Power Clinic

Health insurance companies insist on a clinical diagnosis for all their patients. Without a category number, they will not pay. Yet it was by no means clear how I was to label the patient currently before me. Ronald Keys was angry and contemptuous, and his megalomania had evidently caused others to suffer. But corruption by power is not listed in the Diagnostic and Statistical Manual of Mental Disorders, (DSM IV). Though prevalent across history, it has no category or numeric. Mad leaders are sometimes diagnosed in retrospect, but only to ask whether their illness impaired their executive judgment.[i] Adolph Hitler, for example, is variously seen in the psychiatric literature as possibly sociopathic (DSM # 301.7[ii]) and/or paranoid schizophrenic (# 295.3). Some say he had bi-polar disorder (# 296.44), others narcissistic personality disorder (# 301.81) and obsessive-compulsive disorder (# 300.3). Yet none of these quite capture his boundless will to lead, his growing self-deception and utter abandonment to evil. Most insane tyrants escape psychiatric diagnosis, and corruption by power in the tiny empires of our everyday lives is barely studied.

The case history is interesting, particularly the organisational setting. Ronald Keys began his career as a popular and enthusiastic member of an office supply company on the edge of an industrial estate near Swindon. Smart and hardworking, he was soon promoted, and then promoted again. He took his new responsibilities seriously, and seemed, to his colleagues, rather quick to believe in the company slogans. His confidence grew, as did his belief in decisive leadership. Whereas before he was part of the team, he came at last to stand aside and above; sometimes impatient with subordinates, sometimes wearied by responsibility. Increasingly able to cut through excessive and unproductive discussion and overcome resistance to change, he made bold decisions that relied on his instincts. Indeed, in Keys’ case, the capacity to dismiss naysayers and to value his own perspective over those of others was a growing source of pride in himself and alarm in his colleagues. Former friends found themselves sidelined, seen as ditherers, resistors, shirkers. At last, they used a telling everyday phrase to describe him to new recruits: power, they said, had “gone to his head.”

He bought a new car, a house, the company. He opened another office, remarried and branched out into property. When he closed the Swindon office, the old crowd tried one last time to speak to him directly. But now only he could see. Only he knew what was good for them. Only he had the exceptional skills needed to run the company.  Keys’ self had, as it were, expanded. The company had been successful because of him. It now existed for one overriding purpose: to serve Keys.

In his new office, high above the Thames, people learned to tread with care. They knew he was afflicted. His outbursts were ever more unpredictable, and were often directed at those with the very least status. If anyone disagreed with him, they risked his wrath, and perhaps being labelled as incapable and requiring discipline. To preserve his stature, Keys was prepared to commit any act of recklessness, to bend any rule and tell any lie. And all the while, he insisted it was for the good of all. He believed it. To that distorted end, he sought to propagate his view of the world and maintain his control. When this attitude hardened further still, he became increasingly defensive, so that at last even the smallest act of resistance drew absurd punishments. Interestingly, he always – very carefully and almost inadvertently – worked to make sure his subordinates did not gather and talk. Even the idea was abhorrent to him. And so those around him spoke less. They resented him. They looked busy and they kept their distance. Keys’s world thus began to shrink. By the end, he was its only inhabitant.

His business failed, and all those he had stepped on to build his empire now sought their revenge. He faced bankruptcy, lawsuits and the most public of failures. He shouted and wept and pounded his hand on my desk, and I nodded. The man before me had been arrogant and cruel. Once again, I wondered how to diagnose him. I leaned back in my chair and surveyed him.

Clearly, corruption by power involves privileging one’s own view and devaluing that of others. Yet the progression profile of this subtle affliction also suggests a gradual separation from the world, a pulling back; so that only the obsequious are listened to, and soon not even them. As John Dewey once said, “all special privilege limits the outlook of those who possess it.” What is so extraordinary, however, is that all these developments are then subjected to a kind of defensive hardening, an insane intensification so that every symbolic element of power and control is adhered to, and petty and arbitrary nastiness now accompanies grand schemes of world domination.

Finally, gloriously, the absolute corruption by power is characterised by the brazen construction of ignorance. As the leader becomes ever more separated from his subjects, and surrounded by obsequious advisors, so too does he lose the capacity to learn and adapt. Now isolated, and with all external sources of knowledge shut down, only force can root him out. At this point, the world serves merely to confirm the leader’s delusions. Those who suffer from hubris, therefore, are not lying; nor are they cynically manipulating their environment for their own gain. Rather, they cannot see.

Keys sat half on his chair, ranting against his enemies, barely noticing me at all. It was growing late, and the rain continued to fall beyond my office window. I observed the wild oscillation of his mood, which in a heartbeat swung from morbid self-pity to aggrandised mania. There must, I thought, be something pathological at the heart of charismatic leadership. Soon I would need to decide. Perhaps an appropriate DSM category would be Psychotic Disorder (# 295). As for the type, it might carry a designating suffix of 91. This would give the new and intriguing diagnostic category: that of Authoritarian Disorder (# 295.91). Principle clinical indicators would be (in an organisational setting):

  1. The inflation of the self
  2. The devaluation of others
  3. Isolation
  4. Lack of awareness of the condition
  5. The chronic failure to learn

Psychiatry makes no provision for the diagnosis and treatment of corruption by power. It offers no assistance to those seeking to avoid promoting or electing susceptible individuals, nor does it inform the careful management of patients when they do assume any authority at all. Nor was it going to help me assign a category number to this: my most hubristic of patients. Keys had ruined people’s lives. He had benefitted from the suffering of others. Now he received his nemesis: to be sat here in this dirty office; on a rainy Monday night; with me.


[i] Schioldann, J.A. “The Psychiatry of Leadership,” Australian and New Zealand Journal of Psychiatry, 1988, 22: 245-256; Redlich, F., Hitler: Diagnosis of a Psychopathic Prophet, New York: Oxford University Press, 2000.

[ii] Now re-categorised as ‘Antisocial Personality Disorder’.

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