On the international community psychiatrist.
In our recent end-of-the-year eulogy, we focused for the first time solely on 1 psychiatrist due to the scope of his career and the apparent dearth of recent psychiatrist deaths. At that time, little did I know that another prominent psychiatrist who I knew had died. Instead of being a community psychiatrist in the United States, as Joel Feiner, MD, was, Dr Post could be considered to be an international community psychiatrist.
When I finally heard of Dr Post’s death, I wondered about the delay and extent of media coverage. The coverage of his death was shrouded in as much uncertainty as his professional life was at times. The mystery was not in his medical conditions, as he had a severe stroke in July and tested positive for COVID-19 the week before his death. The mystery was why nothing appeared in the New York Times or from the American Psychiatric Association (APA) as of December 6th, when he died at the age of 86 on November 22, 2020.
Dr Post’s professional work was of immense importance to the US government and thereby the world, but controversial and necessarily secretive. He essentially started a new field in working for the Central Intelligence Agency for 21 years, ending in 1986. Can you imagine starting a pilot program in the political profiling of international leaders right out of residency training, as Dr Post did in 1965? I thought that I was in over my head right out of residency when I and a fellow psychiatrist became the only psychiatrists for an Army base specializing in the military police and women in the service! Given that his work and team became a fixture at the CIA for 21 years, it must have been valuable. Of course, secrecy is part of intelligence at the CIA. Even so, knowledge of the analysis of leaders around the world, such as Fidel Castro and many others, leaked out now and then.
President Jimmy Carter asked him for profiles of Egyptian President Anwar Sadat and Israeli’s Prime Minister Menachem Begin for his Camp David retreat in 1978, which led to a peace treaty. He publicly attributed much of the success to using Dr Post’s profile, including the shared knowledge that Sadat had a “Nobel Prize Complex” and Begin had a biblical preoccupation.1
After the CIA, he became director of the political psychology program at George Washington University, where he continued his political profiles. For example, he helped when our country was concerned about Saddam Hussein after the September 11, 2001, tragedies and the possible weapons of mass destruction. Dr Post was concerned after he discovered that Hussein’s father died during pregnancy and that his mother tried to abort him. He learned that Hussein’s stepfather was abusive and about the uncle with whom he lived who planted dreams of glory that turned into what Dr Post thought was dangerous malignant narcissism, as well as the paranoia that caused him to build bunkers under his palaces and hide from the United States in a hole in the ground.2
If applied and used, such profiles clearly would have worldwide major repercussions. Of course, no double-blind studies could be conducted for accuracy and outcome. The underlying concern was one of national security, in the sense of whether personal conflicts and psychology was playing out in their international leadership for better or worse. If it seemed worrisome for the United States, then Dr Post’s analysis could help establish the necessary political treatment. Certainly, we assess the security of our individual patients as far as suicidal, homicidal, and self-care is concerned; Dr Post tried to do something similar for our nation. For such work, he was awarded the Intelligence Medal of Merit in 1979. This was one of many awards he received, and he also became a Life Fellow of the American Psychiatric Association.
President Trump and the Goldwater Rule
After President Donald Trump was elected, Dr Post was one of the few psychiatrists who spoke publicly about the risks of that presidency due to his psychological profile. He often worked with the psychiatrist Bandy Lee, MD, who edited the Dangerous Case of Donald Trump.3 For the expanded edition, he wrote a chapter titled “The Charismatic Leader-Follower Relationship and Trump’s Base.”4 I also co-wrote a chapter—“The Age of Thanatos: Environmental Consequences of the Trump Presidency”—but only after insisting that I would not comment on the president’s psychology, only his administration’s policies. I attended the book release in Washington, DC in March 2019; Dr Post was the psychiatrist on the panel. However, the expected media coverage for this follow-up of the original best-seller dissipated. Dr Lee came to know him well and wrote her own tribute.5
Questions soon emerged about the reason for the sudden drop-off in coverage and whether the APA had something to do with it.6 Why would the APA be concerned? That seemed to stem from a tightening of the ethical Goldwater Rule in March of 2017, essentially conveying that a member of the APA should not comment publicly about a public figure from a professional point of view.7 Nevertheless, Dr Post wrote his own book about President Trump and his followers; the book was released exactly a year prior to the 2020 election.8 In it, he described the president’s desire for adulation and how his followers crave a “father figure” for protection against evil, which corresponded to some previous analyses. Dr Post maintained his concerns until his death. One particularly new insight was that a number of “second choice sons” became leaders due to older brothers who died or rebelled: President Trump, President Kennedy, Israeli Prime Minister Benjamin Netanyahu, Syria’s Bashar Asad, and the Indian leader Rajiv Gandhi. This insight mirrors the successful second sons like Jacob and Moses in the Torah.
We are left with some conundrums about Dr Post’s political profiles, are we not? On the one hand, it is not a violation of the Goldwater Rule if such analyses are used by the government.9 On the other hand, when that information is made public, it could be considered a violation. Moreover, the distinction is not made between political leaders in the United States versus abroad; many years ago President Bill Clinton was featured in one of Dr Post’s books.2 That leads me to conclude that perhaps there is an implicit understanding within the APA that Dr Post was an exception to the Goldwater Rule, as most rules always have their exceptions. Dr Post, nevertheless, felt constrained and morally conflicted at times. With some regret, he kept his opinion about the religious extremist David Koresh to himself in 1993.7 Later, he opined that Koresh had messianic traits which could lead to mass killing, which it did. In my opinion, the APA should collect a small cadre of psychiatrists with similar expertise that can be called upon to assess the potentially immense risks of leaders and their leadership. Such psychological portraits are too important to national security and risk management to leave solely to political pundits and the public.
I have not yet mentioned that Dr Post also had a private clinical practice. He also was a man of many other talents. He was a well-regarded jazz pianist and could quickly write new lyrics to Gilbert and Sullivan operetta tunes. Perhaps these activities helped him handle any undue stress about the implications of his work.
Although uncertainly remains about how much of Dr Post’s work should have been publicly revealed during his life, and now after his death, he surely changed the world and challenged psychiatry’s role in it. Our country’s well-being, and our own well-being, may be at stake in how the legacy of his life is leveraged in the future.
Dr Moffic 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 being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric TimesTM.
1. Carter J. Keeping Faith: Memoirs of a President. Bantam Books; 1982.
2. Post J. The Psychological Assessment of Political Leaders: With Profiles of Saddam Hussein and Bill Clinton. University of Michigan Press; 2005.
3. Lee B, ed. The Dangerous Case of Donald Trump. Thomas Dunne Books; 2017.
4. Lee B, ed. The Dangerous Case of Donald Trump: 37 Psychiatrists and Mental Health Experts Assess a President. Thomas Dunne Books; 2019.
5. Lee BX. A tribute to Dr. Jerrold M. Post. AlterNet. November 26, 2020. https://www.alternet.org/2020/11/dr-jerrold-m-post/
6. Kendall J. Muzzled by psychiatry in a time of crisis. MadinAmerica. April 25, 2020. https://www.madinamerica.com/2020/04/muzzled-psychiatry-time-crisis/
7. Ghaemi N. The Goldwater Rule and Presidential mental health: Pros and Cons. Medscape. June 7, 2017. https://www.medscape.com/viewarticle/881006
8. Post J, Doucette S. Dangerous Charisma: The Political Psychology of Donald Trump and His Followers. Pegasus Books; 2019.
9. Appelbaum PS. Reflections on the Goldwater Rule. J Am Acad Psychiatry Law. 2017;45(2):228-32.