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Described as "speaking shakily," and with a "slight slurring," Boris N. Yeltsin took the oath of office on Aug. 9 as the first democratically elected president of the independent Russia. He gave no inaugural address and spoke for less than one minute. Yeltsin, hospitalized twice last year for heart disease, has been suffering what his aides called a "colossal weariness" that has kept him out of the public eye for more than a month, according to the Christian Science Monitor. Yeltsin plans to take a one- to two-month vacation, amid rumors that he might undergo a bypass operation. In the article below, Martin Ebon, veteran observer and writer about Russia, discusses Yeltsin's health problems, including his intermittent depressions, his drinking bouts and his periodic disappearances. - Ed.

Yeltsin's V.I.P. Depression
by Martin Ebon

Russian Federation president Boris Yeltsin is ebullient and aggressive, enigmatic and mysterious. He is notorious for lengthy, unexplained disappearances, erratic outbursts, occasional public intoxication and unpredictable changes in staff and policies. His life is also riddled with puzzling incidents and life-threatening accidents.

One controversial incident, not mentioned in Yeltsin's memoir,The Struggle for Russia (1994), occurred during a highly stressful period of his career. He was traveling by car to the village of Uspenskoye, outside Moscow, to visit a friend from the days when Yeltsin was Communist Party boss in Sverdlovsk (now Ekaterinburg). The narrative of events is muddy and depends entirely on Yeltsin's own recollections-except for a local police station's record that he suddenly turned up, fully dressed, and wet from head to foot.

What had happened? Looking back, Yeltsin was not sure. He said that he had been driven to within a few hundred yards of his friend's house, had dismissed the driver and decided to walk the rest of the way. But as he about to cross a bridge, another car pulled up. And then, Yeltsin states abruptly, "I was in the river."

The Moscow rumor mill quickly buzzed with various explanations of the bridge incident ranging from attempted assassination to Yeltsin's being drunk and falling in. It included the speculation that, in a fit of depression, Yeltsin had tried to end his life by drowning, but misjudged the height of the bridge and his own ultimate will to live. Like other incidents in Yeltsin's life, this event is obscured by Yeltsin's vague recollections.

Similar confusion surrounds one of the numerous stories of Yeltsin's supposedly drunken behavior. During his first visit to the United States in 1989, someone went to the trouble of taping Yeltsin's talk at Johns Hopkins University in Baltimore. During his lecture and question-answer session, Yeltsin's speech was distinctly slurred. The videotape, which showed a seemingly intoxicated Yeltsin, promptly appeared on Moscow television, with his actions slowed down at crucial points.

Talk about Yeltsin's drinking has become something of a routine sneer among the Russian public and media. He admits readily that like many Russians, he enjoys a drink now and then. When he attended the ceremonies that accompanied the withdrawal of Russian armed forces from Berlin, he imbibed enough champagne to borrow the baton from the conductor of the Russian Army orchestra and engage in a bit of impromptu conducting himself.

During his visit to the United States for talks with President Clinton, Yeltsin was on his most sober behavior throughout the fast-paced, grueling trip. But once he boarded the Russian aircraft that would take him home, he apparently dropped his caution and ended the stressful visit with a drinking bout that caused him to sleep straight through the trip-unable to meet the foreign minister of New Zealand or the prime minister of Ireland during a scheduled stop-over.

Yeltsin's drinking and periodic disappearances would not, of themselves, be basically significant, if they did not relate to his intermittent depressions. He is quite open about these. In The Struggle for Russia, Yeltsin states candidly that he suffers from "debilitating bouts of depression." He adds that he has had to endure "grave second thoughts" after major policy decisions, as well as frequent bouts of "insomnia and headaches in the middle of the night." Yeltsin also admits that he experienced "tears of despair," when confronting "the sadness at the appearance Moscow and other Russian cities."

Yeltsin's successive depressions have a very realistic root in the compounded setbacks and frustrations that have marked the career of this impatient man. As he puts it, he has suffered deeply from "the harassment campaign at the [Russian] Congress sessions, the entire burden of the decisions made, the hurt from people close to me who did not support me at the last minute, who didn't hold up, who deceived me."

