Political Disorders

Title In Sickness and in Power: Illnesses in Heads of Government During the Last 100 Years

Author By David Owen

Publisher Praeger

Year 2008

Pages 448 pp.

ISBN 2147483647

Price $44.95

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Conventional diseases are not the only maladies that plague leaders. For many heads of state, the experience of being in power brings about psychological changes that can lead to grandiosity, narcissism, and irresponsible behavior. Leaders suffering from this political hubris syndrome believe that they are capable of great deeds, that great deeds are expected of them, that they know what is best under all circumstances, and that they operate beyond the bounds of ordinary morality. Such leaders often insist that their nations are forces for good in the world and can do no wrong. And the longer they stay in office, the stronger these tendencies seem to become -- as the cases of Mao Zedong, Fidel Castro, and Robert Mugabe have made clear. The result, observes Owen, is absolute "incompetence in carrying out policy."

To illustrate the symptoms of the hubris syndrome, Owen focuses on one leader he knows well and another whom he has met: former British Prime Minister Tony Blair and U.S. President George W. Bush. Of Blair, who once considered going into professional acting, Owen writes, "Politics offered him a very large stage on which to perform," adding that "actor-politicians tend to be especially narcissistic." According to Owen, as prime minister, Blair also possessed an absolute moral certainty -- a conviction that his motives were always supremely honorable. This certainty drew the British prime minister to Bush, who also seems to believe that he functions for a higher purpose. According to Nabil Shaath, who was then the Palestinian foreign minister, in 2002 Bush told him and other assembled Palestinian officials, "I'm driven with a mission from God. . . . God would tell me, 'George, go and end the tyranny in Iraq.' And I did." Such religiosity and missionary zeal bound Blair and Bush together in their effort to oust Saddam Hussein.

To a hubristic leader, lying, cutting corners, and even invading foreign countries are justified in the interest of accomplishing a supremely moral mission. As time passes, such a leader's inherent overconfidence is bolstered by his or her unchallenged and increasing power. Once it reaches this stage, the hubris syndrome becomes full-blown and its victim delusional in his or her tendency toward grandiosity. It is a common error of physicians to overestimate the decision-making capacities of their patients. But this everyday phenomenon becomes far more dangerous when the patients are heads of state.

Owen is not the first to observe that hubris sometimes overtakes leaders, but he is the first to argue that it is a pathological condition that requires serious study, especially of the ways in which it affects decision-making. Looking back on the eight years of the Bush presidency, this seems sensible. Owen's book should be read by all practicing physicians responsible for the health of political leaders -- and by the leaders themselves. After all, the hubris syndrome is probably not only a preventable disease; it may be a reversible one as well.

Having brought the disease of hubris to the world's attention, Owen offers only one possible remedy for it: "strengthening national democratic checks and balances." It is weak tea, but it may help. The U.S. Constitution already provides one such check: the Twenty-fifth Amendment allows the vice president and a majority of cabinet officials or of Congress to declare the president unfit to serve if they feel that he or she is unable to discharge the responsibilities of the office. In such a situation, accurate, unadulterated information from a presidential physician would be vital for decision-makers.

But there are stronger safeguards that should be considered. In cases involving physical illnesses, such as Eden's or Kennedy's, a single physician should be placed in charge of both overseeing the patient's treatment and issuing medical reports to political advisers and the public. This would commit the doctor to transparency in cases in which the national interest is concerned, guarantee that the public is informed, and result in better care for the leader. A doctor treating a leader must also be on the alert for hubristic behavior and inform the head of state and his or her closest advisers when the symptoms arise. After all, by its very nature, the hubris syndrome makes it unlikely that someone afflicted with it will recognize it in him- or herself. But early warnings from doctors and top advisers could ward off its full-blown expression. Finally, heads of state should, on taking office, agree to forego medical privacy. And the doctors treating them should waive their commitment to doctor-patient confidentiality for the greater good of the country.

Too often, confidentiality is confused with secrecy, transforming physicians into willing accomplices in a conspiracy to mislead the public. But deliberately distorted medical reports that paint a rosy picture can endanger national and international security. Rather than hiding the truth when a head of state is severely ill, doctors should not hesitate to disclose important health information. Some might argue that public discussion of leaders' ailments and official recognition of the hubris syndrome would lead to more secretiveness, defensiveness, or even paranoia. But in democratic societies, discussion of leaders' and potential leaders' medical problems should become the norm. And if a defensive or paranoid head of state ever dismisses a doctor for sharing medical information with the public, such conduct should constitute grounds for impeachment.