My considerably updated ebook version of In Sickness and In Power, originally published in 2007/8, provides new material and in particular draws on the evidence to the Chilcot Inquiry in relation to his chapter on Bush and Blair. There is also a completely new chapter on hubris syndrome in the military.
I've long been interested in the inter-relationship between politics and medicine and used my deep knowledge of the brain as a neurologist to undertake this unique study of illness in heads of government during the last 100 years and the influence of their medical advisers.
The course of 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. There are separate chapters on such diverse political personalities as Sir Anthony Eden at the time of Suez in 1956; the illness of the last Shah of Iran; and President Mitterrand of France who suffered from prostate cancer.
I also focuses on the "intoxication of power" and diagnose hubris syndrome acquired while in office by Lloyd George from 1919-22, Neville Chamberlain 1938-40, Margaret Thatcher from 1988-90, and Tony Blair from 2001 to the present day and Bush from 2001 until it abated with the 'surge' and ended when he retired.
I also outline some of the safeguards that society needs to address as a consequence of illness in heads of government and challenge the medical profession to look more deeply into defining 'hubris' symptoms amongst business leaders in particular but also in most other areas where power can change personality.
Here's an extract from In Sickness and in Power on Tony Blair...
Although the war in Iraq was overwhelmingly an American-led enterprise it makes sense to begin by discussing the evolution of Blair's approach to Iraq, since he came to power in May 1997, three and half years before George W. Bush entered the White House. I first met Tony Blair for a serious conversation on 15 July 1996 at his home, when he was leader of the opposition and the issue was whether I was willing to publicly support New Labour. I declined for a number of reasons, not least because of his passionate belief that Britain should adopt the euro on the basis at that time of zero knowledge. I first discussed Iraq with him on 2 March 1998 in Downing Street and, as a sign of my depth of feeling about Saddam Hussein's regime, gave him a book about the Kurds written by Jonathan Randal, an experienced war correspondent with the Washington Post. It reflected why I believed that the handling of the Kurdish position, so long ignored by the Western democracies, had become so crucial. I suggested to Blair that his chief of staff, Jonathan Powell, should read the detailed analysis in the book and brief him on it, as it posed many questions for the future. For example, it discussed how the aftermath of the defeat of the Iraqi forces in 1991 had much to be desired.
The American planning was a hodgepodge of naivety and realpolitik, more tactics than strategy, seemingly consistent only if its peculiar assumptions were correct. No-one should have been surprised by anything that happened from 2 August 1990 when Iraq invaded and occupied Kuwait to the end of the following March, when Saddam Hussein crushed the Shia and Kurdish uprisings.
I followed up the concerns I had expressed at that meeting with a letter to Blair on 12 November, arguing that there had to be a political strategy involving the Kurds to help topple Saddam Hussein. Blair replied: 'We are not working to bring down Saddam Hussein and his regime. It is not for us to say who should be President of Iraq, however much we might prefer to see a different government in Baghdad.' This exchange encapsulated the UK's particular problem: most British governments have felt legally bound to use similar wording on regime change based on a particularly inflexible interpretation of the United Nations Charter. That position needs re-examining, particularly in the light of the UN declaration of 2005 on the Responsibility to Protect, and is touched on in Chapter 9 in the sections on despotic leaders.
Following the withdrawal of UN inspectors from Iraq in December 1998 in response to Saddam's non-cooperation, the United States and Britain launched a four-day bombing campaign against Iraqi targets. The military operation was undertaken, as in 1993 and 1996, and again in 2002 and 2003, with the US and the UK claiming the authority of the UN resolutions passed in 1990 and 1991 and in addition UN Security Council Resolution 1205, passed in 1998.
Tony Blair asked me to dinner at 10 Downing Street on 18 December, the third evening of the bombing blitz. The main reason for the invitation was Blair's wish to dissuade me from establishing a cross-party organisation later called New Europe, which opposed the UK joining the euro. But we also discussed Iraq at some length. His mood was quite different from what it seems to have been two days earlier when, over dinner with his wife and two close friends, he was reported to be 'distinctly nervous'.
