Is Trump men­tally fit to lead the coun­try?

Los Angeles Times - - OP-ED - By Prudence L. Gour­gue­chon

Since Pres­i­dent Trump’s in­au­gu­ra­tion, an un­usual amount of at­ten­tion has been paid to the 25th Amend­ment to the Con­sti­tu­tion. That’s the mea­sure, rat­i­fied in 1967, that al­lows for re­moval of the pres­i­dent in the event that he is “un­able to dis­charge the pow­ers and du­ties” of the of­fice. What does that mean, ex­actly? Lawyers surely have some ideas. But as a psy­chi­a­trist, I be­lieve we need a ra­tio­nal, thor­ough and co­her­ent def­i­ni­tion of the men­tal ca­pac­i­ties re­quired to carry out “the pow­ers and du­ties” of the pres­i­dency.

Although there are vol­umes de­voted to out­lin­ing cri­te­ria for psy­chi­atric dis­or­ders, there is sur­pris­ingly lit­tle psy­chi­atric lit­er­a­ture defin­ing men­tal ca­pac­ity, even less on the par­tic­u­lar abil­i­ties re­quired for serv­ing in po­si­tions of great re­spon­si­bil­ity. De­spite the thou­sands of ar­ti­cles and books writ­ten on lead­er­ship, pri­mar­ily in the busi­ness arena, I have found only one source where the ca­pac­i­ties nec­es­sary for strate­gic lead­er­ship are clearly and com­pre­hen­sively laid out: the U.S. Army’s “Field Man­ual 6-22 Leader De­vel­op­ment.”

The Army’s field man­ual on lead­er­ship is an ex­traor­di­nar­ily so­phis­ti­cated doc­u­ment, founded in sound psy­cho­log­i­cal re­search and psy­chi­atric the­ory, as well as mil­i­tary prac­tice. It ar­tic­u­lates the core fac­ul­ties that of­fi­cers, in­clud­ing com­man­ders, need in order to ful­fill their jobs. From the man­ual’s 135 dense pages, I have dis­tilled five cru­cial qual­i­ties:

Trust

Ac­cord­ing to the Army, trust is fun­da­men­tal to the func­tion­ing of a team or al­liance in any set­ting: “Lead­ers shape the eth­i­cal cli­mate of their or­ga­ni­za­tion while de­vel­op­ing the trust and re­la­tion­ships that en­able proper lead­er­ship.” A leader who is de­fi­cient in the ca­pac­ity for trust makes lit­tle ef­fort to sup­port oth­ers, may be iso­lated and aloof, may be ap­a­thetic about dis­crim­i­na­tion, al­lows dis­trust­ful be­hav­iors to per­sist among team mem­bers, makes un­re­al­is­tic prom­ises and fo­cuses on self-pro­mo­tion.

Discipline and self-con­trol

The man­ual re­quires that a leader demon­strate con­trol over his be­hav­ior and align his be­hav­ior with core Army val­ues: “Loy­alty, duty, re­spect, self­less ser­vice, honor, in­tegrity, and per­sonal courage.” The dis­ci­plined leader does not have emo­tional out­bursts or act im­pul­sively, and he main­tains com­po­sure in stress­ful or ad­verse sit­u­a­tions. Without discipline and self-con­trol, a leader may not be able to re­sist temp­ta­tion, to stay fo­cused de­spite dis­trac­tions, to avoid im­pul­sive ac­tion or to think be­fore jump­ing to a con­clu­sion. The leader who fails to demon­strate discipline re­acts “vis­cer­ally or an­grily when re­ceiv­ing bad news or con­flict­ing in­for­ma­tion,” and he “al­lows per­sonal emo­tions to drive de­ci­sions or guide re­sponses to emo­tion­ally charged sit­u­a­tions.”

In psy­chi­a­try, we talk about “fil­ters” — neu­rologic brak­ing sys­tems that en­able us to ap­pro­pri­ately in­hibit our speech and ac­tions even when dis­turb­ing thoughts or pow­er­ful emo­tions are present. Discipline and self­con­trol re­quire that an in­di­vid­ual has a ro­bust work­ing fil­ter, so that he doesn’t say or do ev­ery­thing that comes to mind.

