An open letter to the editor was posted in the New York Times by a man I hold in the highest esteem. Dr. Allen Frances speaks clearly to all psychologists and psychiatrists who would “diagnose” Donald Trump. We are not to diagnose him. To label him as having narcissistic personality disorder is not appropriate, and to say he is incapable of serving as president because of narcissism is similarly inappropriate. The letter follows:
To the Editor:
Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.
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.
Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).
Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.
His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.
The writer, professor emeritus of psychiatry and behavioral sciences at Duke University Medical College, was chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV).
However, Dr. Frances does make a comment in his letter to the editor that Mr. Trump does not experience distress based upon his narcissistic traits. Using his own argument, I do not believe he can say that unless he has actually interviewed him. There is no way to know the level of pain or psychological distress that Mr. Trump is experiencing. We can only speculate about this. And we can also examine the data. This includes the following:
- rambling circular arguments designed to never clearly answer a question
- externalized blame and little to no acknowledgment of fact
- frequent physical separation from his wife and child for extended periods of time
- defending himself constantly and praising himself by emphasizing ratings rather than deeds
- well documented emotionally abusive relationship with his father
- endless tirades of what can only be considered bullying of individuals with disability, religious differences, or alternate political opinions
I AM a psychologist. And I do consider Donald Trump as having narcissistic traits. And I cannot ignore the impact that such narcissism can play on his ability to lead this country. I am a United States citizen. And I will voice my opinion that his narcissism goes to such depths that such traits are directly affecting his leadership of our country. I am greatly concerned. And I’m also wondering that as narcissism has become the personality of the United States, it makes a lot more sense that he is our president. I’m pretty sure Rome fell for the same reasons. “Sad. So Sad.”