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(This is an updated version of my 2023 essays about this topic, originally published in https://secondenlightenment.net. I have updated it because I believe it is even more relevant today.)

What is Sanity? When a politician has the ability to reason things out and has emotional stability. Apropos to a definition of ‘sanity’ implying a sound mind and good judgment, it must be understood that these qualities are neither fixed in a person nor are they permanently linear. They are temporary, lasting until opposite behavior manifests itself.

What is Power Neurosis? When a self-absorbed political leader becomes emotionless towards people and eventually represses any normal understanding of reality for people on the ground. The leader is obsessed with and possessed by power.

What is Political Psychosis? When a political leader completely loses touch with reality and puts himself and his ranting delusional mind ahead of any public interest. He develops a megalomaniac perception with political hallucinations, which leads to paranoia and the collapse of rational politics. It is a state of toxic vegetation.

Perhaps because of the sensitivity of power structures, there has never been such a thing specifically identified as ‘political illness’ in medicine or in the Standard Psychiatric Manual, and there is no formal study of ‘political psychiatry.’ The question is why hasn’t there been political illness scrutinized, when all other kinds of illnesses have been studied, medications found, means of diagnosis and treatment and prevention developed, etc… But why not for politics? What is special about politics? It seems there is no precise framework to pin down the signs and symptoms, nor is there a linear course that this ‘illness’ follows. For now, we have more questions than answers.

This essay is designed to address the deterioration of mental health in politicians when they rot in power and make their people suffer. It offers a view not only to bridging psychiatry and politics, but also, by having a clear-eyed view of this phenomenon, a way to move towards prevention by finding ways to enhance screening our politicians before it is too late. (As an aside, we will be referring to such politicians as “he” because this situation overwhelmingly applies to MEN who get in positions of power.)

First, we will put the pathology of power in perspective, and then we’ll explore a number of preventive and pragmatic political alternatives or solutions.

Putting the Pathology of Power in Perspective

The closest we have gotten to diagnosing a political leader is ‘malignant narcissism,’ describing a leader whose love for himself and his beliefs is so huge that he is willing to sacrifice the entire nation for his personal gratification. (The term ‘malignant narcissism’ was coined by Erich Fromm in 1964.)

Another psychiatrist, Lord David Owen, coined the term ‘Hubris Syndrome’ in 2007.^[1]Since the Greek term ‘hubris’ means those who become arrogant, overconfident and do not respect the opinion of others, Owen used ‘Hubris Syndrome’ for those politicians who are intoxicated by power and thus go through syndromic deterioration of their mind. (In his book, Owen focused on George Bush and Tony Blair.)

While perhaps not a formally developed theory, there is no shortage of casual ‘diagnoses’ of politicians today. (Among many such articles, a recent New York Timesarticle of 23.01.2026 covered the ‘neurosis’ of an authoritarian leader such as Trump in a democracy. )

But let us take a closer look at what this illness entails, and how it manifests. Initially, while in the stage of ‘Sanity,’ the new leader may seem healthy and have good intentions; he does not necessarily consciously wish to become a despotic ruler, or to take over the society or the world. He may even make some reforms for the good of the people and the country at first. But the more he receives compliments and adoration from his entourage as well as the people, the more deterioration we can expect in his psyche. As he begins to experience more and more gratification at how his populistic politics are working, he takes more and more credit for successes and increasingly feeling how ecstatically the crowd loves him, while often ignoring failures. His megalomania starts taking shape. He lets fewer and fewer people be involved in making decisions. In this stage of the political illness, the mindset of the leader begins to shift from Sanity and psychological stability to Power Neurosis.

Detection of Power Neurosis

Power neurosis involves the evolution from possessing power to being possessed bypower. A feeling of suspicion grows toward staff and close associates; this suspicion leads to a frenzied paranoia of outsiders, a condition that can range from mild to severe. Perceived threats to his power, particularly caused by ideas or plans that are different from his own, lead to elimination of any opposition, and extensive scapegoating. The leader expresses more and more fury at the slightest resistance to his power. With this consolidation of power, he begins to justify the use of intimidation, suppression and even violence against opponents both real and imaginary.

This stage of neurosis is recognized by a sense of personal ownership of the government and the nation.

