This week Jerrold Post looks at drug abuse among political leaders.
The prospect of senior world leaders wrestling with complex politico-military crises while under the influence of narcotics, stimulants, sedatives or alcohol is dreadful to contemplate. But in point of fact the history of the 20th century is rife with such examples.
Ups and Downs on Downing St.
Throughout his career, Winston Churchill drank heavily. A man of patrician taste, he favored cognac and champagne. During World War II, the heavy drinking continued, augmented by what he termed his "reds" (barbiturate capsules) which he required for sleep. Yet few would fault his leadership performance as wartime commander.
In his term of office as prime minister during the 1950s, however, Churchill became increasingly dependent on drugs. This was especially the case after his 1953 stroke. Churchill even named his tablets: majors, minors, reds, greens and "Lord Morans" (the name of his doctor). These medications were sometimes taken during the day and with alcohol. Cerebral arteriosclerosis (hardening of the arteries of the brain) was probably the principal factor leading to Churchill's progressive incapacity; but excessive use of alcohol and drugs aggravated the situation. Increasingly enfeebled, he took stimulants to project an image of vitality. For the last year in office, his intellectual functioning was so compromised he could not effectively participate in decision-making. The gravity of his condition was carefully shrouded from the public while Anthony Eden played a stabilizing role behind the scenes.
While the public image of Churchill's successor, Anthony Eden, was of a suave, urbane and self-contained man, in point of fact he was extremely high-strung with a noticeably nervous temperament. His 21 months in office were marked by a number of severe national and international crises including the Suez debacle. Especially under the stress of crisis, his leadership behavior was apparently degraded by prescribed medication and self-medication.
Eden had been troubled by gall bladder difficulties for many years. He was intermittently ill in office due to debilitating fever probably associated with that condition. There is reason to believe Eden became dependent on narcotics during a painful sustained bout of blockage of the biliary tract in the early 1950s. At this time he carried a box with him containing a variety of medicines including morphine.
But it was addiction to the powerful stimulant amphetamine which rendered this previously thoughtful and moderate statesman erratic and injudicious to the extreme and undoubtedly contributed to his disastrous leadership during the Suez debacle. Sustaining himself on less than five hours of sleep a night, Eden has acknowledged that he "was practically living on Benzedrine" during the crisis. Demonstrating signs of amphetamine intoxication, according to one witness he was "almost in a state of exaltation" during the period. According to another witness, he talked ceaselessly and was given to hysterical outbursts when Nasser's name was mentioned. A concerned physician confided that "Anthony could not live on stimulants any more." Biographer William Manchester observed that the deleterious effects of the drug were not known at the time. "Years later medical scientists discovered that amphetamines could rob a sensible man of his good judgment, and this is what happened to Eden in 1956."
The Case of JFK's 'Vigor'
It appears that amphetamine abuse, which had spread to the general population in the 1960s, began in elite groups in the 1940s and '50s. "Celebrity doctors" may have played an important role in first establishing this pattern.
Dr. Max Jacobson had fled Hitler's Germany in 1936 and soon took up medical practice in New York City. Although he had no staff privileges at any hospital after 1946, during the 1950s he acquired a reputation as a doctor for celebrities, among whom he was known as "Doctor Feel-Good." Eddy Fisher, Truman Capote, Alan Jay Lerner, Otto Preminger, Emilio Pucci, Anthony Quinn, Tennessee Williams and Cecil B. DeMille were among his patients. He also became a physician to John F. Kennedy, and is depicted in an intimate family photograph in "John F. Kennedy: A Family Album."
The source of Jacobson's popularity with the famous appeared to be in part the energizing injections of amphetamines he gave them. (Usually amphetamines are given by mouth; by injection, their effects are especially powerful.) Several patients of Jacobson suffered from amphetamine poisoning while under his care. Mark Shaw, the photographer of "Family Album," died while under Jacobson's care. The official autopsy showed no major evidence of heart disease, but did report heavy residues of methamphetamine in Shaw's organs. Under questioning, members of Jacobson's staff admitted to buying quantities of amphetamines sufficient to give many large doses daily. In 1969 the federal Bureau of Narcotics and Dangerous Drugs seized all controlled substances in Jacobson's possession. Six years later Jacobson's license was revoked by the New York State Board of Regents.
What was Kennedy's relationship to Jacobson? Although their association (which extended to the Vienna summit) is authenticated, medical records are not available. Harvey Mann, a Hollywood casting director who claimed to have been an assistant to Jacobson in the 1960s, wrote that on at least one occasion he mixed a solution containing 85-percent amphetamines for hypodermic injection. He then accompanied Jacobson to the presidential suite in New York with this material, and Jacobson and the president retired to another room. Mann then found the empty vials and used syringe. The president, according to Mann, had the flushed appearance characteristic of people who have recently been injected with amphetamines. Still, as with Jacobson's other patients, without the medical records there is no way to be sure that Kennedy received amphetamine injections from Jacobson, or, if he did, that he was aware what the injections contained.
Rumors have been widespread in medical circles that Kennedy selected Jacobson as his physician explicitly because of the amphetamine injections -- and that JFK was high at the Berlin Wall. (These stories were noted by physicians who participated in a commission established by the University of Virginia's Miller Center to discuss presidential disability and the 25th Amendment. The group issued a report in January 1988.) Absent convincing proof, however, such allegations remain conjectural.
