Abstract
The election of President Trump has led to interest in his mental health and has resulted in heightened scrutiny regarding the American Psychiatric Association's Goldwater Rule, with its prohibition on opining psychiatrically on the mental health of public figures whom one has not examined in person. This article highlights the historic, methodological, forensic, and ethics challenges regarding psychiatric approaches to leadership analysis, and how these can offer policy makers options regarding national security decision-making.
The 2016 campaign and election of President Trump has led to a flurry of interest in not only his mental health,1 but more generally, in the mental health of world leaders. This has resulted in extensive scholarly commentary regarding the American Psychiatric Association's Goldwater Rule,2 with its prohibition on opining psychiatrically on the mental health of public figures whom one has not examined in person.3,–,7 This article, by a psychiatrist who has published numerous profiles of world leaders,8,–,15 outlines challenges regarding psychiatric approaches to leadership analysis.16 Overall, political psychology approaches to leadership analysis are but one piece of a larger, more complex analytic puzzle, which can serve national security interests in understanding the psyches of our adversaries, allowing policy makers greater options regarding decision-making in a variety of diplomatic and public policy settings.
The origins of leadership analysis and political psychology profiling date to 1943, when Dr. Walter Langer published, at the behest of the Office of Strategic Services, a classified analysis of Germany's Führer, Adolf Hitler; this work was later de-classified and published in 1972.17 Although beholden to the psychoanalytic approach of the day, Langer created a multidisciplinary team that analyzed raw data including Hitler's writings, speeches, movies of rallies, classified intelligence data, his medical reports, defector accounts, and collateral accounts of persons who had met Hitler in person. Langer emphasized understanding of Hitler's psychological makeup, and also made accurate predictions of his future behavior. Langer's work exerted a powerful intellectual influence, both in the fields of leadership analysis and political psychology, as developed by Dr. Jerrold Post, and criminal personality profiling as pioneered by Dr. James Brussel.18
In 1965, Post joined the Central Intelligence Agency (CIA), where he founded a unit for the analysis of the psychology of world leaders. Over the next several decades, Post followed Langer's model, leading a team of psychiatrists, internists, psychologists, anthropologists, historians, and intelligence analysts, who developed classified leadership profiles of various world leaders for the intelligence community and senior U.S. policy makers.16,19 A high point involved the declassified “Camp David Profiles,” in which individual psychological assessments of Israel's Menachem Begin and Egypt's Anwar Sadat helped U.S. President Jimmy Carter achieve an understanding of negotiating tactics and unique circumstances, which paved the way for a successful outcome: the 1979 Camp David peace accords.20 In 1986, Post retired from the CIA and continued his career at George Washington University, where he and his associates published numerous leadership profiles, including those of Saddam Hussein,21 Bashar al-Assad,22 Kim Jong Il,23 Muammar Gaddafi,24 Hugo Chavez,25 Fidel Castro,26 Vladimir Putin,27 Osama bin Laden,28 Radovan Karadzic,8 and Slobodan Milosevic.9 Such profiles often attracted controversy, because of Post's use of diagnostic categories such as “malignant narcissism,” and the labeling of many such people as “rogue leaders.”29,–,31 But Post's methodology, like that of Langer, entailed a close examination of the leader's childhood, young adulthood, transition to midlife, relationships, speeches, collateral data, and writings. Post did not shy from predictions, some of which turned out to be wrong, but the greater emphases in such portraits involved a psychological understanding of a given leader's traits and political behavior and how such understanding might prove useful in diplomatic negotiations. Like Langer before him, Post emphasized the close relationship, almost a lock-and-key fit, between charismatic, narcissistic leaders, and their impassioned followers.