At a certain point in this political illness, these leaders become extremely infatuated with their own sense of self, becoming quite verbose (“logorrhea”) and not ashamed of their own, often egotistical, behavior. They love having the stage and can orate only about what they think; they are not at all concerned with the interest of common people. In a state of self-righteousness with an extreme ‘know it all attitude,’ they subject a captive audience to unreliable reasoning and ranting thoughts.

His desperate obsession with power leads to the complete rejection of the transition of power to any other leader. Any political transition is seen as a conspiracy and an impossibility. These leaders feel they are the favorite of the masses, sometimes even designated by God, and think they will remain in this state for as long as they are alive. Sometimes they even use enormous amounts of state funds to construct monuments to themselves in order to leave a legacy behind, so their memory will ‘live forever!’

The detection of power neurosis in its insidious progression is both easy and difficult. It is easy because the leader’s promulgation of unnecessary fear among people and his self-designation as a ‘savior’ are obvious signs and symptoms. It is at the same time tricky, because it is not always a linear, predictable process. The afflicted one is very clever, and his supporters have fallen under the spell of his energy, often making it very difficult to overcome such an entrenched leader.

People subjected to leaders with power neurosis can take two directions: they either detect the pathology behind the behavior of their leader and develop an oppositional front against it, or they join in and follow, supporting the leader and the direction of his abnormal political process. They become part of the sociopolitical neurosis – ‘mass hysteria’ – those who cheer with exaggerated rhetoric for a dysfunctional dictator and his policies.

The phenomenon of self-deceived tyrants and their relationship with people was studied by Manès Sperber between 1937-39 in his book Zur Analyse der Tyrannis (Analysis of Tyranny), in which he draws our attention to two contributing currents in the nature of tyranny: the willpower and mental tension of the leader, and the applause of the people. This adulation is in itself paradoxically responsible for the establishment and continuity of tyranny: the people’s adoration brings to power a man who eventually makes their lives miserable.

Stanley Milgram in the early 1960s conducted series of experiments on ordinary people and their blind obedience to a leader and authorities, as described in his book Obedience to Authority: An Experimental View. Milgram emphasized how the masses are subdued, anesthetized and brainwashed, explaining how people can come under the sway of an order given to them by their superior or a charismatic yet neurotic leader. Also, Erich Fromm in his book On Disobedience and Other Essays (1981), discusses the control of thought, brainwashing the crowd to the point where they can kill others ruthlessly out of pure blindness. And Hannah Arendt famously analyzed the phenomenon of obedience and the danger of seemingly banal behavior, such as ordinary people following simply orders – of a narcissistic leader. In other words, the power neurosis is brought to life through the effect of a mentally damaged leader’s neurosis coupled with a power structure in which average people enthusiastically participate, either for financial, political, or social gain, out of ignorance, or following the crowd. It all gives an impression of ‘normalcy’, despite the pathology underneath. The leader’s mind and the people’s mania and cluelessness complement each other.

Political Psychosis

The next, even more consequential, stage of political illness can be called Political Psychosis. Power intoxication, messianic delusion, and self-aggrandizement completely take over the mind of the leader. The illness inevitably reaches its terminal stage, a state of political psychosis, when the leader completely loses touch with the reality of life in his own country. He is trapped in his delusions, ignoring the new generation and their legitimate demands while also oppressing them and any necessary and healthy opposition in the political process.

This illness begins as the story of a man and his country (a politician and his politics) which morphs into the story of just the man, as he and the country become indistinguishable in his politically erratic mind, even to the point of self-identification with the nation itself. The country becomes him; he becomes the country. The people lose any worth in his mind; they ‘belong’ to him as captive spectators, workers, and supporters whose lives can easily be sacrificed in order for him to maintain his own power, sometimes even taking the liberty of ordering to kill his people in cold blood if they oppose him.

The end stage is always tragic. Either he is summarily brought down from the pedestal by angry mobs, or he who was once beloved ends up being hated. ‘His’ people are eventually compelled into revolting against his despotic rule and despotic mindset as they strive to re-assert themselves as being worthy of dignity. Or in other instances, the situation could evolve into a personality cult and mass psychosis results, always to terrible ends. Eventually they are either toppled or simply die, leaving behind a dysfunctional and damaged country.

