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IAbs~ract] The present study examines psychological characteristics of

Ge~rgian President Mikhail Saakashvili, concludes trom the analysis ofavailable data that he has certain psychiatric disturbances and makes

a diagnosis. The study offers also practical advicewhich should be followed

whi ledealingwith PresidentSa.akashvili. In view of its sensitivity the study isfor limited distribution only.We wish to acknowledge the contribution to the study made by:Tonsherg Psychiatric. Centre, Orsnessale, Norway;Nat!cnal Tnstituteof Public Health, Oslo, Norway;

Department of Psychiatry, Kuopio University Hospital, Finland;Ce.ntre for Nervous Deceases, Christian Atbrecht University, Kiel, Germany;

Dcp!!rt~en{ of Psychiatry, University of Geneva, Switzerland;Department of Psychoanalysis and Psychotherapy,University of Vienna Medical School, Austria;Department of Clinical Psychology, University of Amsterdam, Netherlands.

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1. Anamnesis and family historyInformation about Saakashvili's childhood and adolescence is insufficient. Raised in asingle-parentfamilyenvironmenthe grew much attached to his mother. Early in his life due to adeep emotional trauma he became very negative and aggressive towards his biological father.His relationship with his stepfather later in his life was also tense and bitter. He also haddifficultiesin undemanding and e~tablishingrelationswith other people of his age and was oftentreated as an outcast and a "loner". This situation was partially corrected and his social skillsimproved when in high school he joined a school theatre group and took part in some of itstheatricalproductions.

At the same time, together with some other classmates, he became actively involved in an amateurfilm production, including pomo films. When this incident finally became public and a scandalbroke at school he had to leave his homctown and went to Kiev. During the following period heimmersedhimselfinto a lifestyleof destructivebehaviour,parties and sex. His apartmentatthat time was often offered to his fetIow studentsand friends as a place for intimateencounters and he used this as a way to gain popularity and establish his place in the "in crowd".By the end of his freshman year he got involved in yet another confrontation with theestablishment and was expelled from Komsomol organization. In order to calm things downhe volunteered in the Anny and spent two years in service.

2. Behavioural pattern~The overall partem of SaakashvjJj's social behaviour is defined by persistent conflictexisting.between this exteriorized behaviour a.ndhis internal emotional component. Whiledemonstrating and often exaggerating his sincerity, expressivenessand communication skillson the outside,he presents all the signs of internal tension,nervousness,suspicion and emotionalvulnerability.The nonverbal component of his behaviour is especially representative andinformative in this respect. While his facial expression is usually lively and matches thebehavioural context, his gesticulation (his hand movements tend to be uchopping-like" withpalms being constantly spastic and this "closed-inUpattern doem!t change during the wholeperiod of verbal communication,even when the communication environment is in its mostpositive and favourablephase),body postureand rigidbody languageare all out of context

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On the scale of motivational factors his fOOitionon pride and self-esteem and his egocentrismprevail over altruistic tendencies and public interests that he pretends to demonstrate in public.This detemUnes his inability to adequately control his internal outbursts of resentment when hefeels that he is not being appreciated enough. These outbursts may happen even when heconsciously and sincereJy intends to express his loyalty and readiness to cooperate with thecounterpart. Saakashvi1i has demonstrated th.8the finds it difficult to organize his thoughts andexpress himself when he is being coniTonted with unexpected, compHcated and personallyunpleasant issues. Though in general be has a fairly good level of verbal skills, under the abovecircumstances he tends to get confused and resorts to obviously meaningless, lengthy andempty wording in order to avoid a clear-defined and down to business answer and thus intendsto oVeIWhelmhis counterpart. A situation when during one of his public appearances he wasaskedabout his income can be a good illustrationof such a pattern of behaviour.

Extremeegocentricity of Saakashvili's personality often becomes an obstacle for himself whena situation is cal1ingfor a fresh and original ideas and spontMieousreactions. He intuitivelyrecognizesthis constraintand tries to mask his egocentrism by acting out in a verbose andextremely eloquent manner, expecting to produce a "spell- like", mesmerizing effect on hisopponents.

