The Impact of Illness on World Leaders<i> by Bert Edward Park MD (University of Pennsylvania: $24.95; 373 pp., illustrated)</i>

Is the world led by senile old men? In this book, Bert Edward Park, a neurosurgeon, focuses on evidence of neurologic impairment in several 20th-Century world-class leaders. And he does find cases of dementia attributable to maladies associated with old age.

No American reader is likely to find Park’s subject matter too academic. He has studied the 25th Amendment to the Constitution, intended to provide for presidential disability, and finds it inadequate. He thinks “that the real emergency will come in the area of presidential neurologic disability.” Three such emergencies, he notes, have already arisen in this century--under Woodrow Wilson, Franklin Roosevelt and Dwight Eisenhower. He adds, pointedly, “none of these men were as old at the time as our current President.”

Park’s three longest case studies concern Wilson, F.D.R. and Hitler. He finds that both Presidents suffered, in their last rounds of summitry (Paris and Yalta respectively), from considerable neurologic impairment, due in part to the effects of atherosclerosis and high blood pressure.

Recently, other physicians have debated the origins of Wilson’s well-known tendencies to rigidity and paranoia. Park’s detailed analysis does not agree with those who ascribe some of Wilson’s behavior to strokes experienced as early as 1896, when he was still a professor at Princeton, nor does he support the notion that Wilson incurred brain damage from a stroke in Paris in April, 1919. He does believe that encephalitis, an aftereffect of a flu attack in that month, accelerated an intellectual decline already in progress due to his atherosclerotic and hypertensive condition.

This acceleration, Park thinks, is enough to account for the onset of the dementia Wilson exhibited in the terminal weeks of the Paris peace conference. He showed “emotional and mental instability” and “a pathologic sense of paranoia unrestrained by reason.” Wilson became self-isolating and suspicious of his advisers. During this period, he made many concessions to Clemenceau, especially on the issue of punitive measures against Germany. The concessions were seen, even then, as a threat to the future peace of Europe and as inconsistent with the high principles that Wilson had formerly professed.

Park tells us that Wilson’s decline into senility brought to the forefront traits that had been apparent in his “personality profile” before the onset of his illness. Indeed, the irrational, unrealistic moralizing that Park attributes to senility was already pronounced in the young and vigorous Princeton president.

Park is somewhat easier on F.D.R., though he is unforgiving of his physician, Ross McIntire, an ear-nose-throat man who owed his appointment to Cary Grayson, the doctor who had helped Edith Galt Wilson cover up the seriousness of her husband’s last illness. McIntire minimized and misrepresented Roosevelt’s multiple symptoms of lung obstruction, high blood pressure and atherosclerosis, though Park believes that these did not cause mental crippling until after the Yalta conference.

Churchill’s last sad years of depression and impaired mental functioning have already been chronicled by his doctor, Lord Moran. Park recounts them briefly, but they have little bearing on his role as leader of the Free World in the early years of the Nazi onslaught.

Park seems unfamiliar with the documentary history of some of the political decisions he considers. He mistakenly gives F.D.R. credit for France’s membership in the Allied Control Commission for Germany after World War II. (It was Churchill and Eden who insisted on this and overcame F.D.R.’s opposition.) He is also off the track in indicting Anthony Eden, Britain’s prime minister in 1956, for mishandling the Suez crisis. Park is seemingly unaware of the domestic pressures on Eden, particularly within his own cabinet. He suggests that responsibility for the failed British-French-Israeli policy that year lay in Eden’s “thought processes,” which “may have been influenced by the effects of chronic amphetamine abuse on a naturally high-strung personality.” (Eden took Benzedrine to keep alert.)

Park’s brief treatments of Ramsey MacDonald, Jozef Pilsudski and Paul von Hindenburg show the same shortcomings. The neurosurgeon’s diligent description of signs of encroaching senility in these three short-termed, inter-war leaders of Britain, Poland and Germany is of small use in explaining their respective governments’ failure to stand up to Hitler’s menace in the 1930s. Leaders of other Western countries, including France and the United States, were no more effective, though presumably not senile.

Park’s treatment of Hitler’s medical history provides some new emphases. In addition to affirming evidence for Parkinsonism and chronic painful inflammation of the gall bladder, Park stresses the aggravating effects of toxic and stimulating drugs on what he believes to have been Hitler’s psychomotor epilepsy originating in the temporal lobe of the brain--drugs administered by the unscrupulous and ill-trained physician, Theodor Morell, who attended the Nazi leader after 1935.

The panorama of Hitler’s pathology was so vast it is not surprising that Park touches only a part of it. He gives no account, for example, of several important psychohistorical reconstructions based on evidence of severe impediments to Hitler’s development in early childhood. He refers to Robert G. L. Waite’s more comprehensive discussion (“The Psychopathic God,” Basic Books, 1977), but he mentions neither the evidence given there that Hitler lacked one testicle nor the medical findings on psychopathology associated with this abnormality.

In fact, the psychological insight produced by Park’s neurological hypotheses is scanty: tendencies to hypergraphia (writing autobiographies), religiosity, bad temper ANDaggressivity seem trivial compared with what needs to be understood about the specific content and method of Hitler’s madness.

Park’s thesis is that Hitler’s mental condition worsened radically after 1941, but one example of this that he says Rauschning observed in 1944 actually took place in 1933-34. As with Wilson, Roosevelt, or anyone else, the basic personality was already in place.

“Old age accentuates certain features of character developed in earlier years,” Park admits. What we need to know is what these features are and how they form.

Park claims that his contribution to the medical record may “offer insight into motivations” for Hitler’s “unnecessary” declaration of war against the United States in December, 1941. But neural synapses--whether they click or not--tell nothing about motives. They refer only to the transmission of stimuli. He thinks that, in the light of Hitler’s “personality disorder caused by illness . . . the promulgation of the Final Solution and the . . . medical experiments . . . may therefore take on even more sinister implications.” Why? Would a better-organized, more “rational” Hitler have had less evil intentions? Park himself notes that Hitler’s irrational misjudgments saved the fleeing British forces at Dunkirk in 1940.

The views of an expert like Park are valuable. He convincingly describes physical processes at work in the mental decline of recent heads of governments. His is a distinctive and interesting perspective.

But in the end it is the character of the political leader that must be understood--developmentally and qualitatively--before we can make sense of the effect of neurological change. And neurological science, so far, is of little help in this. Promising as brain research may be, its contribution to psychological understanding of mental development and processes still lies largely in the future.