H. Steven Moffic, MD

Kings, Conquerors, Psychopaths: From Alexander to Hitler to the Corporation

by Joseph N. Abraham, MD; Hidden Hills Press, 2020

You know the saying: you cannot judge a book by its cover. However, in the case of this cover designed by Renee Rogers, you can—that is, if you look closely enough and analyze it, as a psychiatrist would be wont to do. At first glance, or at enough distance, it appears to be an attractive, even beautiful cover. Looking closer, the O in “Psychopaths” is replaced by what looks like a dead head in a pool of red blood. Above the head is a couple of drops of red blood from the Q in the word “Conquerors.” That made me wonder—was it intended to relate to the Q of QAnon, the American far-right conspiracy theorist and theory? QAnon started to become popular in 2017 and the first edition of the book came out in 2018. Were they related?

What makes such speculations so fascinating is their parallel to the essential psychology of kings, conquerors, and psychopaths—from Alexander to Hitler and to the corporation, as the author Joseph N. Abraham, MD, shows. One common factor is that such leaders can appear so engaging and promising—at least as they are accumulating 

. Then they turn out to spill the blood of so many. Psychopathy combined with malignant narcissism can lead to attempted genocide, such as with Hitler and the Jewish people. At its worse, Abraham deems this sort of confluence as the Dark Tetrad: criminal psychopathology, narcissism, Machiavellanism, and sadism.

On the cover, of course, is also the name of the author, Dr Abraham. In the prologue, he discusses why he wrote this book. This is an especially important question, given that his prior book from over 20 years ago, 

Happiness: A Physician/Biologist Looks at Life

, seemed to be at the other end of the life satisfaction spectrum. Was it his further life experiences that led him to explore the dark side this time around?

Interestingly enough, while Abraham does not comment on this cover, late in the book he describes what he had in mind as an alternative cover: a portrait of Queen Victoria with a Hitler mustache. Why that? Queen Victoria is reputed to have been the greatest conqueror of all, subjugating over 400 million individuals. Yet, as in the case of many despots, she seemed kind to family and friends. The psychiatrist Robert Jay Lifton, MD, in his analysis of Nazi physicians, came up with the concept of doubling: the Nazis could mentally dissociate and separate their feelings toward family from their feelings toward 

The key question in the book, given the common human history of such 

 and dependent (even admiring) followers, is why humanity has not learned from such history of trauma, loss, and death? One psychological mechanism, based in our perceived self-esteem and sense of security, is that we admire the powerful who promise good and better things.

This book is unique, delving deeply into the worst horrors and most brutal leaders in history, at least from the perspective of those ruled by or critical of such rulers. His answer suggests a new interdisciplinary specialty, psychiatric archeology, for studying genocidal leaders and organizations. One contribution to this specialty could come from 

. Being an emergency physician lends itself to a “certain dark paranoia” of trying not to miss anything really important when evaluating patients. That translates into trying to think about the worse things that could be happening. Second, Abraham also feels that his evolutionary biology background makes a great contribution. Any evolutionary biologist encounters constant and enormous death and horror—such is the natural results of our human nature and the survival of the fittest. Most living things die early.

Being a scientist and physician also means focusing on negative data. What is missing in evaluating a patient? Sometimes it is just a feeling: 

. Abraham posits that much of the book is based on data that is “shocking and heinous,” something he often discuses through meticulous research. The violence associated with some patients in the emergency room is a small parallel to the tableaux of 

Trauma, whether directly experienced or heard about, can be so frightening that it is often ignored, forgotten, or dissociated from our consciousness. It is no wonder then that Dr Abraham concludes in the epilogue that in order to rehabilitate and advance humans from our long history of physical, verbal, sexual, and intellectual abuse—primarily (but not exclusively) done by men—psychiatrists, psychologists, and other mental health professionals must be the saviors. To do so, we must educate the public about how we can heal each, he submits.

I would add that we need more women leaders who do not follow previous male leaders’ quest for power, but rather focus more on enhancing relationships and interdependency. Prevention, or trying to recognize potentially dangerous leaders as early as possible, and treat and rehabilitate them, could head off problems too. For example, during childhood would-be sociopaths exhibit cruelty to animals and a lack of any remorse, supplemented by related brain imaging changes. To reduce undue narcissism, parents need to provide realistic feedback about their children’s abilities.

Abraham rightly recognizes that the dangerous leader nowadays may be corporations as much as individuals, although the 2 can work together synergistically. We know that there are many more sociopaths outside of jails and prisons than in them. He also comes up with the insight that there may be 

, whose psychopathy can be channeled into good. The main example here is the neuropsychiatrist, James Fallon, PhD. Though Fallon’s wife once compared him to the film character Hannibal (“The Cannibal”) Lecter, and his colleagues suggested he might be a 

, he is generous to individuals, and finds them interesting. Fallon is a demonstration of how the field of medicine has been taken over by for-profit corporations, which are responsible for the epidemic rate of physician burnout. Business ethics need to supplement healthcare ethics, not take them over.

“Because when all of the other checks and balances begin to fail, then we must be the final check. Only we can restore balance. We are the last feedback in the system,” said Abraham.

Specialists in psychiatry and history should be especially interested in this book. The dangers Abraham describes potentially effects everyone, and everyone could learn from this book. Acknowledging our tendency to ignore the danger of our leaders and world can be difficult. Abraham closes the book by discussing potential saviors. That can only happen if our vulnerability to cultish and 

 following of dangerous leaders is overcome with freedom of thought.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues relate to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

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