Bush on the Couch: Inside the Mind of the President [Paperback]

The reader who keeps an open mind about Adult ADHD (Attention-Deficit/Hyperactivity Disorder) will find this book an eye-opener and its author incredibly astute and prescient.

Dr. Frank extensively and authoritatively documents his suggestion that Bush has Adult AD/HD. In fact, he does an astounding job linking untreated ADHD symptoms with Bush's lifelong patterns. In so doing, he demonstrates that, when ADHD is not recognized (in the child or the parent), fatal personality flaws might develop from what initially were minor or at least treatable symptoms.

For that reason alone, this book should be at the top of the bestseller list. Bob Woodward's book excellently records the facts of all that's transpired during this administration, but what's missing in his and all the other accounts is the WHY. The pundits always seem so flummoxed as to why Bush has done the things he's done - as if his actions have been deliberate and calculated, not unwitting but troubling neurobehaviors.

I read the first edition when it came out, so my memory is a bit foggy about that version. But I seem to recall that edition as being a more heavily swayed by the psychoanalytic side, which disappointed me. Moreover, psychoanalytic theory too often misses the genetic inheritance; that is, that the child has most likely inherited his or her brain "wiring" from one or both parents. For example, if the mother is narcissistic, did her behavior make the child narcissistic or did the child inherit the neurogenetic tendency to be narcissistic? After all, low empathy is a function of the brain; and narcissism is associated with low empathy. Could anyone witness Bush during Katrina (and many other examples) and not shudder at his obvious lack of empathy? It was quite obvious to me that he simply did not, could not, feel any.

To those long befuddled about why Bush motivations and "persona," here are some very good answers. The irony is, when it comes to neuroscience, too many in the "liberal media" are as anti-science as some of the people they criticize in their writing. But if you're going to argue for evolution, you should argue for science as it affects the brain, too.

PLEASE keep in mind that ADHD has many different manifestations. It is a syndrome. There is no one-size-fits-all descriptions for ADHD, and most people ADHD are not like Bush or even close! But, as Dr. Frank makes clear, Bush suffers from his own personal variation of the core deficits of impulsivity, hyperactivity, inattention, and dysregulation of temper -- complicated by an unusual family situation (to say the least).

Yet, to many Americans, Bush's impulsivity and impatience at working through ponderous details initially looked like "decisiveness." His inability to accurately assess risk and apply forethought was seen as "confidence." His intolerance for sustained mental effort was seen as a "CEO President" doing a heckuva job delegating. But oh, how dangerously wrong those perceptions were.

Until voters learn to recognize the signs of neurocognitive disorders, they will keep making ghastly misperceptions -- and our country will keep suffering the fallout. Untreated and unrecognized ADHD hurts mostly everyone: the adults who have it, their loved ones, and -- with the leader of the free world manifesting untreated, unrecognized ADHD symptoms -- the entire globe. It should be a sobering thought for every voter.

So, the part of the book I found most substantive was that which focuses on Bush's likely ADHD symptoms and explaining them in light of neuroscience. The rest -- the psychoanalysis - seemed a bit more like story-telling. Maybe true. Maybe fantasy. And, on the whole, not that useful, in my opinion. On the other hand, neurocognitive deficits are a lot more quantifiable, and obvious.

Examples from the book:
--"Impulsive, hair-trigger responses to real and perceived threats are also common for people with ADHD, who often act before determining whether the threat they perceive is in fact genuine."

--"To make matters worse, ADHD is often found to coexist with other learning disorders, the most common belonging to the family of dyslexias....Because the erratic attention span, impulsivity, and restlessness that are the primary symptoms of ADHD can make reading difficult, ADHD can mimic dyslexia, but they are two separate disorders. Bush's dyslexia is not officially documented, but his reading habits are, and they reveal several earmarks of the disorder. He has said repeatedly, with a pride that might mask defensiveness, that he does not read newspapers."

--"People with untreated ADHD can have difficulty functioning as members of a social group, because they find it hard to follow substantive discussion and social interaction. Finding it too hard to grasp thoughts coming from multiple directions, they often resort to telling jokes and disrupting the proceedings; they content themselves with being one of a group of fun-loving people, and avoid more serious interactions."

Another reviewer pointed to some of Bush's foibles as possibly being the result of cocaine or alcohol abuse. I would turn that around. It's well-known that many people with certain brain disorders "self-medicate" with substances; they are thought to be trying to calm the noise in their brains and find focus. In fact, adults with untreated ADHD suffer a higher risk of substance abuse, and these substances can stretch the gamut from overspending or overeating to excessively smoking cigarettes, drinking alcohol, smoking marijuana, viewing porn, and even talking too much. Some even pursue sports in an extreme way (daredevil mountain-biking, for example) or perform other physical risk-taking activities.

