vasavada leadership hhcme 2018 - huntsvillehospital.org · he will harm himself • he was an...

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Leadership: Styles &

Psychopathology of Leaders

Tarak Vasavada, MD

Professor of Psychiatry

UAB School of Medicine Birmingham-Huntsville Campus

Objectives

• Definition of a leader

• Are leaders born or made?

• Various leadership Theories

• Mental illness issues in great leaders

• Goldwater rule and its implication in the

current age

Audience Response:

• Definition of a leader

• Who is a leader amongst you?

• Why are you a leader?

• What is your leadership style or one that you

admire in other leaders?

• What is different between leadership and

management

Definition of Leadership

• What is your definition?

• It is hard to define being an abstract like love,

peace and democracy

• Definition has changed over time

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History of Leadership

• 1900-1930: emphasized control and centralization of power with a common theme of domination

• 1930: traits and personality, influence on group appears

• 1940-50: group theory, relationship that develops shared goals, effectiveness,

• 1960: Group to organization theory,

• 1970-80: skills, Transformation and transactional theory

• Current: styles of leadership: authentic, servant, adaptive,

Styles of Leadership

• Trait theory

• Skills theory: autocratic, democratic, creative

• Behavioral : task and relationship

• Situational

• Transactional

• Transformational

Are Great Leaders Born?

Trait TheoryWhat is Wrong with Trait Theory?

• Too many traits

• Trait studies fail to take situations into account

• This approach has resulted in highly subjective determinations of the most important leadership traits

• Research has failed to look at traits in relationship to leadership outcomes

• It is not a useful approach for training and development for leadership

• However… it does provide direction regarding which traits are good to have if one aspires to a leadership position. MMPI, Myers-Briggs, DISC

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Is it a skill?

• Katz’s Thee skills: Technical, Human and Conceptual bases on the level of management

• US army Skill Model: Teaches competencies (Problem-Solving, Social Judgment, Knowledge) in context of an organization.

• Pros: emphasizes the development of skills in existing leaders, a novice can acquire it, tailored, provide structure to learning

• Cons: too expansive, not many productivity studies, some components are based on traits

Styles Theory

• Authoritarian: Lincoln, Nixon, Patton, JD

Rockefeller, George Ramsey,

• Democratic : George Washington, Jefferson,

Google, William Mayo

• Laissez-faire: Suited for creative companies,

start ups, research groups. Ronald Reagan,

Warren Buffett, Donna Karen, JFK

Guess the style

Autocratic, Democratic or Laissez-faire

• Lou Holtz: “It’s a fine thing to have ability, but the ability to discover ability in others is the true test.”

• Vince Lombardi: “Leaders aren’t born, they are made. And they are made just like anything else, through hard work.”

• Dwight D. Eisenhower: “Leadership is the art of getting someone else to do something you want done because he wants to do it.”

Behavioral and Situational• Behavioral: leadership is composed of two kinds

of behaviors: task and relationship. They provide structure and nurture (rated 1-9)

• Situational: High or low directive and high and low supportive behaviors(S1-4) and based on competence and motivation of followers. (Think of medical students, residents and senior fellows to an attending)

• Dwight Eisenhower, Pat summit,

• Path- Goal theory

• Leader-Member Exchange

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Behavior Leadership Grid Situational Leadership

Path Goal Theory

• Based on Adapting a leadership style according to

follower’s expectations and motivation.

• Leadership Behavior can be directive, supportive,

participatory or achievement-oriented

• Followers: preferences for structure, needs for

affiliation, desires for control, and self-perceived

level of task ability.

• Task: Ambiguous, Repetitive, structured, complex

Transactional Leadership

• Transactional leadership relies more on

"trades" between the leader and follower by

which followers are compensated for meeting

specific goals or performance criteria.

• Transactional leaders motivate subordinates

through the use of contingent rewards,

corrective actions, and rule enforcement.

• Bill Gates, Lombardi, Meryl Streep in “Devil

wears Prada”

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Transformational

• Motivates its team to be effective and efficient

• Communication is the base for goal

achievement focusing the group on the final

desired outcome or goal attainment.

• This leader is highly visible and uses the chain

of command to get the job done.

• Integrity, High EQ, Builds coalition

• Mandela, FDR, William Demming,

Transformational

• John D. Rockefeller: “Good leadership consists

of showing average people how to do the

work of superior people.”

Emotional Intelligence

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Authentic and Servant Leadership

Authentic Leader: purpose manifest as passion, Behavior shows true values, connectedness builds relationships, consistent self-discipline, They have a heart that shows in their compassion

MLK, Warren Buffet, Ophra, Dalai llama

Servant Leader: They are there in first place to serve

Listening, Empathy, Healing, Self-awareness, Persuasion, Conceptualization, Foresight, Stewardship, Team and community building

Jesus, Gandhi, Mother Teresa

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Authentic and Servant Leadership

• Max De Pree: “The first responsibility of a

leader is to define reality. The last is to say

thank you. In between, the leader is a

servant.”

