What makes a tyrant tick? Ask a political psychologist

How one medical school graduate’s “career in the shadows” began with an unexpected job offer.

In 1965, the CIA presented an unusual job opportunity to the young psychiatrist, then completing his residency at the National Institute of Mental Health, that was enticing enough for him to turn down a faculty position at Harvard.

Asked to develop a pilot program for what he described as “assessing at a distance the personality and political behavior of foreign leaders,” Jerrold M. Post, M.D. ’60, decided this diversion justified delaying a trip into academia. Little did he suspect in 1965 that some of the world’s most important leaders would soon be stretched out on his analyst’s couch—figuratively speaking—and that his CIA side trip would last until 1986.

As founding director of the Center for the Analysis of Personality and Political Behavior (CAPPB) at the CIA, Post led an interdisciplinary behavioral science unit composed of clinical and research psychiatrists, social psychologists, political sociologists, anthropologists and political scientists. Their job was to develop political personality profiles of foreign leaders.

“We looked at foreign leaders in their cultural and political context and gauged to what degree they were playing out personal conflicts on an international stage,” says Post, who today is frequently quoted on television and in newspapers and magazines.

During what he calls his 21-year “career in the shadows,” Post probed the pathologies and personalities of some of the world’s most dangerous minds. He continued to develop political personality profiles after joining the faculty at George Washington University in Washington, where he is professor of psychiatry, political psychology and international affairs and director of the political psychology program. Among the contemporary leaders he has profiled are Slobodan Milosevic, North Korea’s Kim Jong-Il, Osama bin Laden and, most famously, Saddam Hussein. His analysis of the Iraqi leader was presented in testimony in December 1990 to the House Armed Services and Foreign Affairs committees. Post’s intimate knowledge of the Iraqi leader was called upon again by national media in March 2003, when war with Iraq began, and again last December, when the Iraqi leader was captured.

“No worse beginning is imaginable,” Post says of the dictator’s formative years. “His father and 12-year-old brother died during his mother’s pregnancy. She tried to kill herself and then tried to abort Saddam. She wouldn’t even look at him when he was born in a mud hut in Tikrit.”

According to Post, Saddam was passed off to an uncle, who took care of him, then returned him to his mother after she’d remarried. His stepfather abused him physically and psychologically. But when he was eight, wanting an education that his parents refused, he went back to his uncle, who filled his head with dreams of glory. “As he accumulated power,” Post says, “Saddam created these marvelous palaces, and yet they all had enormous bunkers down below, like the defiant paranoid self beneath his grandiose façade. When he was captured in Tikrit, he wasn’t just back in the mud hut. He was in a hole underneath the mud hut, as low as anyone could go, representing Saddam’s shattered self.”

Among Post’s proudest CIA achievements were the Camp David profiles his unit prepared of Menachem Begin and Anwar Sadat for President Carter in 1978. Using these assessments, the president was able to ready himself for that groundbreaking summit. In his book, Keeping Faith (1982), Carter acknowledged that these analyses influenced his negotiating strategy and paid rich dividends.

“After Camp David, there was scarcely a major summit without our being asked to prepare profiles and assessments of the foreign leaders,” Post says. “Part of my pride was in crafting an entirely new field of intelligence at the CIA.” Post was awarded the Intelligence Medal of Merit in 1979.

Since leaving the CIA in 1986, Post has established himself as an expert on “the mind of the terrorist,” which is, in fact, the title of the book he’s currently writing. In addition to consulting for the departments of defense and homeland security, Post was an expert witness at the 1997 trial of an Abu Nidal operative and the July 2001 trial of an al-Qaeda member for the bombing of the U.S. embassy in Tanzania.

He is the author of several widely cited books, including When Illness Strikes the Leader (Yale University Press, 1993) and Leaders and Their Followers in a Dangerous World (Cornell University Press, 2004). Post is often quoted on matters related to Saddam Hussein, Osama bin Laden and the psychology of suicide terrorism.

“I have always seen my role, in government and outside it, as communicating complicated concepts in a way that is useful for intelligence professionals, policy officials and the general public,” says Post. “I’m not always reassuring, but I am trying to facilitate understanding.”

—Alan Bisbort

Familiar Faces

Looking to mechanics to explain what cells do and how they develop

Mavericks start out young, it seems. Once, after performing an advanced earth science experiment with other ninth-graders, Donald E. Ingber, M.D. ’84, Ph.D. ’84, arrived at a different result. “I wrote down 12,” he says, “even though they all wrote down 88.” The instructors informed the class that there were indeed two correct answers, but that among the few students who had discovered the less obvious solution, only one—Ingber—hadn’t scratched it out in favor of the more popular result.