Incredibly, some adults with untreated ADHD even self-medicate by initiating conflicts; the adrenaline quiets a too-noisy inner state and they feel eerily peaceful amid the tension.

Finally, it's ironic that the public sees only the risks to stimulant medications (which in fact are among the safest medications studied), not the risks from the alternatives. But the biggest risk comes from ignorance that ADHD is real, and it's considered even more impairing than disorders such as depression and anxiety.

Denial about ADHD is hurting us all - in our private lives and in our public lives.

Gina Pera

Dr. Frank's insights into our tragically flawed, incurious and destructive 43rd president are first rate. This new edition, an easier read than the first, is both penetrating and profound on every page, and the elegant epilogue alone fully justifies the price of the book. It is intriguing to compare this work to GWB's own just released memoir, Decision Points. It seems to me (admittedly as the author of The President's Therapist: And the Secret Intervention to Treat the Alcoholism of George W. Bush) that in denying the facts of his abusive upbringing, "forgetting" that flamboyant huckster Arthur Blessit brought him to Jesus (naming instead rather more acceptable Dr. Billy Graham), and so strenuously asserting, on page one, no less, that not a drop of liquor passed his lips while he was president, Mr. Bush merely confirms Dr. Frank's central thesis that the management of anxiety is the key to understanding the late president's essentially infantile personality. Dr. Frank does an excellent job of dissecting W's use of frat-boy sarcasm as a persistent coping device, permitting him to evade the need to provide serious answers to serious questions. Some readers might argue that Bush On The Couch is insufficiently objective, too much the polemic. Unfortunately, as history will surely judge, the GWB presidency was an American tragedy of such proportions that to attempt to be "fair and balanced" is to fall into a Catch-22 conundrum. Sure, parts of George W. Bush's heart may have been less addled than others, but no matter his intentions, W served the dark side of human nature for eight years, ultimately delivering, to America's eternal shame, incompetence, lies, cruelty--and sheer evil--on a breathtaking scale. I happen to agree with Dr. Frank that the American media bear much blame for so cowardly succumbing to the bullying ways of the 43rd administration; it might be fitting, therefore, to remember "The Second Coming of 43" a sonnet by Ethan Alter, apparently written while watching the live, all-networks broadcast of George W. Bush's 2005 inauguration address:

From heaven we look down upon your tongue
and ponder on past promises eclipsed,
as sycophantic aides you strut among
who hail your empty words and arrant quips.
For flowers were never strewn at our feet
and siren songs for us were never sung;
our mission met a deadlier drumbeat
as vaunted claims of conquest came unstrung.
Yet still you swagger, surly as you bleat,
propped by opulent puppeteers galore,
and fawning, fulsome phrases of deceit
come wafting from your acquiescent jaw.
Those words hang briefly in the air like chaff,
but your lies will rise as your epitaph.

--Ethan Alter
20th January 2005

Whether you love or hate President Bush, or believe or disbelieve the analysis here, this is a serious book about the application of the latest psychoanalytic techniques.

That said, I found many of the author's examples of the President's behavior, just a bit too facile. Most of them could be explained equally as a result of his intense alcoholism or perhaps as a result of a brief but intense cocaine habit, neither of which were dwelled on at any length by the author. Thus the highlight of the book is not so much belief in the author's "psychoanalysis-at-a-distance," as it is in his comprehensive outline of, and use of Melanie Kline's paradigm for psychoanalysis.

As one who did read Dr. Henry Murray's psychoanalysis of Hitler, as well as Valmik Volkan's analyses of Richard Nixon (A Psychobiography of Nixon) and Anthony Storr's excellent Freudian analysis of Sir Winston Churchill, Franz Kafka and Sir Isaac Newton, I can say without a doubt that the tools of a serious psychoanalyst are prominently on display here. The book is worth five stars alone for demonstrating how Kline's psychoanalytic framework is to be put to good professional use.
If he had called his work "psychobiography," instead of "psychoanalysis," I would have felt better about the analysis, and perhaps would have given him a pass.

Giving the author his just due, the outlines for a sound psychoanalysis are certainly in place here, especially in regards to the inconsistent, if not poor parenting received by George Jr., from Barbara and George senior. But as he so carefully notes, that was a function of the pre-Freudian times that they became parents. And while Kline's analysis places a preponderance of weight on developments during the formative years, they are far from the full story.

There are still just too many other intervening variables that the author could not have "tapped into" that could have had an equally decisive impact on the development of the President's character and personality. At the very least a personal interview should have been required to confirm the author's findings. Otherwise these results must remain tentative and preliminary, if not just plain suspect.

Despite these nitpicks, this is a fine piece of work, not at all the unbalanced piece I was expecting. Five stars