This concise volume provides psychological evaluations of 31 British prime ministers—from the first, Robert Walpole, to the 51st, Tony Blair. While conceding the risks and causes of false estimates, Jonathan Davidson quantifies 75% of these prime ministers as having had significant psychiatric problems and "nearly all" as having shown active symptoms. He estimates that 42% were impaired while in office and that psychiatric problems contributed to the resignation of 18%. However, he concludes that having a major psychiatric disorder did not appear to be incompatible with effective political leadership and that there were only a few examples where the leader's mental illness led to a catastrophe.

In arguing that most prime ministers brought their psychological problems to the office, Davidson quotes Lucille Iremonger (1) in stating that many "suffered from the handicap of an unimpressive face and body, unattractive and even repelling personality, and other crippling disadvantages" (p. 43), while the job demands and "culture of booze" acted as provoking agents. Davidson emphasizes that these prime ministers emerge not as "demigods but flawed yet talented human beings grappling with tough problems" (p. 179).

The psychopathology evidenced by these individuals who did not lead everyday lives ranged broadly and beyond parameters we might assume from the job description. The reader is struck by high rates of social anxiety in those seemingly blessed with skills to debate extemporaneously with intelligence and wit, of morbid and enervating grief, and of drug and (particularly) alcohol excess, especially since Davidson is conservative in applying diagnoses of alcohol dependence. For example, although Winston Churchill would commence his high daily intake of whiskey and soda soon after breakfast and drink champagne and multiple brandies at both lunch and dinner, Davidson merely concludes that "the possibility of alcohol dependence or abuse cannot be entirely excluded" (p. 140).

While cluster B diagnoses were rare, arguing against prime minister status being an ecological niche for the "successful sociopath," Davidson quantifies depression as the most common disorder (at 43%). The high prevalence of bipolar disorder is perhaps the most intriguing finding. Davidson views such a diagnosis as unequivocal in two (Pitt the Elder and Gladstone), and possibly in four (Grey, Disraeli, Lloyd George, and Churchill), prime ministers, although he documents bipolar patterns in two others (Canning and Macmillan), giving an upper estimate of 16%. He suggests that the bipolar highs might have fired their ambition and capacity to reach the top and that prime ministers with bipolar disorder may have demonstrated a positive harnessing of potential flaws and therefore provided "greater service" (p. 166) to the country (particularly in wartime) than that offered by those with cautious and self-doubting traits.

Beyond descriptions of psychopathology, these histories detail the sad fate of politicians—rooster one day, feather duster the next—and underline a theme of hubris. Clearly, those the gods seek to destroy they first make a British prime minister.

While such quantification of pathology risks gratuitous gossip, meta-messages and conclusions are more worthy of focus. If "black marks" are prevalent in these individuals, surely destigmatization is assisted by establishing that it is not only the most psychologically resilient who reach the top of the greasy pole? Since the consequences and concealment of psychiatric illness risk great harm, Davidson considers previous and possible future checks and balances—offering caveats to most—to conclude that honest disclosure may be the best policy.

This brief volume provides an aerial overview, with some prime ministers considered in less than a page, and thus depth is obviously sacrificed to breadth. However, since each prime minister already has at least one individual biography, there are advantages to this panoramic scan.

Davidson writes as he speaks—modest and cautious in tone, picking the wheat from the chaff, avoiding any gratuitous tone—to present an overview of a fascinating topic that argues against any a priori opinion that those with psychiatric problems should abrogate political aspirations. We appreciate his profiles, placing each of these individuals in a larger context not defined or limited by a mental illness and thus depreciating the stigma of a psychiatric diagnosis.