At dinner on the 18th in similar circumstances with our wives I found him relaxed, almost laid back. He had started well as Prime Minister, particularly in handling Northern Ireland, and it looked as if he was set to be a successful premier. There was no undue hyperactivity. He did not excuse himself to get an update on the attacks that had been launched and I found him cool, rational and anything but hubristic. He was ready to discuss the complexity of the relations between the Shiite majority and the Kurds and Sunnis in Iraq in some detail but he was not very knowledgeable about them and he had obviously not yet read Randal's book. We agreed that the situation which allowed Saddam to stay in power was totally unsatisfactory and shared the frustration about UN limitations within which he, Blair, felt formally he had to operate. Meanwhile the Iraq Liberation Act had been passed by an overwhelming majority under President Bill Clinton, as mentioned above. The challenge was Saddam's continuation in power, not WMD, which were only briefly mentioned, though we both believed they were still present in Iraq.
The US and the UK dropped more than 600 bombs and launched 415 cruise missiles against Iraqi targets during this action, killing an estimated 1,400 members of Iraq's Republican Guard. The action, which had been targeted on some nuclear facilities, was later assessed as having set back Saddam's nuclear weapons programme by two years. Clinton, though committed to the Congressional resolution calling for regime change in Iraq, was never likely to authorise the full military invasion necessary to achieve this. American public opinion was not ready for military re-engagement on the ground in Iraq. The failed impeachment of Clinton over Monica Lewinsky in February 1999 had weakened his authority to go to the American people and demand action and this may have been a factor also when deciding what to do with the growing threat to the United States of Osama bin Laden and Al-Qaeda. The priority issue for military action for NATO, in the year ahead, was Kosovo.
My next conversation with Blair was during the Kosovo crisis when NATO was engaging in air attacks on Serbia. On 16 April 1999, the Prime Minister unexpectedly rang me wanting a long and detailed talk about his anxieties over the deteriorating situation. The Serb military were still largely unaffected by the NATO bombing and he wanted to discuss my publicly stated views that we should from the outset have been prepared to use NATO ground forces. Somewhat unconventionally, I had been attacked by name for these views, along with Henry Kissinger, in an article by General Charles Guthrie, then the UK Chief of the Defence Staff. This was a small but significant sign of an undue politicisation of the chief of staff. Clinton's advisers had apparently told the President that Slobodan Milošević would fold if threatened and, when he did not, that bombing would do the trick in forty-eight, then seventy-two, hours. It took eventually seventy-eight days of bombing and, even more importantly, a powerful intervention from Boris Yeltsin for Milošević to agree to withdraw the Serbian armed forces and police. They left reluctantly, never conceding military defeat.
I mentioned to Blair at an early stage that I was speaking from Berlin on an open line. He laughed and said he wanted anyone listening to know about his anxieties. Blair was surprisingly frank and we had an animated discussion. I sensed, however, for the first time a note of exaltation in his voice. Soon afterwards real tension developed between Blair and Clinton about the need to prepare to send in ground forces and on 21 April Blair told Parliament that ground troops were an option.
The following day Blair made a speech in Chicago, in which he tried to identify the circumstances in which Britain 'should get actively involved in other people's conflicts' in defence of our values. Whatever its rights and wrongs, and in large part I agreed with it, what was extraordinary for such an important speech was how little examination of its implications took place in Whitehall. It was drafted by a professor of war studies, Lawrence Freedman, who was himself surprised that Blair made very few changes to his proposed text. Freedman's text is on the website of the Iraq Inquiry, to which Freedman, a distinguished member, felt, quite rightly, he should make full disclosure of relevant interests. The input from the Foreign Office and the Ministry of Defence on that speech was clearly minimal. The speech has not withstood the test of time.
One damaging side effect of Kosovo, in retrospect, was the mood of self- confidence and personal dominance that began to appear in Blair's handling of foreign affairs. Kosovo was Blair's first test in a big international crisis and unmistakable signs of hubristic attitudes were beginning to emerge. Visiting refugee camps he was hailed as a hero. At one stage, Clinton angrily told Blair to 'pull himself together' and halt 'domestic grandstanding'. He was starting to display excessive pride in his own judgements. Clinton's aides mocked Blair's 'Churchillian tone'.19 One official who frequently saw him said: 'Tony is doing too much, he's overdoing it and he's overplaying his hand.' One of Clinton's aides suggested Blair 'was sprinkling too much adrenalin on his cornflakes'. Clinton, who has hubris in his make-up, was nevertheless one of the most empathetic politicians of the twentieth Century and this is one of the factors that protected him from acquiring hubris syndrome.
