by Es Will

Introduction

The  historian Herodotus, in his Histories, followed the Greek idea of global symmetry in arguing that there must be a southern equivalent to the North (a Hyperaustralia).¹ In the same vein, the observation that some past UK nephrologists were so idiosyncratic that the specialty did not want to work with them begs a question as a corollary. A common feature was their persistent seriousness, with little concession to the traditional English style of modest self-deprecation. What then is the range of social behaviours that have allowed colleagues to be acceptable? And then, do the routines of professional encounter have any historical downside?

The opposite of the seriousness of the rejected would be, one supposes, some lightness of touch. That I discussed in the previous essay as the assumed and preferred tone of historical professional meetings: competence, if not brilliance, worn lightly. Such consensual politesse offers individuals and their ideas a comfortable model for presentation. Modesty in performance makes it acceptable to a specialty group. Are there other versions of conventional levity that need be considered?

Marketing ourselves

In so far that we are constantly marketing ourselves to others, especially in public  settings, an analogy with modern retailing is not inappropriate. We are currently passing through a phase of retail ‘joy marketing’, which is said to have succeeded the ‘emotional marketing’ of branded goods.³ At every turn we are offered smiling faces, often nubile, to make us feel comfortable and positive about a brand, the commercial proposal. Such apparent gratification promotes optimism and the universal instinct of Hopefulness. The medical and professional journals are also caught up in this ultimately tedious artifice, as agents of (branded) ideation. It is the latest consequence of the introduction of cognitive psychology into public presentation between the wars, started by Freud’s nephew, Edward Bernays. He used style as the vehicle to encourage US women to smoke, for example.³ In that shift, personal psychology was exploited for social, economic and ultimately political ends. The advent of social media has thoroughly mixed these strands. However, the basis of the approach is the personal, emotional ingratiation we all use to promote positive social interaction with other individuals, particularly in an urban world of short encounters and a need for the instant judgement of one another.⁴ At the interpersonal level, that judgement usually accepts  the offered  front of personal self-regard, in the absence of any other criteria. There is now a similar carry-over in communal communication. How is this experienced professionally?

Intuitive tropes

The need to manage the presentation of the self is especially obvious when we are outside our usual social setting, say in Europe interacting with colleagues at ERA (European Renal Association). We then assume a minor formality of exaggerated politesse, take care to be seen listening to the other, and are cautious in responding to anything controversial. This is recognisable as a soft , restrained, version of marketing, but of the self.

It is desirable to create a predictable atmosphere of ease and pleasantness when language cannot be measured enough to convey one’s personality reliably (especially aspects of humour and any discontent). In the event, foreignness blurs any assessment of the nuances of social background and education, which is often a relief to a visiting foreigner.

Directed conversation

Occasionally such deliberate agreeability can be felt to have gone too far. It is not uncommon in exchange with some individuals for the topics of conversation to regularly advantage them, being subtlely diverted towards their interests and expertise, and implicit dominance. There can be a predictable, systematic imbalance in the most benign exchanges.

While such distortions are typically accidental, based on intuitive, personal communication style, there is an obvious element of possible mischief in any manipulation of social exchange. Notwithstanding the likelihood that we tend to focus on our own, current preoccupations to set an agenda, the ideal essence of conversation is a joint attempt at understanding, with  an effort to share fellow-feeling, not manipulate the other.

The benefit of acceptability

Having indicated a pitfall in apparently uncomplicated exchanges, there are recognisable positive consequences of feel-good attitudes. The post-millennial acceptance by the specialty of a Renal ‘tsar’ can be used as an example of the neutralisation through personality of any reaction to an unprecedented imposition by government.⁵ The well-established, generous bonhomie of the first incumbent (Donal O’Donoghue), and his warmth at the bar, carried the day through his character and trusted style. Other examples are perhaps fewer and more complex. The charming smile and impeccable manners of Hugh de Wardener complemented his bulk and carriage as a token of his status in the specialty, as well as his manifest clinical and scientific contributions. However, having been invited to chair a committee to explore haemodialysis provision in the mid-1960s, he was not protected by a positive public persona from the subsequent suppression of the conclusions.

