As the current Presidential campaign/circus proceeds with unheard of antics on a daily basis, I have become reminded over and over again of the importance of the modern phenomenon of narcissism. As a tongue in cheek pictorial example to set the tone for this series of posts in the few weeks before the national election, I have chosen the famous but perhaps forgotten by many of our younger generations of the prototypical fashion dandy of Britain in the early 1800’s, Beau Brummel. In a way, he could be the male forerunner of the phenomenon of fame seekers such as the ubiquitous Kardashians.

In spite of the now rampant, free-wheeling, arm chair psychologizing and analyzing of the Republican nominee for the Presidency Donald Trump, there persists in the blather and smoke of the nondebate political exchanges among the candidates, an issue that still is important. This is the somewhat famous “Goldwater Rule,” formulated and made part of the American Medical Association’s section of Psychiatric Ethics in 1973. It basically stated that psychiatrists were being unethical if they held forth on diagnosing, attaching specific psychiatric labels and such to Senator Barry Goldwater of Arizona who was in 1964 the Republican nominee for the Presidency. A magazine published for approximately 3 years by Ralph Ginsburg, a prominent counter-culture writer in the 1960’s.

Section 7.3, which appeared if the first edition of the APA’s code of ethics in 1973 and is still in effect as of 2016,^[7] says:

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.^{[1] [From Wikipedia}

It basically stated that psychiatrists were being unethical if they held forth on diagnosing, attaching specific psychiatric labels and such to Senator Barry Goldwater of Arizona who was in 1964 the Republican nominee for the Presidency. A magazine published for approximately 3 years by Ralph Ginsburg, Fact, a prominent counter-culture writer in the 1960’s, and brother of the very controversial beatnik poet Allen Ginsburg. The editor of Fact magazine sent out a survey sent a survey out to over 17,000 psychiatrists about Senator Goldwater’s fitness to serve as President in 1964. On the survey, there was room and encouragement to add any additional expository opinions or personal remarks about Senator Goldwater. Fortunately, the vast majority of psychiatrists paid no attention to the survey and did not respond. A smaller group stated they did not know enough about Senator Goldwater to say anything about him. Less than 2,000 however, did respond with negative opinions and all kinds of rash, unsupported, and frankly off the walls pronouncements and diagnoses. This created a lasting scandal and controversy for years and resulted in the institution of the “Goldwater Rule.”

Just this past month, the current lady President of te American psychiatric Association wrote in opinion piece reminding bluntly psychiatrists of the tenets and requirements of the Goldwater Rule.

Amore recent article,  by Kroll, J; Pouncey, C (June 2016), “The Ethics of APA’s Goldwater Rule”, Journal of the American Academy of Psychiatry and the Law, 44 (2): 226–235, PMID 27236179, writing from the viewpoint of the American Academy of Psychiatry and the Law, took a slightly critical position on the Goldwater Rule, saying that one of its flaws was that it was too protective of the profession as a whole. I will not go into that argument and the reader can pursue if she/he wishes, but I think it is a little off base.

The most recent article on this whole sad and stupid affair is presented in an article of commentary in the national publication for psychiatrists, Psychiatrist News, by Dr. Ronald W. Pies MD, entitled, “Deconstructing and Reconstructing the ‘Goldwater Rule,'” in the current October 2016 issue. I would refer interested readers to its online printing for a very good and well thought out exposition of when “psychiatrizing” is OK and when it is not.

In any case, I wish to focus in this article on the history of “profiling” famous figures who have been seen as dangerous and try to get away from the whole mess of the present jibber jabber of whether Donald Trump is a narcissistic personality or so. It has only diverted in my idealistic view of politics, from having a campaign that focuses on issues. But this debate if one can call it that, or national slinging of aspersions has served to remind some of us that this phenomenon has some interesting and enlightening roots in history.

But first I will call the readers’ attentions to a very recently published book co-edited by a psychiatrist geographically close to me, Dr. Stephen Buser MD of Asheville NC. This is a very interesting book and comes very close to butting up against the Goldwater Rule as one can almost tell from its provocative title,  A Clear and Present Danger: Narcissism in the Era of Donald Trump.

To quote this book on page xx in its foreword/first chapter, “…this book is composed thoughtful essays on topics related to narcissism.” All in all, the book sticks to this mission as its chapters delve in narcissism in some detail, doing a very good job of illustrating its workings and manifestations and how it has become an accepted diagnosis, even listed in the diagnostic Bible of psychiatry, The Diagnostic Statistic Manual-5 (its current and Fifth edition).

The book is heavily based on the theories of Carl Jung, one of Sigmund Freud’s early circle who broke with Freud in later years as he pursued his theories of “archetypes” and the “collective unconscious.” These ideas, simply put deals with cultural myths and powerful national themes and have long been applied to the phenomenon of Nazi doctrine as defined by Hitler and the national belief system that came to define the Third Reich of Hitler in the 1930’s and World War II. For the most part, this book does a decent job of explaining these themes though for the uninitiated to Jungian theory, some of the chapters are a bit heavy slogging. Speaking as a psychiatrist who was trained for 14 years in Freudian psychoanalysis in my training years at aDuke and UNC departments of psychiatry, this body of theory at least holds powerful explanations for how ideas can define and drive a culture and nation. This emphasis arises out of the fact that Asheville is a center for Jungian analysis and Dr. Buser and his co-editor drew heavily on Jungian practitioners nationwide to author many of the chapters and do a creditable job.

