Bush on the Couch

February 15, 2009
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Bush on the Couch: Inside the Mind of a President

bush on the couch Dr. Frank's book

In 2004, a book called Bush on the Couch: Inside the Mind of a President, was published and offered an in depth look at our nation’s Chief Executive. The analysis produced sheds considerable light on why George W. Bush chose to rush the United States into the long and expensive mistake known as the Second Iraq War. Bush on the Couch: Inside the Mind of a President, written by psychoanalyst Justin Frank, M.D., accesses the vast record of public statements, behavior, and biographical information available on the forth-third President, in order to develop a psychological profile along the lines of the applied psychoanalysis assessments of world leaders routinely developed by our Central Intelligence Agency. Dr. Frank is a practicing psychiatrist with more than thirty years experience in the mental health field, and is also a clinical professor in the Department of Psychiatry at George Washington University Medical School in Washington D.C. [1].

bush on the couch Dr. Frank's bookAlthough “Bush on the couch” was not well promoted, it is a serious study on an important subject and has been the object of acclaim as well as controversy. Carefully written, it offers an in-depth framework from an informed perspective for better understanding of the man who was, for eight years, America’s commander-in-chief.

Management experts have long understood that the behavior of an organization to a large degree reflects the personality of its leading executives [2], [3], [4]. The picture Bush on the Couch presents is troubling, but the themes it develops enlighten many of the themes developed by the Bush administration. In science, the utility of a theory is directly proportional to the range of phenomena it is capable of explaining.

A great deal of Bush on the Couch is taken up with providing sufficient fundamentals of the clinical process to permit the lay reader to grasp the gravity of George W. Bush’s psychological problems. The book is a devastating psychological dossier on the 43rd President, and a compassionate profile of a human being in need of care.

Jeffrey Steinberg [5]

According to Dr Frank, George W. Bush displayed signs of mental health issues through-out most of his life that, while although allowing him to be functional, made him poorly suited to the responsibilities of leading a democratic nation, especially the world’s most powerful. Dr Frank describes George Bush as suffering from the need to defy authority, from megalomania, and as probably being incapable of genuine compassion [6]. He observes indications of sadism, notes that Bush feels entitled to live unencumbered by the constraints that apply to ordinary people, and that he is inclined toward knee-jerk judgments in his decision making process [7]. He also points out the former President’s aversion to introspection and tendency to deny responsibility [8].

Stop throwing the Constitution in my face. It’s just a goddamned piece of paper.

George W. Bush, November 2005, White House meeting with Republican Congressional leaders [9]

The American Psychiatric Association holds that it is unethical for a psychiatrist to offer a professional opinion on a subject with whom the analyst has not had the chance to conduct an examination. Dr. Frank points out, however, that the research he did on G.W. Bush was similar to the psychological assessments of world leaders routinely developed by the CIA [10]. The Center for Analysis of Personality and Political Behavior, the applied psychoanalysis unit of the Central Intelligence Agency that formulates in-depth personality profiles on world leaders was established under Dr. Jerrold Post, a colleague of Dr. Frank’s at George Washington University Medical Center [11].

If one of my patients frequently said one thing and did another, I would want to know why. If I found that he often used words that hid their true meaning and affected a persona that obscured the nature of his actions, I would grow more concerned. If he presented an inflexible worldview characterized by an oversimplified distinction between right and wrong, good and evil, allies and enemies, I would question his ability to grasp reality. And if his actions revealed an unacknowledged—even sadistic—indifference to human suffering, wrapped in pious claims of compassion, I would worry about the safety of the people whose lives he touched.

For the past three years, I have observed with increasing alarm the inconsistencies and denials of such an individual. But he is not one of my patients. He is our president [12].

Applied psychoanalysis holds that public figures offer, with the notable exception of emotional interaction with the clinician, more material for analysis than patients typically do when seen under the more limited circumstance of the clinical setting. By virtue of being in the public eye, a President of the United States creates hundreds of hours of video footage and reams of biographical information on himself, many of his close associates and almost every member of his family, all of it offering an abundance of material to the trained analyst [13]. In developing a characterization of President Bush, Dr Frank had access to considerably more data than he normally does with his own patients which he rarely sees in their everyday lives.

And I am really struck by how much more I see of Bush and everything that I know about my patients is based on work in the consulting room, and then my fantasies about them, you know, how I think about them.

Dr. Justin Frank [14]

In Bush on the Couch, Dr. Frank draws a picture of a President suffering from serious, psychological disorders including: Attention Deficit Hyperactivity Disorder (ADHD), an omnipotence complex, paranoia, sadism, a mild form of Tourettes Syndrome, a diminished capacity to distinguish between reality and fantasy, and untreated alcoholism. These disorders stem from what Dr. Frank describes as Bush’s “diminished ability to manage anxiety.” Many of these difficulties stem from significant and shocking episodes of unresolved childhood trauma, in which his parents, George H.W. Bush and Barbara Bush, failed to provide the needed loving adult care that would have enabled him to grow through the experiences. Dr. Frank thus presents a compassionate picture of the former President.