Considering the alternating setbacks, comebacks, denunciations, public acclaim and derision Yeltsin has experienced, it is not surprising that he should be subject to what we may term VIP Depression-a condition that has been observed among several heads of state, but which remains difficult to define or confront.

Boris Nikolayevitch Yeltsin was born Feb. 1, 1931, in the village of Butko, in Russia's Sverdlovsk Province. During his baptism, the priest, well-supplied with vodka, got into an argument and forgot the baby in the baptismal font. The frightened mother fished the infant out of the tub. The priest is said to have muttered, "Well, if he can survive such an ordeal, it means he's a good, tough lad, and I name him Boris."

Family legend or not, the pattern for and life of difficult hurdles had been established. Yeltsin followed his father into the construction business, becoming a civil engineer. He joined the Communist Party of the Soviet Union in 1961, and for decades, he divided his career between construction work and Communist Party activities.

Yeltsin was appointed First Secretary of the Sverdlovsk Communist Party in 1976 during the regime of Leonid Brezhnev. His later frustrations stand in contrast with his decisive, unquestioned personal influence during this period. "In these days," he recalled, "a provincial party secretary was a god, a czar-a master of his province-and on virtually any issue the first secretary's opinion was final."

At that time, Mikhail Gorbachev occupied a similar position as first party secretary in the Stavropol region. The two men had cordial contact by telephone. When Gorbachev was made agriculture secretary of the party's Central Committee, Yeltsin welcomed his appointment "with enthusiasm." Gorbachev was instrumental in having Yeltsin appointed secretary for construction in Moscow in 1985. Yeltsin was then 54 years old and found the change to be "very scary." In fact, by the time he arrived in Moscow and was assigned an apartment, Yeltsin "was feeling so depressed I didn't really care what place it was."

Later that year, on Dec. 22, Yeltsin was summoned to the Politburo, the top governing body of the Soviet state, and asked to become first secretary of Moscow's Communist Party Committee -roughly equivalent to mayor of Moscow. The following February, Yeltsin became a candidate member of the Politburo, the top governing body of the Soviet state.

But becoming "czar" of the complex, semi-chaotic, corrupt city of Moscow was a two-edged sword. Yes, it gave Yeltsin unusual powers, but his efforts to clean up and streamline the city inevitably created friction and antagonisms. Yeltsin not only mingled with the city's populace, its commuters, workers and shoppers, he also confronted the established bureaucracy, as well as the town's retail merchants, with his brusque attacks on their inefficiencies and corrupt practices.

On one occasion, he stood unrecognized in line at a butcher shop, knowing that a shipment of veal had been received. When he came to the head of the line and was told that no veal was available, he identified himself and created a ruckus. He discovered that the veal was in the process of being loaded onto a truck at the back of the shop, obviously for sale on the black market. The store management was fired for corrupt practices.

Yeltsin traveled all over Moscow and its suburbs, not in official, luxurious ZIL limousines but by bus and subway. This did not sit well with some of his Politburo colleagues.

Yeltsin's pushiness, his aggressive populist approach angered Soviet officialdom, including Gorbachev. Finally, at a Politburo meeting on Sept. 12, 1987, Gorbachev made a personal attack on Yeltsin, stating that the city of Moscow was in near chaos and that Yeltsin was the major cause of these anarchic conditions. As Yeltsin recalls in his first memoirs, Against the Grain (1990), Gorbachev's words were "highly critical, almost hysterical." He concluded: "There can be no doubt that at that moment Gorbachev simply hated me." Yeltsin left the session "in a depressed mood," which accelerated during the coming days.

Yeltsin sent Gorbachev a letter of resignation and followed this action with a speech at the October 1987 meeting of the party's Central Committee. Breaking the general mood of self-congratulation, Yeltsin made his resignation public and presented a severe criticism of overall Soviet government function and performance. He was publicly ridiculed by his former colleagues.

What happened was that "eyes ablaze, people came up to the rostrum who had long worked beside me, who were my friends, with whom I was on excellent terms-I found it extremely hard to bear their betrayal," Yeltsin said.