In all fairness, though it focuses primarily on the phenomenon of narcissism as a distinct part of everyone’s personality, and especially on overdeveloped or psychologically pathological kinds of narcissism, now embodied in the resurrected phrase “malignant narcissismI would gently set the stage by a little developmental psychological tidbit and reminder (since I am partly a developmentally oriented child psychiatrist) that a certain amount of narcissism is in all of us and good for all of us. It arises partly out of the young child’s wish to please the good parent and earn  praise and approval. It helps us wish to excel and do well, and for instance, strive to do well in chores, schoolwork, do our homework,  make good grades and get rewards that are good fuel for the young developing personality and self-image.

I would gently set the stage by a little developmental psychological tidbit and reminder (since I am partly a developmentally oriented child psychiatrist) that a certain amount of narcissism is in all of us and good for all of us. It arises partly out of the young child’s wish to please the good parent and earn  praise and approval. It helps us wish to excel and do well, and for instance, strive to do well in chores, schoolwork, do our homework,  make good grades and get rewards that are good fuel for the young developing personality and self-image.

What I really wish to focus on, the past fascinating history of the origins of “profiling,” which nowadays everyone associates with such televisions shows as “Bones” and especially the long-running series “Criminal Minds.” Profiling seemed to jump into the national fascination with the movie, starring Jodie Foster, “Silence of the fee Lambs,” which focused on serial murderers such as the unforgettable character Hannibal Lector played  by Anthony Hopkins. By this time the FBI had been utilizing profiling in complex serial murder cases nationally for a number of years.

But few people know that profiling started with World War II, when the Allies, especially the American military upper echelons of command realized they needed to know more about Hitler and his psychological makeup to possibly anticipate his military command patterns. This partly was the idea of the then head of the new American intelligence agency, the OSS, or Office of Strategic Services headed by the brilliant lawyer William “Wild Bill” Donovan. A psychoanalytically trained psychologist, Walter Stanger was hired to produce a psychological analysis of Adolf Hitler and it was released some years after the world. This author highly recommends its reading if one has the slightest bit of interest in any aspect of profiling, narcissism, Hitler, etc. This was an  uncannily accurate portrayal of Hitler and did help the command of the Allied Forces anticipate Hitler’s moves especially the last year or two of WWII as Hitler became more erratic and “came loose.”

Lasch’s book posits that the personality phenomenon of narcissism had begun to take hold or increase at that time. His thoughtful essays are fascinating to read especially now as we have been through a time of dominance of the workings of such motivations in leaders at many levels in our societies. Indeed Time magazine’s later famous issue entitled “Greed,” though focusing on the new worlds of mergers, junk bonds, and the later disasters of the new financial instruments, drew many parallels from the concept of narcissism in its portrayals of those times and the growing ideologies in business not seen since the ages of the barons of the monopolies of industries in the late 1800’s and early 1900’s.

Lastly, a more modern example of profiling which is still my main focus in this article and not the political misuses of psychiatric and psychological diagnoses would be a recent book I would also recommend to the reader. It is also about Hitler, alas…But it is another very well done example of psychological/psychiatric profiling of a fascinating figure in recent history and can be compared to Walter Stanger’s book which occurred at a younger “stage” in the development of the practice of personality description and scientific categorization. That books is, Diagnsosis of a Destructive Prophet, Hitler, by Fritz Redlich MD who was formerly chair of psychiatry at Columbia University and now professor emeritus at UCLA. This book was published originally in 1998. It has the advantage of having access to more specific records about Hitler such as his medical records after WWII which Stanger, of course could not have had to review.

Dr. Redlich had interesting motivations for authoring this book which he worked on for apparently almost 15 years. Some of his motivations were personal as he was forced to flee Europe when he became aware that he had Jewish ancestors and would be targeted as a Jew. But one compelling reason he stated openly in his foreword is that after he retired to California he witnessed in the 1980’s the growing worrisome phenomenon of “Holocaust denial,” which he saw germinating in southern California at that time, before it became a widely recognized social shorthand term for a new form of anti-Semitism

Dr.Redlich called his book in his preface, a “pathography, rather than a profile or historical biography. He defined.a pathography on page xii as “the study and character of the life of an individual, as influenced by the disease.” The inclusion of the word disease gives the reader that this book would be different than the many other works about Hitler as Redlich as a physician and psychiatrist focused on many questions of physical and mental health issues attributed to Hitler. Adolf Meyer was a famous figure in early American psychiatry who emphasized the “biopsychosocial” understanding of our patients, taking into consideration all aspects of their lives and development. This typifies the approach taken by Redlich within the limits of the knowledge uncovered about Hitler in the decades since the end of World War II. For that reason alone, Redlich’s book brings a fuller portrait of Hitler and tries to weave together a very comprehensive understanding of his personality, its many influences the medical and psychodevelopmental forces that led him to be the “spellbinder,” and depraved mind and leader he evolved to be.

Profiling as it is practiced in the popularized field of law enforcement, now almost regarded as routine in its familiarity in recent years from its exposure through the mass media, is practiced in a very careful manner, based on evidence, long documented and “normed” patterns of behavior gathered from years of research by generations of historians, investigators and archivists.

The factual informational evidence of legitimate profiling, done with a purpose of helping to apprehend heinous criminals should in no way be equated to the modern currency of instant information of today’s world. The tsunami-like onslaught of such information has been accelerated by the many forces of the power and all intrusive quality of public information and the media, ranging from the early days of   paparazzi, the gossip columnists, to privateering bloggers and supermarket newspapers and finally the 24 hour instantaneous power of modern information transmission. Privacy has become a rarer and treasured and shrinking province of personal life. But the constant presence of such information seems to have gained a partial acceptance or even approval and tendency toward unquestioning belief in the modern citizen, perhaps not seen in past eras. This quality is dangerous and careless irresponsible spreading of such profiling pushes reasonable discourse to the sidelines, now seen for almost two generations in politics which should be the time for careful examination of our national tasks, needss and responsibilities.