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Saakashvili's behaviour consistently demonstrates that his emotionaJ response and his abiJityto express signs of excitement and genuine interest primarily occur when his persona., hisexceptionalityan-dsignificancebecome the centretopic of the discussion. He looked exited andradiant,if not happy. when he Wasonce posing in front of hjs car, showing bullet holes in thewindshield.To him the fact that he was a "target"of an assassinationattempthad put him in linewith other world leaders and dignitaries. His exaggerated, theatricaJ and openly deliberatepersonal style nevertheless lacks spontaneity, easiness and showmanship, so typica1forother hysteroid types.

3. Psychologicalaspect3.1. Intellectual component IQ level is above average with active type of reasoning, goodlevelof abstract and analytical capabilitiesand ideation. Subject's ideation activity on onehand combines impulsiveness,tendencyto followemotional logic and initial internal impulseand on the other hand above average ideationrigiditywith tendency to constantly conceptualize,create static, emotionally saturated ideas and groups of ideas, capable of asserting theimportanceand exclusivity of his own personality.Due to the extreme rigidity of these ideasSaakashviliisopen onJyto the informationthatagreeswith his conceptual structure and he totallyexcludesthe rest that exists outside this scope.Taken to the extreme, this tendency may beCQmetransformedinto megalomania, obsessive or maniacal syndrome characterized by a personalconvictionof being destinedto be the "chosenone",

Thoughhis general education level is above average and his ability to form channels of verbalcommunicationis sv.,ift,smooth and even with a hint of artistry, his reasoning Jacks depth,originalityand independence. Pretending to be special, creative and exclusive his reasoningnevertheless is rather ordinary, predictable and often based on common knowJedge andplagiarism.Finding himseJf in an unexpectedsituation or being confronted with unanticipatedquestionshe finds it difficu]t to come up with the right answer and in order to save his face hebecomesverbose,sidetracksand eventuallyswitchesto othertopics.

3.2. Motivational component. Subject's general level of activity is noticeably elevated.Primary motivational factors include ambition, vanity, superiority, extreme competitivenessand dominance. We may assume that Saakashvi1i's low self-esteem and compJex ofinferiority,both formGdearly in the childhoodbut suppressedat present, have determinedhisstTOngurge for power. These dominant internal factors have transformed through hypercompensatorymechanism of defence into partialand at times complete loss of sense of reality,adequatebehaviouralresponseand capacityto perceivecontextualreality.

His overwhelming egocentric desire for se1f-affirmationand strong conviction in personalsuperiorityput him into a position when his politicalcareer becomes only an instrument in hisquestto gainsocia1rccognition that he has been denied for so long. He is so overwhelmed withthis interna]passion for proving himself at all times that he is not capable to accept the civicvaluesof the society that once rejecte-dhim. We may only expect that this win lead him intomoreconflictswithtilissocietyin the future.It is importantto recognizethat in his pursuitforpowerhe may easily loose the sense of danger and natural fear of consequences of his owndecisionsand this makes him capable of provokingserious conflicts, including political andmilitary.

33. Emotional component Emotionalexcitationlevelis above average.His personality tends topresent stab1esigns of hyperactivity, elevated 1evelsof emotional status, excessive self-esteem and extremely high ex-pectations.He is very active, vigorous and resourceful inachievinghispersona}goals.At thesametime,beingextremelyself-centred,he can be easilyheart, tends to hold a grudge and be very emotionalabout it, even to the point of seeking

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revenge. His exterior emotional manifestations are expressive, intense and at time theatrical.He easily develops internal tension and becomes defensive, negative and jealous towards people,who herecOgni7..eSas surt-'assinghim in something.

4. DiagnosisExpansive type of paranoid dysfunction (according to ICD-IO) combined with narcissist type ofhysteroid personal1ty.

Paranoid aspect is translated into excessive intellectual and emotional rigidity, tendency to"getting stuck" and form fixations on certain ideas and concepts. In case of Saakashvili thismay have been caused by extremely high emotional status of his past experiences carrying aspecialsignificancefor him.

