The unconventional behavior exhibited by our President over the past 2 years has led many to question his mental state. Andrew Sullivan was the first mainstream journalist to suggest in writing, (The Madness of King Donald), that Mr. Trump was “mentally unstable”. There has been a lot said about his apparent narcissistic tendencies with many, myself included, who have suggested that he might satisfy the criteria for the diagnosis of narcissistic personality disorder. In the past there have been instances of harm done to famous people by those of us who should know better than to draw conclusions with incomplete data. This can happen when we violate the principal of never making a diagnosis without a personal examination. Consequently; there have been ethical caveats against such long distant evaluations.
Nevertheless; there is much in Mr. Trump’s behavior that tempts one to speculate about his sanity which led a group of mental health professionals to publish an open letter to the New York Times suggesting that he was unfit to be President due to mental illness. Most would agree that he is impulsive, erratic, insulting, and unpredictable, with an ego that knows no bounds. His supporters explain his numerous falsehoods and distortions as “alternative facts”, while others call him a damned liar. So the big question is: what makes this guy tick? Is he so dominated by his megalomania that he actually feels that his saying it will make it so?
For example, he talks almost exclusively in superlatives; consequently there can be only two kinds of people either the best or the worst. Since he is the best of the best it only makes sense that he would have won the popular vote so the only logical explanation is that there must have been fraudulent voting. Could it be these behaviors fulfill a pathological need for attention? Could it be a well thought out strategy to provoke his opponents into taking actions against him in order for him to continue to play the role of victim which was so successful in his campaign. Even more frightening is the idea that he might be downright delusional, or could it be that he is “crazy like a fox”? Either conclusion is very frightening for he occupies a very large henhouse.
In the midst of all this speculation, along comes Dr. Frances Allen with his own letter to the New York Times followed by an interview with CNN. Dr. Allen comes with impressive credentials, having written the criteria for the diagnosis of narcissistic personality disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. He is also Professor Emeritus at Duke University. He asserts that the Donald does not suffer from the diagnosis of narcissistic personality, or any other mental illness. Indeed he goes on to say that to excuse Mr. Trump’s behavior as mental illness is “an insult to the mentally ill”.
In lieu of a psychiatric diagnosis Dr. Allen asserts that Mr. Trump “can and should be appropriately denounced for his ignorance, incompetence, impulsivity, and pursuit of dictatorial powers”. Dr. Allen does describe him as a “world class narcissist” at the same time denies that he meets criteria for the diagnosis of narcissistic personality which probably accounts for the confusion as the distinction is likely lost on most people including myself.
Dr. Allen does make a good point in that when it comes to evaluating our president it only makes sense to focus on behavior rather than a label. As the Bard said “what’s in a name”? We Psychiatrists have always been fond of diagnoses. They have some important uses such as in demographic research and filling out insurance forms; however there are down sides: 1) labels can be stigmatizing, and are not easily removed, 2) When teaching, I cautioned my students to avoid focusing on diagnosis as I never saw a patient who fit perfectly in any category. In this case I agree with Dr. Allen that psychiatric verbiage does little to deal with the Trump problem. Crazy or not is irrelevant since he is obviously not committable.
Both people who I have quoted in this little ditty expressed concern about the effects this man may have on our democracy; feelings which I share. I was hopeful that after the election he would give up the disturbing comments and distortions which marked his campaign, but I have been sorely disappointed. I attempt to reassure myself that this democracy has survived many crises, and that I am overly pessimistic. This evening I watched portions of another post- election campaign speech, the tone and content of which was all too familiar. I was angry and scared.