Daily Times

Israeli Prime Minister (PM) Benjamin Netanyahu’s psychiatrist MosheYatom was found dead at his home in Tel Aviv from an apparent self-inflicted gunshot wound. A suicide note at his side said that PM Netanyahu had been his patient for the last nine years and he had “sucked the life right out of me”. Yatom became depressed due to lack of progress in getting the PM to acknowledge reality and he eventually suffered a series of strokes while attempting to grasp Netanyahu’s thinking, which he characterised in one diary entry as “a black hole of self-contradiction”. Sceptics worry that Yatom was about to publish a book on his work on PM Netanyahu titled Psychotic On Steroids.

The course of modern world history has been critically shaped by the physical and mental illnesses of heads of state, sometimes in the public eye but usually in secrecy. Democratic politicians as diverse as Woodrow Wilson, Franklin D Roosevelt, Churchill, Kennedy, Johnson, Nixon, Pompidou, Mitterrand, Blair, George W Bush, Chirac and Sharon all lied about their health. Mental illness amongst political leaders is difficult to diagnose and often, even if it is diagnosed, it may be impossible to ensure treatment. One of the most probing questions about leaders committed to brutal policies is: are they mad? Hitler and more recently Saddam Hussein, Milosevic, Mugabe and Benjamin Netanyahu have often been described as being ruthless and callous in newspapers when in fact they have not been far from being certifiable.

Was President Milosevic mentally unbalanced? Some quote the history of mental illness in his family (both his parents committed suicide) to explain his attitude towards the great brutality that took place in the break up of former Yugoslavia. Watergate journalist Bob Woodward, wrote in his book that US intelligence reports claim Hamid Karzai, the president of Afghanistan, has a diagnosis of manic depression. Karl Eikenberry, US ambassador to Kabul, has been quoted as saying: “He is on his meds, he is off his meds.” If it is true that Mr Karzai suffers from bipolar disorder, which is what manic depression is more accurately called these days, I doubt he is the only national or world leader, president or PM who has symptoms of it. There is little to no need to worry since all the VVIPs who sit opposite to me in my therapy successfully show that it would not affect their ability to do their job, if it is properly treated.

Adrian Levy writes in his book Deception about Dr AQ Khan and his psychiatric treatment for depression. There have been other cases in the political history of Pakistan where features of personality disorder and alcohol dependence came significantly close to a clinical examination. The brutalising effect of grandiosity seen in civil and military dictatorships had a deep effect on General Yahya, Zulfikar Ali Bhutto, Ziaul Haq and Musharraf, as on many others in their cabinets. Like Bhutto, when Musharraf came to exercise absolute power, he still relied on elections but he did not hesitate to manipulate them. He justified using the mechanisms of a totalitarian power, controlling the important sections of the media while leaving the less important relatively free because, to him, and many surrounding him, the opposition parties were fighting for their existence. Zulfikar Ali Bhutto died as an acknowledged nationalist leader. Ziaul Haq was the victim of a conspiracy and succumbed to a fatal air crash whilst Musharraf has ended up in the courts.

The longer a leader lasts in office in these regimes, the more their power stems not from popular consent but from imposition. National minorities within our divided country gave these leaders ethnic electoral support but such leaders were vulnerable to coups or assassinations. They led ever more secretive lives, became out of touch with the people they led and the reality of the world around them, and developed paranoid tendencies. In addition, these leaders became corrupt. Never has there been a truer aphorism than that of Lord Acton: “All power corrupts, absolute power tends to corrupt absolutely.”

The overriding question raised by all these case histories is how, in a democracy, it is possible to construct a legal procedure whereby a head of state or government can be legitimately breached out of office. Psychiatrists and legal eagles have to be very careful in formulating fixed structures for a political situation that will often be in considerable flux. First, we have to be clear as to whether it is reasonable for the personal physicians of a head of state or government to be charged with a dual responsibility, both for the good of their patient and in the best interests of their nation.

Some argue that the accurate meaning of the Hippocratic Oath is that a doctor should go to his grave with the secrets of his patients and not even leave behind any paper records for posterity. Another view, one that I share, is that history can sometimes benefit from the analytical insight of the personal psychiatrist of a head of state or government and that publication devoid of casual conversation can be very valuable after the close family has died.

An important question is whether in democracies the electorate are entitled to an independent medical and psychiatric assessment of all the candidates standing for the position of head of state or government. There would be even more furore if there were medical disclosure prior to any election for leader by political parties. Against such provisions, one wonders that if such a rule had existed, certain leaders we have valued and are still esteemed would never have served in the highest office.

Public opinion today remains frightened of psychiatric illness and this makes advisors to heads of state feel that psychiatric information should be withheld. It is hard to see any rule being made selective of certain categories of illness. Politics is not a rational business and democratically elected political leaders have often used dubious means of clinging on to office. Former President Asif Ali Zardari, a man never to be underestimated, was flown to the UAE in a medical emergency. General Kayani was known to have had a cardiac bypass surgery whilst on the job. Both he and Asif Zardari continued in their offices even when their health conditions were known. They downplayed the significance and fought by all possible means to convince the Pakistani people, press and both national and international political leaders that they were fit for office.

I believe there should be provisions in place in a democracy to ensure that, before voting any candidate for head of state or government into office, whether for the first or for subsequent elections, the general electorate should know the results of an up to date independent medical examination. Relying on a politician, ambitious for office, to reveal their true health or on their own personal doctor, family or friends is not sufficient.

Reluctantly, I must also accept that if a head of state or government becomes ill in office, different considerations apply and there can be no set rules. Too many times, historically, democracy has been better served through letting medical events take their place in a spectrum of considerations on whether to force a head of state or government out of office. Any automaticity involving panels of independent doctors examining elected heads of state or government at regular intervals and releasing their findings to politicians or the public puts too much authority into the hands of doctors, I fear ideally, removal from office must ultimately depend on the judgement of senior political leaders in their cabinet and in the elected legislative chambers.

The writer is a professor of Psychiatry and consultant Forensic Psychiatrist in the UK. He can be contacted at fawad_shifa@yahoo.com