George W. was six years old at the beginning of the tragic episode that he has said yielded his first vivid childhood memories—the illness and death of his sister. In the spring of 1953, young Robin was diagnosed with leukemia, which set into motion a series of extended East Coast trips by parents and child in the ultimately fruitless pursuit of treatment. Critically, however, young George W. was never informed of the reason for the sudden absences; unaware that his sister was ill, he was simply told not to play with the girl, to whom he had grown quite close, on her occasional visits home. Robin died in New York in October 1953; her parents spent the next day golfing in Rye, attending a small memorial service the following day before flying back to Texas. George learned of his sister’s illness only after her death, when his parents returned to Texas, where the family remained while the child’s body was buried in a Connecticut family plot. There was no funeral. [15]

Dr. Frank found his publication of Bush on the Couch: Inside the Mind of a President, was well received by those who read it, but not widely appreciated within the psychiatric community or by Republicans, the latter dismissing it as awful even though few actually read it.

But as far as the psychoanalysts and psychiatrists, a lot of people are disturbed about it, they’re not very familiar with applied psychoanalysis, and then when they are, they feel that it should only be used for foreign leaders; and Gerald [sic] Post [Dr. Jerrold Post of The CIA’s Center for the Analysis of Personality and Political Behavior], in fact, feels that way.

Dr. Justin Frank [16]

For the Republicans, it was unfortunate that they generally choose to avoid reading Dr. Frank. By the time President Bush finished his two terms, he had managed to splinter the conservative movement, gut the Republican Party of intellectual vitality, and enable the Democrats to return to power in Washington. Much of that might have been avoided had Republicans been more willing to understand where they were being lead.

I would love to find who they are [Republican audience interested in the book], and if I could find Republican groups, I would be very interested in talking with them, because I do think there’s an audience for this. I think that they are very concerned about a couple of things: One is the deficit spending; two is really pre-emptive war.

Justin Frank, M.D. [17]

Dr. Frank does not believe Vice President Dick Cheney secretly ran the Bush Administration. He credits George W. with more intelligence than most of the nation was willing to grant by the middle of his second term. He says that Bush was the decision maker and gave Cheney the job of thinking those decisions through and articulating them. This view is consistent with that presented by Dick Cheney, who not only stated that he looks at the Office of the Presidency as that of a king and poured considerable effort, as Vice President, into enhancing the powers of that Office. According to Dr. Frank, Bush knows what he wants to do, but does not like the work of thinking because it makes him too anxious. Franks believes the core of George W’s functioning lies in defending himself against anxiety.

Yes, it has to do with the fact that he was never able to mourn, and when you don’t mourn, you can’t integrate your inner life. What happens is that, as I write in the book, sorrow is the vitamin of growth, and until you face who you are and what you’ve lost, you really can’t organize your mind, and so what happens is when you’re the first born, and the next one dies, you’re left with a lot of unworked-out hostility, anger, guilt, that maybe your wishes killed them. You have lots of magical thinking, and if you don’t have a family that helps you gather those things together, you can be in a lot of trouble.

So then you have to manage your feelings yourself. And one of the ways people do manage them when they are that age, is they have friends to talk to; but he doesn’t seem to have had anybody to talk to much. But they also read, and pay attention to things, so they learn about human beings from reading about other people, if their parents aren’t responsive to them. But he really has such a hard time reading, that it’s like swimming with weights. I mean, it’s just too much for him. So he didn’t have that avenue either, so he became sometimes cruel to people, with animals, which is one way of managing your aggression, and then to drink in order to manage his anxiety, and he became a very heavy drinker, that’s very clear, till he was 40, at least.

Justin Frank, M.D. [18].

Dr. Frank believes one of the reasons the press was afraid to ask President Bush tough questions was because there was a tacit recognition that dealing with the President, an untreated alcoholic, meant walking on egg shells for fear of upsetting him with unknown or unfortunate consequence.

The only way [to really break through, and get through to him] would be for somebody to actually directly confront him in a clear way, to bring him out, so you would really see the bully, and you would also see the fear.

So Cheney is very powerful, and Cheney is really a destructive guy, but I don’t think that Bush needs him as much as we like to think he does. That is one of the strengths of Bush. Bush is an amazing person at ducking blame and ducking responsibility, so he’s even got a lot of people who oppose him thinking its all Cheney’s fault. And through this secret way, it’s a way of getting off the hook yet again.

Dr. Justin Frank [19]

To better understand how the United States got into its current mess, the American people have to better understand the many-sided and distorted world of the man who, more than any other, led them into it. Dr. Frank includes a chapter in Bush on the Couch that discusses why American choose him as their leader. Bush then choose Cheney, Rumsfeld and the neo-conservative theoreticians that set the tone of administration and actively pursued such traditionally un-American doctrines as preventive war, an aggressive nuclear policy and attempts to socially engineer the Middle East for America’s benefit, while trying to support such counterproductive, illegal, and wasteful policies through lying and spying on the American people, using techniques of torture, and misdirecting a ‘War on Terror’ that undermined our nation’s military and national security while enriching their friends and associates [20].

