Man of the Month Affairs of the Presidency: From Healthcare to Intern Care Imagine a hypothetical President who was just elected and is settling into the most powerful office in the world. Like all Presidents, he brings in his own group of loyal advisers. Except that in this case, because his party was out of power for many years, his advisers are mostly young and inexperienced. In appointing them, this President does not heed advice to cast a wider net and bring in some more experienced outsiders. He seems to feel so confident in his own abilities that loyalty is more important than expertise. In fact, he feels so self-confident that he appoints his wife - a smart, capable woman but with no expertise in that area - to head the most important task force of his administration. The fact that he will now have a dual relationship with her - as wife and as subordinate - and therefore will be hard pressed to discipline or fire her if she fails - doesn't bother him because he is confident she will not fail. After all, he knows her well and he is, once again, confident in his choice. And so this hypothetical President puts his wife in charge of the effort to revolutionize one of the most complicated economic and social systems in the world - America's medical health insurance. And in attempting to implement his great plan he takes on some of the most powerful lobbies in the country, apparently underestimating the realities of their powers. And in the next couple of years, it seems, this President continues to make the same mistake in a series of political miscalculations. For example, in striving to end discrimination against gays in the military he completely underestimates the resistance to such reform in the military and in congress, without whose cooperation he cannot win. So far what's here is a man who is flexing his vision muscles, attempting to impose his ideas on a complicated, resistant reality. Why would such an intelligent individual fail to see that reality? The answer, I propose, lies in the compensatory aspect of his grandiosity. He overreaches in order to prove his potency. He strives for the big play to avoid feeling small. But therein lies the masochistic ambush encountered by all narcissists: if you ignore reality it ignores you. So this President's well-intentioned health care reform ends up accelerating market forces for managed care, arguably resulting in a worse, rather than better health care system. Likewise, his initiative to end military discrimination against gays seem to lead to more, not less, discriminatory discharges of gay men from the military. And it is largely in reaction to this kind of presidential overreaching that in the mid-term election the country elects a right wing congressional reality which then puts an end to this President's liberal vision. Lest you think this is a political discourse against the liberal political agenda, and more importantly, in order to illustrate the positive side of narcissistic grandiosity, let's imagine that this President was successful in reforming healthcare and in opening the military to gays. He would have been seen as a courageous, visionary leader, a man ahead of his time, an idealistic, principled person who's undeterred by practical obstacles. He would have been considered a secured statesman who mentored and developed a new generation of young leaders in his party. And he would have been seen as a model husband/partner who trusted his wife with everything that was important to him. In a sense then, defensive grandiosity can only be defined retrospectively - when it fails. Had Bill Gates told his therapist at 16 that one day he would be the richest person in the world, his therapist no doubt would have tried to help him to accept his limitations rather than to indulge in grandiose fantasies. In other words, "thinking big" is not all bad, and not only for a President - it's part of the American dream, isn't it? Now back to our hypothetical President. Hitting his head against the brick wall of reality over and over again, he finally learns from his mistakes and changes direction. Now, instead of imposing grand ideas on reality, he begins to infuse minor ideas (such as promoting uniforms for school children) with grand meaning. And he begins to moves to the political center, appropriating from the opposition popular political causes such as fiscal responsibility, welfare reform, small government and anti-crime legislation. This politically shrewd maneuvering raises the question as to what's this man's real beliefs. Well, the narcissist doesn't really have real beliefs. Not because he is an opportunist - that may or may not be true - but because his psychological mission is to be seen and to be heard, which he can't help but equate with being loved and admired. In this sense, he is a chameleon who can genuinely be all things to all people. Now once again, this is not all negative. For example, moving to the political center can be seen as reflecting the will of the country and as a positive way of building national consensus. Furthermore, because this President is so eager to please he can really hear what's important to the people. He can thus "feel their pain," and allow it to influence his legitimate political agenda. Also, because he is so eager to please he is likely to be charming and warm and loving and remorseful - at least in public. I say in public, not because it's an act, but because - like the "method" actors - he actually can be all those things to his audience. It's like the actor who can be incredibly intimate and real on stage - using his own emotionality to bring a character to life - but who has a different personality off stage. In terms of private behavior, for our hypothetical President, it appears, being the most powerful man in the world is not enough. Imposing and exposing himself on the world stage is not enough. He seems to also need to feel good about himself in the most unprivileged, vulnerable area of his life - his physicality. Like a handful of other individuals in the world, this man can bomb other countries with a push of a button. And with some extra effort he may even influence the stock market a bit. But like all other people, he cannot transcend his body. Like all other people he will age and die, and there's nothing he can do about it. Except, he can momentarily defy this fact with the illusion offered by a sexual encounter with a young White House intern. Like a child-king, he can be powerful and yet be loved and serviced. And he can get away with it all - all while being investigated by a hostile independent counselor. Now that's being alive. But his choice of sexual partner and his conduct with her virtually guarantee that he'll be caught. So like his healthcare reform initiative, this entire affair highlights the masochistic nature of trying to defy reality. It also highlights the narcissist's worst psychological quality: his inability to empathize with those who are close to him. In having an affair this President - who seems to genuinely care about the feelings of strangers - completely disregards the feelings of his wife and child. Unfortunately, this is quite typical. The Self-Involved man can be generous and kind to everybody except to those whose love he has already earned. This is why a Don Juan is often a narcissist. But what looks like an ugly conquest from the outside is often experienced by this man as simply doing what's necessary to be loved. And he desperately needs to be loved so that he can love himself. Now even this appalling lack of empathy is not without merit. Sometimes a President must make decisions - the most obvious of which is going to war - that could not be made without turning off the capacity for empathizing with the likely consequences of these decisions. And more generally, no human being can be expected to perform at his best under the kind of stress the President is subjected to, without this mental ability to "compartmentalize." From this discussion we can see that the basic features of narcissism - for better or worse - are potentially useful, if not required qualifications for the job of the President. We can also see that while the essentials of narcissism apply equally to men and women, there's a particular masculine flavor to those decorating the Self-involved man. In evolutionary and historical terms, this flavor is perhaps best captured by the work of biological anthropologist Richard Wrangham who, together with Dale Peterson, traced the development of male leadership all the way from the Chimpanzee culture to the human civilization that eventually sprung out of it. As shown by these authors in their book Demonic Males, the emperors of all major civilizations - including the Aztec, Babylonian, Chinese, Egyptian, Incan, Indian and Roman - have all had harems of at least several hundred women. These women were always young, and therefore fertile, and they were guarded in well-fortified sites, usually by eunuchs. Wrangham and Peterson's point is that at least historically, the logic of sexual selection is such that when males win power they use it to mate as many women as possible, with the expressed - if possibly unconscious - purpose of expanding their reproductive opportunities. Granted, these days the preservation of the human species hardly requires an increase in reproduction. And furthermore, most contemporary societies are built on some form of shared, rather than absolute power. So there's presently little actual connection between the attainment of power and mating advantages. And yet, at least anecdotally, it seems that men in position of power still engage in a greater number of sexual conquests than the rest of us. Certainly this appears to be true for our hypothetical President. Ironically, but fully consistent with our theory, it is also true for some of the powerful men who wished to depose him because of his bad behavior.		Archive Gary Condit Rudy Giulliani Ariel Sharon George W. Bush President Clinton