Paranoiac dictators

American journalists and political observers have been having a holiday pouncing on the language used by US President Donald Trump and his team.

I’m referring to language as words, especially because Trump likes to use Twitter, his postings then taken apart by analysts.

Trump’s been getting a break lately as the media people shifted their focus to Anthony  Scaramucci, who served as communications director for a mere 10 days and chalked up a record for a bad temper matched by a vile tongue.

In a New Yorker article about the new communications director, Ryan Lizza quotes Scaramucci as describing his archenemy Reince Priebus, who was the White House Chief of Staff, as a “f—ing paranoid schizophrenic, a paranoiac.”

Back to paranoiac. Social media began to buzz asking if Scaramucci had invented the word, as well as asking what the term meant. Paranoid is a common term but paranoiac?

Journalists began to research and one of them, Heather Murphy, was able to track down an early, and deadly, use of the term, as documented in a scientific article written by Jürg Kesselring in the journal European Neurology.

Paranoia and murder

The title is enticing: “Vladimir Mikhailovic Bekhterev (1857-1927): Strange Circumstances Surrounding the Death of the Great Russian Neurologist”, which shows you scientists deal with all kinds of mysteries, including the kind you associate with detective novels.

Bekhterev was attending a medical congress in Moscow when he was called to examine Josef Stalin. Bekhterev checked the dictator, returned to the convention and told colleagues he had “examined a paranoiac with a dry, small hand”.

The “dry, small hand” may have been a reference to Stalin’s left hand, which was smaller than the right one, a congenital condition. Bekhterev had noticed that… and probably didn’t realize that his comment may have been heard by others. The walls have ears, as the expression goes.

It seems that from the congress, Bekhterev went to a theater and was approached by “two unknown young men” who “offered him cakes and drinks”. Bekhterev went home afterwards and then began to violently vomit. The next day, two “uninvited” doctors went to check him and were later identified as members of the Secret Service. The neurologist died that day.

Fast forward 90 years. “Paranoiac” has not entered popular usage even by psychiatrists but now that Scaramucci used it — I actually suspect he just pulled out the term without knowing its medical or historical origins — there’s a mad (pardon the word) scramble to use it.

The European Neurology article says Bekhterev was probably right in diagnosing Stalin as being paranoid, and quotes from the International Classification of Disease description of that disorder: “excessive sensitivity to rejection; bearing on slights, suspicion; tendency to distort experiences; neutral or friendly actions of others misinterpreted as hostile or contemptuous; recurring unjustified suspicions regarding sexual fidelity or spouse or sexual partner; contentious and continued insistence on their own rights; inflated self-esteem and frequent, excessive self-absorption.”

Hubris disorder

Some time back I wrote about how the Trump presidency has led to all kinds of long-distance analysis from psychologists and psychiatrists, with several suggesting he has narcissistic personality disorder.  Other mental health professionals have warned against this long-distance diagnosis.

Then this term “paranoiac” comes up and as I read through a trail of medical journal articles, I was struck by the articles, and a book, by David Owen, a physician and a member of the British House of Lords, who suggests that one variation of paranoid personality disorder might be specific to politicians.  He calls this hubris disorder, described as “exaggerated pride, overwhelming self-confidence and contempt for others”.

Owen suggests that this is an acquired disorder, which comes about with leaders who have been in power for a number of years.  These leaders may in fact be quite charming and charismatic, which advances them in political careers but their power inflates their egos—he says narcissistic personality disorder can be present as well—and leads to the problems of paranoia.  An article Owen wrote for the journal Brain names several British prime ministers, including Margaret Thatcher and Tony Blair and the US President George Bush as possibly having this hubris disorder.

In a paper he read to the Royal College of Physicians in 2008, Owen warned that hubris disorder “is a greater threat than conventional illness to the quality of leadership and the proper government of our world.”

Reading Owen, I thought that paranoia divides strong but democratic leaders and the despots.  A paranoid leader becomes ruthless because he trusts no one, and therefore builds a massive network of surveillance whose reports only further fuel the leader’s paranoia, and his hold on power.  The dictator’s ego is also fed by sycophants (sipsip in Filipino is such a descriptive term) who further distorts his sense of reality.

In the Philippines we borrowed the English term and transformed it to “praning”, a term that is widely used to describe a wide range of people, from the excessively jealous spouse or partner, to the psychosis induced by the use of shabu or metamphetamines.  I’ve seen some of the praning shabu users, who will not leave their homes, with windows always shut not so much because of fear of the police than of often imaginary enemies.

I have yet to hear our leaders or bosses being called praning but the psychiatric term certainly fits some of the despots we have in families, workplaces, and government. If we were to be kinder in our views about them, we can say that the more dictatorial they become, the more they expose their weaknesses and insecurities.

Roy Porter’s A Social History of Madness could not have summarized it all more succinctly, all the way up to the mania that accompanies paranoia: “The history of madness is the history of power. Because it imagines power, madness is both impotence and omnipotence. It requires power to control it. Threatening the normal structures of authority, insanity is engaged in an endless dialogue — a monomaniacal monologue sometimes — about power.”

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