THE saying `It's tough at the top' is a familiar one and we can all easily understand, or at least empathise with, the truth of the statement.
Stress is a companion of the responsibility that comes with authority, and the higher the authority the more constant the companion.
Responsibility of office does not come higher than the Presidency of the United States. The stress and ill health associated with this office was the subject of a recent study by Robert E. Gilbert, a Boston Professor of Political Science.
There are several well known examples of comments made by American presidents to illustrate the responsibility and stress of the office. For example, two sayings that come to us from Harry S. Truman (president from 1945 to 53) are, `The buck stops here' and, `If you can't stand the heat, get out of the kitchen.
Harry, like all presidents, had to make his share of tough decisions, one of which was to go ahead with the atomic bombings of Hiroshima and Nagasaki in 1945.
It has become appreciated in recent decades that stress plays a significant part in causing disease, and most people are familiar with the connection between stress and both cardiovascular disease and ulceration of the gastrointestinal tract.
However, there is good evidence now that stress is implicated in about 70 per cent of illnesses. There is a striking correlation between a certain personality type and cardiovascular disease.
This is the type A personality, which is characterised by impatience, ambition, aggressive attitude, compulsion to work very hard, cynicism, and little time for recreation. This type of personality must characterise many of the politicians who have scrambled to the presidency at the top of an excruciatingly tough political system.
They are then confronted with a life of unremitting stress and the combination of this factor with a driven personality is a particularly unhappy one.
On the face of it, American presidents should enjoy better life expectancy and health than the average. They have all been white males, mostly with college degrees, and many of them have been lawyers. In the general population such qualities are associated with life expectancy and health that are higher than average.
However, with the exception of the first 10 presidents, the life expectancy of the remainder has been considerably lower than the average. This statistic applies to the presidents who died from natural causes, and is not biased by taking into account the four presidents who were assassinated.
Historians have ranked the presidents in order of their effectiveness on the job. Gilbert compared the 10 judged to be most effective with the least effective and found that the most effective presidents significantly outlived the least effective ones.
He concludes that success may ease some of the emotional burdens of the office. On the other hand, a feeling of ineffectiveness is particularly debilitating.
Warren G. Harding (1921 to 23) is generally judged to have been ineffective. He was aware of his limitations and must have experienced very high levels of stress.
This is illustrated in this touching appeal he made to a friend: "Jud, you have a college education, haven't you? I don't know what to do or where to turn on this taxation matter. Somewhere there must be a book that tells all about it, where I could go to straighten it out in my mind.
"But I don't know where the book is, and maybe I couldn't read it if I found it! There must be a man somewhere who knows the truth of this matter. But I don't know where to find him. My God, this is a hell of a place for a man like me to be.
Most modern presidents have battled severe illness during their stay in the White House. For example Woodrow T.Wilson (1913 to 21) suffered a stroke and served out the last 18 months of his presidency as an invalid.
His wife Edith and his physician saw to it that Wilson's condition was kept secret. Edith's control over Wilson's affairs was so sweeping that she has been called, in effect, the first woman president.
President Harding died of a stroke after two years in office. He was only 57. Of the seven presidents who died prematurely in this century (and who were not assassinated), six died of cardiovascular disease (the two Roosevelts, Wilson, Harding, Coolidge and Johnson).
Lyndon B. Johnson (1963 to 69) felt relief at the swearing in of his successor, Richard M. Nixon. He wrote, "The nightmare of having to be the man who pressed the button to start World War III was passing."
Johnson declined to seek a second full term in 1968 because, he said, "I frankly do, not believe I could survive another four years of the long hours and unrelenting tensions I have just gone through.
Four years to the day after he left office, Johnson died of a heart attack. He was 64, a decade short of the average life expectancy.
Apart from the strain, described so piercingly by Truman, of constantly watching the buck roll to a halt on your desk, the president also has to carry a very heavy workload.
Soon after occupying the Oval Office, Jimmy Carter (1977 to 81) complained about the unrelenting stream of paperwork that arrived at his desk. Ronald Reagan (1981 to 88), dealt with this problem rather neatly by refusing to read any memo that could not be accommodated on a 6in by 4in card.
Carter decided to deal with the problem by taking a course in speed reading. Reagan's tactics aroused derisive comment in the media about the casual habits of the Teflon President.
However, Reagan may have had a more sensible attitude, than Carter. Reagan served two full terms as president and left the White House looking as young as the day he entered, it. (Unfortunately Ronald Reagan has since developed Alzheimer's Disease). Carter served only a single term as president and aged visibly during his period in office.
SURPRISINGLY, the structural supports designed to help the president to carry his burden of office are weak.
Delegation of responsibility to the vice president would seem an obvious mechanism to ease the burden. However, such delegation has rarely, if ever, been employed.
The most graphic description of the office of the vice president came from John Nance Garner, vice president under Franklin D. Roosevelt, who compared his position to a pitcher of warm spit. Aspiring vice presidents are usually chosen to satisfy considerations such as geographical location, ideological position and a stature that never overshadows that of the president.
An obvious way to ease the burden of office for the president would be to ensure that only people of the highest calibre are appointed vice president, and to delegate significant responsibilities to the holder of that office.
One way to improve the calibre of candidates for the vice presidency would be to ask the presidential nominee to submit the names of several acceptable running mates and to leave the final choice to a majority of the delegates to the party's national convention.
In any event, whatever the mechanism used, it would be, in everyone's interest if the presidential burden was easier to bear and it became more difficult for killer stress to stalk the corridors of the White House.