Another notable example of this controversial trend is provided by a writer (Abse, 1989) who wrote a book purporting to ‘explain’ the phenomenon of Margaret Thatcher. It was widely applauded by people who loved Margaret Thatcher, and widely denounced by people who hated her.

Bokassa.
“The extrapolation can be extended back to biblical times. King Nebuchadnezzar of Babylon suffered from what was obviously a psychotic condition.‘Emperor’ Jean Bedel Bokassa of the Central African Republic who declared his impoverished African country an ‘Empire’ with himself as ‘Emperor’ over it was the subject of much speculation about what seemed to be grandiose and paranoid symptoms he exhibited in office.”

Other Issues pertaining to Mental State Testing

Would, or should – even the confirmed presence of a psychiatric illness automatically bar a person from eligibility for political office?
Some years ago, in the run-up to a local government election, there were sensational newspaper headlines about a politician who was accused by a rival of ‘once being a patient at Aro’.
The issues to be considered here include the anti-stigma campaign championed by all mental healthcare workers, and the fact that people with histories of formal psychiatric illnesses (like John Nash) have won Nobel Prizes and are holding down sensitive jobs in Industry, in the Judiciary, as well as in Medicine and the Arts.

Where is testing currently being employed?
Work: A major area of current use is in pre-employment screening, especially for senior executive/management positions in some industries. These tests are usually conducted by psychologists, and are not looking for pathology but focused on such things as aptitude, judgment, personality types/temperamental attributes. They are used by recruitment firms to select between eligible candidates.

Some people are rightly skeptical about the value of such tests. What, for instance, is the ‘right’ personality type or attitude for a Chief Executive of a car manufacturing company? Are they different from those required for the head of a Nursing Home? Is there a place where Science stops, and Instinct takes over? In any case, the test instruments do not purport to determine that one candidate is ‘normal’, and the others ‘abnormal’. The final choice is still left to the panel. The spectre of the ‘rejected’ candidate at one executive placement interview going on to flourish visibly in another company is a very familiar one.

Adoption: The statutes require that a couple requesting to adopt a baby should undergo a test of ‘mental fitness to adopt’. It is very loosely interpreted.

Legal and Forensic: In situations where it is necessary to establish Mens Rea (either due to a plea of ‘Not guilty by reason of Insanity’ or at the instance of the court on account of the nature and circumstances of the case), or to establish ‘Fitness to Plead’.

Kwame Nkrumah.
“There is a subjectivity to speculation about other people’s mental health based on their public image or behaviour. The observation may be coloured by the attitude and political sympathy of the observer. A writer (Vertzberger, 1990) described how some ‘experts’ speculated, based on his behavior and pronouncements in office, that Kwame Nkrumah suffered from a paranoid condition. Obviously, many Africans with a pan-African passion, including psychiatrists, would have disagreed with such people.”

Airline Industry
There has been a clamour lately, based on the experience of the Germanwings flight 9525 that was taken down in France by a 27 year old suicidally depressed co-pilot – Andreas Lubitz, leading to the deaths of 144 passengers and 6 crew members, that compulsory and regular mental state testing should be instituted for airline pilots. This arrangement is not yet universally in place. Even where a pilot is receiving treatment privately from a psychiatrist, the protocols that would created an obligation to report feared ‘dangerousness’ to an employer without the consent of the client is still under discussion, a case of the doctor-patient confidentiality potentially clashing with the larger good of all.

What Value – the Test?
In the Legal and Forensic area, the outcome of the test may be literally a matter of ‘life and death’. In the airline industry, the stakeholders are still groping for the right solution that would protect everybody’s interests, including the passengers, without violating the rights of the pilots themselves. In some of the other areas, the value may be somewhat more dubious.

Why the clamour for Psychiatric Testing for Politicians?
While Prof Adeoye Lambo may have provided a professional face to the clamour in Nigeria for politicians to be tested, the perception that some politicians are ‘mad’ is a widely prevalent one, even now. The real issue, in taking this attitude, is that there is a perception that people are driven into politics not by an altruistic desire to do good and improve society, but by a selfish desire to amass wealth and power. The real complaint therefore is about Ethics and the tendency of a class of people all through the past years of military and civilian rule to behave persistently in ways that are detrimental to the public good. Apart from this, some politicians dislike other politicians intensely and would often label them ‘mad’. A good example is how Mummar Ghaddafi was labeled ‘schizophrenic’ by his Egyptian counterpart President Anwar Sadat because they never agreed on anything.

