The bit that I want to bring to your attention is the faux "diagnosis" of Bill Clinton as a sociopath. Remember that meme? Cons repeated it a lot back then, and they'll probably recite the same mantra twenty years from now. Apparently, Clinton's great sin was to be "charming." And the source cited for this diagnosis is -- get this -- the Merck manual.
Correct me if I'm wrong, but I thought that manual was all about drugs. It's the DSM-IV -- or, at the time, the DSM-III -- which offers criteria for what is properly called Antisocial Personality Disorder. Of course, diagnoses of psychopathology are to be made by clinicians, not political hit men.
Very well, then. Two can play at that game. This page notes these APD traits:
Sense of entitlement; Unremorseful; Apathetic to others; Unconscionable behavior; Blameful of others; Manipulative and conning; Affectively cold; Disparate understanding; Socially irresponsible; Disregardful of obligations; Nonconforming to norms; Irresponsible.And here is the DSM-IV list:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrestSeems to me that we've just painted an excellent verbal picture of our current prez.
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated fights or assaults (both physically or mentally)
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Sense of entitlement? That's Dubya, not Bill. No remorse? Ain't seen a sign of it yet. Manipulative and deceitful? W lied us into war. Failure to plan ahead? On the grandest possible scale! Irritable and aggressive? This is the President known for flipping the bird while others die. Disregard for others? I don't think he cares how many kids are sacrificed on behalf of his folly. Inability to sustain steady work? If this creep weren't named Bush, he'd be homeless.
Charm has no place on this list, incidentally. At any rate, I'm leery of anyone who says charm equals dysfunction. Were Cary Grant and Audrey Hepburn sociopaths? Is it possible or desirable for a non-charming person to achieve high office?
Paging dr. elsewhere...! Are you there? I'd love to hear your perfessional opinion...
12 comments:
Charm doesn't automatically indicate dysfunction. But the kind of superficial charm exhibited by someone like Ted Bundy is something to watch out for.
I would hope that Dr. Elsewhere would keep in mind her professional ethics and not diagnose someone who is not a patient of hers.
blogger Rivka at Respectful of Otters, in her June 11 2004 posting "So Much For 'Social Responsibility'" said it well:
"It wasn't okay when their side did it, and it's not okay for our side to do it.
She was discussing Psychiatrist Justin A. Frank's book Bush on the Couch."
"You don't diagnose a patient you haven't examined. You don't discuss your diagnoses without the patient's permission. And if your only defense against the latter rule is that the person you've publicly diagnosed isn't really your patient, that alone ought to let you know that you've strayed far from the requirements of professional ethics. A psychiatric diagnosis is a clinical tool, not a rhetorical device; to treat it otherwise substantially undermines the reputation of psychiatry and psychology. Frank is a former leader of the Physicians for Social Responsibility, but there is simply nothing socially responsible about using psychiatric terminology as a stick with which to beat your political enemies. There's nothing socially responsible about misusing the mantle of the professional expert. I am appalled."
The posting has a lot of useful discussion in the comments section.
http://respectfulofotters.blogspot.com/2004_06_01_respectfulofotters_archive.html#108695655124202757
Justin Frank responds in a June 16, 2004 posting. Again, good points made in the comments:
http://respectfulofotters.blogspot.com/2004_06_01_respectfulofotters_archive.html
have to agree with - and defer to - ferry fey here. with gratitude; thanks for those links.
i, too, was appalled that dr. frank was so, er, frank in his open diagnosis of bush. compare this to our reaction to frist diagnosing terri schiavo.
frist is under scrutiny from his medical board for this little faux pas, as should frank be.
but in addition, a henry miller who claimed psychiatric credentials (google him; though an md, psychiatry is hardly his work)claimed in 2004 that al gore suffers from narcissistic personality disorder.
i wrote dr. miller threatening to file a complaint with the ama. his response was a snot-nosed taunt, daring me to do just that since the ama was 'toothless.'
the sort of response one might expect from, well, those with symptoms joe listed.
it is not ethical for me or any professional to offer a diagnosis outside a clinical setting. but in bush's case, who needs a diagnosis? his list of flaws says all we need to know.
besides, john dean's description of the authoritarian personality allows us to get the job done without committing professional suicide.
here's the link to miller's diagnosis of gore:
http://www.nationalreview.com/comment/miller200406010833.asp
As a layman, I have a question.
In my former life, I had twenty years experience in an occupation that required adherence to a set of professional ethics. I considered this a sacred duty and I deeply respect the views of both Dr. Elsewhere and ferry fey.
But as one of the common stock of citizenry, I think at a certain point the common good may well be served by a formal diagnosis. Many Bush supporters are fine with "somethings a little funny with George." And maybe that really is the extent of the problem in GWB's case. But, hypothetically, if the "problem" with a world leader were truly seated in a serious personality disorder or mental illness it seems there would come a point when there would be a moral imperative to breach the ethics.
This moral imperative could only come in the event that the professional involved accurately outlines the limitations of his or her analysis, adhere's to the strictist objectivity, truly believes that significant risk accompanies the lack of revelation and a peer review is conducted.
Without these criteria, most of us would be left reading dimestore psychology books and making wild stabs at a diagnosis, without the benefit of professional insight.
I have no brief for remote diagnosis, and the Merck manual is notorious for medicalizing what amounts to existential conditions, but we're all students of behavior -- we have to be, to survive, it's our nature.
A doctor might be prevented, by professional ethics, from referring to Dubya's behavior as pathological, but for the rest of us it's a matter of necessity and common sense. When you're around someone acts Dubya, or have to work with someone like Dubya (and that behavior was marvelously captured by Merck), you make your adjustments, you'd be a fool not to.
