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Politics and Madness

Haider Rizvi - 4/19/2011

The fate of people, the destinies of nations and history itself are determined to a substantial extent by political leaders. When electing a national leader, voters frequently base their decision on the image created by the mass media and professional image makers; they also tend to take into account only current events and tasks.

Financial Post article published on August 25 2008 comment regarding Mr.Asif Ali Zardari as:
• Mr.Asif Ali Zardai spent 11 of the past 20 years in Pakistani prisons fighting corruption allegations, during which he claims to have been tortured.
Psychologists have a consensus that knowledge about the time frame of the development of symptoms can be helpful when evaluating the evidence of torture. Intrusive thoughts and emotional instability appear in many victims immediately after the traumatic event. Typically, sleep disturbance sets in days later, with irritability, concentration difficulties and memory disturbance. Weeks or months later, emotional numbing becomes prominent, with hyper vigilance, reactivity and avoidance.
• While Mr Zardari was not available to comment, Wajid Shamsul Hasan, Pakistan’s high commissioner to London, speaking on his behalf, said he was now fit and well.
Mr.Wajid Shamsul Hasan has no authority to comment on the psychological health; This authority can only be used by any mental health professional or Philip Saltiel who made the first diagnosis and may revise it after a thorough psychological examination.
• Philip Saltiel, a New York City-based psychiatrist, said in a March 2007 diagnosis that Mr Zardari’s imprisonment had left him suffering from “emotional instability” and memory and concentration problems. “I do not foresee any improvement in these issues for at least a year,” Mr Saltiel wrote.
Remarks of this sort raise a host of questions. For example, how do we recognize mental illness? What is the difference between 'lay' and 'professional' opinion? Do the comments represent the 'true' picture—a neutral, scientific observation—or is it, too, influenced by the media/political rivals? Does the use of psychiatric terminology enlighten our understanding of public figures? Does it undermine, invalidate and insult the individual in question? And, crucially, should mental health professionals pass clinical judgment on people they have never met?
There are no laboratory tests to diagnose major depressive disorder. Physicians rely on a thorough psychological examination and the elimination of other disorders as diagnoses.
What type of messages are we going to give to the common psychologically sufferers that – these disorders would never be treated? Amazingly, if laymen comment then it is ok but if any mental health professional expresses his opinion then it is a matter of grave concern and be advised to look into the essentials of diagnosis.
If the diagnostic report is more than six months old the test taker must also submit a letter from a qualified professional that provides an update of the diagnosis, a description of the test taker's current level of functioning during the preceding six months, and a rationale for the requested testing accommodations. (under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act (ADA)).
Essentials of diagnosis are stated as Signs & Symptoms, without them, no scientific diagnosis could be made. Signs are what a doctor sees, Symptoms are what you experience. Symptoms are subjective presentations of medical problems and diseases. Only the person with the disease can really know it is there. Did you know that 90 - 95% of a doctor's diagnosis will come from what you say? It is customary to personally examine the patient, where the physician will take a patients’ history using a mnemonic called, "OPPQRST." Every doctor on the planet follows this mnemonic. This translates into: Objective, Palliative, Provocative, Quality, Radiating, Subjective and Timing.

Personality traits are characteristic ways of interacting with one's environment. When personality traits are maladaptive and inflexible, and cause social or occupational dysfunction, then personality disorders are said to exist. Personality disorders tend to become evident by adolescence or by early adulthood and tend to be sustained thereafter, with some attenuation of the more dramatic personality traits towards middle and late age. The course of the symptoms of a personality disorder may fee adversely affected by psychosocial stress, an unstructured living situation, alcohol or substance abuse and noncompliance with psychiatric or psychological treatment.
For psychologists, much of this more interesting debate will be stimulated by the belief that the current diagnostic system is based on the medical model of psychopathology, accompanied by the attitude that this is a bad thing. While it is true that the current diagnostic practice is based on the medical model, it is not necessarily true that this is a bad thing. Attitudes to the contrary are predicated on a misconception of the medical model -- a misconception that is widely shared by psychologists and psychiatrists alike.
We speak of symptoms of mental illness, publicly observable manifestations of psychological abnormality; syndromes of mental illness, clusters of symptoms that tend to occur together; and mental diseases, syndromes with a known pathology. We speak of the etiology, course, and prognosis of mental disease. There is diagnosis, an activity in which a clinician assigns a classificatory label to a patient on the basis of his or her presenting symptoms.
Psychoanalyzing political leaders is a dicey business, and psychologists are quick to caution that without extensive research or personal contact with Mr. Hussein, nothing can be said with certainty about his psychological makeup. Even, psychologists assert that bad does not equal mad. Most historical analysts have rejected the notion that mental illness could explain the actions of either Stalin or Hitler. The Madman theory was a primary characteristic of the foreign policy conducted by U.S. President Richard Nixon. His administration, from 1969 to 1974, attempted to make the leaders of other countries think Nixon was mad, and that his behavior was irrational and volatile. Fearing an unpredictable American response, leaders of hostile communist block nations would avoid provoking the United States.
George Prochnik rightly points out the utility of a Freudian inquiry into the deeper personal motivations of ''divinely inspired'' leaders like Woodrow Wilson and George W. Bush. But psychoanalysis alone cannot fully illuminate those motives, whose manifold spectrum of meanings can be captured only in the broader social and political context of their resonance with mass constituencies and the cultural zeitgeist.
In discussing the role of mortal illnesses in political leaders, Jerrold M. Post, includes world figures such as Franklin Roosevelt, Winston Churchill, Woodrow Wilson, Francois Mitterand, and John F. Kennedy and speculates on the role of prescription drugs in the latter. Post goes on to discuss the illnesses of Mustafa Kemal Ataturk, Andreas Papandreou, the Shah of Iran, and Ferdinand Marcos. He speculates on the role their illnesses played in their decisions, on their respective governments, and on world events. The leaders he discusses include Fidel Castro, Osama bin Laden, Saddam Hussein, Kim Jong Il, and Slobodan Milosevic.