I’ll be long gone before some smart person ever figures out what happened inside this Oval Office.

George W. Bush, Washington, D.C., May 12, 2008

Much of this misdirection and departure from traditional American values could be foreseen in Dr. Frank’s profile. By the time George W. Bush left office, most of America recognized that something had gone wrong and the country was no longer headed in the right direction. This understanding was reflected in polls of Bush’s approval numbers and in the fact that the great American ship of state had begun to act as though it had struck an iceberg and was dangerously taking on water.

You can fool some of the people all the time, and those are the ones you want to concentrate on.

George W. Bush

What, then, is to be said about the twenty percent of Americans who, by Bush’s approval ratings at the end of his Presidency, who never did recognize that the nation was being taken down a track of self-destruction. Were these Americans just working too hard to pay attention, too easily mislead by sophists such as Rush Limbaugh, too inclined because of America’s long history of responsible leadership to take a default perspective in favor of the President; or do they really not understand what America is about, how its promising composition of choice, chance, and historical struggle made our country something very few of its citizens have not considered themselves fortunate to experience and very many of its citizens have given their lives that it be maintained, it being something that none of its citizens can afford to take for granted. Or, is it that too many of that twenty percent are of a psychological mind set that allows them to be comfortable with having a sociopath in charge of the country?

Such reflects the fate, more than 2,000 years ago, of the also great Roman Republic, and it remains that those who will not understand history are bound to repeating it. George W. Bush’s administration was inhabited by individuals who claimed the United States was ‘the indispensable nation’ and wore the garb of ‘American Exceptionalism’, but failed to understand that a nation loses the right to claim these distinctions by the degree to which it acts as though they have conferred privilege [21]. The Art of keeping Power lies in the cultivation of wise humility and graceful respect, ideals that have always been indispensable to America at its best.

Beware the leader who bangs the drums of war in order to whip the citizenry into a patriotic fervor, for patriotism is indeed a double-edged sword. It both emboldens the blood, just as it narrows the mind. And when the drums of war have reached a fever pitch and the blood boils with hate and the mind has closed, the leader will have no need in seizing the rights of the citizenry. Rather, the citizenry, infused with fear and blinded by patriotism, will offer up all of their rights unto the leader and gladly so. How do I know? For this is what I have done. And I am Caesar.

— Julius Caesar


[1] Justin A. Frank, M.D. Biography, HarperCollins Publishers;

[2] The Naked Management – Games Executives Play;

[3] The Leadership Challenge – Why Great Leaders Don’t Take Yes for an Answer: By Michael A. Roberto, ©2006, GovLeaders.org;

[4] [PTypes - Neurotic Solution: Narcissistic Type, Dave Kelly, Copyright © 1998-2006;

[5] [The Ugly Truth About G.W. Bush, BOOK REVIEW, by Jeffrey Steinberg, Executive Intelligence Review, August 20, 2004;

[6] [Justin A. Frank, M.D., Author of "Bush on the Couch" Gets to the Heart of the Matter: We Have a Sociopath as President, A BUZZFLASH INTERVIEW, BuzzFlash, January 2 2007;

[7] [Justin Frank: The Cruelty of George W. Bush, FORA.tv;

[8] Justin Frank: Inside the Mind of President Bush, FORA.tv;

[9] Bush on the Constitution: “just a goddamned piece of paper”, PeaceVet, Daily Kos, Dec 11, 2005;

[10] Bush on the Couch, Wikipedia Encyclopedia;

[11] Center for Advanced Defense Studies, RIT/CADS Professional Studies MS Program;

[12] [The Ugly Truth About G.W. Bush, BOOK REVIEW, by Jeffrey Steinberg, Executive Intelligence Review, August 20, 2004;

[13] The Ugly Truth About G.W. Bush, BOOK REVIEW, by Jeffrey Steinberg, Executive Intelligence Review, August 20, 2004;

[14] INTERVIEW: DR. JUSTIN FRANK, George Bush: `A Puppet Who Chose His Puppeteers’, Executive Intelligence Review, August 20, 2004;

[15] The Ugly Truth About G.W. Bush, BOOK REVIEW, by Jeffrey Steinberg, Executive Intelligence Review, August 20, 2004;

[16] INTERVIEW: DR. JUSTIN FRANK, George Bush: `A Puppet Who Chose His Puppeteers’, Executive Intelligence Review, August 20, 2004;

[17] INTERVIEW: DR. JUSTIN FRANK, George Bush: `A Puppet Who Chose His Puppeteers’, Executive Intelligence Review, August 20, 2004;

[18] Justin Frank, M.D. [INTERVIEW: DR. JUSTIN FRANK, George Bush: `A Puppet Who Chose His Puppeteers’, Executive Intelligence Review, August 20, 2004;

[19] [INTERVIEW: DR. JUSTIN FRANK, George Bush: `A Puppet Who Chose His Puppeteers', Executive Intelligence Review, August 20, 2004;


[21] Only in America, Economist.com, Apr 24th 2008;



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