Mental Health, Ethics, and Political Conviction. The issue of ‘Personality’
One of the foremost figures in Psychology (Eysenck, 1956) wrote on the peculiar fact that there were observable similarities in the personalities of politicians who held extreme political views at both ends of the ideological spectrum – Fascism and Communism. It would have been very fascinating to learn if he would make a similar pronouncement about the personality of the religious extremist such as Boko Haram or IS in the present day.

Hugh Freeman (Freeman, 1991) quotes the anecdotal observation of another writer – Dixon, that people ‘who are unfettered by moral scruples, who are prepared to lie or cheat their way to the top, who will make promises they cannot keep and may even assassinate their rivals have a huge advantage over those held back by moral scruples’. It sounds like a page out of Machiavelli!

At a surface level, if Freeman’s source is to be believed, a certain streak of Sociopathy may come in handy in the struggle for political office. Unfortunately, after attaining the office, the requirement for a successful public service is described in such words as consideration, empathy, transparency, and commitment to the public good, which are very different from the attributes that facilitated the attainment.

Politics and the Psychiatrist – a slippery terrain
If psychiatric testing were to be accepted as policy, who would be the candidates? Is it ALL politicians? (Unwieldy, unmanageable, in the light of existing dearth of manpower). Is it only those vying for high office? (Governor, Senator, President?)
Any level of testing would automatically make Psychiatrists the ‘gatekeepers’ of the political space, with all the dangers and temptations this embodies.

The Dangers and Temptations
One of my teachers during my years studying to be a Psychiatrist was a charismatic, world-famous psychoanalyst in the Freudian tradition. Every so often, this great teacher would be caught shop-lifting in the city of Edinburgh. This was a sad failing of his, and one day because he knew the rumour had spread round, he actually mentioned it in class, ending on the note that every time it happened it showed him that he needed still more intensive psycho-analysis himself to deal with his underlying problem. What this taught me was that psychiatrists were themselves potentially flawed human beings like the rest of society, and not necessarily disinterested observers dealing with the frailties of other people.

In the same way, in the area of Politics, psychiatrists are not necessarily dispassionate specialists practising an objective science, and passing judgement on their clients. To give but one example, during the Nazi era there were well-known German psychiatrists who supported the Nazis and labored to justify the ‘eugenic’ experiments they were carrying out on live human beings in scientific terms. In the same way, in the old Soviet Union, there were allegations that psychiatrists diagnosed illness in people who held dissenting views and forcibly admitted them into hospital ‘for treatment’. Western Psychiatry, vociferously led by the Royal College of Psychiatrists, UK, rose in protest that was heard all over the world. There were allegations about unethical practice in apartheid South Africa. And my own experience working in newly independent Zimbabwe revealed that there had been racial segregation and official discrimination in the handling of patients by the ‘white’ mental health work force.

The Limits of the Psychiatric Test
1. It will not show conclusively who will steal from the public purse, and who will not deliver on his promises. It may show attributes of personality which suggest that an individual may not be motivated by ‘social interest’. However destroying a career on the basis of ‘personality’ is getting into very murky waters, and will be certain to excite controversy.

2. A formal test will turn up information on family history, and past psychiatric history. It will make a judgment on the individual’s present mental state. All of this will reveal if a person has been ill in the past, or if he is currently ill. Illness ranges in a spectrum from the transient ‘minor’ Anxiety disorder to the ‘severe’ Psychotic disorder. The implications for function and recovery vary across the spectrum, and so no generalization can be made. If a person is ill currently, he obviously needs to be treated. What about the person who had an acute psychotic episode five years ago, and has been well since? What about the person who has Bipolar Affective Disorder, and is stable on treatment? What about the person who falls ill in office, is declared temporarily unfit, is treated, and gets well (like Nebuchadnezzar!).

What is to be done with the information?
After the rigmarole of testing, what indeed is to be done with the information? Is there any bond of confidentiality between the doctor and the patient? Is the person who is ‘ill’ or prone to major illness to be ‘banned’ or quietly advised to withdraw, or advised to get treatment and stay on it? Is the information ‘private’, or is the public entitled to it in order to make an informed choice?