Ethics, Law, and the Goldwater Rule
In March 2017, the American Psychiatric Association (APA) affirmed its position regarding the Goldwater Rule, in response to a flurry of publications regarding the psychology of President Donald Trump.32 While the organization's focus has appeared to reflect its concern for embarrassment to the profession, in his recent review Dr. Paul Appelbaum cites other dangers.3 Psychiatrists publishing profiles of world leaders should be concerned not only with potential lawsuits, but also the risk of being reported for ethics violations or licensing board complaints.33 In any legal setting, it remains unclear whether such leadership profiles could pass a Daubert test, which involves the admissibility of expert scientific testimony.34 If practitioners and their customers in the policy, national security, and diplomatic communities believe that such profiles have value, then the Goldwater Rule may have a chilling effect and may serve to dissuade subsequent generations of younger practitioners from entering the field.
The other critical question, which the Goldwater Rule does not explicitly address, involves the intended audience or customer for the profile. In the case of work by Post and others, the audience includes not only academia and the media, but most saliently, the national security community and policy makers at the highest levels of the U.S. Government.35 In today's world, any such published profiles can also expect to receive careful analysis by the subject leader's national security team and intelligence services.36 A controversial profile could lead to hacking, online attacks by Internet trolls, or more serious forms of public and private harassment.37
Academic institutions may be sensitive to the media image created by work involving the intelligence community. Similar public relations concerns have at times dogged psychiatric and psychological researchers involved in studying military survival-evasion-resistance-escape (SERE) psychology, interrogation, and other topics involving national security.38 Academic practitioners of leadership analysis and political psychology might consider consulting their parent institution's public affairs offices before publication of such profiles.
In a sense, such concerns are common to forensic psychiatry, and both training and a solid grounding in its principles and challenges is a worthy background for practitioners of leadership profiling and political psychology. In addition, experience and familiarity with the national security strategy can assist in understanding the analytic process and how such information gets developed, disseminated, and used by senior policy makers.39
Methodological Challenges
The current state of the art has changed little since the publication of Post's work in 2003.16 Leadership profiles rely on a psychobiographical approach, although the descriptive language used today is less psychoanalytic, per se. The raw data, subject to different interpretations and various biases, include a leader's published writings, interviews, social media activity, speeches, videos, media appearances, and interviews with the leader's intimates, contacts, colleagues, and former employees/contacts/intimates, and defectors. Medical data, although often not available overtly, may be available via inference, or from the study of a leader's physique, gait, and other data; in addition, private medical data can be made available via leaks, interviews, writings, and publications by a given leader's treating clinicians.40,–,43
In the absence of overt mental illness (and most leaders profiled do not have mental illness), current methodology emphasizes the description of a leader's psychological traits, rather than DSM-V diagnoses. As Allen Frances has noted, most potential diagnoses of world leaders lack validity, not only because of the absence of a face-to-face evaluation, the problem explicitly addressed in the Goldwater Rule, but also because the leader likely evidences no clinical distress or dysfunction because of his purported symptoms and signs.44 Calling leaders narcissistic becomes a bit like calling bright persons smart.
A larger problem involves estimations of potential leaders' intellectual abilities, emotional intelligence, and IQ, based on inferences, often linked to their use of language and level of education, as well as accomplishments.45 Although potentially useful, such data can have methodologic pitfalls as well. A risk of cultural, implicit, and hindsight biases can easily bedevil the authors of such profiles. This is true, not only of IQ tests and of estimates of leader performance, but also of hypothetical psychological tests applied at a distance. Many such tests were developed and normed for a white, Western, male population, and norms for other cultures may not exist. Cross-cultural and implicit biases can thereby present formidable challenges to leadership analysts. Hence, deep understanding of a given leader's language and culture (including political culture) is critical in preventing cross-cultural or linguistic misunderstanding.