During the ensuing weeks, Yeltsin noted, "I took it all very badly." On the anniversary of the Bolshevik Revolution, Nov. 7, walking solemnly among other top officials toward Lenin's tomb, Yeltsin found himself again "in a depressed mood."

Two days later, he was hospitalized with a series of apparently psychosomatic symptoms, including headaches and chest pains. He was medicated, mainly with tranquilizers. Ignoring his condition, Gorbachev telephoned Yeltsin to come and see him right away. Yeltsin asked himself whether Gorbachev actually wanted to finish me off physically. He was "barely conscious" when he faced the Moscow City Committee. In his autobiography, Yeltsin says:

"What do you call it when a person is murdered with words? Because what follows was like a real murder. After all, I could have been dismissed in a sentence or two, then and there, at the plenum. But no, they had to enjoy the whole process of public betrayal, when comrades who had been working alongside me for two years, without the slightest sign of discord in our relations, suddenly began to say things that to this day my mind refuses to absorb. If I hadn't been so heavily doped, of course, I would have fought back. I would have refuted the lies and shown up the treachery-yes, the treachery-of everyone who spoke."

He returned to the hospital to overcome his breakdown. Gorbachev later telephoned the hospital and offered Yeltsin the position of deputy director of Gosstroi, the Soviet construction agency. He accepted the offer immediately.

Almost overnight, Yeltsin had to abandon his manic schedule as Moscow's "czar" and face almost total isolation. He recalled that it seemed as if an invisible circle had been traced around him, "which no one could enter for fear of contamination." He was, as he put it, "some kind of leper." "I was only nominally alive," he said. "Politically, I didn't exist. Politically, I was a corpse. Another thing that left me vaguely depressed was the absence of telephone calls from people who had once constantly phoned."

Meanwhile, Yeltsin went through an agonizing self-appraisal: "I was engaged in a constant, obsessive process of analysis, day and night, night and day. I would sleep for three or four hours, and then the thoughts would come creeping back...None of my previous, often naive faith remained...All that was left where my heart had been was a burned-out cinder. Everything around me was burned out, everything within me was burned out."

Yeltsin's headaches at that point were so severe that he often required what he called "emergency medical service." The pains were, at times, so excruciating that he "felt like crawling up the wall and could hardly restrain myself from crying out loud. It was like the tortures of hell. I used to think my patience had simply snapped and my head was about to split open."

For some 18 months, Yeltsin found himself in the position of a political outcast. While Yeltsin was able to give interviews to foreign correspondents, he was effectively silenced within the Soviet Union itself. Feeling isolated and immensely frustrated, he was eager to justify his position before a wide home audience. This opportunity arose with the next Communist Party meeting (the 19th All-Union Party Conference). Yeltsin gained admittance as a member of a minor delegation, representing the Karelia district (near Finland). With Gorbachev in the chair, and parliamentary manipulation used to keep Yeltsin at bay, he finally marched brazenly up to the rostrum and demanded to be heard.

Yeltsin delivered a detailed, rambling attack on the organization and performance of the Gorbachev administration. Naturally, he was once again violently attacked by the party leadership. As he remembers the crowd's reaction, "All those around me were afraid even to turn and look at me." Concerning his own feelings, he recalls: "I sat motionless, staring down at the rostrum from the balcony, feeling that at any moment I might lose consciousness." In fact, his condition became so critical that attendants took him to a physician, who "gave me an injection to enable me at least to hold out and stay in place until the end of the conference." Returning to his seat, he felt "as if I were on fire inside, and everything was swimming in front of my eyes."

This condition of extreme tension lasted for several days. According to Yeltsin, he did not sleep for two nights, "agonizing and wondering" and fearing that, somehow, this "was the end." He was caught between triumph and doom. As the conference proceedings had been televised nationwide, Yeltsin had gained vast publicity, either as a notorious troublemaker or as a courageous spokesman for public discontent. As a result, in March 1989 the Moscow region elected him delegate to the Congress of People's Deputies, the Soviet legislature. His political comeback had begun.

