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