CLINICAL ANALYSIS

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Here's an interesting perspective from Dr. Minot, a psychiatrist in Waterville, Maine: Bush's "irrational" consideration of a "surge" in the wake of the Iraq Study Group report -- which apparently defies all credible counsel - has begun to generate speculation regarding his sanity.References to Bush's "delusions" have appeared in the mainstream media and throughout the blogosphere. As a psychiatrist, I understandably get concerned when I see clinical terminology bandied about in political discourse, and thought it might be of interest to share a professional perspective on this question. I have a distinct clinical impression that I think explains much of Mr. Bush's visible pathology. First and foremost, W. Bush has a Narcissistic Personality Disorder. What this means, is that he has rather desperate insecurities about himself, and compensates by constructing a grandiose self-image. Most of his relationships are either mirroring relationships -- people whoflatter him and reinforce his grandiosity -- or idealized self-objects -- people that he himself thinks a lot of, and hence feels flattered by his association with them. Some likely perform both functions. Hence his weakness for sycophants like Harriet Miers, and powerful personalitieslike Dick Cheney.Even as a narcissist, Bush knows he isn't a great intellect, and compensates by dismissing the value of intellect altogether. Hence his disses of Gore's bookishness, and any other intellectual that isn't flattering him. Bush knows that his greatest personal strength is projecting personal affability, and tries to utilize it even in the most inappropriate settings. That's why he gives impromptu backrubs to the German Chancellor in a diplomatic meeting -- he's insecure intellectually, and tries to make everyone into a "buddy" so he can feel more secure.The most disturbing aspect about narcissists, however, is their pathological inability to empathize with others, with the exception of those who either mirror them, or whom they idealize. Hence Bush's horrifying insensitivity to the Katrina victims, his callous jokes when visiting grievously injured soldiers, and numerous other instances. He simply has no capacity to feel for others in that way. When LBJ was losing Vietnam, he developed a haunted expression that anybody could recognize as indicative of underlying anguish. For all his faults, you knew he was losing sleep over it. By the same token, we know just as well that Bush isn't losing any sleep over dead American soldiers, to say nothing of dead Iraqis. He didn't exhibit any sign of significantconcern until his own political popularity was sliding -- because THAT'S something he CAN feel.

Which brings us to his recent "delusion." To be blunt, I don't see any indication that Bush has any sort of psychotic disorder whatsoever. The lapses in reality-testing that he exhibits are the sort that can be readily explained by his characterological insensitivity to the feelings and perceptions of others, due to his persistently self-centered frame of reference.

Mr. Bush knows that things aren't going his way in Iraq, and he knows that it is damaging him politically. He also sees that it is likely to get worse no matter what he does, and in fact it may be a lost cause. However, he recognizes that if he follows the recommendations of the Iraq Study Group, that Iraq will almost certainly evolve into a puppet state of Iran, and given his treatment of Iran he will completely lose control of the situation -- and he will be politically discredited for this outcome.

The ONLY chance that he has to avoid this political disaster, and save his political skin, is to hope against hope for "victory" in Iraq. Advancing the "surge" idea offers Bush two political advantages over following the ISG recommendations. One is that if it is implemented, maybe, just maybe, he can pull out some sort of nominal "victory" out of the situation. The chances are exceedingly slim, granted, but slim is better to him than the alternative (none).

Alternately, if the "surge" is politically rejected, he gains some political cover, so when things inevitably go bad, he can say "I told you so" and blame the "surrender monkeys" for the outcome. Most people probably won't buy it, but some (his core base) will. Now, I know what many of you are thinking -- is Bush willing to risk the lives of hundreds, maybe thousands more American soldiers, on anoutside chance to save his political skin, in a half-baked plan that even he knows probably won't work at all? Yes, he is. Because Bush is that narcissistic, that desperate, and yes, that sociopathic as well.Especially interesting about Mr. Bush, but quite common, Narcissistic Personality Disorder is frequently associated with alcoholism. The insufferable "holier than thou" attitude associated with "Dry DrunkSyndrome" is indicative of underlying narcissism.Also, the way that Bush embraces Christianity is characteristically narcissistic. Rather than incorporating the lessons of humility and empathy modeled by Jesus, Bush uses his Christian faith to reinforce hisgrandiosity. Jesus is his powerful ally, his idealized "buddy" who gives a rubber stamp to anything he thinks.Finally -- and this will sound VERY familiar to many readers -- those persons with NPD are notoriously unable to say they're sorry. Admitting error is fundamentally incompatible with their precarious efforts tomaintain their sense of order. Anyone having this particular character flaw almost certainly has NPD.Dr. L. Minot, MDA Psychiatrist in Waterville, Maine (ME)

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