The year 1990 was an almost continuous upgrade on Boris Yeltsin's roller-coaster career. Successively, he was elected deputy from Sverdlovsk to the Russian Congress of People's Deputies and chairman of the Russian Supreme Soviet-all this during a period when Russia, as an independent nation, was asserting its regional sovereignty within the Soviet Union. In July, Yeltsin exploded a political bombshell when he used the 28th Convention of the Communist Party to announce his resignation from the party.

The following year, the election campaign for the presidency of Russia, the largest republic of the USSR, presented Yeltsin with an array of rivals. He won an overwhelming victory at the polls. His description as the "first freely-elected president of Russia" dates from this historic moment. It also marks the beginning of either Yeltsin's faulty judgments of associates or his disillusionment at what he regards as a series of personal betrayals. An example was Alexander Rutskoi whom Yeltsin chose as his running mate and vice president. Ultimately, Rutskoi became Yeltsin's most violent opponent.

As Yeltsin later recalled, he hadn't known whom to choose as a running mate during the presidential election campaign. He hit on Rutskoi, a retired combat pilot and veteran of the Afghan war, almost by accident. Rutskoi had taken a "reformist" position in Parliament, looked the part of the dashing warrior, had received the Hero of the Soviet Union Award, and spoke firmly and eloquently. Yeltsin saw him as a "real tiger." Arguing like a true politician, Yeltsin figured that Rutskoi would be the favorite of "middle-aged matrons" but also attract the military vote. But, from the start, Rutskoi did not accept the shadow role of vice president.

Yeltsin reached the height of popularity during the three days in August 1991, when a group of high-level conspirators sought to gain control of the soviet state in a coup. They virtually imprisoned Gorbachev at his vacation home near the Black Sea. Yeltsin became the symbolic center of resistance to the coup, particularly when he mounted a tank outside the Russian Parliament building (known as the "White House") in defiance of the conspirators. At that time, Rutskoi firmly supported Gorbachev and Yeltsin.

Toward the end of the year, the Soviet Union broke apart. Gorbachev resigned, and, as head of the Russian Federation, Yeltsin began to occupy much of Gorbachev's position and authority. But soon a relentless tug-of-war started between the Russian Parliament and the Yeltsin regime. Rutskoi, despite his position in the executive branch, kept siding with Yeltsin's antagonists, refusing any sort of administrative discipline or adherence to official policies. From the moment he took office, Yeltsin issued decree after decree, designed to restructure the Russian state administration, and particularly its economy. But much of what he so firmly ordered was blocked in the legislature or ignored and sabotaged by a recalcitrant bureaucracy. The confrontation between the Rutskoi group escalated after Yeltsin dissolved Parliament. Rutskoi defied him. Opposition culminated in outbreaks of severe violence in Moscow, threatening civil war. That's when Yeltsin ordered the Army to attack the Parliament building. Yeltsin confessed to being deeply troubled by this succession of events. He recalled that, on the morning of Oct. 3, 1993, as he rode to the Kremlin, "I was tortured by the thought-had I done the right thing? Was there another option? Could it have been done another way? Had I exhausted all the alternatives? Russia was drowning in lawlessness. And here I was, the first popularly elected president, breaking the law-albeit a cumbersome law-that was pushing the country to the brink of collapse."

Yeltsin regards the amnesties of the August 1991 coup plotters and of the October 1993 parliamentary rebels as a public betrayal of his position and judgment. Intermittent withdrawal from his official duties and a pattern of self-isolation increased after these events.

Yeltsin' s puzzling disappearances had begun even earlier. In late September 1991, he complained of chest pains and canceled engagements for several days. In late January 1992, he once again disappeared from the Kremlin for several days, while his spokesman, Pavel Vozshchanov, asserted: "He is in more than excellent health." There were similar sudden absences, often only half-explained by Yeltsin's associates; but news of his whereabouts and health was particularly disturbing early in 1994.

In February, Yeltsin disappeared for three weeks with what was vaguely described as an attack of the flu. Then, again, on March 14, he went on what was called a "working holiday" of two weeks at the Black Sea resort of Sochi. The pro-Yeltsin Moscow paper, Izvestia, took note of the president's increasing withdrawal from official duties. It commented: "Nervous excitement begins when the president is either absent or is not politically active. It is no secret that the president in recent months found himself in the 'shadow' more often than the country's situation demands. Any discussion about the reasons for this have been a banned topic in the mass media, and such discussions were declared unpatriotic."