The role of classified data in leadership analysis warrants careful thought and commentary beyond intelligence agencies' concern regarding exposure of sources and methods;46 but attention to potential biases, including hearsay, personal motivations of sources, vetting of such sources, and risks of embellishment or minimization, requires the same cautions as exercised in the disciplines of forensic psychiatry and intelligence analysis.39
Predicting long-term health prognoses for leaders remains fraught with difficulty. Much of the epidemiologic literature regarding risk factors for cardiovascular disease, stroke, cancer, neurocognitive impairment, and mental illness is based on Western or U.S.-based norms.47 This becomes no less salient when one recognizes that most of the leaders of today's G-20 are in their 60s or 70s. Assessment of such risks may be mitigated by the fact that leaders tend to have access to state-of-the-art medical care, although Post and Robins have argued that being a national leader often predisposes one to getting less-qualified medical care, because of the psychological dynamics involved and the fact that the leader's physician(s) may have little meaningful influence on a given leader's health habits.48 Medical professionals, especially psychiatrists, are uniquely versed in understanding neuropsychiatric illness and behavior and the psychological overlay of medical/surgical illness. In 2010, President Clinton's personal physician accompanied him to North Korea, where he was included in Clinton's meetings with Kim Jong Il, which allowed for closer observation of the latter's purported residual neurologic and neurocognitive deficits after his stroke in 2008.49,50 Medical leadership analysis also requires understanding of a given leader's protective health factors, including genetics, psychological resilience, health habits, hobbies, and relationship with intimates, family, friends, and colleagues.
Novel quantitative approaches such as intelligence forecasting,51 psycholinguistic analyses,52 operational code analyses,53,54 and quantitative prediction55 may offer ways of predicting leadership behaviors differently from traditional, qualitative medical intelligence approaches, as has been highlighted in the work of Dr. Phil Tetlock56 and his colleagues in the Good Judgment Project, which is an intelligence community-sponsored project using crowdsourcing to forecast world events. Such approaches, combined with novel artificial intelligence (AI) approaches, may offer new insights into leadership behavior.57,58 Overall, this highlights the importance of leadership analysis and political psychology as one piece of intelligence analysis and as one piece of a larger methodological puzzle. It behooves psychiatrists and psychologists who perform leadership analyses to have some exposure, familiarity, and professional experience in intelligence analysis, international relations, and quantitative research methods, as noted above.
Finally, the work of Post (and others using similar methodology) has not been subjected to rigorous scientific outcome measures. Such criticisms are not new and have been noted in published critiques of the CIA's work in this field.59 In addition, senior leaders and policy makers, as well as media personalities and corporate executives, may have greater personal access to a given leader during summits, negotiations, and conferences, offering them raw data unmatched by the data presented in leadership profiles. Psychiatrists and psychologists working in this field should be able to anticipate and manage such methodological concerns.
A more complex concern involves the degree of influence (and how this in turn relates to underlying methodology) of such leadership profiles, which is impossible to measure and to separate from methodology, per se. The gold standard in the U.S. government would be for a profile, or components thereof, to be included in the Presidential Daily Brief (PDB).60 But the PDB is a heavily edited and carefully revised living document, and elements of a given profile may be enhanced, diluted, or even taken out of context. The question of degree of influence may be even more the case when customers (including senior leaders) in the diplomatic, intelligence, and policy communities express a distrust of such analyses, either because they trust their own instincts and political judgments, or because they have an inherent distrust of psychiatric and psychological approaches to understanding political and leadership behavior.
Future Considerations
What does the future hold for psychiatrists' roles in leadership analysis and political psychology? I would offer that the Goldwater Rule requires further revision to account for contemporary methodological, legal, and ethics concerns in leadership analysis and political psychology profiling, as noted above. It can serve as a useful set of guidelines and ought to allow for media activity and academic publishing, while encouraging practitioners to understand similar ethics, legal, and methodologic cautions and limitations as seen in the practice of forensic psychiatry. The answer, as in forensic psychiatry, lies in setting high, continuously evolving standards of education, scholarship, and peer review. There is an ongoing need for more education and formal training in the field of leadership analysis and political psychology, and professional psychiatric organizations should support such continuing education activities. Novel quantitative and AI methodologies can be expected to shape the field in many ways, given the rapid and amazing advances in such technologies. Forensic psychiatric researchers can follow in the rich legacy of Drs. Langer and Post and play an important role in leading this discipline through the 21st century.
Acknowledgments
The author thanks Ambassador Joseph DeTrani, Ambassador John Beyrle, Graham Fuller, Dr. Marc Sageman, and Dr. Paul Appelbaum for their thoughtful comments regarding this paper.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2018 American Academy of Psychiatry and the Law
