Since his appearance on the political scene, there has been a great deal of speculation as to the mental health of our current president. Mr. Trump was first seen by many, including myself, as a publicity seeking entertainer with a day job as real estate developer. He has been very successful at the former, and eventually was successful at the latter with help from an army of lawyers and the bankruptcy courts. I even heard one TV pundit defend Trump’s bankruptcies as simply “good business strategy.” It sickened me to think that it might be standard practice to make use of the legal system in order to avoid paying one’s bills. I admit that debtor’s prisons were an extreme method of encouraging fiscal responsibility, but they must have been much more effective than is our current system.
NO LAUGHING MATTER
Many of us laughed when we learned that he had actually paid people who happened to be walking by his castle to come into the lobby of Trump tower, and cheer as he announced his candidacy, but we are no longer laughing. With years of experience as a self-promoter, he would have been well aware that in advertising there is no such thing as bad publicity, and his outrageous behaviors garnered him many more times the amount of TV time than all his opponents together. When he donned a baseball cap with a catchy phrase inscribed on it, this billionaire who grew up in privileged circumstances became one of the guys. The kind of person with whom you would like to have a beer while you bitched about the government.
BIGGEST AND BEST
As he did during his campaign, he continues to always use superlatives to describe himself or his accomplishments both real and imagined. Never mind the veracity of his comments e.g. his inauguration crowd was the largest ever, his would not be a great presidency but the greatest presidency ever, people whom opposed him were not merely bad but the worst ever to hold that particular office, that his would be the biggest tax cut ever and so on. I grant you there is a long tradition of shading the truth in political discourse, but this president appears to be on his way to setting a new world record in that department. He appears to be well on his way to developing a legacy as the lyingest president in the history of the republic.
The Washington Post has been tracking via their fact checker, the falsehoods of Trump and reported 1628 false, misleading claims or flip-flops made publicly since his election which averages nearly 6 per day. Bella DePaulo who was involved in research studying liars and lying while a Professor at the University of Virginia, found that the average person told a little over 1 ½ lies per day some of which were so called white lies designed to be kind such as the use of flattering comments and reassuring words. Less than 10% of Trumps lies fit into that category. The study of Trump’s lies of course included only his public comments leading one to believe he fulfills the requirements to be labeled a pathological liar. As a matter of fact, DePaulo begins her assessment with the statement: “I study liars, I’ve never seen one like President Trump”.
In addition to his Olympic class lying Mr. Trump’s other outrageous behaviors such as his grandiosity, lack of remorse, impulsivity, paranoia, narcissism, rage reactions, lack of empathy, unwillingness to take advice, and disregard of consequences have been excused by his supporters. They use the word unconventional, and applaud his disregard for presidential decorum while others simply see him as “crazy”. Eugene Robinson of the Washington post said it well in a column in which he wrote: “I used to think he (Trump) was crazy like a fox, now I think he is just crazy”. Naturaly, Trump’s behaviors caught the attention of those of us experienced in the diagnosis and treatment of mental illness, and many quietly questioned his sanity. It was not long before a book written by a group of 27 mental health professionals led by Bandy Lee M.D., M.Div. Assistant Clinical Professor at Yale titled: The Dangerous Case of Donald Trump was published, and became an immediate New York Times best seller. In the book Dr. Lee writes:
“At no other time in history has a group of mental health professionals been as collectively concerned about a sitting president. This is not because he is an unusual person—-his presentation is almost typical for a forensic psychiatrist like myself whose patients are mostly violent offenders—but highly unusual to find such a person in the office of the presidency. For the U.S. it may be unprecedented; for many parts of the world where this has happened before, the outcome has been uniformly devastating”.
She then goes on to say:
“Robert Mueller’s investigation is not just a matter of criminal indictments; as Trump feels increasingly walled in, his mental stability is likely to suffer, and hence the public safety. Mental impairments and criminal- mindedness are not mutually exclusive, not only can they happen at the same time, when combined, these two characteristics become particularly dangerous. Trump has shown marked signs of impairment and psychological disability under ordinary circumstances, hardly able to cope with basic criticism or unflattering news. Presumably, additional stressors will make his conditions worse. So far, the signs have been almost too predictable.
DAMNED IF YOU DO AND DAMNED IF YOU DON’T
As you might expect, the book resulted in a great deal of controversy among mental health professionals. There was immediate blowback from other psychiatrists who were quick to quote the Goldwater rule, so named for a lawsuit filed and won by Barry Goldwater in 1973, which led to the declaration of The American Psychiatric Association that to diagnose a public figure without having carried out an examination is unethical. On the other hand, those who supported the conclusions of Dr. Lee’s book reference the Tarasoff decision rendered by a California court in 1976, which conferred on mental health professionals a “duty to warn and protect” anyone endangered by their patient, a classic catch 22.
As to the question as to whether Mr. Trump is suffering from significant impairment, it now appears that the ayes have it, as at last count there were nearly 80,000 people including myself who have called for an evaluation. Admittedly it is not clear how effective or in what manner such an evaluation could be carried out, and an interview without a patient’s cooperation is problematic at best especially in the types of personality disorders alleged.
THE LABEL DOESN’T FIT UNTIL HE FALLS APART?