• Authentic leadership is the full expression of

“me” for the benefit of “we”.”

Where do bad leaders come from?

• Mental illness

• Personality

• Akrasia: Incontinent Behavior: Story of

Pinkberry

• Misguided values

• Avoidance of Reality

• Complicity of Followers

Neurochemistry of Leaders

• Frontal cortex is understood to be especially responsible for executive functioning such as self-regulation and planning

• Temporal lobes have been shown to play a critical role in memory, perception, language, and personality

• Ventromedial prefrontal cortex, may help a person to balance emotions in decision making, especially in situations in which outcomes are ambiguous or uncertain

• Leaders can take the stress well and had lower cortisol levels. Who has heard of Executive monkey?

Neurochemistry of Leaders

• Managers with dominant left hemispheres (logic and rational thinking) may make good

planners

• In contrast, managers with dominant right hemispheres (imagination, creativity, visual imagery, and emotional response) may make good managers or leaders.

• High coherence in the right hemisphere could suggest greater emotional balance and EQ

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Mental illness

• Mood Disorders

• Anxiety and nervousness

• Dementia

• Medical illness

• Substance abuse

• What is the highest recorded age of any of US

presidents or vice president?

Mental Illness In U.S. Presidents

Between 1776 and 1974

• Eighteen (49%) Presidents met criteria

suggesting psychiatric disorder: depression

(24%), anxiety (8%), bipolar disorder (8%), and

alcohol abuse/dependence (8%) were the

most common.

• In 10 instances (27%), a disorder was evident

during presidential office, which in most cases

probably impaired job performance.

Davidson: The Journal of Nervous and Mental Disease 2006

Depressive Disorder

“Both read the same Bible”• Family Hx of depression/Bipolar ran thick

• When he was nine years old, his mother died at age of 34

• Had frequent bouts of depression around stressful circumstances and never carried a pocketknife with a fear that he will harm himself

• He was an honest shop kipper and lawyer and president of USA

• For a while, neighbors had to take care of him in 1835

• Absent from Congress and treated with bleeding and mercury pills

• “I should prefer emigrating to some country where they make no pretense of loving liberty-to Russia, for instance, where despotism can be taken pure, and without the base alloy of hierocracy.”

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Depression and Empathy Tempered

with Hardy Realism

• Honest Abe listened to both sides

• His painful early life experiences became the source of life-long compassion and concern for others.

• "I want in all cases to do right, and most particularly so in all cases with women.”

• Wrote about his feelings seeing lines of slaves chained in New Orleans

• Lincoln sought to comprehend the Southerners' position through empathy

• “When your enemy is most vulnerable, when you could hurt him badly, that is when you must not do it”

• Depressed people have more compassion and

affective empathy

• Empathy centers in insula and Anterior

cingulate cortex

• Depressed leaders may be not be an effective

if in current episode

• How many US vice presidents are still alive?

Mouth of the South and

Captain Outrageous

• Expelled from Brown University

• Father committed suicide in 1963, kept his silver pistol in his drawer

• From billboard company to radio stations

• 1980 his WTCG channel starts 24 hours news channel

• Challenged Murdoch to a fist fight, dangerous yacht sailing accident, frequently drove at 120 miles/hour

• Bouts of depression and mania, treated with lithium

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“They answer

question nobody

had yet asked, but in

doing so they

produced other

questions that

nobody can yet

answer.”

Creativity and Bipolar

• There are numerous studies linking creativity and Bipolar

• One study showed that executives are more likely to have bipolar traits as their siblings had more chances of having a bipolar illness

• These leaders are great in crisis or innovation and breaking boundaries

• They refuse to bow down, inspire others, has high energy and optimism

Kyaga, S., BJP 2011

“History will be kind to me for I intend

to write it.”-ChurchillMasqueraders of Illness

• Politicians are no wiser than boxing champion

in selecting to hang up their gloves

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• Three US presidents are born in 1946 only

nine weeks apart. Can you name them?

Anxiety disorder to Personality

Changes due to CVA

• Could not read till age 9 but masters photographic memory and shorthand

• Left law school due to nervousness as was rejected of love by his first cousin

• Became president of Princeton

• In 1896 he develops Writers cramp vs. CVA?

• In 1906 (left eye blindness) and 1913 (left hand) and advised to take it easy but denial prevails

Cover up and Making of First female

President (Unofficial)

• Married his second wife Edith

• Leaves the USA for Paris for 6 months while being president!!!

• 1919 develops and personality changes marked by paranoia

• Again in1919 developed CVA

• His Secretary, his wife, and Dr. Grayson decided to keep this as secret. Grayson testified in Congress that he had nervous indigestion and fatigue

• His wife Edith decided what will be presented to him by cutting off the cabinets senators

• Which states has produced the most

presidents

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Intoxicated with Power or Designer

Drugs?