Saakashvili's personality is characterized by typical for paranoid types excessive self-esteem,hypertrophied sense of pride combined with excessive sensitivity towards failure and negativesocial response. He attaches special importance to everything that is related to his ownpersonalityand his personal interests.At the same time anythingexisting outside this "personalcircle" becomes exc1uded fTom the domain of his active attention. Saakashvi1i presentspersistent tendency to put himself in opposition with the rest of the society and perceive theworldaround him as a hostile environment.As an obvious responsehe expresses this perceptionin a form of extreme vigilance and distrust towards others.

He is incapable to act based on idealistic motives and rejects this ability in others. He is prone tosuspect others of being unfair, insolent:, and envious, with intentions to humiliate, insult, entrapand dishonour him. Above described personality disorders could be observed in Saakashvilisince very early in rus adolescence and throughout his adult life.

Saakashvili's tendency to create super ideas is especially typical for paranoid dysfunctions.Super ideas totally enslave the entire personality and completely determine its behaviouralpatterns. One of such super ideas thatkeep Saakashviliobsessedat the moment is his pursuit forpowerand self-promotion.,-

A distinctive feature of Saakashvili as of an expansive paranoid type is his vigour, dynamism,at times even restlessness and disregard for rest andfatigue.

Saakashvili'snarcissism combined with hysteroid traits determines his pathological ambition,aITogance,sense of superiority and exuberantly high opinion about himself. He is irrefutablyconvinced in his own righteousnessand personal importance, is intolerant towards any fonn ofcriticism and tends to exaggerate his personal accomplishments.His ability to work effectivelygoesalongsidewith desirefor publicattentionand admiration. His decision to choose politics asa profession was a very natural choice for him, since he wouldn't have got himself involved inanyotherfieldthathadn'thadpromisedhima speedygratificationin a fonn affame andpublicrecognition.As most of narcissistshe lacks empathy, is indifferenttowards other people's needsand feelingsand "perceivesthe rest of humanityas facelessapplaudingcrowd".

5.RecommendationsTaking into consideration the combination of paranoid dysfunction with hysteroidsymptoms that dd'im: Saakashviiias a person, we offer the following recommendations with thepurpose of creating an atmosphereof personaltrust and opennesswhich may open a window ofopportunityfor loweringhis self-controland predisposehim to act in an openand sinceremaIIDer:

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It is advisable that the counterpart (interlocutor) should demonstrate an obviouslypositive intention in a foml of expressing sincere interest in Saakashvili'spersonaJityand demonstratingappreciationand "proper"recognition.Contrast approach: initial phase should include a demonstration of interest ineverything concerning Saakashvili's personality, his merits, praise his real andnonexistent accompJishments and then introduce a comment putting thisstatement under a shroud of doubt. We expect that under the circumstancesSaakashvili may try to substantiate his "reputation" and talk more than it wasinitially intended. .Tt is possible to motivate Saakashvili t.o repeat his discourse about a situation ofcertain importance and demonstrate a degree of scepticism. Under this sort ofpressure. hysteroid types terydto exaggeratethe fictionalcomponent and add new detailsin order to make it al1 look more credible. Often these additional details arecontradictory and thus add new semantic shades to the whole narration about thesame account. This may open an additional ground to add questions, single outcontradictions and request clarifications.It is very probable that Saakashvilihas low tolerance towards infonnation deprivation,anticipation, inactivity and loss of interest towards himself. Being forced to operate insuch a context he may initiate a communicationprocess, may develop a desire to "speakhimself out" and attract attentionall for the singlepurpose of maintaining the status ofthe focal point of the public interest. Anyone potentially capable to offer him suchan opportunitymay become awelcomepartnerfor SaakashviIi.Being the type of a personalitythat existswith the conviction that "he knows best" and isready for competitionat any time, he tends to reject any action that he perceives ascontradictory to his publicly expressed views about a particular situation. In order tomotivatehim to act in 8 preferred way he should be convinced that in this particularsituation he is in charge of setting goals and findingways to accomplishthem.

5.1. Be aware of:Under no circumstance use imperative tone or give him a reason to believe that he isbeing humiliated or disrespected and even more so if it is done in public. Incase that he is stuck in controversies it is advisable to anow him to find his wayout in order to save his face and even, if it is needed, offer him a suitable and honourablerout of escape.At the same tjrne~it is advisable not to give in all the time. His personality typerespects power and any indisputable authority generates a sense of respectin him and desire to be part of this force and use it for his own benefit.

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