Two elements of projected pleasantness

There are two related elements here that can be discriminated, judgement of which comes to depend on the intention of their deployment.

The concern for the consequences of charm were advertised by the character of Anthony Blanche in  Evelyn Waugh’s novel Brideshead Revisited. He warned against the potentially damaging bland presentation of the aristocracy, the well-named ‘Flytes’. Charm may be the reflection of personal social confidence and respect for the other but is also a potent vehicle of influence and manipulation, of ingratiation. The magic implied in the term is binary, of course, being for good or ill. The grotesque characters of some modern cartoons are typically presented with a kind of snide charm as an introduction to the presentation of (entertaining) wickedness and vicarious mischief-making. The wolf of Red Riding Hood was charming, but his (disguised) intentions were malign. While charm can imply a mature and reliable worldliness, it can morph imperceptibly towards a tacit means of control. Its absence was the unmediated seriousness of those rejected, preoccupied colleagues!

That brings us to the second element, that of charisma – Greek ‘Divine Gift’. It is undeniable that some individuals are ‘larger than life’ and have a personal magnetism that draws one to want to be with them, the very opposite of rejection. ‘Celebrities’, as presented in the Media, come to display a kind of glamour that generates a positive and optimistic mood around themselves. They offer a universal dignifying experience and promise a personal, existential meaning through familiarity. A numbered football shirt offers children a specific team identity. The historical overlap is with iconography.

A mindfulness approach detects three components in this, Presence, Power and Warmth.⁷ Power and brilliance are attractive – a Nobel Prize, for example, confers immediate charisma, especially if combined with self-conscious presence and/or personal warmth.

The career-long charisma of the nephrological icon, Stewart Cameron, started early, his signature flamboyant style in dress announcing a performative individualism, a presence. He had several idiosyncrasies in conversation that augmented that presence; long pauses for thought, an openly reflective, inclusive, patient approach to topics and a tendency to self-evidently interesting diversions. While he appears to have benefitted in detail from several role models, historical as well as contemporaneous, he always showed the engagement and intense attention that are characteristic of a modern charismatic style, his warmth.⁷

The power of his contribution was magnified by the charisma of the picturesque glomerulus, to which he and his contemporaries were notionally in thrall.⁸ Charisma can be extended to the inanimate!?

Salient properties of charisma

In the event there are several other common features to the tactics and maintenance of personal charisma and those can be taught.⁸ The idea of an unexplained ‘gift’ in the Greek name is then perhaps inappropriate? It is noteworthy that a charismatic style is not necessarily permanent but can be deliberately performative to some extent.⁶ It seems likely that incumbents start with a certain set of personal capacities, which they develop according to circumstances, an opportunism. It appears that learned behaviours become intuitive and spontaneous ultimately, a very important touchstone of honesty in the course of self-presentation. The triad of Power, Presence and Warmth is apposite, but the conversion of intuitive attraction into a device for creating disciples has required the promotion of two additional elements.

Irresistible geniality

A common feature is a contrived geniality, that offers inclusiveness at the cost of accepting the charismatic’s world view and agenda. Geniality had a place in European culture as a feel-good trope (Friar Tuck, Falstaff), and its use to make oneself, and a personal agenda, acceptable is a common, unselfconscious intuition. Those regarded as over-serious seem to have had no instinct or talent for lightening conversation. They tended to feel that the relevance of their preoccupations was enough not to need any sweetening or facilitation in exchanges with others.

In recent times geniality has become weaponised by public charismatic individuals as a means to disarm and convert to  their point of view.  A modern baseless geniality is important as an alert to their purposes, for good or ill. It betrays the wish to seduce through positive and shared emotionality, through feeling rather than any considered judgement, an instrumental intent. An expectant atmosphere of fun is not easily resisted, at the cost of being seen as a spoilsport. It is elsewhere the trusted  milieu of the stand-up comic, to which we comfortably submit for entertainment.