The Moscow daily's observations went to the heart of the problem that afflicts VIPs with either physical or emotional problems. In this respect, the Yeltsin situation is not unique, either historically or on the contemporary world scene. The taboo on Yeltsin's emotional health was violated seriously only once in public: a member of the Russian Parliament, Vladimir Isakov, demanded that a medical commission be appointed to report on the president's health. Isakov, a lawyer, noted that Yeltsin had been "not too firm on his feet" when he was shown talking to a journalist on the television program "Vesti." Isakov expanded on his views in the Moscow paper Sovetskaya Rossia (May 19, 1992), as follows:

"Tolerance toward failings (is there anyone without them?) is an appropriate human trait. But there are failings and failings. Personal life is something completely different from alcoholic addiction in someone who is in charge of the 'nuclear briefcase.' His weakness is a threat to the security of the [Russian] republic and of other countries. That is why I approached the microphone and suggested that Parliament study the president's ability to continue exercising his lofty and responsible powers. There were good reasons for doubt! "The response by the president' s supporters was perfectly predictable and followed immediately. Slander! Insult! Sue him! Fine, if I have slandered anyone, I am prepared to answer to the court. But which court will take to task those who today are bashfully turning away their eyes, trying to disregard the president's condition when he makes his statements, his inconsistency, his unpredictability and the contradictory nature of his decrees-briefly, the obvious signs of ineffective executive power?"

Isakov's comments were, of course, those of an opposition spokesman. But the Moscow paper Komsomolskaya Pravda, a paper Yeltsin has praised in the past, expressed conditional agreement with Isakov when it wrote that "the president's weakness, like his general state of health, is not just his personal affair." The paper added: "After all, he is not running some routine office, but a nuclear power, and this is precisely how the world sees it." And long-time Yeltsin supporter, Yegor Yakovlev, wrote in an "Open Letter" to Yeltsin: "Your weakness for alcohol is a secret to no one but yourself."

Surveying Yeltsin's roller-coaster career and examining his self-observations, one is prompted to regard his "drinking problem" as a symptom rather than cause for concern. Clearly, Yeltsin's intermittent depressions are an integral part of his emotional history. Yet it seems unlikely that such a condition on the part of the Russian president will be diagnosed and treated as such. The state of Russian psychiatry remains at a low point; it has not recovered from its dubious record during the Soviet years. Moreover, the Kremlin's social culture is not oriented toward easy acceptance of modern psychological methods.

The British physician Hugh L'Etang observed in The Pathology of Leadership that "The list of international statesmen, senior officials and officers who have borne supreme responsibility, while in the grip of disabling and debilitating illness, is certainly long and forbidding." But, he noted, "leaders and their entourage are likely to engage in an unspoken conspiracy of trying to camouflage deficiencies and discourage proper medical attention." Former U.S. Secretary of State Dean Rusk acknowledged in Foreign Affairs (April 1960) that "The international list of those who have carried great responsibility while ill is a long one." The 65-year-old Yeltsin suffers back pains that go back to the time he was in a Spanish plane that was forced to crash-land. He is presumably receiving pain-killing medications that should not be mixed with alcohol. Reports of his medical condition have also included cirrhosis of the liver; this may, however, be no more than an extrapolation from his drinking habits. As L'Etang observes, "It is never unreasonable to suggest that men after middle life have an enlarged prostate, liver or kidney disease, diabetes or degeneration of the nervous system."

The complexities involved in situations such as Yeltsin's were examined by the Committee on Governmental Agencies, Group for the Advancement of Psychiatry, in its study The VIP with Psychiatric Impairment. ("VIP," of course, stands for "Very Important Person," a term coined by Sir Winston Churchill.) The study noted that associates of a public personality tend to "conceal the weakness of their leader from public view, to the point of blocking diagnosis and effective care." It said that "competence to perform a job or hold political office is generally considered not a medical question but a matter of political judgment."

Martin Ebon is a veteran observer of the Kremlin scene, whose books range from World Communism Today (1948) to KGB: Death and Rebirth (1994).