesses of the powerful, Owen devotes a lot of space to "hubris syndrome" - a combination of traits, including narcissism, messianism, exal tation, recklessness, exaggerated self-belief, contempt for the advice of others, loss of contact with reality and unshakeable faith in the verdict of history or of God. Here he is on trickier ground. The mental and physical illnesses he describes in the rest of the book are established medical conditions. Even so, they are often hard to diagnose. But the medical profession has not - or, at least, not yet - recognised "hubris syndrome" as a condition. Owen thinks it should, and he makes a powerful case. For the moment, however, the diagnosis has something arbitrary, even circular about it. Owen's prime examples of this syndrome are Bush and Blair, the subjects of part three of the book. He has no difficulty in showing that they displayed the symptoms of "hubris syndrome" as he defines it; and no one who reads his account can doubt that the disasters and occasional barbarities that have followed the invasion of Iraq lie at their door.
Yet the boundary between "hubris syndrome", as defined by Owen, and heroic defiance in the face of impossible odds can be very blurred. Winston Churchill and Charles de Gaulle are both examples. Owen shows that Churchill's mood swings had at least a touch of bipolar disorder about them, but exonerates him of hubris syndrome. I agree with Owen, but I can't suppress the feeling that this is because I think Churchill was right during the supreme test of his career, when he squashed Lord Halifax's proposal to open negotiations for a compromise peace in May 1940. Today, nearly 70 years later, I suspect it would be hard to find anyone who disagrees.
At the time, however, when the French armies were in headlong retreat and the Wehrmacht was at the gates of Calais, reasonable men - and Halifax was nothing if not reasonable - could have been forgiven for seeing Churchill's refusal to negotiate as a gross and possibly fatal example of hubris. If the Germans had won the Battle of Britain, as they nearly did, and proceeded to launch a successful invasion, as they could then have done, the charge of hubris might have seemed well founded.
As for de Gaulle's lonely stand after the fall of France in 1940, what could be more hubristic than for a mere junior minister and temporary brigadier general, armed with nothing but a will of steel, to defy the legally constituted government of his country, led by a field marshal, whose unyielding fortitude in the First World War had made him the symbol of French glory?
None of this detracts from Owen's achievement, however. On the "hubris syndrome", he has said the first (or perhaps the second) word, not the last. He has shown that, despite its associated boundary problems, there is such a thing; that it lurks in the psychic depths of the powerful and isolated, waiting to pounce; and that the best defences against it are constitutional and cultural checks and balances to save the overmighty from their worst selves. On the wider issues of phy sical and mental ill-health, and the temptations to deception to which they give rise, his call for a systematic screening of candidates for political leadership and for open disclosure by leaders once they are in post are patent common sense. If Gordon Brown wants to give real bite to his call for a new constitutional settlement, he could do worse than take a leaf out of Owen's book.
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