Hitler's Medicine Cabinet
Perhaps the most remarkable case of drug abuse by a 20th-century leader, and one which helped shape history, was that of Adolph Hitler. Over 70 medications were given to Hitler by his doctor, Theodore Morrell, who was widely known as a quack. Nicknamed "the Meister-Jabber" by Hermann Goering, Morrell, according to medical historian Hugh l'Etang's book "Pathology of Leadership," administered to Hitler "vitamins, bromides, barbiturates, cardiac stimulants, laxatives such as castor oil, desoxycorticosterone for muscular weakness, hormones both from the female placenta and from the testes and prostrate of young bulls, sulphanamides, penicillin powder for skin disorder and belladonna."
Moreover, Morrell daily gave his own golden Vitamultin tablets to Hitler. On chemical analysis, these were found to contain both caffeine and Pervitin, a form of amphetamine. He also injected Hitler with Eukodal (Percodan, a narcotic of equivalent strength to morphine) for his abdominal pains.
After the attempted assassination in July 1944, Hitler began receiving daily cocaine treatment for his chronic sinusitis. The drug, in 10-percent concentration, was frequently swabbed on Hitler's nostrils, and Hitler himself twice daily used an inhalator containing cocaine. Hitler's ear-nose-throat physician was later to testify that although Hitler was "not your common drug addict," nonetheless "his neuropathic constitution led to his finding certain drugs . . . like the cocaine in the sinus treatments I gave him, particularly pleasurable; and there was a clear indication toward becoming an habitual user of such medications as he himself admitted to be."
The precise effects of this pharmaceutical cocktail on Hitler's mental state is difficult to gauge. Suffice it to say, in the jargon of the street, that Hitler was simultaneously taking coke and "speed." Amphetamine alone would have had major deleterious effects upon Hitler's decision-making.
Among the initial effects of amphetamines which make it attractive to a leader in a crisis situation are an increase of alertness, lessened fatigue, feelings of well-being and lessened need for sleep. In a crisis, an individual "high" on stimulants may be insufficiently cautious or unduly optimistic. Compounding the felony, under sustained stress some will utilize serially stimulant and hypnotic drugs, producing a "high-low" sequence.
But with continued use, the feelings of well-being can mount to the point of euphoria, grandiosity and exaltation. Suspiciousness and irritability mount. There is a tendency to loss of emotional control and hyperactivity. Decisions are made without judicious consideration, in impulsive haste. Continued amphetamine use can lead to confusion about time and place, distractibility, vagueness, rambling speech, delusions of persecution, hallucinations and psychotic behavior resembling paranoid schizophrenia.
Hitler's biographers and the memoirs of German generals provide descriptions of Hitler's distractibility, irritability and sudden, apparently arbitrary decisionmaking. To confront Hitler with bad news was to precipitate an attack of rage and risk losing one's job. Many of these behaviors were in evidence earlier in his career before he was operating under the influence of drugs. Almost certainly the multiple drug use would have magnified many of the observed characteristics.
The Cloud of Unknowing
The substance most frequently abused by political leaders is alcohol. It is certainly the most common agent of self-medication, regularly employed to relieve both anxiety and depression; and the world of politics is a particularly salutary environment for the concealment and facilitation of alcoholism. What begins as a pleasant duty may become a painful addiction, but the association of alcohol and politics is so pervasive that reporters and political opponents characteristically do not report or exploit incidents, even after frequent repetition. (Witness, for example, the numerous stories of heavy alcohol consumption, especially during crises, by former president Richard Nixon.)
A precarious balance may exist among the alcohol abuser's personal life situation, his political capacity and his work circumstances -- until a change in any of these factors precipitates a major episode or a permanent condition of alcohol incapacity. Thus an alcohol abuser might manage reasonably well so long as his wife is alive, but will become incapacitated by her death. Or he might function successfully as a minor cabinet official, but not in a more demanding role.
The best known instance of alcohol abuse in high office is that of President Andrew Johnson, whose condition figured in the debate concerning his impeachment. The best documented case of an alcoholic under the stress of excessive responsibilities is, however, that of Key Pittman, chairman of the Senate Foreign Relations Committee during FDR's presidency. As his disappointment mounted that he did not achieve the influence within the Roosevelt administration that he desired (and felt he deserved), his alcohol consumption mounted precipitously. This in turn led to inappropriate social and political behavior, including very careless speech, which further degraded his influence, which led to increased alcohol consumption, in tragic downhill spiral.
World leaders operate under unusual stress and often feel entitled to special treatment. While the use and abuse of alcohol and drugs is by no means universal in their ranks, it is not uncommon. Leaders have unrestricted access to alcohol and psychoactive drugs. Unfortunately, the long-term effects of chemical abuse are not apt to become manifest until months or even years after critical interludes. Substance abuse by major political leaders is not a private illness. For the leader under the influence of drugs or alcohol, be he mayor or chief of state, every aspect of his functioning is affected -- his perceptions, judgment, decision-making and the balance between his own needs and those of his followers. Especially during crises, when the mighty are high, the lowly should tremble.