We must painfully acknowledge that while such leaders become mentally and politically ill because of their own dispositions, the masses also contribute to the problem. In not stopping his increasingly irrational acts of control and power, the people in fact accelerate his deterioration. Perhaps it can be seen as a sort of co-dependency, where there is also irrationality and dogmatism among the people following their leader.

Preventive and Pragmatic Political Alternatives

There is no cure for power neurosis and political psychosis; there is only prevention.

In the same way that the public was made aware of the cancer risks involved in smoking, we can bring to light the “cancers” that can arise in the minds of neurotic and psychotic leaders when they are given too much power. We can then suggest the means to prevent it. We have seen neurotic and psychotic leaders being installed over and over through the centuries, in both modern and ancient times, leading to predictable results. Many of them have shown capability of transgressing even the laws limiting his power.

Have we finally learned how to predict such situations? If so, what can we do to stop such cancers before they grow?

Prevention: A Team of Psychiatrists Can Do More Than Legislators Can!

Many, if not most, professions require some kind of license and exams in order to qualify to work in a given field. Even plumbers, let alone engineers, judges, dentists and doctors have to take exams. So why shouldn’t politicians who run for important political office, who will be making decisions that affect people’s lives, be required to take an exam? Why shouldn’t they be screened to ensure that they are qualified, with a sound mind, for the good of the country and the world?

In an Age of Reason and Education like today, we need better tools to renovate our politics. Amending constitutions and establishing international norms to evaluate the mental health of politicians before they take office would reflect our maturity and the power of reasoning in the field of politics.

How could this work?

1. Psychiatric Evaluation: A panel of renowned and non-partisan psychiatrists could be established for psychiatric evaluation to screen political candidates before they run for a high office, particularly presidencies, premierships and parliaments.

2. Political training institutions: Combined with psychiatric evaluation, it would make perfect sense if politicians attended highly specialized schools to ensure basic knowledge of political sociology with a focus on modern issues such as housing, healthcare, etc. As mentioned above, candidates must take exams and graduate in order to qualify for the office they seek.

3. Political Guardrails: Preventing power neurosis and political psychosis requires inhibiting the metastatic growth of unchecked power. Additional tools include strict term limits, national referenda, regular constitutional re-evaluations, and setting wealth and lifestyle limits for political figures. This can prevent the political illness of power from following its etiology to the terminal end.

This approach of combining a sound mind with sound knowledge would improve the chances of making wise and well-informed decisions on the job. Laying a foundation for our modern politics in this way ensures public safety and makes democracy stronger.

This innovative medical and pedagogical screening in politics is meant to prevent the ascension of clever, crazy, ignorant, or merely wealthy people to power. This may seem to imply that a country should be run by experts and some may reflexively refer to this as ‘elitism’ – but in fact a country SHOULD be run by experts, just as a patient is operated on by an expert surgeon. A hospital is not run by untrained and unsound individuals. We should not misunderstand democracy to mean that just any unruly and clumsy character can lead a country. We must be able to run our modern politics with more precision by employing sophisticated and compassionate minds.

Too much is at stake in the lives of people to leave politics to untrained, unexamined individuals.

Needless to say, outdated-styles of monarchical, military, oligarchical (e.g., Putin of Russia), ideological (e.g., Xi Jin Ping, and Kim Jong Un) and religious (e.g., Khamenei of Iran, and the Taliban of Afghanistan) rulership is still prevalent in the world and needs to be identified, addressed and abolished. Even in democratic countries we witness the evidence of political pathology (e.g., Netanyahu, Trump and Orban). Obviously, the psychological screening of a dictator, a king, or political powermongers in a dictatorship is challenging to say the least, and may in fact seem impossible. This is where the international legal and human rights organizations, and indeed the world’s people, must put more pressure for a humane and empathetic transition of power.

At this point in our human history, a Global Enlightenment movement that actually learns from the past and takes concrete steps to end political abuses and bloody revolts rather than just bemoaning them, means being in an Age of mature political awareness.

Mostafa Vaziri, MD, PhD

January 27, 2026

^[1] In 2012, Lord David Owen published a book entitled The Hubris Syndrome: Bush, Blair and the Intoxication of Power. The term ‘hubris’ was prompted by the Iraq invasion in 2003, as Owen described George Bush and Tony Blair having been intoxicated by power and thus developing “Hubris Syndrome.”