As long as there have been political dictators, psychologists have been fascinated with them. While many psychologists try to understand what happens in normal, rational people that leads them to follow such clearly dangerous leaders, some psychologists have been more interested in characterizing the personality profiles of dictators themselves. After all, who hasn't attempted an armchair psychiatric diagnosis of a famous personality?

In 1939, Carl Jung met Hitler and Mussolini in Berlin and observed their interactions. Personality psychologists Coolidge and Segal from the University of Colorado write that "Jung said Hitler never laughed, and it appeared as if Hitler was sulking and in a bad mood. Jung viewed him as sexless and inhuman, with a singleness of purpose: to establish the Third Reich, a mystical all-powerful German nation, which would overcome all of Hitler's perceived threats and previous insults in Germany's history." Hitler inspired in Jung only fear. By contrast, Mussolini apparently came off to Jung as an "original man," who had "warmth and energy."

With the possible exception of Jung, it is exceedingly difficult for most people to get any one-on-one time with political dictators, and essentially impossible for psychologists or psychiatrists to conduct a face-to-face clinical assessment. Therefore, most investigations into the personality profiles of such leaders have used "informant reports." While certainly less than ideal, such reports have nevertheless yielded tremendous insight into the mental lives of some of the worlds most notorious dictators. One study (PDF) revealed that informant reports are generally in "modest agreement" with self reports, and also that informants tend to agree with each other. Even among standard run-of-the-mill personality disorder patients, informant reports end up being quite useful to clinicians. Informant reports are especially important when symptoms of personality disorders may lead patients to provide clinicians with inaccurate information.

In 2007, Coolidge and Segal rounded up five experts on Hitler, and asked them to evaluate him on the basis of DSM-IV psychopathological syndromes and personality disorders. The consensus among the experts was that Hitler had highly elevated scores on the following personality disorder scales: paranoid, antisocial, narcissistic, and sadistic. Hitler's derived personality profile also suggested that he probably had schizophrenic tendencies, including excessive grandiosity and aberrant thinking.

In another 2007 study, Coolidge and Segal gave the same treatment to Saddam Hussein. Just as with Hitler, they derived a consensus personality profile for Hussein based on informant reports from eleven Iraqi adults who "knew Hussein intimately" for a median of 24 years. The study revealed that Hussein had high scores on the same personality disorder scales: paranoid, antisocial, narcissistic, and sadistic, though sadistic features were stronger in Hussein than in Hitler. Like Hitler, the Hussein study revealed probable schizophrenic symptoms as well. There was a relatively high correlation (.79) between the derived personality profiles for the two men.

Combining the results from both studies, Coolidge and Segal hypothesized a "big six" constellation of personality disorders that may commonly reflect the personalities of dictators more generally: sadistic, antisocial, paranoid, narcissistic, schizoid, and schizotypal.

Then, in 2009, Coolidge and Segal extended their research to include the recently deceased dictator of North Korea, Kim Jong-il. Through professional colleagues, Coolidge and Segal were introduced to a South Korean academic psychologist who had "advanced psychological training and intimate and established knowledge of Kim Jong-il." The anonymous psychologist agreed to provide an informant report on the psychological profile of Kim Jong-il.

The personality profile of Kim Jong-il showed the same "big six" constellation of personality disorders: sadistic, antisocial, paranoid, narcissistic, schizoid, and schizotypal.

The table below shows each dictator's score for each of the fourteen DSM-IV personality disorders as well as for schizophrenia and psychotic thinking (click to enlarge). The disorders are ranked according to how strong they were scored on each disorder's scale: each of the three dictators shared the same top six personality disorders (in slightly different orders), and all show high scores for schizophrenia and psychotic thinking.

Further comparisons among the dictators revealed that Kim Jong-il had more in common with Saddam Hussein (their profiles had a correlation of .67) than with Hitler (their profiles had a correlation of .20). Indeed, both Jong-il and Hussein had sadistic personality disorder as their highest rated item, and their scores were nearly identical - more than three standard deviations above the population average!

The nagging question is: how could an individual with such extreme personality disorders - especially ones that have a "spectrum relationship" to psychotic disorders such as schizophrenia - attain and hold such high positions of power and control over others? Schizophrenia is, after all, highly debilitating. Coolidge and Segal point out, however, that there are other well-known cases of "murderous schizophrenic persons" who had likewise held tremendous power over others, such as Charles Manson and Jim Jones, though admittedly on a smaller scale.

