Book Review

In Sickness and in Power: Illness in Heads of Government during the Last 100 Years

N Engl J Med 2008; 359:2297-2298November 20, 2008

Article

In Sickness and in Power: Illness in Heads of Government during the Last 100 Years
By David Owen. 420 pp. Westport, CT, Praeger, 2008. $44.95. ISBN: 978-0-313-36005-3

This book is about heads of state — presidents, shahs, prime ministers. Author David Owen seeks to examine the relationship between the health of leaders and the quality and integrity of their governance. Owen comes to the subject with appropriate credentials: He was trained as a physician with a concentration in neurology and psychiatry. His principal career has been in politics as a member of the British Parliament, and he has held several cabinet posts, including Minister for the Navy, Minister of State for Health, and Foreign Secretary. This experience gave him substantial and intimate exposure to the personal traits of a series of British prime ministers and leaders of other countries. He was a close observer of and intimate participant within several British governments. For a period in his career, he combined the practice of medicine with the world of politics.

Owen begins the book with an encyclopedic recitation of episodes of disease and disability in 32 state leaders from 1901 to 2007. President Theodore Roosevelt was judged to suffer from bipolar disorder. President Woodrow Wilson had hypertension and atherosclerosis. British Prime Minister Neville Chamberlain had cancer. President Warren Harding was considered depressed, as was President Calvin Coolidge. British Prime Minister Winston Churchill had angina and myocardial insufficiency, as well as bouts of severe depression.

In most of these cases, Owen claims that these afflictions and disabilities directly influenced decision making and leadership. However, he observes that most heads of government compensate for a while because they have “extraordinary, even abnormal, personalities.” Yet an underlying conviction of the author is that “indecision or wrong decisions, as a result of illness amongst heads of government over the last hundred years, have been among the factors producing poor government.”

This work focuses on the mental conditions of leaders and on the personality features that shaped the character of their leadership. In particular, in Owen's view, hubris and hubristic behavior affect a large percentage of leaders, and their hubris increases the longer they are in power. Owen contends that the very experience of holding office seems to infect heads of government with what he describes as the hubris syndrome — unbounded confidence, unwillingness to brook ideas and advice from others, and misrepresentation of reality. He points out that hubris is not recognized as a clinical condition, but he urges acceptance of the hubris syndrome as a clinical diagnostic category.

Owen proposes a series of risk factors that increase a person's probability of having hubris syndrome. One is a personality that leads the person to seek power and higher office; another is time spent in the seat of power. Owen goes on to illustrate these points by discussing a series of exaggerations of hubristic behavior, including the cases of Joseph Stalin and Adolf Hitler. To emphasize the point, he devotes 70 pages to an intimate and highly critical account of the behavior and patterns of governance of President George W. Bush and British Prime Minister Tony Blair.

Owen believes that the illnesses of leaders seriously threaten the integrity of government and the well-being of the state. He ends his book with a series of institutional recommendations that are designed to take the measure of the health of leaders both before they assume office and periodically during the course of their leadership. He combines this with a brief discussion of mechanisms for the exchange of political power when a leader is deemed unable to serve.

This is an interesting work. It is not primarily a medical treatise, but instead a provocative observation of the world of politics. It is an important commentary on the relationship between personality and behavior and the character and consequences of leadership.

Edward J. Burger, Jr., M.D., Sc.D.
Institute for Health Policy Analysis, Washington, DC 20006
ejburger@worldnet.att.net