Judg­ment and crit­i­cal think­ing

These are com­plex, high-level men­tal func­tions that in­clude the abil­i­ties to dis­crim­i­nate, as­sess, plan, de­cide, an­tic­i­pate, pri­or­i­tize and com­pare. A leader with the ca­pac­ity for crit­i­cal think­ing “seeks to ob­tain the most thor­ough and ac­cu­rate un­der­stand­ing pos­si­ble,” the man­ual says, and he an­tic­i­pates “first, sec­ond and third con­se­quences of mul­ti­ple cour­ses of ac­tion.” A leader de­fi­cient in judg­ment and strate­gic think­ing demon­strates rigid and in­flex­i­ble think­ing.

Self-aware­ness

Self-aware­ness re­quires the ca­pac­ity to re­flect and an in­ter­est in do­ing so. “Self-aware lead­ers know them­selves, in­clud­ing their traits, feel­ings, and be­hav­iors,” the man­ual says. “They em­ploy self-un­der­stand­ing and rec­og­nize their ef­fect on oth­ers.” When a leader lacks self-aware­ness, the man­ual notes, he “un­fairly blames sub­or­di­nates when fail­ures are ex­pe­ri­enced” and “re­jects or lacks in­ter­est in feed­back.”

Em­pa­thy

Per­haps sur­pris­ingly, the field man­ual re­peat­edly stresses the im­por­tance of em­pa­thy as an es­sen­tial at­tribute for Army lead­er­ship. A good leader “demon­strates an un­der­stand­ing of an­other per­son’s point of view” and “iden­ti­fies with oth­ers’ feel­ings and emo­tions.” The man­ual’s de­scrip­tion of in­ad­e­quacy in this area: “Shows a lack of con­cern for oth­ers’ emo­tional dis­tress” and “dis­plays an in­abil­ity to take an­other’s per­spec­tive.”

The Army field man­ual amounts to a guide for the 25th Amend­ment. Whether a pres­i­dent’s Cabi­net would ever ac­tu­ally in­voke that amend­ment is an­other mat­ter. There is, how­ever, at least one his­tor­i­cal prece­dent. The jour­nal­ists Jane Mayer and Doyle McManus tell the dra­matic story in their 1988 book, “Land­slide: The Un­mak­ing of the Pres­i­dent 1984-1988.”

Be­fore he started his job as Pres­i­dent Rea­gan’s third chief of staff, in early 1987, Howard Baker asked an aide, James Can­non, to put to­gether a re­port on the state of the White House. Can­non then in­ter­viewed White House staff, in­clud­ing top aides work­ing for the out­go­ing chief of staff, Don­ald Re­gan. On March 1, the day be­fore Baker took over, Can­non pre­sented him with a memo ex­press­ing grave con­cern that Rea­gan might not be suf­fi­ciently com­pe­tent to per­form his du­ties. Rea­gan was inat­ten­tive and dis­in­ter­ested, the out­go­ing staff had said, stay­ing home to watch movies and tele­vi­sion in­stead of go­ing to work. “Con­sider the pos­si­bil­ity that sec­tion four of the 25thA­mend­ment might be ap­plied,” Can­non wrote.

After read­ing the memo, Baker ar­ranged a group ob­ser­va­tion of Rea­gan for the fol­low­ing day. On March 2, Baker, Can­non and two oth­ers — Rea­gan’s chief coun­sel, Arthur B. Cul­va­house Jr., and his com­mu­ni­ca­tions di­rec­tor, Tom Griscom — scru­ti­nized the pres­i­dent, first at a Cabi­net meet­ing, then at a lun­cheon. They found noth­ing amiss. The pres­i­dent seemed to be his usual ge­nial, en­gaged self. Baker de­cided, pre­sum­ably with re­lief, that Rea­gan was not in­ca­pac­i­tated or dis­abled and they could all go on with their busi­ness.

Much has changed since the Rea­gan era, of course. Be­cause of Trump’s Twit­ter habits and other fea­tures of the con­tem­po­rary me­dia land­scape, far more data about his be­hav­ior are avail­able to ev­ery­one — to cit­i­zens, jour­nal­ists and mem­bers of Congress. And we are all free to com­pare that ob­serv­able be­hav­ior to the list of traits deemed crit­i­cal for lead­er­ship by the U.S. Army. Prudence L. Gour­gue­chon, M.D., is a psy­chi­a­trist and psy­cho­an­a­lyst in Chicago.

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