What a U.S. Psychiatrist Saw Behind Closed Doors in Russia | Ken Dekleva

Overview of the Role

A U.S. State Department psychiatrist, Ken Dekleva (discussed throughout the interview), describes his work as a regional “on-call” mental health provider covering much of the former Soviet Union and beyond. He explains that the job often meant responding to urgent crises—sometimes only by phone, sometimes requiring travel—to support embassy personnel and their families across many countries. In his words, the responsibilities could feel like being “on call for half the world.”

What His Work Covers

Dekleva distinguishes between:

• Common outpatient needs, such as:
  • anxiety
  • depression
  • ADHD
  • stress-related illness
  • alcoholism (often only reaching care after significant deterioration)
• Occasional high-acuity cases, such as:
  • suicidal patients
  • rare instances of psychosis or mania, which may require evacuation back to the United States for evaluation

Beyond diagnosis and treatment, he emphasizes that care in these environments involves supporting the mental wellbeing of people who may not be his patients—especially diplomats’ children. He notes that trust in psychiatry is low, and that the environment itself can be psychologically destabilizing, increasing stress and anxiety even without a formal disorder.

The “Embassy Ecosystem” in Moscow

In Moscow, Dekleva describes the embassy environment as intense, high-stakes, and constantly monitored. He reports:

• Pervasive surveillance and harassment by Russian security services (FSB)
• Bugged housing and computers
• Social pressure and routine police stops designed to wear people down
• A need for secure embassy spaces for sensitive conversations
• A feeling that “you are never alone”

He also describes how some people struggle to tolerate these conditions. To cope, he developed strategies—often encouraging rotations and rest breaks, such as flying to Western Europe every couple of months. He adds that his documentation of these psychological stressors helped support hardship allowance and related policy backing.

Model of Care: Treat Families, Not Just Missions

A central “model of care” theme is that clinicians must treat families as well as the mission. Dekleva ties this approach to a special-forces philosophy attributed to Robert Marsh:

Caring for the operator requires caring for the operator’s family so the individual can focus on their mission.

He describes “house call”-style interventions, including reassuring children after targeted threats and attempted break-ins even when there was no psychiatric disorder—framing the effort as stress support and stability rather than clinical treatment for a diagnosable condition.

Psychiatry and Geopolitics: Case Examples

Dekleva portrays psychiatry-for-diplomats as inseparable from real-world geopolitics and security, citing experiences across several regions:

• Ukraine / Kiev: initially delayed by visa issues
• Mexico and Central America: extensive travel to consulates and care across multiple regions
• Cuba: hostile counterintelligence dynamics, including being followed by Cuban handlers/informants and navigating access and harassment around the U.S. interest section

He describes social events where adversaries could still interact as humans, while also acknowledging that intelligence recruitment and manipulation attempts occur within those same environments.

Profiling Political Violence and Mass Killers

The interview shifts to Dekleva’s long-running interest in “profiling” political violence and mass killers using psychiatric and psychobiographical frameworks. He connects his career to Dr. Gerald Post, founder of the CIA profiling unit, and discusses early academic profiling work involving figures such as:

• Radovan Karadžić (a psychiatrist-poet implicated in genocide)

Genocide Requires More Than Individual Pathology

Dekleva argues that genocide depends on more than individual pathology. Instead, it requires:

• dehumanization
• propaganda that manufactures hatred before violence

He compares patterns across genocides such as Rwanda and connects these dynamics to precursors like the Nazi “T4” euthanasia programs. In his view, leaders and systems often cultivate beliefs and narratives that allow ordinary people to rationalize brutality.

Karadžić: “Evil,” Not “Mentally Ill”

Dekleva frames Karadžić as “evil” rather than mentally ill, arguing the decisive transformation is rooted in deliberate justification and social reinforcement. He emphasizes that the process is less about “insanity” and more about how communities normalize and defend extreme overvalued beliefs.

Modern Threats: Revisionism and Online Acceleration

He extends these ideas to modern contexts, warning about:

• online revisionism of historical atrocities (including atrocities associated with Hitler and Stalin)
• how social media can accelerate extremist narratives
• how people may rationalize present suffering by rewriting past events

He also discusses nationalism as potentially healthy—supporting pride and identity—while warning that it becomes dangerous when redirected into scapegoating.

Profiling Authoritarian Leaders (Including Putin)

Dekleva discusses profiling other authoritarian leaders, including Vladimir Putin. He argues psychiatric labels can be unhelpful and suggests a broader analytical framing using a “three Rs”:

• Rational
• Ruthless
• Resilient

Applied to leaders such as Putin and Kim Jong-un, he characterizes Kim as “rational”—meaning goal-directed power preservation and negotiability—rather than madness. He cautions, however, that negotiation and strategic interaction should not be mistaken for endorsement.

Presenters / Contributors

• Ken Dekleva
• Interviewer (unnamed)