Dementia and the pathology of leadership…

I described previously the problem of the ‘Pathology of Leadership’ (here), with a further post mainly devoted to dementia in our leaders (here). It’s not just political leaders who have health problems.

I mentioned Ferdinand Sauerbruch in the second post. It’s difficult now to overemphasise just how renowned a surgeon he was in the inter-war period. From very modest origins, he rose to be the top surgeon in the top hospital, the Charité in Berlin, in Germany. He was deservedly internationally famous for his achievements, even if today he is largely forgotten. He remained in the Charité throughout WW2; though never a Nazi, his record in this area is rather ambiguous.

After the fall of Berlin he remained in post, under the new political masters, the German Democratic Republic. Sauerbruch continued as before; in a distinctly Teutonic way, he largely ignored piffling politicians. He published his autobiography, Das war mien Leben (That was my life) in 1951. The English translation, A Surgeon’s Life, appeared in 1953. The publishers of the English version included a prefatory note:

Sauerbruch’s uncompromising attitude in professional matters, combined with an unorthodox personality, earned him a controversial reputation not only in the medical world of his day, but also in the fashionable circles that he enjoyed frequented. The publication of his memoirs…revived this controversy, for his book reflects that idiosyncratic attitude to men and affairs that often aroused the despair of his friends and the apprehension of his enemies. So seriously, indeed, did some of his friends regard the publication of these memoirs that efforts were made to discredit their authenticity…

This waffle is publishers’ code for ‘take all here with a very large grain of salt’. Sauerbruch was demonstrably dementing when he wrote and dictated his memoirs, describing at times utterly fantastical activities. And dementing not only when he wrote the memoir, but quite clearly for some time beforehand, when he was still the top surgeon in the Charité. There are numerous stories of his incapacity, of the errors he made; it was common for patients on whom he had operated during the day to be surreptitiously returned to theatre at night, when the juniors would patch up his botched work. One private patient described how, when attending as an outpatient, Sauerbruch had confirmed that a lump in her breast was malignant, and began to operate then and there. Sauerbruch operated on his kitchen table, using the available domestic culinary implements.

This was well known to the East German government; but such was his reputation, his international prestige and the power of his personality that they felt constrained to act; this same supposedly all-powerful government that, through the Stasi, routinely spied on most its people, was rendered almost impotent. Jürgen Thorwald published the story of his eventual removal as Die Entlassung (The Dismissal) years later. It took 250 pages to describe how the authorities were eventually, over a period of years, able to dismiss him.

Did you watch A very English Scandal, broadcast recently on the BBC? Based on the book of the same name by John Preston, it describes the rise of Jeremy Thorpe to the leadership of the Liberal party, and his eventual trial at the Old Bailey on charges of conspiracy to murder Norman Scott; he was found not guilty. The jury felt that there had been a conspiracy to intimidate Scott, but, as Thorpe wasn’t charged with this, they could not convict. As an aside, there has always been the suspicion that the hand of the Establishment was at work here, protecting one of its own; the judge’s summing up was so biased that Peter Cook mercilessly satirised it. (Here)

One jury member wrote an article for the Guardian; it was declined. However, Bruce Page the then editor of the New Statesman did publish it. The New Statesman and its editor were promptly sued for Contempt of Court by the Attorney General; the charges were dismissed. (Subsequently, the law on contempt was put on a statuary basis through section 8 of the 1981 Contempt Act. Jury research is now impossible.) During the proceedings, one judge asked, some hours into the trial, who Bruce Page was. He also ‘read his legal books upside down’. (More here)

This judge was Lord Widgery, the Lord Chief Justice of England. Second only to the Lord Chancellor, he was the head of the judiciary. He is more famous in N Ireland for the ‘whitewash’, his report into the Bloody Sunday killings. Upon appointment, he was well regarded for his administrative abilities; indeed, that seems to have been a main consideration in his appointment. By the time of the New Statesman trial, he was clearly dementing. His judicial colleagues ‘carried him’ and would write judgements for him. Private Eye said of him:

he sits hunched and scowling, squinting into his books from a range of three inches, his wig awry. He keeps up a muttered commentary of bad-tempered and irrelevant questions ‘What d’you say?’, ‘Speak up’, ‘Don’t shout’, ‘Whipper-snapper’, etc

Dr Alois Alzheimer originally reported what he thought was a new condition, that of pre-senile dementia, or dementia praecox. Today, this and ‘ordinary’ dementia are considered as one condition, though Alzheimer’s original description is now called ‘early onset dementia’. Dementia is not an acute illness; rather it is slowly, initially insidiously, progressive.

Lord Widgery does seem to have had early onset dementia. There were 500 submissions to his Bloody Sunday Inquiry; he is said to have read 15 of them. The Report believed the word of the soldiers, and exonerated them. After considerable pressure from the public, a further Inquiry under Lord Saville began work in 1998, completing this twelve years later. This found that the public’s version was essentially correct. It is difficult at this stage to know to what extent Lord Widgery’s mind was clouded by dementia at the time of his Report, but that he was then suffering from Alzheimer’s disease cannot be seriously doubted. (More here) Even though Iris Murdoch was still able to write a novel when she had early dementia, it wasn’t so well received. Undoubtedly, sufferers from Alzheimer’s disease will be capable of some levels of work and thought; but certainly not crucially important work requiring attention, industry, precision and accurate judgment at the highest level.

Yet again, these potted biographies raise serious and troubling questions. While many industries have an Occupational Health Department (the health service here certainly does), these are reliant on people self-reporting. As fas as I know, only airline pilots are compulsorily required to undergo regular checks.

If serious illness can impair those at the top of their professions, the top judge, the top surgeon, even presidents and prime ministers, who then will say to them, ‘Enough, it is time to go’. And who has the power to enforce this? Who will guard the guardians? The silence is telling.

After the broadcast of A very English Scandal, Jonathan Freedland asked in the Guardian which British scandals would any commissioning editor be on the look out for? Apart from his ideas, there were 735 replies; clearly, a lot of scandals awaiting an airing. And these are only the ones we know about; what else has the Establishment buried that hasn’t yet seen the light of day? (A word of caution; in common law, the dead cannot be libelled, but the living can.)

Likewise, Brian (here) in an article about the Last of the Magdalenes, asked which will be the next Irish scandal(s). We can be certain that there will be something, even if we can’t exactly say what.