Successful leaders possess a personality disorder, and a modicum of psychopathology is a prerequisite for exceptional performance. Influenced by recent advances in neuroscience and genetics, I argue in a book that leadership and followership are evolutionary adaptations that developed in order to enhance group cohesion, to maximise chances for survival and reproduction, two basic functions of living organisms. A prodigious leader should enhance, or appear to enhance, these two imperatives. Therefore, leader emergence must be biologically determined and, consequently, heritable, as we observe in the animal kingdom, where pecking orders and hierarchies are genetically determined.

Personality traits, and I suggest tendencies to assume leadership roles, are genetically based. Neuroscience teaches that epigenetic characteristics (acquired structural changes that affect the expression of DNA) are also heritable, providing evidence to support the influence of experience beyond genetics.

It follows that either genetically or epigenetically (or through a combination thereof) leadership emergence is rooted in our biology; survival of our species would have otherwise been greatly endangered. The book demonstrates that certain personality traits are more conducive to leadership ascendance than others. A dependent personality, for example, would be poorly prepared for leadership versus an extrovert.

In studying notable leaders throughout history, I concluded that paranoia confers leadership characteristics on humans because it combines attributes such as extroversion (a paranoid is more up to expressing himself and declaring his beliefs, especially when challenged), a characteristic mastery of language (good handle on its constructs, abstractions and innuendos, and targeted, straight-to-the-point messages), and a charismatic personality. Moreover, the paranoid type possesses skill in verbalising his constituents’ wishes and goals, as well as potential or real threats; he therefore projects a leadership persona.

The question is how much paranoia is necessary? A person with no paranoia would be indecisive and ineffective. Conversely, an extremely paranoid person would be marginalized by his psychopathology. A mild degree of paranoia, which is conferred biologically on relatives of people with severe psychotic disorders, enables leaders and their organizations to succeed. There are many historical examples of great individuals who numbered psychotic members in their families. Einstein, for instance, fathered a schizophrenic son. Goodness and badness appear to cluster in families. Carrying this fact further, I hold that schizophrenia, along with other related psychotic conditions, is the illness that made us human by supplying mildly affected individuals (relatives of schizophrenics) who excel in the arts, literature, politics, religion, leadership etc. They define our culture and our ‘humanness’. ‘Normal’ individuals from average families are not endowed with leadership potential but constitute suitable followers.

Another contribution of schizophrenia is the development of language which connects us to our past and future and enhances the development of culture and civilization. In support of the role of this biological and uniquely human illness, is the fact that it affects all societies, past and present, at a constant frequency despite its tragic consequences; for this reason alone it should have been eliminated by evolution, however it persists precisely because it promotes and maintains necessary attributes for our survival and culture as argued above.

Too much paranoia would eventually lead to disaster as the example of Adolph Hitler clearly points out; Churchill was also paranoid but not in psychotic proportions, just enough to foresee dangers lurking and prepare his nation’s defense. Integrity emerges as another key ingredient for successful leadership because it brings about the so-called reparative charismatic leadership, whereas its absence promotes destructive charismatic leadership; Martin Luther King is an example of the former whereas Jim Jones, who initiated and promoted mass suicide in Jonestown, Guyana, of the latter.

Depending on the culture, historical circumstances and issues at hand, a leader-follower dyad emerges. Leaders stand out; they are not ‘typical’ members of society. The difference they carry is a deviation from expected behaviors and may be labeled abnormal or pathological. They are often permitted by constituents to deviate from norms in order to achieve goals and overcome vicissitudes. Following the tragic events of 9/11 in New York City, Americans were more accepting of governmental mingling in their privacy in order to enhance their security. Europeans are slowly permitting their governments to monitor their lives in order to combat terrorism.

Leadership attributes therefore combine the gift of language (and persuasion), charisma, extraversion, sensitivity for their followers’ wishes, and paranoia; these attributes are genetically linked through human evolution and endow leaders-to-be. These biologically heritable qualities form the core of successful leaders’ personalities.

Paranoid personality is contrasted to other leader types that are not as effective in the long-run; the narcissist tuned into himself, not the followers, who eventually fails; the psychopath, with propensity towards lying and deceit, lack of social concern and conscience, who eventually brings destruction to his followers. Threatening times are conducive to the rise of charismatic and messianic leaders, attuned their supporters’ anxieties; thus we can explain unforeseen voter choices such as Brexit and Mr. Trump’s election.

Any organization that faces competition or hostility, be it a nation or a commercial company, would benefit from a leader with a mild degree of paranoia. Boards and stakeholders, in addition to voters, should keep this in mind. Managers are ‘picked’ by Boards and stakeholders and are expected to exhibit effective leadership and company success in terms of profits and growth, but not necessarily charismatic human resource management. Situations where leaders rise spontaneously, or by consensus, require the presence of the attributes identified above. Managerial leaders who possess these attributes will be successful not only in the eyes of their Boards but, also, by the judgement of their subordinates. Boards should vigilantly monitor their executives’ behavior to identify personality traits of psychopathy or narcissism and avert phenomena such as that of Barings Bank.

Through coaching, guidance, and personal experience, people may develop the ability to perform leadership acts; the closer the match of their personality to the leadership core characteristics is, the more successful a leader will be.

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Savvas Papacostas is Senior Consultant Neurologist and Head of the Epilepsy and Behavioral Neurology Clinic of the Cyprus Institute of Neurology & Genetics. He completed his medical studies at the University of Ohio and a combined residency in Neurology and Psychiatry at the University of Rochester. He then undertook a fellowship in Clinical Neurophysiology and Epileptology at Columbia University, where he was appointed Clinical Instructor in Neurology at the faculty of the Presbyterian Hospital. With the establishment of the Cyprus School of Molecular Medicine, he was appointed Professor of Neuroscience. He has also held a visiting associate professorship at the University of Cyprus in Nicosia as well as an adjunct associate professorship at the University of Rochester.