The most common diagnoses alleged are: Sociopathic personality, and Narcissistic personality. Allen Franses MD a Professor at Duke University who wrote the criteria for the diagnosis of Narcissistic Personality in the American Psychiatric Association’s latest version of their diagnostic and statistical manual not only condemns the practice of “making a diagnosis from a distance”, but insists that Trump is not mentally ill. In an article in Psychology Today he arrives at this conclusion with the following analysis:
“Trump’s consensus diagnosis among amateur, at-a-distant diagnosticians is narcissistic personality disorder. They have reviewed the DSM definition (which I wrote) and found him to meet all the criteria: grandiose self-importance; preoccupations with being brilliant and successful; feeling special and having to hang out with special people; requiring constant admiration; feeling entitled; being exploitive; lacking empathy; being envious; and being arrogant. Bingo. Trump is all this in spades. But they ignore the further requirement that is crucial in defining all mental disorders—the behaviors also must cause significant distress or impairment. Trump is clearly a man singularly without distress and his behaviors consistently reap him fame, fortune, women, and now political power. He has been generously rewarded, not at all impaired by it.
PRONOUNCEMENTS FROM THE IVORY TOWER ARE TOUGH
At a personal level, I was disheartened to learn that as a result of my dump Trump affiliations I am still an “amateur diagnostician” after a lifetime of suffering under the delusion that I was a professional. I do take issue with his failure to address the likelihood of Trump reacting violently when cornered as predicted by Dr. Lee, an opinion with which I strongly agree. It is this phenomenon which most frightens me. I also find it difficult to understand why we must wait for him to fall apart to make a diagnosis. There is also the question of how much distress or impairment is necessary to confirm the diagnosis via the Dr. Franses rule. Some of Mr. Trump’s tweets suggest that he is quite distressed on those occasions when he is challenged. As far as I am concerned the necessity of a personal examination is greatly overblown in these types of personality disorders. Interviews are most often useless, and one must rely on witnessed behaviors and information from many outside sources in cases of both narcissistic and antisocial personality disorders.
THIS PERSON REALLY KNOWS HOW TO HURT A GUY
Dr. Franses is gracious enough to acknowledge that we who support Dr. Lee’s book “mean well”, but others are not as tolerant in their critiques. One such person is Jeffery Lieberman M.D. who is chair of the Department of Psychiatry at Columbia University, and Past President of the American Psychiatric Association. Dr. Lieberman, writing in Psychiatric News (a publication of the APA) in a disclaimer admits that he was a supporter of Hillary Clinton and served on her advisory council, but still in his heart of hearts feels bound to abide by the Goldwater Rule. He points out the world’s history of using psychiatry in the service of totalitarian despots, and that we “are using our professional credentials to express a medical opinion when we have neither the right nor the evidence to do so”, a statement with which I strongly disagree. I believe we not only have the right, but the duty to lend our opinions. Furthermore, Trump’s own words and tweets provide ample evidence of mental instability without the need for a personal interview. In his review of Dr. Lee and her colleagues’ book he is even more critical with the following opinion: “Sadly, the Dangerous Case of Donald Trump is not a serious, scholarly, civic minded work, but simply tawdry, indulgent, fatuous, tabloid psychiatry”. I think that means he didn’t like it, or perhaps he thinks the authors should be impeached.
NOT ALL MENTAL ILLNESSES ARE EQUAL
The pertinent issue in this controversy is Trump’s fitness to be president. His mental health is only relevant as to the effect it has on his ability to carry out his elected responsibilities. A psychiatric diagnosis of itself is not disabling as some of our most successful presidents such as Lincoln and both Roosvelts have suffered mood disorders of sufficient severity to satisfy our current criteria for psychiatric diagnoses. One could even make a case that their emotional problems may have been an asset. In Lincoln’s day Trump’s type of behaviors would have been seen simply as character flaws, and not given the benefit of a psychiatric diagnosis. Although some behaviors we now find repugnant were widely accepted, veracity was highly valued, and liars were despised. Now, Trump’s lying is excused by some with the statement that “all politicians lie”. If lying has become accepted as the standard in political discourse, we are indeed in big trouble.
HE IS ONLY PART OF THE PROBLEM
Once again, “these are the times that try men’s souls”. At a time when our country, and governing philosophy are under attack from several directions, we remain more divisive than at any time since the civil war, thus enhancing our vulnerability. The maxim “united we stand and divided we fall” is as true now as it was in Ceaser’s day. There appears to be little effort from either of our political parties to promote the unity necessary for us to secure a bright future for succeeding generations. Their focus on winning impairs their ability to govern. Unification requires leadership and leadership requires inclusiveness, qualities now sorely lacking at all levels of our government. Over the last several decades the office of presidency has gradually accrued more power, and the thought of a president with impairment sufficient to affect his judgement is very frightening.
Trump’s mental health is likely a moot point at this time. With a majority in congress, the requirement of the 25th amendment that expulsion due to impairment be initiated by his cabinet or congress, it is unlikely that his tenure will be shortened other than by criminal indictments resulting in impeachment. I do find some comfort in the reported trend towards more involvement of the citizenry in political affairs with the goal of holding those we hire to run things accountable. I also reassure myself with the thought that though democracy is fragile our country has survived and prospered following serious crises in the past. Let us hope this time of political bitterness is only a period of rapprochement, and that statesmanship will become the norm once again.