• Developed Addison’s disease as a teenager but took years for it to be recognized

• Hurt his back in 1943 when his PT boat collided with enemy vessel but heroic effort saved 11 sailors

• Hyperthymic, witty and charismatic who was know for his high libido

• Multiple hospitalizations for infections and back pain and remained on steroids and indulged in Anabolic steroids too.

Intoxicated with Power or Designer

Drugs

• At times he took Max Jacobsen’s injections that contained testosterone, Amphetamines and narcotics

• Arch of Surgery published a case of how a 37 years old with Addison's disease was managed during surgery

• In a medical coupe, this habit was controlled by white house physician and brother Robert (and dismissing his own physician and Jacobsen).

• Kennedy after 1962 was much different than before

• Did he benefit with designer drugs?

Commander in Chief of Resiliency

• Born into a wealthy family in NYC

• Became a senator at the young age of 28

• Married his own fifth cousin

• Lost elections (as a senator in 1914 and vice president in 1920)

• Developed Poliomyelitis in 1921

• Refused to give politics and stayed on crutches for many years but stayed in the political limelight

• Became Governor of NY

• 1932 became president of USA for 4 terms

Resiliency Stretched too Thin?

Refusing to Retire

• Ran for fourth time in 1944 despite his illness in May 1944

• Died of CVA at the age of 63

• Some believe that he had cancer of the lung and should not have run for the 4th time

• Considered as weak against Stalin and gave in in regards to eastern Europe, Manchuria and Japan war

• Still in his last few months was able to keep US Atomic bomb project a secret

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Dementia

• Regan’s mannerism including stumbling over his words, his occasional falling asleep in public, his weak memory all suggested dementia

• His son thought he had dementia

• His house doctors denied it and neuropsychological test given in first three years did not show any decline.

• His speeches were analyzed later on and showed a possible cognitive decline

• There is also a likelihood that he had many head injuries resulting in CTE

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Snakes in Suits

• Psychopaths, Sociopath and antisocial PD

• Dark triad: Psychopathy, Narcissism and

Machiavellianism

• Machiavellianism is characterized by

manipulative tactics. These individuals will lie,

manipulate and exploit others to get their way.

• 3.5% of top executives scored highly on measures

of psychopathy, which is larger than the 1% found

in the general population.

Narcissism: Grandiose and Vulnerable

• Grandiose narcissism primarily reflects traits

related to grandiosity, aggression, and

dominance

• vulnerable narcissism reflects a defensive and

insecure grandiosity that obscures feelings of

inadequacy, incompetence and negative affect

http://journals.sagepub.com/doi/abs/10.1177/0956797613491970

Narcissism: Grandiose and Vulnerable

• Grandiose narcissism primarily reflects traits

related to grandiosity, aggression, and

dominance

• Vulnerable narcissism reflects a defensive and

insecure grandiosity that obscures feelings of

inadequacy, incompetence and negative affect

http://journals.sagepub.com/doi/abs/10.1177/095679761349197048

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Grandiose and Vulnerable

Grandious Vulnerable

Agreeable Negative Negative

Neuroticism Negative Positive

Extraversion Positive Negative

Self Esteem Positive Negative

Childhood

Experience

Prince/Princess Abused

Emotional

Dysregulation

Absent/low High

K Woven: Grandiose and Vulnerable Narcissism: Where Do the Emotional Differences

Lie?

US Presidential Ranking on

Narcissism Indices

Watts A: http://journals.sagepub.com/doi/abs/10.1177/0956797613491970

Productive Narcissist

and Secondary Narcissism? • Andrew Carnegie, Henry Ford, and John D. Rockefeller, Steve Jobs

were exceptionally productive

• They have great vision

• They have great followers

• Undeterred belief in self

• Not afraid to take a risk

• Seen as leaders in first impression: energy, dominance, self-confidence and charisma, all of which are characteristics associated with narcissism.

• Poor listeners, lack of empathy, disaster for mentoring, intense desire to compete and crush and less pro-social behavior

Charles A. O'Reilly:

https://escholarship.org/uc/item/8m364215

History

• Senator Barry Goldwater was running for the presidency in 1964

• Johnson campaign focused on the fact that he might actually use nuclear weapons as opposed to using only for deterrence.

• “In your heart you know he is right, In your guts, you know he's nuts”

• Fact magazine published a psychiatrists poll about U.S. Senator Barry Goldwater and whether he was fit to be president

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Goldwater RuleAPA Ethics section 7.3

• On occasion psychiatrists are asked for an opinionabout an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement [Ref. 2, p 9].

Arguments against

• Tarasoff’s like principle: duty to warn goes beyond

• We are commenting on dangerousness and incapacity and not disease

• Can it be a public education about a disease

• Is it ok to create a psychobiography of a dead person?

• Can it be used as an advantage for CIA or other organization? What if it becomes your job?

• Why can a psychiatrist not influence 25th amendment?