Commentary: the Psychiatry of Hubris
Authors: Simon Wessely
Journal: Journal of the Royal Society of Medicine (2006)

The medical profession in general, and the psychiatric profession in particular, have moved away from the liberal use of descriptive, usually pejorative, terms to describe people who are difficult, dangerous, or different. It is over 40 years since psychiatry abandoned the concept of hysterical personality disorder, ever since Paul Chodoff showed that it was simply a caricature of male views of femininity. We no longer use ‘psychopath’ simply to mean a nasty piece of work, and we leave megalomaniac to the script writers for James Bond.

Indeed, psychiatrists are increasingly cautious about entering into the minefield of understanding the minds of prominent people, let alone predicting their behaviour. During the Waco siege the FBI commandeered a group of psychiatrists and locked them in a hotel room until they had predicted the likely behaviour of David Koresh, the cult leader. The one thing on which they were agreed was that Koresh would not commit suicide, which is what he did. It is rumoured that the same psychiatrists later predicted that Saddam Hussein would prefer suicide to capture, which he did not. It is territory that few mental health professionals care to tread.

I have myself dabbled in these dark arts on occasions—in Roger Chickering's recent biography of General Erich Ludendorff, the man who steered the German Army to defeat in the First World War, and whose oft iterated and fanatical views on why the Jews and Freemasons, and not himself, had led to this outcome, were such that even Hitler thought he was cranky—I am cited as the source for the observation that the General and his even more bizarre psychiatrist wife were ‘not mad, but the kind of person you wouldn't want to sit near at a dinner party’. But Ludendorff is safely dead.

However, neither the general public nor politicians show any such compunction. Our current media psychiatrist, Raj Persaud, took Jack Straw to task for calling suicide bombers ‘crazy’ and Bin Laden ‘psychotic’. Both observations were factually untrue, impeded rather than assisted understanding, and stigmatized those who are genuinely psychotic, but I suspect that neither the now ex-Foreign Secretary nor the public paid Raj much attention.

And now another ex-Foreign Secretary swims in the same dangerous waters. However, this is no politician using psychiatric terminology because he knows no better. As most people will know, David Owen qualified as a doctor, and came perilously close to a career in psychiatry. Indeed, if he had taken the SHO post he was offered at the Maudsley he might have ended up where I am now.

Putting aside that tantalizing ‘what if’—or ‘counter factual’, as historians call it—in recent years Lord Owen has returned to his roots, and has become increasingly fascinated with the question of how illness influences history via the health of politicians. That raises a host of ‘what ifs’ well beyond the early career of David Owen. What if Woodrow Wilson had not had the stroke when he did—would America have ratified the Treaty of Versailles and hence not started twenty years of isolationism, until Pearl Harbour reminded them they were a superpower after all? Would Stalin have managed to hoodwink Roosevelt at Yalta had the latter not been on his death bed? Or my favourite—what if Sir Morrell McKenzie, the best ENT surgeon in Europe, had not diagnosed influenza when called on to explain the hoarseness of the still youthful Crown Prince Friedrich, but instead the early stages of the throat cancer that would kill the heir to the German throne almost as soon as he had come to power? In that case we would have been spared his son, Kaiser Wilhelm II, with his dangerous combination of withered arm, blind ambition, reckless misjudgements, and jealousy of the British Empire. There might have been no naval arms race and no First World War, at least not involving us.

But physical health is always simpler than mental health, and now Lord Owen has gone beyond his previous studies of the physical or neurological health of the good and great, to consider their psychological make up. In particular he draws on the Greek concepts of hubris and nemesis as a way of understanding what many of us struggle to understand: the minds of Bush and Blair.

Lord Owen lands some heavy blows, finding them guilty of numerous sins of pride, over-confidence and messianic zeal, a case he makes at greater length and with numerous insights from his own career and interactions in the book of which this paper is a part. But it is inevitable that in seeking to make his case, he must over-emphasize the personal at the expense of the political. Just how much do the failures in Iraq owe to Bush's pride, and how much to the complex political agendas of Cheney, Wolfowitz and Rumsfeld, and their neo-conservative Cold War gurus such as Albert Wolstetter?

It is often said that all political careers begin brightly, and end in failure. But are all politicians doomed to make the journey from success, via hubris, to nemesis? Hubris is excessive pride that leads in Greek tragedy to the downfall of the hero, when he meets his nemesis. But the hubristic hero must first have carried out great deeds, which makes the subsequent nemesis all the more tragic. When Ajax accuses Achilles of hubris in book nine of the Iliad, there is no doubting Achilles' previous feats and valour. It is always a mistake to underestimate George Bush, but not even his closest admirers could call him a war hero.

But which David Owen has the most telling insights: is it Owen the doctor, or Owen the politician? It must be the latter. Understanding the motivations and mind set of our leaders will be the historian's task, not the psychiatrist's. Personal issues may play a larger role in the grand scheme of events than we care to admit—who knows how historians will unravel the tangled web of rivalry between Number 10 and Number 11 and how that influenced decision making? But the historian who comes to weigh up Blair's Wars will need to take into account a far wider range of factors, political, social, economic, cultural and much else besides. David Owen's own observations of Blair at his zenith will be part of this reckoning, and his analysis of events demands and receives respect. But will this future historian also draw on the findings of cognitive neuroscience, as David Owen suggests, to unlock the secrets of Blair's mind? I doubt it. Owen the doctor gives us some insight into the characters and motivations of the powerful, but it is Owen the politician who delivers the most compelling verdicts.