SPECIAL ARTICLES Psychiatry and politicians: the ‘hubris syndrome’{ Gerald Russell1 The Psychiatrist (2011), 35,140-145, doi: 10.1192/pb.bp.110.031575 1The Priory Hospital Hayes Grove, Summary Lord Owen has alerted us to the dangers of ill health in heads of Hayes, Kent government, especially if they strive to keep their illnesses secret. The description of Correspondence c/o Conciec¸ao the hubris syndrome is still at an early stage but Owen has provided psychiatrists and Santos-Sinclair ([email protected]) other physicians with useful guidance on how to recognise its appearance in persons First received 18 Jun 2010, final who hold positions of power. He has also provided advice to doctors caring for such revision 16 Sep 2010, accepted 5 Nov 2010 persons. Declaration of interest None. Lord Owen presented his ideas on the psychiatry of politicians at decisions made by heads of governments. He has covered the 2009 General Meeting of the Royal College of Psychiatrists the past 100 years through the presentation of clinical to a packed audience. Hitherto his work has been published vignettes of statesmen, ranging from Theodore Roosevelt in books and in general medical journals.1-3 This review is and Woodrow Wilson in the early 1900s to Ronald Reagan intended to make it available more directly to psychiatrists. and Boris Yeltsin in more recent times.1 David Owen has had a rich and varied career. He moved Further depth has been added through a detailed rapidly from medicine (including a significant psychiatric historical analysis of four leaders whose illnesses had a input) to the higher echelons of politics (parliamentarian, profound effect on world events, Anthony Eden, John F. foreign secretary, Social Democratic Party leader and peace Kennedy, the Shah of Iran and Franc¸ois Mitterrand. In envoy to the former Yugoslavia). He became an influential, order to maintain a psychiatric emphasis in this article, only albeit controversial, political thinker. In writing on the the first two will be further discussed, but a third person medical aspects of prominent politicians’ behaviour during will be added in whom frank mental illness was evident. the past 100 years he has approached his subject from a These accounts are necessarily brief and run the risk of not unique vantage point, combining the mindsets of clinician doing justice to Owen’s scholarly researches especially into and politician. Four main themes can be discerned in his the available medical records. However, an interplay will be writings. First, he describes the crucial importance of ill demonstrated between fluctuations in the three men’s health in heads of government, whose decisions may gravely health and their political skills. affect the interests of people they represent. Second, his case histories reveal the common tendency for heads of Anthony Eden state to keep their illnesses secret thereby avoiding the best medical advice and treatment. Third, he has identified the Anthony Eden’s career came to an end following the Suez ‘hubris syndrome’, a condition also likely to impair the crisis (October-December 1956). He had decided to take behaviour and decision-making of politicians. Finally, he has military action in Egypt, in alliance with the French and the proposed remedial measures to minimise the impact of ill Israelis, following President Nasser of Egypt’s seizure of the health on the politicians’ ability to deal with affairs of state. Suez Canal. The operation was a military success but a The hubris syndrome has great appeal to psychiatrists, political disaster, especially in terms of relations between partly because it is a new concept, but also because we find the USA and the UK, President Eisenhower not having been it difficult to resist the conundrums of the psychiatric consulted. Eden’s judgement was considered to be seriously classification industry. David Owen’s general contributions impaired with regard to crucial decisions. There was no to the psychiatry of politicians should not be eclipsed by the doubt he had been seriously ill as a result of a bile duct novelty of the hubris syndrome. Although his work mainly injury due to a failed surgical operation, leading to recurrent focuses on politicians, it also has relevance for psychiatrists episodes of cholangitis and high fever. Another factor was and physicians who care for patients who hold other the injudicious prescribing of drinamyl tablets (‘purple powerful professional positions. hearts’, combined amphetamine and barbiturate). Even- tually, Eden came to suffer from severe exhaustion. His Historical accounts of ill health in heads physician, Horace Evans, was adamant he should resign on of government health grounds, and he did so on 10 January 1957. Owen has closely examined the numerous ways in which John F. Kennedy physical or mental illness may impair the quality of Owen describes well how President Kennedy’s political {See