There are three things to note here, and maybe a fourth.

First, a psychiatrist is an MD who has, after his or her general medical training, specialized in matters pertaining to disorders that result in dysfunctional behavior of all sorts, like severe schizophrenia, clinical depression and that sort of thing - and is attuned to the idea that much of this may be the result of chemical imbalances in one's neurochemistry, as well as the idea that some disorders may have some origin in the emotional and social environment of the patient, or in the patient having, for some reason, adopted dysfunctional notions of the best way to behave in any given situation. But the model, as far as etiology goes, is more often than not one of "organic brain damage." As an MD, a psychiatrist can, and likely will, prescribe medication as part of treatment, or even treat severe problems with such things as electrical or chemical shock to alter the operation of the brain itself for a time.

On the other hand, a psychotherapist is not an MD but rather licensed by the state to provide "therapy" to change dysfunctional behaviors or to increase one's ability to deal with debilitating circumstances - thus we have licensed "marriage and family counselors," grief therapists and all the rest. Here etiology doesn't matter very much. This issue is what to do, right now, to get back to something like normal, whatever that is. This is the realm of "talk therapy" and working on cognitive patterns, as how you frame what is happening around you determines your response, your mood, your paranoia and so forth. A psychotherapist cannot prescribe medication, or any kind of medical treatment. When a patient is not responding then it's time to call in the psychiatrist, with his or her arsenal of psychopharmaceutical goodies and physical interventions.

The third leg of the stool, so to speak, is the psychoanalyst. Cue up Freud and Jung - Woody Allen is in the waiting room. Here etiology is everything. This is the realm of hour-long sessions up to five days a week, often over many years, on the couch, delving into past conflicts and one's childhood and sorting out id impulse from ego and super-ego and all that. The idea is that knowledge of how you got to where you are will fix things in the here and now. (Some doubt the logic there.) And of course you do all the work - the psychoanalyst will nudge you along, now and then, as you discover the root of what seems to be the problem, if there even is one. And of the three, the psychoanalyst probably has the most rigorous and lengthy training - he or she goes through deep analysis as part of that training. Needless to say, this treatment, at hundreds of dollars a session, is really expensive. Woody Allen needed to keep making all those films.

All three do agree on what constitutes a condition to be treated, as opposed to the person just being a jerk. There's a book of such things, the DSM-IV - the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. It might be handy to have copy the next time you're in a political argument about the current Republican leadership, or the feckless Democrats. You can then do name-calling with a certain flair.

There is a fourth category of professionals - those who state, on the net, that they are one of the three above, as does one "artebella" here with a post late Sunday evening, October 2, with the title "Danger - Bush Could React Violently To Fitzgerald's Action - How We Can Protect Ourselves."

This is a speculation how Bush would react if he or any close to him in the White House were indicted. The possibility has come up - see October 9, 2005 - Peculiar News on a Slow News Day on the guesswork that this "get Joe Wilson's wife" investigation may lead to criminal conspiracy charges against Vice President Cheney and Bush himself.

But the writer just doesn't sound like a psychoanalyst.

I'm a shrink - a psychoanalyst - and think we can keep this real simple. We have no right to diagnose from afar but we can surely describe Bush in old-fashioned everyday language based on his public behavior.

He's a mean SOB, unable and unwilling to care about others - uninterested in any reality other than the one that comforts him. He clearly needs to be comforted, applauded and admired all the time. (It's no accident that press conferences and election appearances were so controlled). He is amazingly immature though canny and, as a sadistic SOB, he will destroy or have destroyed anyone who opposes him. His characteristics, if seen in a child, are considered ominous. Hence the story of his childhood practice of putting firecrackers inside frogs and lighting them would have sent any thoughtful parents straight to a child psychiatrist screaming for help for their disturbed child. Clearly that didn't happen.

This just doesn't sound professional, in spite of the writer claiming no right to do this "diagnosis from afar." The writer does just that.

Note this on defense mechanisms:

Maybe his "charm" (joke telling, life of the party, etc) protected him while things were going well. But now, when the chickens are coming home to his roost, he's scared - and watch out. He will get mean and meaner. The more deprived of comfort (high poll numbers) the more frantic he will be. Nuking Iran or North Korea are an easy out - just as turning up the terror alerts when things got bad (sliding poll numbers) worked here at home. He got his jollies by scaring the rest of the country so he wouldn't feel so alone in his fear.

Deprived children tend to feel the world owes them something - a lot - to pay back for all that early pain. And they feel totally justified in their anger and the expression of it. I do unto you as was done unto me. So there!! Btw, they usually don't know about this particular dynamic unless they've been in therapy. Clearly that hasn't happened either. Alcohol or any substance he may have used was probably his attempt to self medicate.

