PERSONALITY DISORDERS
The other night while dining with friends, I was asked for my professional opinion as to the mental health of our President. My response was not very professional as I responded “I think he is nuts!” There is a caveat, especially important in our business, that one must carefully consider any pre-determined bias before rendering a diagnosis, and my response suggests that I had violated that rule.
In retrospect, I realize that my friend was asking for a less flippant answer to his question. Anyone who owns a TV (or uses Twitter) would probably agree that Mr. Trump’s behavior is different from what we are accustomed to seeing in our politicians. His detractors suggest this is evidence of significant mental disorder while his supporters applaud him for being earthy and “unconventional.”
I have previously written (click this link to read that post from 2016) about Mr. Trump in not very flattering terms concerning his mental status, and the non-position taken by the American Psychiatric Association of which I am a lifetime member. Those mental health professionals who insist that Trump is mentally impaired and therefore unfit to hold office in most cases make a case for the diagnosis of Narcissistic Personality Disorder. After the conversation with my friend, it occurred to me that most people might be unfamiliar with what signs and symptoms might lead to such an impression
In the first place, it may be helpful to explain what we in the shrink business mean by the term personality disorder as people sometimes overuse a term and its true meaning from a psychiatric standpoint gets watered down (for example: a person who might say upon having a bad day or disappointing day, “I’m so depressed” when in reality they aren’t clinically depressed, just a little down).
Personality Disorders | Definition by Psychiatrists
The general criteria listed in the American Psychiatric Association’s Diagnostic and statistical Manual of Mental Disorders or DSM which is now in its fifth edition. The definition of personality disorder as summarized in DSM IV is “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” (not caused by such things as drug abuse, or other medical problems). Unfortunately, for me the criteria as listed in DSM V are more complex, and since I am a simple-minded person I will stick with DSM IV in my discussion (but perhaps more to the point I am reluctant to invest a hundred bucks in another 900 page dust collector for my bookshelf). In either case, it is clear that those who suffer from a personality disorder are very different.
Signs & Symptoms of Personality Disorders
Signs of personality disorders characteristically have been present for long periods usually from childhood. These patients are difficult to treat. Although some psychotropic medications may be helpful, the gold standard remains long-term intensive psychotherapy, a commodity which is in short supply these days. The symptoms usually serve a protective function. Consequently, patients in treatment have difficulty giving them up. An even bigger problem is that in many cases people who need treatment most are those lacking in insight. Consequently, they are convinced there is nothing wrong with them. This is especially true in cases of narcissistic and sociopathic personality disorders. They believe they are perfect in every way so why in the world would they need a psychiatrist?
Narcissism | Signs | Symptoms | Cause
The term narcissism is from the Greek myth about Narcissus who fell in love with his image while gazing into a pool of water. This did not work out too well for him for he eventually committed suicide when he realized his true love was himself. A bit of narcissism is not a bad thing…as a matter of fact most therapists would probably report that low self-esteem is one of the most common problems they see and that they spend a great deal effort trying to help their patients learn to like themselves. But as with most things in life, it is the extremes which cause us problems. We all know people who are arrogant and self-centered, but those with a narcissistic personality disorder take that to the level where their self-image is so far removed from reality that it approaches the delusional.
He/she of the narcissistic personality disorder is the master of the superlative. He is never simply good at something, he is the best. Others are not bad, they are the worst. Everything in life is measured against the perfection that only he possesses. The need to maintain this distorted image of himself dominates his life and leaves no time to consider the needs of others. He is convinced he is special, and deserves special treatment. He courts admiration or subservience in relationships, and is pathologically intolerant of criticism. This preoccupation with self, frequently distorts perceptions and may affect judgement.