It is worth noting, however, the mention of adrenaline. It is very often referred to when people with no great medical knowledge discuss manic or hubristic behaviour. But if there is any linkage it is a complex one embraced within the two-factor theory of emotion, where the adrenalin may produce a physiological arousal but there also needs to be a thought process or cognition to interpret the meaning of this arousal.
After my telephone conversation with Blair, I was beginning to appreciate how personalised and very different his style of leadership was from the measured and structured style I had witnessed with James Callaghan as Prime Minister. Blair liked to claim he was following Margaret Thatcher's style of leadership, but this claim was false in many respects, particularly over her precise handling of the Falklands War. Unlike him, she had a formidable commitment to a political philosophy and she was renowned for her close attention to detail. But most of all, she was already experienced when she became Prime Minister, having served for many years in governments led by Harold Macmillan and Edward Heath. On taking office Blair was the most inexperienced British Prime Minister since Ramsay MacDonald in 1924, neither having held any ministerial office before entering No. 10. That lack of experience in retrospect was to prove more damaging to Blair's record than I initially thought it would. Blair has been one of Britain's actor politicians, the other most recent one being Harold Macmillan, but Macmillan came to be Prime Minister after a long apprenticeship and having been Foreign Secretary and Chancellor of the Exchequer.
Furthermore, Blair had had no formal training or experience in management. He tried to make up for this by talking to management thinkers and seemed, according to an article in Management Today, to want to act like a chief executive: 'fast on his feet, flexible in his thinking and able to make quick decisions, often taken on the hoof, in shirtsleeves, on the sofa, coffee latte in one hand, mobile phone in the other, running Great Britain plc as if it were a City investment company'. But the role of Prime Minister is not that of a chief executive and the UK government is not a company making profits for shareholders.
Like Blair, Thatcher had sought to accrete more power in No. 10 but she had worked within the existing Cabinet structures to do so. Even though Thatcher made considerable use of a personal foreign affairs adviser, Charles Powell, then a serving diplomat, the Cabinet Secretary remained a powerful independent figure. By contrast, Blair chose a formalised and progressive destruction of the Cabinet system. He started by appointing a political chief of staff, Jonathan Powell, the brother of Charles. Blair's press secretary, Alastair Campbell, and Jonathan Powell were exceptionally given the powers of a civil servant, a novel, far-reaching and ultimately disastrous change. These two progressively undermined the authority of the Cabinet Secretary. Also collective Cabinet discussion and responsibility were progressively and substantially reduced.
Then in 2001, in the flush of victory after winning a second general election, Blair, with no prior parliamentary examination or scrutiny, changed the whole basis of Cabinet government as it had related to foreign and defence matters. A system which had evolved during the First World War was swept aside without a single serious objective study. This was not modernisation but hubristic vandalism, for which, as Prime Minister, Blair alone bore responsibility. Shockingly there was little public or parliamentary recognition of the importance and significance of these changes.
The new structure was deliberately designed by Blair to ensure he could exercise over international policy much the same powers as a US President. The Cabinet Office method of handling foreign and security matters had, until then, been designed to service the Cabinet as a whole. From the summer of 2001 onwards, the key officials and their staff on foreign affairs, defence and the European Union were brought into the political hothouse atmosphere of 10 Downing Street in two new secretariats.24 The No. 10 secretariats were intended to service the Prime Minister alone, politically and strategically. Blair was to do much the same to the Joint Intelligence Committee, in terms of its working arrangements in No. 10 if not of its formal structure. The new foreign and defence organisation in No. 10 was designed to cause the progressive downgrading of the Foreign Office and the Ministry of Defence and their respective secretaries of state. Inexplicably, it was virtually ignored by the press, who had become enamoured of the aura which Blair began to project of a successful Prime Minister.
A few months after the two secretariats were in place in No. 10 the new structure provided the means to project Blair's very personalised response to the 9/11 attacks in New York and Washington and led eventually to the disastrous handling of the invasions of Afghanistan and Iraq.