Seduction to a secular faith through wishful thinking

Charisma is simply a local, personal attribute unless it is allied to an aspiration or message with which to enlarge and project personal influence. The addition of motivating world-views to a geniality creates the potential for an investment of faith in the protagonist; in the movies and theatre sketchy, often vague, ideas were deployed in thrillers as recognisable MacGuffins (the name given to the diversions of plot or message in drama, developed by Alfred Hitchcock, in particular). They  serve to motivate and manipulate candidate adherents towards a charismatic’s world view.⁹ There may be  laudable or charitable purposes folded into such an appeal, or an explicit issue designed to display some benefit, suitably remote of achievement.

The overlap of declared or implied remote aspirations with the vital interests of the candidate adherent determines the strength of the call and the response.

The intended influence of any charisma must be acknowledged as potentially covering a very wide range. In the religious context the parochial modelling and buttressing of faith, an energetic evangelising or the creation of a cult are a continuum dependent on context and roles for charismatic individuals.¹⁰

The unrecognised search for charisma in specialty history?

Readers will be able to invoke their own examples of current and past charismatic colleagues in the specialty and the spectrum of their inferred intentions. Those intuitions can be seen as undocumented versions of the attempt to build the heritage of the specialty. The narrative accounts of specialty history convey various degrees of charisma in our predecessors to which we very much wish to relate, however distantly. Identification with tacitly heroic colleagues from the past is qualitatively similar, though weaker, to the faith-based commitment to contemporary charismatic politicians.

Other common deployments of charisma¹¹

Charismatic leadership has become central to current Politics, in part because of the muting of traditional ideology in political parties and the subsequent rather dull default to a managerial type of government. Despite a need to connect to an electorate, and avowals of ‘listening’, current speeches often deal only with promised political catnip or ‘offerings’.  Other incentives to vote have become necessary. Charismatic leadership has filled that gap. The charisma may be formulated for the general good  (Obama, say), specific projects (Johnson, Trump) or for personal vain-glory (Berlusconi, Farage). The latter has been warped further towards creating scope for abuse (Savile, Epstein). The universal tactics of faux geniality and remote aspiration are manifest as tokens of intended manipulation.

The uncomfortable inevitability of modern advocacy

It is noteworthy that several charismatic politicians have focussed on the ownership of, or appearance in, the media, advertising themselves very widely (Berlusconi, Johnson, Trump, Farage). Selling media advertising space is easier when familiar personal brands are there to be presented repeatedly – the effortful grimace of sportsmen or the knowing smirks of politicians. Do newspapers themselves make an effort to be charismatic? Printed reports need now to be embellished with photographs, however inappropriate, as long as they project pleasantness.

The relevance of this to clinicians is that their routine organs of communication, the medical websites, professional updates, research reports and clinical journals, cannot avoid an element of implicit advocacy in their material, despite disclaimers of neutral opinion. They inadvertently promote branding of views and materiel through mere mention. This has much troubled medical editors in recent times, since the naming of Pharma products in studies, regardless of conclusions, carries a cultural notification and familiarisation. Ghost writing of articles and sponsorship are used for covert commercial reasons in developing clinical science. The well-meant protocols to structure studies (e.g. CONSORT), their presentation and reporting, are used as credentials but cannot define the study conditions that would guarantee reliable evidence.²³ The competitive hotspots of ESAs and iron supplements are specialty cases in point.¹³ The predominant interest and emphasis on dosing betrays the intentions.

Clinical analogies

Of course, rounding clinicians have reason to make themselves acceptable at the bedside, through pleasant demeanour and respectful enquiry. This was wonderfully parodied by Dr Arnold Bloom, a highly respected 1970s North London Diabetologist, who, having mistaken the bedhead consultant label as he turned in a ward bay to the next case, opined ‘what a waste of a smile’ as he loped on!¹⁴ Drolleries apart, the issue remains the basic intention of a pleasant conversational front, whether a neutral quest for understanding or a manipulative wish to seduce the other to a point of view.