As with many mental health problems, the causation is up for grabs. There may be some abnormality of brain function, environmental factors, or both. Some postulate that excessive adoration by parents is the cause, while others feel the opposite, namely that excessive criticism is the culprit. Whatever the cause, most agree that such extremes of narcissism serve the purpose of protecting a very fragile ego. His need for attention is never satisfied. Indeed, the tenacity with which the narcissist holds onto and nurtures these false opinions of himself leads one to suspect an underlying desperation at the core of his being. The most readable synopsis of narcissistic personality symptoms I have found lie in a pamphlet distributed by the Mayo Clinic as follows:
- They have a sense of entitlement and require constant excessive admiration
- Have an exaggerated sense of self importance
- Expect to be recognized as superior even without achievements that warrant it
- Exaggerate achievements and talents
- Preoccupied with fantasies of success, power, brilliance, beauty or the perfect mate
- Believe they are superior and can only associate with equally special people
- Monopolize conversations and belittle or look down on people they perceive as inferior
- Expect special favors and unquestioning compliance with their expectations
- Take advantage of others to get what they want
- Have an inability or unwillingness to recognize the needs and feelings of others
- Be envious of others and believe others envy them
- Behave in an arrogant or haughty manner, coming across as conceited, boastful and pretentious
- Insist on having the best of everything (for instance the best building, golf course, yacht, wife, etc.–the examples are my words NOT Mayo Clinic’s example–they used car and office)
Narcissism & Trump
So, there you have it – all you need to make a diagnosis. You Trump watchers have certainly observed enough behaviors to decide if the shoe fits. If you conclude that the diagnosis of Personality Disorder fits, you should be concerned as to the fitness of POTUS to handle the job. Those so diagnosed are prone to react in irrational ways when their distorted view of themselves is threatened and consequently are very sensitive to any kind of criticism, often reacting with over-the-top rages. Mistakes are never acknowledged for to do so would shatter the myth of their perfection. They react poorly to stress and to change, and there is no doubt that POTUS must be under mountains of stress considering all the investigations currently underway with many of his former supporters on their way to jail.
While in the midst of writing this, I was directed by one of the friends I mentioned in my opening statement to a YouTube presentation by John Gartner, a Ph.D. psychologist at Johns Hopkins. Dr. Gartner is convinced that Trump is demented. Gartner is adamant in his diagnosis and convinced that he should be removed from office. In spite of Gartner’s intensely verbalized political views, he does make a good case for an Alzheimer’s type dementia. However, I believe the evidence he presents is not unusual for one afflicted with a narcissistic personality disorder who is under threat of losing that shield, which protects him from facing the reality of his deficiencies.
Narcissism Exposed (“s#@t hits the fan” time)
As I have mentioned in previous blogs, my major concern is that the current investigations will turn up things which he will not be able to deflect with his usual strategies of denounce, deflect, or deny. Recently, he has seemed less rational with a 2- hour long rant at the Conservative Political Action Conference, and the strange attempts to demonize John McCain months after his death. In the so-called Twitter storm from last week, he seems enraged at everyone within range. It appears that his only respite is the campaign rallies at which he is able to bask in the attention accorded him, confirming to him that he really is “The Greatest.”
Some say our President is “crazy like a fox”. It is true that he has turned self-promotion into a very successful career, even becoming the world’s most powerful man. Those same talents have served the additional function of satisfying insatiable ego needs. I believe that Trump’s narcissism governs every aspect of his life, and explains the “crazy” things he does and says. I believe that he is psychologically vulnerable and likely to demonstrate irrational and impulsive behaviors if his defenses are destroyed. With that in mind, I hope all these investigations do not burst the President’s fragile ego for that could be disastrous.
Editor’s Note: I was slow on the editing of Eshrink’s post and so much has happened since he originally wrote this article. The Attorney General released a 4-page summary of the Mueller Report on a Sunday while many of us were watching our brackets bust during the NCAA basketball tournament. I kept asking why the full report wasn’t being released to the public (the taxpayers paid for it, as POTUS continues to remind us in the context of money wasted) or at least released to Congress (it seems Nancy Pelosi wonders that, too.) However, Eshrink’s post about Narcissistic Personality made me think maybe the inner circle knows more than we think about the stability of POTUS and his psychological vulnerability that could lead to an even worse outcome. History will tell the tale… I’m sure those working inside the Oval Office will have plenty of great material for books once this crazy time in our republic’s history is behind us–if the Republic survives that is. God Bless America. We need all the help we can get!
Several of our ships had been sunk, but there was no accounting yet of the number of casualties. I went upstairs and laid across the bed aiming my brother’s 44-40 Winchester at our backyard vowing to take out any of those slant-eyed devils who might show up.
Many years later, I would come to know a fellow physician who had begun his life in one of the internment camps. He had little memory of the experience, but told how his parents and grandparents had owned valuable land in California that was sold for taxes while they were interred. They came out of the camp destitute.
