I know absolutely nothing about whether or not Gordon Brown is being treated for any medical condition, but I do think the question about illness in heads of government is an important one. A central thesis of my recent book on the subject is that indecision or wrong decisions, as a result of illness amongst heads of government over the last 100 years, have been among the factors producing poor government. Yet there has been all too little systematic research on the relationship between leaders' ill health and poor decision-making.
An article published in 2006 found that 29% of all US presidents suffered mental illness while in office, and that 49% had exhibited features suggestive of mental illness at some time in their lives [see Footnote]. These are higher percentages than one would expect when comparing with the general population. Between 1906 and 2006, seven presidents were judged to have been mentally ill while in office: Theodore Roosevelt (bipolar disorder), William Howard Taft (breathing-related sleep disorder), Woodrow Wilson (major depressive disorder), Calvin Coolidge (major depressive disorder), Herbert Hoover (major depressive disorder), Lyndon B Johnson (bipolar disorder) and Richard Nixon (alcohol abuse).
Mental illness has affected many heads of government in other countries, too. Some have been able to hide their depression from people close to them, and from the public. But it should be an acknowledged duty of every political leader to be open about their health. To campaign in the knowledge they are suffering from an illness that could impair their capacity to lead means they do not have the quality of honesty a nation has the right to expect of its leaders. Whereas, if voters are given the facts independently about a candidate's health, it is up to them to determine whether a particular illness is a disqualification for office.
There is little doubt that in coping with illness a person's personality may be changed, but sometimes this can be for the better. Franklin Roosevelt's polio is quoted as an example of illness making the man. John F Kennedy's Addison's disease shows why we should not countenance a particular illness being a disqualification for high office. Political leaders have overcome the effects of their illness, have been disciplined by it and have governed wisely in spite of it.
Theodore Roosevelt and Winston Churchill, when heads of government, suffered fewer depressions and their mood swings were easier to deal with than when they were out of office. Perhaps the huge responsibilities they were carrying for the wellbeing of others took them out of their own problems.
Nonetheless, even though the relationship between illness and the capacity to govern is not a straightforward one, it is something of which democratic societies need to be more aware. Democratic politicians as diverse as Wilson, Franklin Roosevelt, Churchill, Kennedy, Johnson, Nixon, Georges Pompidou, François Mitterrand and Tony Blair have not trusted their electorates with true factual information about their health.
When Kennedy met Nikita Khrushchev in Vienna in June 1961, JFK's presidential performance was seriously impaired. A combination of back pain and Dr Max Jacobson's (nicknamed "Dr Feelgood") unregulated injections of amphetamines and steroids interacted with the drug therapy for his Addison's disease to cause a state of exhaustion, restlessness and fluctuations of mood that considerably reduced his ability to do the job of president. Fortunately, by the time Soviet missiles were photographed in Cuba on 16 October 1962, the president's back condition had improved substantially, as had his whole medical treatment.
From the start of the missile crisis, Kennedy knew his chiefs of staff wanted immediate massive air attacks and an invasion of Cuba. Kennedy was, however, determined to take his time and not let the chiefs become the dominant source of advice. He was now a very different person from the crying, emotional man after the Bay of Pigs failure in April 1961, or the shattered and shaken man who flew back from Vienna that June.
Mental illness tends to make politicians very secretive. This is because public opinion still regards psychiatric illnesses as more frightening than physical ones. It leads some doctors to argue that releasing psychiatric information to the public deserves exceptional handling, and that some parts can legitimately be withheld. But selective disclosure is not acceptable; politicians must educate public opinion and trust their judgment.
Politicians have long been afraid that the revelation of any mental illness will damage their candidature. They remember the experience of Senator Thomas Eagleton, who was forced to resign as George McGovern's vice-presidential candidate before the 1972 presidential race when it was leaked that he had had three depressive episodes. Yet at the start of the 21st century, public attitudes to mental illness contain less prejudice.
In August 1998, the prime minister of Norway, Kjell Magne Bondevik, had a severe depressive reaction. His initial decision was to resign, but he discussed the matter with his foreign minister, and they announced that he had depression. After four weeks of treatment and adapting his working practices, he returned to work. His frankness was greatly respected by the Norwegian people, and is widely regarded as contributing to the fight against the stigma that mental illness often carries.
Heads of government have a duty to be open about their health, and the media have a duty to expose them when they evade the truth. It is unlikely that cover-ups of the magnitude perpetrated by Woodrow Wilson could happen in the US now, and nor would the American press be as complicit as it was in covering up Kennedy's illness. But the fact that Mitterrand was able to cover up his advanced prostate cancer for more than 11 years should be seen as a warning. The cover-up went on despite the lessons that appeared to have been learned after the death of President Pompidou in office in 1974, whose illness had also been hidden from the French people.
I used to think that the openness with which President Bush Sr dealt with his thyrotoxicosis, presenting as atrial fibrillation, in 1991 meant that we could expect truthfulness in the 21st century, but this has not proven to be the case, with Blair, George Bush Jr, Jacques Chirac and Ariel Sharon all covering up their illnesses.
How, then, are democratic societies to ensure they have the information they need about the health of their leaders? In the past, the public has often had to rely on statements made by the personal physicians of heads of government. But the primary responsibility of a personal physician to their patient means they cannot be expected to balance the best interests of their patient against the best interests of the country. Personal physicians should not be expected to attempt to combine the two roles, and when they do, it usually backfires. Lord Moran, Churchill's personal physician, an eminent doctor and a president of the Royal College of Physicians, attempted to combine the two roles but it ended in failure. He has rightly been criticised for his misleading public statements about Churchill's health, particularly in 1953.
It would help if the medical profession established a code of conduct over the issuing of public medical bulletins for prominent people. One guideline could be that a personal doctor's advice should remain simply that – personal. Another would be that an independent doctor is best used whenever a medical assessment is needed.
Democracies should be encouraged to enact legislation that makes public, independent medical assessment mandatory on all candidates for the post of head of government before they submit themselves to election. Nothing, of course, can stop politicians giving their medical history their own spin – but this way, at least, most would calculate it is better to give their explanation well in advance, so there are no surprises left to affect their potential voters.
In Sickness and In Power: Illness in Heads of Government over the Last 100 Years by David Owen is published by Methuen. The paperback is due out in October (rrp £14.99). To order a copy for £13.99 with free UK p&p, go to theguardian.com/bookshop or call 0330 333 6847.
[• This footnote was appended on 27 October 2007: The study referred to in this article is: Mental Illness In US Presidents Between 1776 and 1974, by Jonathan RT Davidson MD, Kathryn M Connor MD, and Marvin Swartz MD, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina. It was published in The Journal of Nervous and Mental Disease, Volume 194, Number 1, January 2006. The classifications used in the study are those of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.]
