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History lessons from the ill men whose power never waned

Some of the most important politicians of the last century didn't let serious illness impair their performances, but some were forced to keep it secret from the general public.

Patrick Freyne reports

Brian Lenihan was diagnosed with pancreatic cancer in December

Franklin D Roosevelt hid the fact he was largely wheelchair-bound from the US electorate

Winston Churchill walks arm in arm with US supreme allied commander General Eisenhower in France in 1944

Francois Mitterand had inoperable prostate cancer

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Minister Brian Lenihan was diagnosed with pancreatic cancer in December and last Monday he revealed that he would be staying on in the role of finance minister whilst receiving treatment. Most felt nothing but sympathy for the minister and his family, and nobody suggested that it wouldn't be possible for him to continue doing his job.

And that's as it should be. Transparency on health issues, however, is a relatively recent historical departure for both politicians and electorates. It's now known that many of the most iconic figures in history held top political jobs while suffering from very serious illnesses indeed, but for the most part they did so in secret. Neither of these facts is surprising. Most politicians achieve success in politics in the second half of their lives and that's when health problems start to arise. Furthermore, politics is a sedentary and high- stress business. Yet up until very recently illness was seen as a political weakness, rather than a sad fact of life.

In the US, the health of the president has always been a PR issue (even in the last election). The man who brought the world out of the previous economic crisis, Franklin D Roosevelt, hid the fact that he was largely wheelchair-bound due to polio from most of the US electorate, and he did so with the complicity of the media (nowadays, as TV3 demonstrated, the press are over-eager to report these things). This wasn't the end of Roosevelt's medical problems. Before campaigning for his fourth term in 1944 he was, unbeknownst to the American people, suffering from a very serious heart complaint, and by 1945 when he was in Yalta carving up Europe with Stalin and Churchill, he was a very sick man indeed.

Heavily medicated

Another iconic president, John F Kennedy, was afflicted with the adrenal disorder Addison's Disease. He was heavily medicated with steroids which, as Kennedy watchers have noticed retrospectively, made his features seem puffy during periods when he needed to use them most extensively. This was kept out of the public arena for fear of damaging his youthful image. Even after his death, in a bit of linguistic trickery, Bobby Kennedy pointedly denied his brother had "classical Addison's disease"; which was true, in that Kennedy didn't have the "classical" version of the illness. More problematic than that, however, was the fact his doctor, Dr Max Jacobson (nicknamed "Dr Feelgood"), was also prescribing him with monstrous amounts of amphetamines. An unwise cocktail of medications is reputed to have led to a notoriously unsuccessful and fidgety first meeting with Soviet premier Nikita Khrushchev in 1961 although Kennedy was much more clear-headed when dealing with the Cuban Missile Crisis a relatively short time later. Jacobson was, incidentally, eventually struck off.

Our neighbours in the UK were just as secretive about illness in the past. British prime minister Neville Chamberlain kept his stomach cancer under wraps until shortly after he stepped down from the role in 1940. Anthony Eden dealt with the Suez crises in 1956 while taking Benzedrine for a bile duct problem. Winston Churchill, Britain's beloved wartime leader, is now known to have had depressive mood-swings, most likely the symptoms of bipolar affective disorder (he called it "the black dog"). And he wasn't in the greatest of physical health either. He suffered a heart attack in 1941, which his doctor, Lord Moran, revealed in a memoir years later to the consternation of the family. At the time, Lord Moran thought it in the best interests of the country to let Churchill believe he'd merely strained a chest muscle.

This isn't the only time a doctor has kept a political leader's condition secret even from the leader themselves. The shah of Iran was diagnosed with leukaemia in 1974, but he was only informed of the condition by name in 1978 (one year before the Iranian revolution and two years before his death in exile in Cairo). The shah was being treated by French doctors, which is fitting because the French also knew their way around a medical cover-up. Francois Mitterrand had vowed after secrecy surrounding the health of Georges Pompidou in the '70s (Pompidou had cancer), that he would be transparent about health issues. However, when he himself was diagnosed with inoperable prostate cancer soon after his election to the presidency in the early '80s he kept it out of the public domain for 10 years. Responding to rumours as early as 1981, Mitterrand simply told the press he had lumbago.

More recently, politicians tend not to cover up their health issues. Dwight Eisenhower was probably the first American president to embrace a more transparent approach. His cardiologist regularly updated the American people about his condition after he suffered a heart attack in 1957. By the time Ronald Reagan was diagnosed with colon cancer in 1984, being candid was the default option for politicians and he spoke openly about it. On the other hand, when he was shot it's now known that his advisers underplayed the seriousness of his injuries. Reagan was also, quite probably, suffering from Alzheimer's by the end of his presidency. UK prime minister Harold Wilson was having memory lapses at the point he retired in 1976 and was subsequently diagnosed with Alzheimer's.

Certainly not everyone embraced the open approach. The Russian president Boris Yeltsin's non-appearance from his airplane in Shannon Airport to greet taoiseach Albert Reynolds in 1994 is now known to have been due to a heart attack rather than drunkenness as was rumoured at the time. In recent years, the media have made a meal of minor health issues in the cases of Tony Blair (he had a health scare which turned out to be a digestive issue in 2003) and French president Nicolas Sarkozy (who last year collapsed whilst out running due to "heat and overwork"). And at least one fictional president wrangled a dramatic plot out of hiding his multiple sclerosis (president Josiah Bartlett in The West Wing).

Struggle with bulimia

Mental health issues have also been hidden from the people. Politicians from Abraham Lincoln to Theodore Roosevelt suffered from depression, probably exacerbated by the pressures of their jobs, yet to this day few politicians will admit to feeling the mental strain. Recently the former British deputy prime minister, John Prescott, spoke openly about his struggle with bulimia, but only after he left office and he was mocked for his honesty. In 1999, the Norwegian prime minister Kjell Magne Bondevik was probably the first western leader to openly admit that he needed to take time off for depression. After three-and-a-half weeks he returned to work and he was successfully re-elected in 2001.

The western electorate is growing up. Taboos about illness in politics really date back to a more superstitious era when leaders were seen as an embodiment of the body politic, and when any bodily imperfections were seen as symbolic of a national malaise. Now we're more realistic.

Politicians are there to represent the people and like the people they get sick. And when this happens, sad though it may be, life goes on and work continues. In general, the problems that resulted from the illnesses of these politicians were issues created by secrecy rather than symptoms and few people think the world would have been a better place if Roosevelt, Churchill or Kennedy had stepped down earlier (that's probably not true of the shah of Iran, however).

After all, former president George W Bush was so fit he ran three miles a day, but he brought his country into a recession, a disastrous war, and still nearly ended his career by choking on a pretzel.