“Rosie the Riveter” was hailed as a heroine. Factories were in need of more employees as most began running three shifts. The word was that there was big money to be made in the defense plants sometimes as much as a dollar an hour. This got Dad’s attention besides, they needed him in the war effort since he was too old to serve so he quit his man killing job, and went to Akron where he went to work the second shift at the recently built (in record time) 

Many had the same idea as Dad and housing was very scarce, but he found two rooms behind a barber shop on the south side of Akron (not exactly a posh neighborhood) and called for us to come join him. Mom got a job on the same shift doing some clerical work, and even my brother, who had just turned 16, worked there filling vending machines throughout the plant. Schools were so crowded that classes were only held in two four-hour shifts per day. Initially, I enjoyed the solitude of being home alone. I was able to spend my evenings in the darkened barber shop watching the occasional fights outside the beer joint across the street. I even had free reign to sample the many hair tonics. School in Akron was a bummer. There was a lot of racial tension largely due to a an unusual number of southerners who had migrated north to cash in on those high wages, and were unaccustomed to dealing with uppity black folks.
After covering the European theater, he moved on to The Pacific and was killed by Japanese machine gun fire. Of those who commanded our rapt attention on the radio, the most famous was Edward R. Murrow, who broadcast from London during the Blitz.
He recorded his experiences on multiple bombing missions over Europe, and at times one could hear the sound of anti-aircraft. These flights were not without danger…over 2,000 planes were lost prior to D-Day, according to war department records. After the war, Murrow made the switch to television once that new medium was introduced.
Editor’s Note: THANKS for reading! Stay tuned for the next installment where Eshrink walks us through the turning point of the war…spoiler alert (the good guys won!)
It seemed that everyone except him knew that there would be no stopping the Germans until they had punished all of Europe for Germany ‘s defeat in WWI. Those dates are remembered by me since the death of my paternal Grandfather was during the Russian invasion of Finland, which happened three months after Germany conquered Poland. As we listened to the news, I was enthralled by stories of how, although hopelessly outnumbered, a
Death
It was a marvel of engineering which I had read about in history class, but its effectiveness was lost when the Huns simply went around it, picking up Belgium in the process. With that they were able to surround the French and English forces leading to the disaster at
since looking up his history, I realize Dad had disliked Coughlin not because he was Catholic, but because his preachings had become anti-semitic and pro fascist. Coughlin heaped praise on Hitler, Mussolini and Hirohito, and felt Hitler was correct in blaming Jews for his country’s problems. His programs had taken this turn apparently due to his antipathy toward Roosevelt whom he had initially supported. He is said to have had 30 million listeners to his weekly program, many of whom had joined his “National Union for Social Justice.” He was forced off the air when the war started.


look forward to listening to the exploits of their heroines daily. Even those moms committed to 24-hour service to their families planned their daily activities around the schedule of their favorite soap opera, and friends knew not to call during that time frame. Among the more popular ones were The Guiding Light, Ma Perkins, and General Hospital. If you were listening to a baseball game at one of those times you were best advised to leave the premises.
calling baseball games. At a time when things looked bad, many looked for a hero to follow. This was the time of Babe Ruth, Jesse Owens, and Joe Louis for whom some records still stand. Everyone loved “the Babe.”
Sadly, support for the
only a couple of months following his election, was designed to reassure the country and outline his plans to deal with the country’s financial crisis His informal style of speaking was well received, even by republicans, and subsequent broadcasts would be carried on all of the networks throughout his presidency. They were particularly useful in maintaining morale during the dark days of the horrible war soon to come. Somehow, we were among the 40 percent of families to have a radio. Consequently; we usually had as many interlopers show up for the fireside chats as we did for the Joe Louis fights. As for me, I recall being angry that all this furor kept me from listening to my favorite show: Gangbusters.
The other big event of 
I recall seeing a photo of her standing beside a Model T Ford that she had been driving that she had rolled over on its top. In those days, for a woman to be driving a car would have be en unusual if not scandalous. That experience must have left her shaken for she would never drive again and her back seat driving performances were legendary. In similar fashion, she would cede much authority to my father while firmly retaining control of her department, i.e. keeping house and raising kids, a very common arrangement at the time.