This is a remarkable book, written by Jerrold M. Post, M.D., a psychoanalyst, founder and director of the Center for the Analysis of Personality and Political Behavior for the Central Intelligence Agency. The book comprises 12 chapters, any one of which could serve as a template for an expanded, book-length exegesis on the prominent political figures of our lifetime. The provocative chapter titles represent a series of elaborated formulations, focusing on specific leaders and specific crises of the 21st and 20th centuries. They include analyses of the "murderous" leaders in the former Yugoslavia, Radovan Karadzic and Slobodan Milosevic, as well as other world leaders, such as Fidel Castro, Saddam Hussein, and Kim Il Jong. The profiles of the political leaders Anwar Sadat, Menachem Begin, and Jimmy Carter make for rich reading in a separate appendix.

Post's examples of "terrorist organizations" include commentaries on the Irish Republican Army, the Red Brigade, Hezbollah, Hamas, Abu Nidal, Basque Fatherland, and the Shining Path, with a detailed psychoanalytic and psychological profile of the "mind of the terrorist." He describes the psychological styles of several terrorists, including Osama Bin Laden. He focuses on the role of charisma in attracting followers and details the psychological styles of the "charismatic" leader and the two types of such leaders: the "reparative" and the "destructive." He describes the transformation of today's terrorist into tomorrow's tyrannical political leader. His psychoanalytic vocabulary and terminology add richness to our understanding of the minds and the motivations of such pathologically flawed individuals.

Post identifies the following psychological mechanisms operating in the development of the terrorist and tomorrow's "pathological political leader:" splitting off "the bad and evil" to a group outside the self by projection; externalization of blame and responsibility onto others; oversimplification of the issues for increased persuasiveness and demagoguery; reductionist, absolutist thinking, such as "it's all because of such and such … all they ever do is … this is the cause of all our problems"; a profound lack of empathy, even for their own people; rationalization; and an aggrandizement of the self, all leading to a polarized reality for the leader and his followers. Such analyses and the use of such terminology are rare in the psychiatric literature these days.

In discussing the role of mortal illnesses in political leaders, Post includes world figures such as Franklin Roosevelt, Winston Churchill, Woodrow Wilson, Francois Mitterand, and John F. Kennedy and speculates on the role of prescription drugs in the latter. Post goes on to discuss the illnesses of Mustafa Kemal Ataturk, Andreas Papandreou, the Shah of Iran, and Ferdinand Marcos. He speculates on the role their illnesses played in their decisions, on their respective governments, and on world events.

This extraordinary book is eminently readable, although the style is somewhat dry. It is a rich review of a consummate, graphic description of pathological narcissism and those who have manifested it. It evokes and conjures memories of worldwide crises and political disasters. For those of us who are interested in all these issues, in the psychology of world leaders, in psychoanalytic principles and psychological mechanisms, Leaders and Their Followers in a Dangerous World is a stunning introduction and review.

Dr. Papas is affiliated with Harvard Medical School in Boston.