ANALYSIS AND COMMENTARY Leadership Analysis and Political Psychology in the 21st Century Kenneth B. Dekleva, MD 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. J Am Acad Psychiatry Law 46:359–63, 2018. DOI:10.29158/JAAPL.003771-18 The 2016 campaign and election of President choanalytic approach of the day, Langer created a Trump has led to a flurry of interest in not only his multidisciplinary team that analyzed raw data in- mental health,1 but more generally, in the mental cluding Hitler’s writings, speeches, movies of rallies, health of world leaders. This has resulted in extensive classified intelligence data, his medical reports, defec- scholarly commentary regarding the American Psy- tor accounts, and collateral accounts of persons who chiatric Association’s Goldwater Rule,2 with its pro- had met Hitler in person. Langer emphasized under- hibition on opining psychiatrically on the mental standing of Hitler’s psychological makeup, and also health of public figures whom one has not examined made accurate predictions of his future behavior. in person.3–7 This article, by a psychiatrist who has Langer’s work exerted a powerful intellectual influ- published numerous profiles of world leaders,8–15 ence, both in the fields of leadership analysis and outlines challenges regarding psychiatric approaches political psychology, as developed by Dr. Jerrold to leadership analysis.16 Overall, political psychology Post, and criminal personality profiling as pioneered approaches to leadership analysis are but one piece of by Dr. James Brussel.18 a larger, more complex analytic puzzle, which can In 1965, Post joined the Central Intelligence serve national security interests in understanding the Agency (CIA), where he founded a unit for the anal- psyches of our adversaries, allowing policy makers ysis of the psychology of world leaders. Over the next greater options regarding decision-making in a vari- several decades, Post followed Langer’s model, lead- ety of diplomatic and public policy settings. ing a team of psychiatrists, internists, psychologists, The origins of leadership analysis and political anthropologists, historians, and intelligence analysts, psychology profiling date to 1943, when Dr. Walter who developed classified leadership profiles of vari- Langer published, at the behest of the Office of Stra- ous world leaders for the intelligence community and tegic Services, a classified analysis of Germany’s Fu¨h- senior U.S. policy makers.16,19 A high point involved rer, Adolf Hitler; this work was later de-classified and the declassified “Camp David Profiles,” in which in- 17 published in 1972. Although beholden to the psy- dividual psychological assessments of Israel’s Men- achem Begin and Egypt’s Anwar Sadat helped U.S. Dr. Dekleva is the McKenzie Foundation Endowed Chair in Psychi- atry I, Associate Professor of Psychiatry and Director, Psychiatry- President Jimmy Carter achieve an understanding of Medicine Integration, University of Texas Southwestern Medical Cen- negotiating tactics and unique circumstances, which ter, Dallas, TX. The views expressed in this paper are entirely his paved the way for a successful outcome: the 1979 own and do not represent the official views of the U.S. Govern- 20 ment, the U.S. Department of State, or UT Southwestern Medical Camp David peace accords. In 1986, Post retired Center. Address correspondence to: Kenneth Dekleva MD, De- from the CIA and continued his career at George partment of Psychiatry, UT Southwestern Medical Center, Mail Code 9070, 5323 Harry Hines Boulevard, Dallas, TX 75235-9070. Washington University, where he and his associates E-mail: [email protected]. published numerous leadership profiles, including 21 22 Disclosures of financial or other potential conflicts of interest: None. those of Saddam Hussein, Bashar al-Assad, Kim Volume 46, Number 3, 2018 359 Leadership Analysis and Political Psychology in the 21st Century Jong Il,23 Muammar Gaddafi,24 Hugo Chavez,25 Fi- ject leader’s national security team and intelligence del Castro,26 Vladimir Putin,27 Osama bin Laden,28 services.36 A controversial profile could lead to hack- Radovan Karadzic,8 and Slobodan Milosevic.9 Such ing, online attacks by Internet trolls, or more serious profiles often attracted controversy, because of Post’s forms of public and private harassment.37 use of diagnostic categories such as “malignant nar- Academic institutions may be sensitive to the me- cissism,” and the labeling of many such people as dia image created by work involving the intelligence “rogue leaders.”29–31 But Post’s methodology, like community. Similar public relations concerns have that of Langer, entailed a close examination of the at times dogged psychiatric and psychological research- leader’s childhood, young adulthood, transition to ers involved in studying military survival-evasion-resis- midlife, relationships, speeches, collateral data, and tance-escape (SERE) psychology, interrogation, and writings. Post did not shy from predictions, some of other topics involving national security.38 Academic which turned out to be wrong, but the greater em- practitioners of leadership analysis and political psy- phases in such portraits involved a psychological un- chology might consider consulting their parent insti- derstanding of a given leader’s traits and political tution’s public affairs offices before publication of behavior and how such understanding might prove such profiles. useful in diplomatic negotiations. Like Langer before In a sense, such concerns are common to forensic him, Post emphasized the close relationship, almost a psychiatry, and both training and a solid grounding lock-and-key fit, between charismatic, narcissistic in its principles and challenges is a worthy back- leaders, and their impassioned followers. ground for practitioners of leadership profiling and political psychology. In addition, experience and fa- Ethics, Law, and the Goldwater Rule miliarity with the national security strategy can assist In March 2017, the American Psychiatric Associ- in understanding the analytic process and how such information gets developed, disseminated, and used ation (APA) affirmed its position regarding the 39 Goldwater Rule, in response to a flurry of publica- by senior policy makers. tions regarding the psychology of President Donald Trump.32 While the organization’s focus has ap- Methodological Challenges peared to reflect its concern for embarrassment to the The current state of the art has changed little since profession, in his recent review Dr. Paul Appelbaum the publication of Post’s work in 2003.16 Leadership cites other dangers.3 Psychiatrists publishing profiles profiles rely on a psychobiographical approach, al- of world leaders should be concerned not only with though the descriptive language used today is less potential lawsuits, but also the risk of being reported psychoanalytic, per se. The raw data, subject to dif- for ethics violations or licensing board complaints.33 ferent interpretations and various biases, include a In any legal setting, it remains unclear whether such leader’s published writings, interviews, social media leadership profiles could pass a Daubert test, which activity, speeches, videos, media appearances, and in- involves the admissibility of expert scientific testi- terviews with the leader’s intimates, contacts, col- mony.34 If practitioners and their customers in the leagues, and former employees/contacts/intimates, policy, national security, and diplomatic communi- and defectors. Medical data, although often not ties believe that such profiles have value, then the available overtly, may be available via inference, or Goldwater Rule may have a chilling effect and may from the study of a leader’s physique, gait, and other serve to dissuade subsequent generations of younger data; in addition, private medical data can be made practitioners from entering the field. available via leaks, interviews, writings, and publica- The other critical question, which the Goldwater tions by a given leader’s treating clinicians.40–43 Rule does not explicitly address, involves the in- In the absence of overt mental illness (and most tended audience or customer for the profile. In the leaders profiled do not have mental illness), current case of work by Post and others, the audience in- methodology emphasizes the description of a leader’s cludes not only academia and the media, but most psychological traits, rather than DSM-V diagnoses. saliently, the national security community and policy As Allen Frances has noted, most potential diagnoses makers at the highest levels of the U.S. Govern- of world leaders lack validity, not only because of the ment.35 In today’s world, any such published profiles absence of a face-to-face evaluation, the problem ex- can also expect to receive careful analysis by the sub- plicitly addressed in the Goldwater Rule, but also 360 The Journal of the American Academy of Psychiatry and the Law Dekleva because the leader likely evidences no clinical distress 2010, President