Trump’s mental condition

Understanding Trump (a follow-up)

Four days after Donald Trump’s inauguration, I suggested that Trump may suffer from a psychological condition known as Narcissistic Personality Disorder. Back then, some readers took me to task for venturing such a diagnosis despite my lack of psychological credentials. And the American Psychological Association — again, back then — specifically prohibited its members from rendering long-distance evaluations of the president’s psyche.

The Devil, or a man in need of help? (Image via Creative Commons/Wikimedia.)

Yet in the intervening eight months, numerous psychiatrists have contended that the president is indeed mentally unstable. Several members of Congress from both parties have publicly suggested the same thing. Twenty-eight Democrats in Congress have signed on to a bill that could lead to a formal evaluation of Trump’s fitness to serve as president.

Other observers, like Elizabeth Drew in the New York Review of Books, have suggested — based on Trump’s increasingly limited vocabulary — that Trump may suffer from oncoming dementia or Alzheimer’s. “If one compares his earlier appearances on YouTube, for example a 1988 interview with Larry King,” Drew wrote in March, “it appears that Trump used to speak more fluently and coherently than he does now, especially in some of his recent rambling presentations.”

(I can think of another explanation: 30 years ago, Trump mostly read newspapers and magazines. Today he’s mostly reading tweets and emails and watching cable TV. His vocabulary has suffered accordingly.)  

Name-calling

Two psychiatrists — one at Brown University, the other at the conservative American Enterprise Institute — remarked last week in the New York Times, “Whether or not they can say so, many experts believe that Mr. Trump has a narcissistic personality disorder. He is grandiose, entitled, desperate for admiration, and so on.” And this month, the American Psychological Association lifted its earlier prohibition: henceforth, its members can offer long-distance evaluations of the president’s psyche.   

Allen Frances, the Duke University psychiatrist who wrote the criteria that define Narcissistic Personality Disorder, has publicly scolded those who engage in “psychiatric name-calling” — not because he supports Trump but because, he argues, calling Trump mentally ill is an insult to the mentally ill. The mentally ill, Frances notes, “are mostly well-behaved and well-meaning,” whereas Trump is neither.

Tweets and tax returns

What’s the point of this discussion? These responses, expert or not, seem mostly geared to seeking some pretext for removing Trump from office under the 25th Amendment, on the grounds that he’s unfit to serve. But that wasn’t my purpose at all back in January. I merely sought to provide some framework for predicting Trump’s behavior. So far, I humbly suggest, that framework has proven reliable. Here’s what I predicted in January (with my follow-up comments in parentheses):

  • “Trump will never release his tax returns. To do so would destroy his self-image as a successful businessman and generous philanthropist.” (Check. He hasn’t yet, and he won’t.)
  • “Trump will never divest his businesses. They mean more to him than the presidency, because they’re central to his image and easier for him to control.” (Check.)
  • “He will never give up his children as advisors, because he views them as extensions of himself; consequently, they’re the only people he trusts.” (Check. In seven months, Trump has abandoned such close advisors as Michael Flynn, Sean Spicer, Reince Priebus, Anthony Scaramucci, and Steve Bannon. Ivanka, Donald Jr., Eric, and Jared Kushner remain in their respective positions.)
  • “He will resist holding press conferences, which involve confronting hostile questions. Instead, he will hold rallies, where he can bask in his supporters’ adulation.” (Check. I might have added: He will avoid any potentially hostile public event. Trump’s no-shows at the White House Correspondents’ Dinner and the Kennedy Center Honors are two examples.)
  • “He won’t give up his Twitter account. For Trump, tweeting to his followers is not the means to some strategic end; it is the end. His need to vent transcends all else.” (Check.)

Making waves

One more prediction: In any given situation, Trump will take the action that makes waves or creates headlines, even if it makes no moral, political, or practical sense. How else to explain his withdrawal from the Paris Climate Accord, his decision to exclude transgender citizens from the military, his singular refusal to condemn white racists in Charlottesville, and his current attempt to deport 800,000 children of undocumented immigrants? From a narcissist’s perspective, how can you attract attention if you simply endorse conventional wisdom?

You know the old joke: What do you call a demented seven-foot-tall man holding a spear? (Answer: “Sir.”) Trump holds the keys to our nuclear codes. Call him “Sir” at your risk. But his behavior, demented or not, is predictable.

Our readers respond

Richard da Silva

of Center City/ Philadelphia, PA on September 05, 2017

I just want to nit-pick and take a swipe at the so-called science of psychiatry. I read in the New York Times (February 14, 2017) the letter from Allen Frances, the medical man at Duke University whom you mention. Consider his second paragraph, a muddle of confusion and contradiction:

"Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn't meet them. He may be a world-class narcissist, but this doesn't make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder."

How's that for a sterling example of the scientific method at work? There's a reason that psychiatry's nickname is "the sick man of medicine." Its claim even to be a medical science is controversial among the informed and intelligent. It's a semantic mess that probably misunderstands a great deal of what it pretends to know about human behavior.

I didn't vote for the current occupant of the White House, but I have been known to pray that the Lord guides him well so as to minimize damage and do some good.

Your own predictions here certainly have held up. Let's hope the waves Donald Trump makes don't drown us.

Bob Levin

of Berkeley, CA on September 06, 2017

Gee, Dan, you're missing the obvious. As Steven Beutler, M.D., diagnosed in The New Republic in February: Irritability, inability to concentrate, delusional thinking and grandiosity, impaired memory and judgment, squinting and hair loss = Stage Three Syphilis.

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