“That was incredible feedback from a teacher,” Ingber says, “for people to do what they believe in and what they think is right.”

Ingber has found this message useful in the years since as he forged an often-controversial career. While most cell biologists use molecular techniques to tease out the genes at work in health and disease, Ingber, now the Judah Folkman Professor of Vascular Biology at Harvard Medical School and Children’s Hospital in Boston, has championed the more radical notion that minute mechanical forces acting on cells—pushing and pulling, compression and tension—are crucial to their normal growth and function, and that disturbances in these forces can lead to disease.

“I’m a person who has always had a strong sense of how things work by looking at them,” Ingber says. “I’m very mechanically minded.” Ingber’s mechanical bent led to an early fascination with the work of another rugged individualist, R. Buckminster Fuller, in particular the concept of “tensegrity,” the complementary interplay of compression and tension that underlies the elegance and strength of Fuller’s geodesic domes.

While a Yale undergraduate, Ingber encountered in an art class the sculptures of Kenneth Snelson, in which pipes and wires, intricately arranged according to principles of tensegrity, create airy yet rigid forms that rise improbably into space. For Ingber, who was doing tissue culture experiments on metastasis with Alan C. Sartorelli, Ph.D., in the Department of Pharmacology at the time, Snelson’s pipes and wires called to mind the actin filaments and microtubules that make up the cytoskeleton—the internal scaffolding of the cell.

Seeing Snelson’s work had the force of a revelation, Ingber says. “I spent multiple two-week vacations in every library at Yale—the art library, the chemistry library, the physics library,” he says. “I bought every book in Atticus Bookstore related to tensile membranes or patterns in nature.”

Ingber gradually became convinced that mechanical forces, largely ignored since the rise of molecular biology, must play crucial roles in the development and behavior of cells. However, when he suggested to a postdoctoral fellow that cells might change their shape because of changes in tensegrity, he received a less than encouraging response. “He told me, ‘Don’t ever say that again!’” Ingber recalls.

But Ingber isn’t one to give up easily. As a graduate student in Yale’s M.D./Ph.D. Program, he sought out a more hospitable environment for his ideas, which he found in the laboratory of James D. Jamieson, M.D., Ph.D., professor of cell biology and director of the program. With Jamieson’s blessing, Ingber devoted a chapter of his thesis to tensegrity, and he is particularly grateful that one of his thesis advisors, the pioneering cell biologist and Nobel laureate George E. Palade, M.D., entertained his unconventional views with an open mind. “Instead of laughing, he gave me Buckminster Fuller’s book Synergetics, which he had received as a gift when he won the Nobel,” Ingber says.

When it came time for his residency, Ingber made the decision to stop his medical training to do research in the laboratory of M. Judah Folkman, M.D., at Children’s Hospital in Boston. No stranger to controversy, Folkman has fought his own long and lonely battle to prove his theory that blocking angiogenesis—the body’s recruitment of new blood vessels—is the key to treating cancer and a host of other diseases.

Shortly after Ingber joined the Folkman lab, a fungus contaminated a tissue culture experiment he was working on. Before pitching his dishes into the trash, Ingber decided to see whether the fungus had any noteworthy effects on the endothelial cells that were being used in the studies. It was a wise decision: the cells had retracted away from the fungus, and Ingber surmised that the fungus was secreting some substance that inhibited their growth. To Folkman’s delight, Ingber had happened upon a substance that led to the development of tnp-470, one of the most promising angiogenesis inhibitors ever discovered. tnp-470 showed potent antitumor activity, but it was shelved when Phase II trials revealed serious neurotoxicity. However, a young scientist now working in Folkman’s lab has recently modified the compound, and Ingber’s chance discovery may yet find its way into the clinic.

In a lab at Children’s Hospital where Ingber continues his study of tensegrity, the walls are lined with framed micrographs of such stunning beauty that they could hang in the upscale galleries of nearby Back Bay. In one, cells cultured on a surface designed to constrain various forces on the cytoskeleton have assumed a number of brilliant shapes, including multihued squares and lozenges reminiscent of Paul Klee.

