Bush's irrational consideration of a "surge" in the wake of the ISG report--which apparently defies all credible counsel--has begun to generate speculation regarding his sanity. References to Bush's "delusions" have appeared in the MSM (notable on "Scarborough Country") 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 my own perspective on this question.

First of all, let me state up front that I probably hate Bush as much (or nearly so) as anybody here. I think he has done more damage to our country than Osama Bin Laden ever did, and probably is the manifestation of OBL's most wicked fantasies following 9/11. Frogmarching him to the Hague (along with Cheney, natch) is too good for him. I think the guy is both stupid and evil, and I have no intention of cutting him any slack here. But in the political/clinical tradition of Dr. Bill Frist's school of diagnostics, I have a distinct clinical impression that I think explains most of his visible pathology.

First and foremost, George W. Bush is a Narcissistic Personality Disorder. What this means, mostly, 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 who flatter him and reinforce his grandiosity--or idealized self-objects--people that he himself thinks alot of, and hence feels flattered by his association. Some likely perform both functions. Hence his weakness for sycophants like Harriet Miers, and powerful personalities like 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 kissing his ass. 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 diploamtic meeting--he's insecure intellectually, and tries to make everyone into a "buddy" so he can feel more secure. (Pathetic, isn't it?)

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 greivously injured soldiers, and numerous other instances. The guy 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 just 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 significant concern until his own political popularity was sliding--because THAT'S something he can definitely 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. By applying Occam's Razor to the question of what is psychologically driving Bush to endorse this "surge", I think it can be readily explained by his narcissism as follows. (Warning: Rampant speculation to follow!)

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 ISG, 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 to shit, 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 George Bush willing to risk the lives of hundreds, maybe thousands more American soldiers, on an outside chance to save his political skin, in a half-baked plan that even he knows probably won't work at all? Damn straight he is. Because George Bush is that narcissistic, that desperate, and yes, that sociopathic as well.

Anyway, that's MY two bits.

Some more thoughts on this: Narcissistic Personality Disorder is frequently associated with alcoholism. The insufferable "holier than thou" attitude associated with "Dry Drunk Syndrome" 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 his grandiosity. Jesus is his powerful ally, his idealized "buddy" who gives a rubber stamp to any cockamie invasion he thinks up.

Finally--and this will sound VERY familiar--NPDs are notoriously unable to say they're sorry. Admitting error is fundamentally incompatible with their precarious efforts to maintain their sense of "okayness". Any friend, partner, or family member that has this character flaw almost certainly has NPD.