As Mr. Cannon said, the Merck Manual identifies pharmaceuticals, the Diagnostic and Statistical Manual describes personality disorders, etc.
But, your point is well taken. Maybe we are better off after all taking wild stabs at guessing (I won't use making a diagnosis)the personality disorders present in dodgy leaders. At least the end result wouldn't be presented with the weight of a diagnosis, even if unintended by the author. And psychologists can remain true to their professional ethics.
Best of all, I am now free to conjecture on the psycological profiles of "W" and company. What the heck, no one is going to listen to me anyway.
IMHO, Yes, a professional needs to use the DSM if they are to render a qualified disgnosis of a mental disorder, in this country anyway.
But I think, implicit in the definition and diagnosis of any mental disorder is the idea that a certain "bar" has been met. That bar is (loosely) the inability to function successfully in important aspects of daily living. That is, when that "problem" affects your daily living adversely, continuously, and probably predictably. For that, Bush qualifies, not Clinton.
Speaking of diagnoses, what about a new one not in the DSM, "Authoritarian Personality Disorder." I envision a mix of bipolar and antisocial as one distinct category which then lends itself to some suggestion of causality. It doesn't exist on paper but it seems to in reality.
Miss P.
I'm truely not trying to be a smart-ass here, but if it looks like a sociopath, acts like a sociopath and smells like a sociopath, then well, um, isn't it? Yes. We can ask, and we can answer.
One could argue that in this case, educating the public about what these "labels" really mean, and what the implications are, is a moral imperative. A Duty to Warn, if you will. (See Tarasoff v. Regents of the University of California, or possibly more importantly, Ewing v. Goldstein.)
I think one could reasonably argue that in this case, this Duty can and should be extended to the general public, which includes young, naive potential military recruits. For all we know, this "warning" may have kept some of them away from the American meat-grinder that is Iraq.
It's kind of like saying, "HEY GUYS - I DON'T WORK ON THIS TOLL BRIDGE, BUT BELIEVE ME WHEN I TELL YOU THAT THE BRIDGE IS DOWN! DO NOT ATTMPT TO CROSS!"
One a more clinical note, the DSM IV (1994) combined APD, psychopathology and sociopathology into one diagnosis. One that many now consider to be a "wastebasket" dx at this point because it eliminates any clear differentiation between the three when there are clear differences that exist. This was a highly controversial decision, and I anticipate needed changes in the next manual. Here are a few of the many links to the subject:
http://personalitydisorders.suite101.com/article.cfm/psychopathantisocial
http://www.angelfire.com/zine2/narcissism/antisocial_sociopath_psychopath.html
For the record, I think that Bush is antisocial on his best day. I base this belief on his public behavior, his utter dyslexia when trying to convey a sense of Presidential compassionate or caring, i.e. putting "food on their families," his callous decision-making, his documented and well-publicized refusal to accept reponsibility for these decisions, his history of abuse to animals, his history of substance abuse, and the equally well documented, well-publicized dynamics within his own family.
I also agree with Dr. Frank that Bush has chosen his own puppeteers like the hand picks the clove. Wonder how they would fit the couch?
Kim in PA
Public education about mental health issues, and more insight into how we humans operate is a good thing.
But having seen how many educated, articulate people still use the term "schizophrenic" to mean having multiple personality, I don't have much hope.
We know that Bush was the kind of kid who would put firecrackers up the butts of frogs. We remember how he imitated Karla Faye Tucker. We can look at comparisons between his relatively articulate spontaneous answers as Texas governor, and contrast them with his current slack-jawed floundering for coherence.
But you know what? He could kill and eat a kitten onstage during the State of the Union address, and we still couldn't get rid of him on psych grounds. And if we did have proceedings against him, it would be for that one kitten, and not hundreds of thousands of Iraqis or 3000 US soldiers.
Upon reflection, I wanted to add that my lack of optimism about being able to have something constructive done about George W. Bush's mental state was not coming from a position of "We're doomed! It will never happen! Woe is us!"
It's just that in this country (and I suppose all others) we don't yet know how to discuss mental illness in any meaningful way. As a whole people are not educated about the facts, but more importantly don't have emotional intelligence about the subject. With that in mind, punishing George Bush's state of mind by taking away the presidency is a political decision that could hurt us plenty down the road.
Ferry,
I didn't say anything about "taking away the presidency" based upon Bush's state of mind. That is an entirely different discussion.
I was responding to the assertion idea that diagnosing from a "distance" is always bad, always unprofessional, under all circumstances. Qualified professionals with relevant insights can help to inform the public and perhaps gradually improve the dialogue around mental health issues.
Indeed, a diagnosis can be used as a "stick," but there are times when a stick is needed. Even a tree truck, for crissakes.
Laypersons who love Bush will continue to ignore the mounting evidence of his destructive instability. He could shit on the Vatican floor and they would blame the Pope.
However, there are many others who see him and hear him, thinking that there is just something "wrong" there. But what? Presenting credible, readable, heavily researched information to these folks validates their intuition and informs their own discussions of the problem.
We may still someday reach a point where people understand that schizophrenia is not simply a "multiple personality," and that pure psychopathology really does exist.
Kim in PA
Buzzflash has just posted an interview with Dr. Justin A. Frank.
http://www.buzzflash.com/articles/interviews/049
A statement by Frank in the early version I saw this morning has been changed. He had referred to the infant Jeb Bush (whose legal name is John Ellis Bush, thus JEB) as "Jack."
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