Maladies and men at the top

Ailing Leaders in Power, 1914-94
May 17, 1996

This is a peculiar little book which is based on a wellknown truism: when people get older they tend to suffer from a variety of infirmities. The author, who is identified only as a doctor who has written two previous works on the pathology of leadership, uses the conjunction between old age and ill health to argue that the world suffers, has suffered, and will continue to suffer from a spate of disastrous political, military, and other institutional decisions and indecisions because of aged and incapacitated leaders.

Like good gossip, many of his examples are alarming. Hugh L'Etang has a penchant for recent American presidents and Winston Churchill. Thus, we learn that Dwight Eisenhower "could well have been" a type A personality with hypertension and ill-temper, Richard Nixon was almost comic in his clumsiness because of possible "minimal brain dysfunction", Ronald Reagan was a forgetful and probably senile gaffer and George Bush may have triggered the Gulf war due to an overactive thyroid. "Hyperthyroidism is well known to lead to shortened attention, snap decisions, frantic activity and fatigue."

As for Winston Churchill, L'Etang's pen knows no bounds. He starts with the extended medical history of Churchill written by his personal physician, Lord Moran, and associates a litany of medical and emotional disorders with a long list of military failures during the second world war.

There is an important and necessary case to make about the problems and pathology of leaders and leadership. But this book does not do so. It is not a work of scholarship. Nor is it a popular but systematic review of the subject. Instead it is opinionated, cliche-ridden and inadequately researched.

All too often, the author relies on second and third-hand sources, or personal adversaries of the figures cited, to justify his conclusions. Thus, in a further swipe at Churchill, L'Etang quotes the present Lord Longford about the prime minister's alleged daily prayers: "O God, I thank Thee for making me PM and grant that the war may last as long as I live."

Typically, L'Etang deploys contiguous, rather than causal reasoning, to prove that this or that person's physical or mental disability caused this or that disaster. Maybe it was true, but I am not convinced that just because Franklin D. Roosevelt was sick in 1945, the Yalta conference became a political catastrophe. Did not Roosevelt, or for that matter, other leaders in comparable circumstances, have a large number of experts to advise him? In this book L'Etang barely alludes to the roles of advisers in making or at least contributing to the decision-making process.

And what about the multiple contexts ( social, political, military, economic, historical or psychological) in which events occur? The author seems to ignore them, yet they are the ground, the background which encloses the figure, the event. Our perception of events can totally change, indeed, go from black to white, or the reverse, if the background changes, even while the figure (a leader's disability) remains the same.

In this respect it is important to consider a person, a leader, no matter how incapacitated or not, within the larger framework of the role he is playing, the expectations of his public and the impact of his leadership.

President Reagan may have been a forgetful fellow, watched a lot of movies and gone to bed early. But he was highly effective in the role to which he was elected, to change the mood of the country from feel-bad to feel-good. Not to recognise this is simply to use a diagnostic entity to cloud a political value-judgement.

There are further fundamental, but ineffable attributes of leadership. The author does pay a passing glance at them, when referring to William Lukash, the personal physician of former president, Gerald Ford. He queried: "Are we to turn down all candidates (for president) except those with perfect bodies?" (Are there not other unmeasurable factors) . . . "such as determination, wisdom, and inner strength that are more important?" Perhaps this is why L'Etang's conclusions and recommendations are so banal and unhelpful. They include regular medical examinations and retirement at 65. "Experience suggests that it should be made impossible for presidents and premiers to remain in office after the age of 65." What if the person will not go? Should he or she be taken off to jail? Is old age itself an illness? Are younger leaders necessarily more wise, and less toxic? Taken to the extreme, L'Etang seems to present us with demagoguery dressed up as medical necessity.

Joseph H. Berke is director, Arbours Association.

Ailing Leaders in Power, 1914-94

Author - Hugh L'Etang
ISBN - 1 85315 247 1
Publisher - Royal Society of Medicine Press
Price - £15.00
Pages - 162

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