The Endgame

Newsletter #53 - Unlikely bedfellows

Toronto, January 21, 2024

Unlikely bedfellows

This is a tale of unlikely bedfellows—Lloyd Austin, U.S. secretary of defence, and King Charles III.

Austin, who is 70 years old, was recently admitted to hospital for prostate cancer treatment which included surgery under a general anaesthetic. He didn’t tell President Biden about his problem, or his deputy in the Department of Defence (who was on holiday at the time), or just about anyone. He simply disappeared. Austin is second to the president in the military chain of command. His absence, described by the New York Times as a “full-blown national security crisis,” seems like an extraordinary lapse of judgment. What was he thinking?

Various explanations have been offered for Austin’s behaviour (see a January 10 New York Times article). The fashionable desire for privacy is an obvious one, but I think that’s a bit facile. For one thing, how much privacy can important public officials legitimately expect? A more interesting explanation is that Austin felt vulnerable and diminished by his illness. On this point, the New York Times article quotes Steven Meyers, chair of the psychology department at Roosevelt University in Chicago. Some patients, Meyers says, may find that there is a stigma attached to their diagnosis that will leave them open to pity. “Some people view being healthy and physically capable as being very central to their role or their identity.” This sensitivity may be more acute if the problem is the prostate, an intimate organ associated with masculinity.

There’s may be another factor in Lloyd Austin’s case. He’s an army man with a distinguished career. He’s a retired four-star general who fought real battles. I don’t know much about the military, but I’m guessing that soldiers don’t like to feel vulnerable. They like to think of themselves as tough guys.

Which brings me to King Charles III, aged 75. On January 17 Buckingham Palace announced that the king would be hospitalized for surgical treatment of an enlarged prostate, also known as benign prostatic hyperplasia or BPH. BPH is a common condition among older men. A palace official said the king had decided to disclose his condition and treatment because he hoped it would encourage other men experiencing symptoms similar to his (e.g., difficulty urinating) to go and see a doctor. Kudos to the king for being forthright and straightforward.

The contrast between Lloyd Austin’s disclosure and that of King Charles is particularly striking. Austin has an important executive job with, so to speak, his finger on the trigger. His physical and mental condition and whereabouts are a matter of public interest and concern. It’s a different kettle of fish when it comes to the king, a ceremonial being with nary a trigger in sight. Interestingly enough, about the same time as the king’s BPH announcement the princess of Wales was hospitalized for what was clearly a serious condition (requiring a two week stay in hospital) but no one has said what that condition is.

A friend of mine mentioned another reason why someone might be cautious in disclosing serious illness. It can be wearying when people keep asking how you are, sometimes with a ponderous tone of concern in their voice. What’s an appropriate reply? Chances are your interlocutor doesn’t want a detailed account of your last visit to the doctor or an analysis of your latest blood test results. What do they want? Probably easy and superficial reassurance, even if a touch synthetic. Sometimes, if your questioner enjoys robust health, you might even suspect schadenfreude.

The other day I was talking about all this with my friend Henry. “The moral of the tale is simple,” he said, after some thought. “Never give an old man a big job. Their prostate will get in the way.”

Note: There won’t be an Endgame next Sunday, January 28. I’ll be away, having my BPH dealt with.

A couple of reader comments on #52:

The irrepressible David Wolinsky writes: “Stress reduction seminars are good. Likewise meditation. However, when it comes to anxiety whatever the cause, as with most things it’s better to rely on a natural and easily accessible remedy, chocolate.”

And reader Gabrielle comments: “If I scanned my body, bit by bit, ‘for pain, tension, or anything out of the ordinary,’ it would take all day and I'd have to withdraw from society. Which would greatly reduce my anxiety.”

I don’t think David and Gabrielle are taking this anxiety thing seriously enough.