The Mental Impact of Boris Johnson's Hospitalization

The psychology of ill leaders in the middle of a national crisis.

Posted Apr 07, 2020

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Boris Johnson when Foreign Secretary visits Japan
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Mental health experts who specialise in the psychological impact of a leader falling ill predict that much hinges on the leader's personality and style.

This is especially true in the midst of a national catastrophe, like the one we face now in the UK. A leader falling ill at an inopportune time can profoundly alter how the crisis is handled.

Two experts who have analysed in depth over 40 cases of chiefs of state stricken by illness while in the seat of power, are Emeritus Professor of Psychiatry, Political Psychology and International Affairs at George Washington University in the USA, Dr. Jerrold Post (who also worked for the CIA, psychologically analysing foreign leaders), and Professor Emeritus of Political Science at Tulane University, Dr. Robert Robins.

Robins and Post published studies, for example in the academic journal Political Psychology, and a book entitled When Illness Strikes The Leader, where they argued that sometimes a leader’s illness, can by itself, alter the course of history.

The dynamic that develops between an inner circle and a weakened authority becomes key.

A leadership style where they already tended to delegate to the inner circle may be a protective attitude when a Prime Minister falls ill. But if their narcissism meant they retained power jealously, not listening to advice, then a leader’s illness can become disastrous for their country.

Post and Robins argue that a disease with a fluctuating course might become particularly troublesome for the leadership inner circle, and therefore potentially most hazardous for the nation. This is especially so when the person in charge is in denial over the true extent of their disability.

Partially disabled leaders might be more manipulated when in a weakened state. Those pursuing power in the inner circle will then seize the opportunity provided by a temporary incapacity. But Post and Robins also warn that subordinates who act too assertively when the leader is weakened may find themselves out of favour (and a job) when the leader improves.

A reshuffle in senior roles shortly after a leader recovers betrays what really happened around the Prime Minister’s hospital bed.

Post and Robins describe an especially dangerous psychological syndrome which they have seen develop recurrently, which they term, "The Captive King and His Captive Court."

This is a particularly unhealthy dynamic where disastrous decisions for the nation are more likely to be made — when neither the leader nor the inner circle really trusts the other, yet each needs the other to survive politically.

But the deep psychological implications of when a leader falls ill can reverberate unexpectedly, for example, the medical care leaders receive historically has been distorted by their fame and power. Post and Robins entitle this section of their academic paper, Being a VIP May Be Hazardous to Your Health.

While our media keeps reporting the party line that the Prime Minister is receiving excellent care, in order to reassure the nation at this psychologically threatening time, clinicians are only human, and can also be impacted by this kind of particularly high-stakes illness. According to Post and Robins’ investigations of this clinical predicament, doctors treating a national leader under this kind of added pressure can disagree more than usual about the diagnosis and correct course of treatment.

Boris Johnson’s particular personal hero, Winston Churchill, of whom he was so enamoured that he even wrote a biography entitled, The Churchill Factor: How One Man Made History, may have suffered from exactly this syndrome of significantly altered medical treatment.

According to a study recently published in the academic Journal of the Royal Society of Medicine entitled, "Did Winston Churchill suffer a myocardial infarction in the White House at Christmas 1941?" Dr. Allister Vale and Dr. John Scadding illuminated a key medical incident that may have changed the course of the war, involving Churchill and his doctor.

While staying in the White House over Christmas 1941, Churchill apparently developed chest pain in the privacy of his bedroom. Sir Charles Wilson, his personal physician, diagnosed a "heart attack." But Wilson, possibly for political and personal reasons, decided not to apprise Churchill of this diagnosis, nor even to obtain support from US medical colleagues. Instead, Dr. Wilson waited until Churchill's return to London, before seeking a second opinion.

But if Dr. Wilson had been dealing with any other patient, and if this patient had not been the Prime Minister, in the midst of a war that was not going well, might the physician have immediately admitted Churchill for precautionary investigations, fundamentally altering the course of history?

Do doctors of Prime Ministers take into account the political implications of treatment and diagnosis so altering their normal hospitalization plan?

Psychologists who conduct experiments investigating how our preferences for leadership qualities change when our society is facing an external threat, like a war, for example, find particularly at those times that we retain a deep psychological tendency to look for more dominance and strength in a leader. We even prefer leaders who just look more physically formidable, when we find ourselves facing an external threat. Evolutionary psychologists have argued this is an almost genetic drive evolving to promote survivability because of our violent ancestral past.

This psychological perspective suggests that when citizens need most to respect and obey the authority of government, for example, over-complying with quarantine restrictions, sickness and therefore weakness in a commander might be disastrous.

But even if a leader makes a successful recovery from an ailment, if it was serious enough to remind them of their mortality, this in itself can have a profound psychological impact, changing them personally, possibly forever.

Post and Robins argue that in these circumstances, narcissistic leaders consumed by dreams of glory, following an illness, may become particularly driven by a sense of mission.

A sense of urgency to accomplish goals before "time runs out" means that, after an illness, a personal timetable might start to take precedence over a nation's longer-term interests.

Dr. Peter Bruggen passed away in 2018. While this article was written by Dr. Raj Persaud, Dr. Bruggen's name is retained biographically as a tribute to his contributions overall. 


The Captive King and His Captive Court: The Psychopolitical Dynamics of the Disabled Leader and His Inner Circle. Jerrold M. Post, Robert S. Robins. Political Psychology, 1990 , 11 (2) , 331-351

The Captive King and His Captive Court: The Psychopolitical Dynamics of the Disabled Leader and His Inner Circle. Jerrold M. Post, Robert S. Robins. FAMILY BUSINESS REVIEW, vol. VI, no. 2, Summer 1993

When Illness Strikes the Leader: The Dilemma of the Captive King. Jerrold M. Post, Robert S. Robins. New Haven, CT: Yale University Press, 1993, 320 pp. US$25.00 cloth. ISBN 0-300-05683-4. Yale University Press, 302 Temple St., New Haven, CT 06511, USA.

Did Winston Churchill suffer a myocardial infarction in the White House at Christmas 1941? J Allister Vale, John W Scadding. Journal of the Royal Society of Medicine Vol 110, Issue 12, 2017

Facial Cues to Perceived Height Influence Leadership Choices in Simulated War and Peace Contexts. Daniel E. Re, Lisa M. DeBruine, Benedict C. Jones. Evolutionary Psychology, Volume: 11 issue: 1. January 1, 2013