Ingber believes he has finally homed in on the interface between physical forces and cell physiology. Many regulatory and signaling molecules cluster on the cell membrane around proteins called integrins, which anchor the cytoskeleton of cells to the extracellular matrix. In recent work, using miniscule magnetic beads that lock onto integrins like a molecular wrench, Ingber has shown that twisting integrins in different ways causes distinctive shape changes in the cytoskeleton, which in turn cause predictable patterns of gene expression. He also can switch cells between growth, death and differentiation by varying the degree to which cells physically distort when bound to a matrix through integrins.

To investigate these processes more deeply, Ingber has developed a femtosecond laser technique along with Harvard physicist Eric Mazur, Ph.D., that will allow him to perform highly selective nanosurgery on cells. Ingber says that the ability to obliterate some structures while retaining cells’ overall function will open completely new avenues to test his theories.

Ingber is confident that the rigor of his experimental work will eventually overcome the skepticism he has long faced, and that his ideas will slowly but surely enter the mainstream of cell biology. “A couple of big Science and Nature papers convinced a hell of a lot of people,” he says. “In science, even if it’s a wild idea, if other people start using it and find it valuable—if it works—it builds momentum.”

—Peter Farley

Straddling law and medicine, and looking for an answer to the malpractice crisis

When health policy guru Troyen A. Brennan, M.P.H. ’84, J.D. ’84, M.D. ’84, began his studies at the School of Medicine in 1978, fresh from a Rhodes Scholarship at Oxford, he “wandered around,” he says, liberally sampling the range of courses Yale had to offer, particularly in public health and law. Brennan already had a strong interest in policy research, and he found the classes at the Law School to be so stimulating that he donned a second hat during his second year of medical school and became a law student as well.

But while Brennan still believes that his immersion in the world of law has been invaluable in his career as a policy-maker, he never doubted that he would spend his working life as a physician. “I always knew I’d practice medicine, not practice law,” he says. “I’ve never taken a bar exam.”

Lawyering is too solitary for Brennan, who prefers the social and intellectual give-and-take of medicine. “The practice of law is pretty isolating, whereas medicine’s just the opposite—it’s always dealing with people,” says Brennan, now professor of medicine at Harvard Medical School and professor of law and public health at the Harvard School of Public Health. “It’s much more interpersonally satisfying.”

So it’s no surprise that Brennan chose a very public way of doctoring. He has been front-and-center in national debates on health care policy for two decades; his research group now focuses on the interwoven issues of improving patient safety and addressing the crisis in medical malpractice.

“Until very recently, the major way in which our health care system dealt with deterring medical injuries and improving safety was through medical malpractice. That was the social mechanism,” Brennan says. “We think those should be torn apart, and that patient safety should be addressed through an entirely different mechanism.”

Brennan argues that both doctors and patients would be far better off with an administrative compensation scheme or mandatory arbitration of claims of medical injury. He envisions a system similar to Workers’ Compensation, where an administrative-law judge would render verdicts after advice from experts and with the help of specifically defined criteria on how avoidable a given patient’s injuries were under present standards of care. Any damages would be awarded according to strict guidelines.

As it stands, state common law governing medical injury claims is a patchwork of wildly varying standards and precedents. A few states—Nevada, Oregon, Pennsylvania, Texas and Illinois, for example—are malpractice hotspots where skyrocketing insurance premiums are leading to a shortage of specialists. The American Medical Association has said that as many as 20 other states are also in “malpractice crisis.” And Brennan says that 50 to 60 percent of insurance premiums now pay attorneys’ fees rather than compensating patients who have been injured in avoidable medical accidents.

Brennan also endorses a greater embrace of “enterprise liability,” where hospitals, rather than individual doctors, are held liable when accidents occur. “In plane crashes, it’s not like everybody goes and sues the pilot,” he says. “They sue the airline, because it’s a big enterprise. The pilot’s part of it, but he’s got to be informed by the systems and processes that are going to make that flight safe. A doctor in a hospital is part of a much larger system, and that system’s got to function well to prevent these types of injuries in the future.”

Brennan says that the simple substitution of “avoidable” for “negligent” under his scheme would represent a major cultural shift away from the simmering cauldron of the malpractice courtroom. When we cast all medical accidents, even some that may have been unavoidable, in terms of negligence, he says, doctors are loathe to come forward when they have made an error.

“If doctors could say, ‘This was an avoidable injury, and we should go ahead and report this,’ Brennan says, “they don’t have to feel as though they’re involved in some sort of moral Passion Play.”

—P.F.


			Originally published in Yale Medicine, Fall/Winter 2004. Copyright © 2004 Yale University School of Medicine. All rights reserved.