They continue (emphasis added):

Furthermore, the current DSM-IV-TR criteria for schizophrenia, paranoid type, include symptoms such as preoccupation with one or more persecutory or grandiose delusions usually organized around a coherent theme. Associated features include anxiety, anger, aloofness and argumentativeness. The DSM-IV-TR also states that persecutory themes and grandiose delusions may predispose schizophrenic individuals to violence, that such individuals may have a superior or patronizing manner in interpersonal interactions, and that such individuals may display little or no cognitive impairment and have a good prognosis in the areas of occupational functioning and independent living.

There are three important caveats here.

First, and perhaps most obvious, is that correlation is not causation. While understanding the "big six" personality disorders may be useful in future international relations efforts when they involve political dictators, there are plenty of people with some or all of those personality disorders who never become dictators, murderers, or terrorists. And there are probably dictators that have a different constellation of psychiatric and personality disorders. Mental illness does not exist in a vacuum, but occurs both in a time and in a place.

Second, to what extent could cultural biases have played in developing these psychiatric diagnoses? It is fairly well-established that certain diagnoses are cross-cultural and universal, such as schizophrenia, but the symptoms thereof can vary both in importance and in significance across cultures. While psychiatric diagnoses all reflect underlying biological dysfunctions, those diagnoses are determined by people. And those people may be subtly biased, even despite tremendous efforts at objectivity and scientific rigorousness. To a similar end, the questionnaires that were filled out by the informants for each of the three dictators were validated according to an American sample. As psychiatric diagnoses are typically defined by statistical rarity, this could be problematic. For example, the mean response for a given item on a questionnaire may be higher or lower in North Korean culture.

Third, of the three studies, only the informants in the Hussein example had explicit personal relationships with the subject of the questionnaires. Therefore, an additional set of biases may have been at play in both the Hitler and Kim Jong-il studies. To that end, the ethical implications of those studies may call into play a principle adopted by the American Psychological Association known as the Goldwater rule, which states that mental health professionals "are forbidden to give a professional opinion about any individual without directly examining that person and getting permission to comment from the patient or other legal guardian." However, the Goldwater rule is explicitly concerned with the way in which mental health professionals interact with the media, and may therefore not apply in these cases.

Ultimately, we may never know just how well this particular psychological profile of Kim Jong-il would have matched with his actual personality. However, the strong correlation among the personalities of Hitler, Hussein, and Kim Jong-il is hard to ignore.

Elsewhere on Scientific American:

Anatomy of a Megalomaniac: Psychological Analysis of Kim Jong-il from Afar by Gary Stix

For more on mental illness:

What is Mental Illness? A Peek Through the Murk - guest post by me on David Dobbs's blog at WIRED Science

What is Mental Illness? - At BPS Research Digest

For more on the ethics of diagnosing-from-a-distance:

The Goldwater Rule page at Wikipedia

Michael Jackson and the rise of the celebrity psychologist - by Martin Robbins at The Guardian

Charlie Sheen, Drew Pinsky, and the Barry Goldwater rule. - by Paul Raeburn at the Knight Science Journalism Tracker

References

Coolidge, F., & Segal, D. (2009). Is Kim Jong‐il like Saddam Hussein and Adolf Hitler? A personality disorder evaluation Behavioral Sciences of Terrorism and Political Aggression, 1 (3), 195-202 DOI: 10.1080/19434470903017664

Coolidge, F., & Segal, D. (2007). Was Saddam Hussein Like Adolf Hitler? A Personality Disorder Investigation Military Psychology, 19 (4), 289-299 DOI: 10.1080/08.995600701548221

Frederick L. Coolidge, Felicia L. Davis, & Daniel L. Segal (2007). Understanding Madmen: A DSM-IV Assessment of Adolf Hitler Individual Differences Research, 5 (1), 30-43 (link to PDF)

Images: Kim Jong Il via Wikimedia/Kremlin.ru; Hitler via Wikimedia/Bundesarchiv, Bild 183-S33882. Hussein via Wikimedia/Public Domain.