Conclusion

An examination of the benign routines of professional social exchange, as a contrast to the habits of serious-minded nephrological dissidents, exposes the norms of personal presentation, their uses and abuses. The answer to the existence of an opposite to relentless professional seriousness then is, well, yes.

That conclusion is consistent with the discrimination of two forms of happiness. A current, transient gratification that can be labelled Hedonic, whereas a Eudaimonic (Aristotle) happiness is deferred and consequent on persistent effort. The rewards of seriousness will belong to the latter category, although to be complete that must be mediated in the social context. We can identify positive hedonic elements in specialty ‘niceness’, of whatever kind. However, the ideal of a comfortable, equal exchange of views and experience in routine encounters can be blemished by exaggeration of the techniques we all use to express our legitimate individual interests. We need to be aware of the deceits of immediate presentation, particularly if charismatic, which have a pedigree expressed even five hundred years ago (see Figure).

Vacuous gaiety, in contrast to a consensual lightness of exchange, is detectable as a typical component of charisma, signalling a facade of play/happiness/optimism as a seductive technique that works through the emotions, towards either benefit or mischief. That  can be very hard to resist, especially if the associated MacGuffins/aspirations coincide with personal vital interests. Clinical training, by insisting on the independent discrimination of realities and rejection of the merely plausible, should be a reliable bulwark against manipulation. To recognise and recoil from abusive charismatic techniques is the only sober response. There are, then, undesirable consequences to each extreme of the behavioural spectrum, both forms of happiness being problematic! Moderation, promoted by Aristotle, seems to be the ‘tracker’ technique in personal engagement that it is safest to pursue?

Figure

A pilgrim encounter on the road (Lakenhal Museum, Leiden,  Netherlands)

The painting shows a respectful pilgrim (left) encountering another on the road. The status of the other, who is suggesting a desirable direction of travel, is betrayed to the onlooker, at least, by the tail dangling below the hem of his coat and the reptilian extremities.

 

 

References

1. Brotton J. Four points of the compass. The unexpected history of direction. Allen Lane pp91 2024.
2. Joy marketing – is this just emotional marketing and does it work? think-beyond.co.uk.
3. Bernays E. The Edward Bernays Reader: From Propaganda to the Engineering of Consent. Ig Publishing. ISBN-10 ‏ : ‎1632462044.
4. Cain S. Quiet: The Power of Introverts in a World That Can’t Stop Talking. 2013. Penguin.
5. Will, E.J. A short cultural history of the UK Renal Registry 1995–2020.BMC Nephrol 21, 338 (2020). https://doi.org/10.1186/s12882-020-01997-1.
6. Fox-Cabane O. The charisma myth. 2012 Penguin. ISBN-13 ‏: ‎978-0670922888
7. https://ukkidneyhistory.org/themes/remarkable-people/remarkable-professionals/stewart-cameron/stewart-cameron-towards-an-intellectual-history/
8. Antonakis J. https://www.youtube.com/watch?v=SEDvD1IICfE&t=552sJ.
9. Hitchcock, Sir Alfred. Leytonstone-born Film Director, Died of Kidney Failure 1980.
10. Worthen M. Spellbound. How charisma shaped American history from the Puritans to Donald Trump. 2025 Forum Books, Random House.
11. Mance H. The art of charisma. Financial Times. The Weekend Essay. Life and Arts. August 2^nd
12. Will EJ. Caveats for scientific publication in the modern market place. Clin J Am Soc Nephrol 4: 1693–1695, 2009. doi: 10.2215/CJN.06460909.
13. https://ukkidneyhistory.org/themes/great-british-contributions/renal-anaemia-erythropoeitin/decision-support-in-renal-anaemia-1998-2019/
14. Author’s personal anecdote of Whittington Hospital 1973..

 

 

 

 

Last Updated on September 22, 2025 by John Feehally