"Post is a pioneer in the field of political personality profiling. He may be the only psychiatrist who has specialized in the self-esteem problems of both Osama bin Laden and Saddam Hussein. "The New Yorker" Policy specialists and academic scholars have long agreed that for U.S. leaders to deal effectively with other actors in the international arena, they need images of their adversaries. Leaders must try to see events, and, indeed, their own behavior, from the perspective of opponents. . . . Faulty images are a source of misperceptions and miscalculations that have often led to major errors in policy, avoidable catastrophes, and missed opportunities.
The amalgam of Contentious (negativistic, or passive-aggressive) and Dominant (aggressive, or sadistic) patterns in al-Zawahiri’s profile suggests the presence of “abrasive negativist” syndrome. For these personalities, minor frictions easily exacerbate into major confrontations and power struggles. They are quick to spot inconsistencies in others’ actions or ethical standards and adept at constructing arguments that amplify observed contradictions. They characteristically take the moral high ground, dogmatically and contemptuously expose their antagonists’ perceived hypocrisy, and contemptuously, derisively, and scornfully turn on those who cross their path (Aubrey Immelman and Kathryn Kuhlmann 2001).
Broadly speaking, three types of psychological evaluations of political leaders are described in the literature—cognitive, personality traits, and comprehensive qualitative case studies integrating psycho-biographic analysis with a psychodynamic analysis of character and personality structure. Stanley A. Renshon, a political scientist trained in psychoanalysis, presents his method with a model emphasizing three key aspects of character: ambition, integrity, and relatedness.
Studies of personality traits also combine strategies of manifest and latent content analysis. Analyses of overt motivational imagery in the prepared speeches of leaders can identify needs that indicate a leader’s propensity for strategies of cooperation or conflict and risk-taking orientation. Classification of the grammar and syntax of more spontaneous utterances in interviews illustrates the use of latent content analysis to detect politically relevant personality traits. Research psychiatrist Walter Weintraub presents his method for assessing key personality traits, drawing on grammatical and syntactical analysis, a method originally drawn from a psychiatric patient population and subsequently modified for application to political leaders. The social psychologists David D. Winter and Margaret G. Hermann both have developed methods for the analysis of motivational imagery. Winter discusses his method for analyzing the need for power, the need for achievement, and the need for affiliation. Hermann presents her methods for analyzing these needs, as well as a complex of other traits she has determined to be of importance in influencing political behavior.
John Gittinger, the developer of the PAS, worked as a psychologist for the Central Intelligence Agency (CIA) during the time he developed the PAS (1950-1960). Early publications describing the PAS appeared in academic publications and did not mention Gittinger's employer. While the PAS has been used in many contexts such as education and clinical work, it was developed by John Gittinger who worked with a number of other CIA employees. Gittinger and his PAS work were related to a wide range of projects, some of which were part of the set of projects called MKULTRA.

In an article published in DAWN on August 29 2008, the well-esteemed author commented on the profile of ex-president of Pakistan as: “He writes about his bullying tendencies; an extension of this behavior was manifested in his authoritarian attitude, love of power, low frustration tolerance, anger and sensitivity to criticism. Such personalities generally tend to be rigid. They may take some very good decisions but later commit mistakes as a result of over-vigilance and anxiety”. I'm a bit annoyed as to why he didn't mention this BEFORE seeking to run the country for a decade. It is a pretty sure fact that probably he never met the President, then how could a well-known psychiatrist on the basis of unfulfilling the essentials of diagnosis has made such remarks. Is it not a bias or pleasing the present regimen or behaving like other lay commentators of the country?

The claims of popular journalists and media experts have been examined from the vantage point of clinical psychiatry and found to be dubious all over the world. But should the vantage point of clinical psychiatry itself come under scrutiny? Should it automatically be privileged as representing the 'truth' of the matter? Many clinicians would have no difficulty in assenting to the proposition that their discipline offers a more accurate perspective on the world of mental disturbance than lay opinions, and would be contemptuous of the postmodern notion that other narratives have equal validity.

So, is our President mad? Without more information, the psychiatrist's answer has to be 'I don't know'. The practice of psychiatry has at its core the one-to-one encounter between doctor and patient, and to offer a diagnosis on lesser evidence condemns psychiatry as a form of idle gossip. More seriously, it encourages the negative stereotyping of the mentally ill and the trivializing of their suffering. Whatever our political opinions of the Prime Minister, psychiatric language should not be invoked to express our disagreement.
If anybody wants to prepare a “psychological profile of a political leader” then primary selection criteria should be first of all a personal interest; be sure to choose a leader who also meets the following three criteria: 1) s/he has already left some "paper trail" in the form of recorded public speeches, interviews, and if possible other forms of written records (i.e., autobiographies, articles, essays, private diaries or journals). 2) Your political figure must have been around long enough for others to have written critical analyses or biographies (i.e., at least one major analysis by a neutral observer); 3) finally, the leader must have played a major role in one or more major public policy decisions with lasting import. After making a preliminary selection, there is a need to determine whether there is sufficient written (or video) material available on the political leader. Without having all such types of information, it is an injustice to label a leader Mad, selfish, hypocrite etc.