As a descriptor of dysfunctional behavior, "he got his jollies," while vivid, probably isn't in the manual.

The there's this:

He's not dumb so on some level at some times he knows something about himself he'd rather not know. Constant movement - bicycling, etc, rigid routines, prayer sessions, surrounding himself with sycophants and fellow sadists will keep further self knowledge at bay.

And let's not forget his belief in the apocalypse. It's a sadist's perfect plan. Total destruction. Yikes.

I had a friend in psychoanalysis for a time, and I cannot imagine her therapist saying "Yikes!" But I wasn't there.

Okay, assume the writer really is a psychoanalyst just adopting a "voice" here, to make the crushingly Freudian stuff accessible to an audience that wouldn't tolerate professional jargon. That's a stretch, but note this:

I've wondered why Bush was "successful" for so long. He did get to be POTUS twice. It can't be all Karl Rove and Diebold. So, it finally dawned on me that he is gifted. He has a special gift for destruction. Think about it - he has destroyed America's reputation in the world, he is well on the way to destroying the economy, civil liberties, the environment, my peace of mind, democracy, the treaties and behavior that kept nations away from the idea of using nuclear weapons, respect for the rule of law, the compact with Americans that the president will do all he can to protect you, the Geneva conventions ...
The point is that when it comes to building and growing anything - this man does not have the psychological ability to handle it. It's not stupidity; I don't even think it's just greed and incompetence - though he and his buddies have plenty of both. It's a knack to be consistent at destroying things. It's related to meanness of spirit - you know the opposite of generosity. The Bush crime family has given nothing to this country. Some robber barons of the past at least left libraries and foundations behind. What has the Bush family ever built (for the benefit or use of others)?

Yes, this is nine parts political rant, one part simplistic idea. This is no professional. But we get anecdotes mixed in, as in this:

I have worked with some sadistic patients. They feel empty inside and/or full of rage. They are certain they have been deprived of love and do not carry a fund of memories of being cared for inside them. They find ways to be with others - charm, but they often haven't a clue as to why people don't really like or trust them.

Oh yes, they know how to exert power over people and keep them in their place. That is the essence of sadism - I am the master - you are the slave. Bush and Rove clearly deserve each other.

This sounds like someone who took one semester of Abnormal Psych years ago and pulled out the old textbook to assume a role here. Well, there's a tradition of such things in political writing and satire. One thinks of Swift's Modest Proposal (1729) - "A Modest Proposal for Preventing the Children of Poor People in Ireland from Being a Burden to Their Parents or Country, and for Making Them Beneficial to the Public." That's Bill Bennett sort of thing - roast 'em and eat 'em - and effective for its reasoned, sane tone.

Here, on the other hand, we get this bogus "psychoanalyst" putting on the tin-foil hat:

Why this matters now is the possible reaction of Bush to Fitzgerald's next serious move. My fear is that the inner emptiness in Bush will respond with absolute panic to the potential loss of Rove and his other pals. Panic in a sadist who believes in the apocalypse is something serious about which we all should be worried.

He could set off a nuclear holocaust. He could merely nuke Iran or North Korea (the latter is less likely for the moment). He will be drawn to do something to make him feel powerful and less humiliated. What can we do about it?

I am writing this diary because I think there is something we can and should be doing now before he is "compelled" to react to the worst news of his life.

We should be predicting his irrational destructive reaction to everyone. With any luck it will get back to him and his courtiers and could slow him down. Or at least some of his marginally sane advisors could slow him down.

BTW, I was worried about his creating a "terrorist attack" just before the election for the obvious reasons and was reassured to learn that the democratic leadership and Kerry campaign were well aware of that possibility and the repugs knew that he was being watched for any such dirty trick which reduced the likelihood of it happening.

In the same spirit, I think we should make sure that as many people as possible should be aware that a man with such a hair-trigger response to humiliation and who has his finger too close to the wrong buttons will be watched and prevented by saner minds from doing his best (which is unfortunately everybody else's worst.)

Well, that may be a reasonable warning. Anyone in a position of enormous power should be watched. That's just common sense.

But it's too bad about the hyperbolic delivery of this amateur psychoanalysis, some of which may be spot on.

Of course, what the writer does not address is the extent to which much of the adult population in the United States these days identifies or even bonds with someone who is spiteful, mean-spirited, and slyly vindictive - and feels unloved and unappreciated, and is a tad paranoid that everyone is against him, and really wants to strike out at others. America and the world, no? That's been our national character for the last five years. More than half of the voters last time around decided that was is just the way it is in this sorry world.

Who we choose to lead us is who we are. We should all be on the couch.