commentaries, pp. 145-150, this issue. astuteness (or lack of it) was dependent on his state of 140 SPECIAL ARTICLES Russell Psychiatry and politicians health, and especially the quality of the treatment he In 1965 Johnson had a cholecystectomy for the removal received. of gallstones. He experienced postoperative depression bad At 43, John F. Kennedy was the youngest US president enough to contemplate his resignation from the presidency, ever elected (November 1960). Despite his youth his health but was dissuaded from doing so. In 1965, close observers was already compromised. He had Addison’s disease, a fact noted his increasingly irrational behaviour, his inner he kept secret in spite of a definite diagnosis in 1947. He was resistance having been undermined by external events - also prone to severe back pain due to injury sustained when the Vietnam War - and crumbling public support. the small torpedo boat he commanded was sunk by a Johnson was a suspicious character and did his best to Japanese destroyer in 1943. He required an operation in hide information about his medical condition. There is little 1954 when a metal plate was used to stabilise his lumbar doubt about the fact that he had deep depression spine, but the site became infected and the plate had to be throughout his life; some psychiatrists have interpreted removed a few months later. his coarse and volatile behaviour as due to hypomania. In The first example of Kennedy’s lack of political skill was 2006, the review of biographical sources of American the failed attempt to destabilise Fidel Castro in Cuba. The presidents considered that during his presidency Johnson American policy was to lend support to 1500 Castro exhibited the features of bipolar I disorder. He went opponents as they landed in the Bay of Pigs in Cuba in through long periods of stress through 1965-1967 and April 1961. Kennedy sensed that open military support was anguish over Vietnam. In late 1967 his physicians warned politically risky, but he was indecisive in overseeing the Johnson’s wife, Lady Bird, of concern over her husband’s concealed US military adventures. In the event of failure health, but already he had confided in her that he would there was an agreed plan for the American evacuation of the resign before the 1968 presidential election. He announced opponents of Castro, but this too was unsuccessful. on television that he would not stand again. Kennedy’s political failure can be attributed to his Clark Clifford (advisor to presidents Truman, Kennedy, medical condition and the poor coordination of treatments, Johnson and Carter) is quoted as saying that ‘had it not because he selected his own doctors rather than accepting been for Vietnam, Johnson would have been one of the most advice from others to appoint recognised specialists. For his illustrious presidents’.1 His early time in the White House back pain one doctor used muscular infiltrations of was outstanding in terms of legislative social reforms, procaine. Another prescribed amphetamine by mouth or particularly on civil rights. However, he became haunted by intramuscular injections, at times supplemented with the war in Vietnam, which, in combination with his steroid drugs in doses above the usual replacement therapy. declining health, led him to resign. In contrast, Kennedy displayed consummate political skill in the way he handled the Cuban Missile Crisis of October 1962. The Soviet Union leader, Khrushchev had The hubris syndrome previously decided to install nuclear missiles in Cuba, a move to support Communism in Cuba and in Latin America. In explaining his term ‘the hubris syndrome’, Owen states Over the course of 2 weeks, Kennedy’s demeanour and that his aim is to establish ‘the causal link between holding power and aberrant behaviour that has the whiff of mental concentration were vastly improved compared with his 2 approach to the events in the Bay of Pigs. He had set up a instability about it’. He carefully avoids explicit terms such as special executive committee whose advice he followed. He madness or psychosis. In fact, he relies on the language of veered away from using air strikes in favour of naval Bertrand Russell, who describes what may happen when ‘the blockade, a more effective method. He gave Khrushchev the necessary element of humility’ is missing: ‘When this check 1 upon pride is removed, a further step is taken on the road opportunity to say ‘I saved Cuba: I stopped an invasion’. 4 Through private diplomacy with Khrushchev, Kennedy towards a certain kind of madness-the intoxication of power’. offered as a quid pro quo the removal of US missiles from The word ‘hubris’ comes from the Greek meaning bases in Turkey. ‘inviting disaster’ as well as ‘arrogance’. Much of the Kennedy’s vastly improved political skills were thought evidence used by Owen to develop his thesis on the hubris to be due to a marked improvement in his health.