Street Roots • October 13-19, 2017
Commentary
Page 11
Regardless of his mental health, Trump is definitely mad
BY MEREDITH MATHIS
AND JASON RENAUD
C O N T R IB U T IN G C O L U M N IS T S
or quite a while pundits, journalists, political
scientists and many others have exclaimed
President Donald Trump is mentally ill. They
usually include some equivocation such as, “I’m
a mental health professional, but,” and somehow
don’t bother to ask a mental health
professional’s opinion.
Meredith Mathis and
However, Trump’s bad judgment
Jason Renaud are with
doesn’t matter whether he has a
the Mental Health
mental illness or not.
Association o f Portland
Let’s unpack that.
You’ve probably heard of the
Goldwater Rule by now. It was an
admonition by the American Psychiatric Association
to its members not to diagnose from afar. This was
in response to strange statements by presidential
candidate Barry Goldwater in 1973, that raised
questions about his mental stability. After Goldwater
successfully proved he wasn’t crazy in a lawsuit
against FACT Magazine, the APA opined it was
irresponsible to diagnose someone without a full
evaluation using psychological tests.
But there’s a sufficient amount of extraordinary
evidence about Trump’s behavior, and not just as
president. Trump has, for decades, spent an
enormous amount of time and money publicizing his
unwaveringly abnormal character and behavior.
From the early 1980s, the New York media
laughingly obliged, routinely scrutinizing his
weirdness and antics while the cognoscenti
snickered at him. The media obliged because his
behavior was aberrant and compounded by a
complete unawareness of his social crudities;
laughing at Trump continuously made good
headlines from the 1980s to the present. The
Shorenstein Center analysis shows that Trump got
the equivalent of $55 million in free advertising
space on major news outlets in 2015 alone.
Together, we laughed at Trump’s behavior, or in
psychiatrist-talk, his symptoms.
Over the past year or so, as we at the Mental
Health Association of Portland met and chatted with
psychiatrists, psychologists, counselors and medical
teachers, we’ve been asking, what is your clinical
assessment of Trump?
Their first answer is no, Trump does not have a
severe and persistent mental illness, such as
depression, anxiety, bipolar disorder or
schizophrenia. These are chronic but treatable
thought and mood illnesses, with an entirely
different set of symptoms than Trump evinces.
But yes, from our informal survey of clinicians,
Trump clearly displays all the qualities of a person
with a narcissistic personality disorder. Indications
of narcissistic personality disorder include a lack of
empathy, grandiose sense of self and need to be
admired; people with this disorder are self-centered
and manipulative. Trump clearly fits the description.
But that doesn’t explain Trump’s interminable
dishonesty. According to The Washington Post, as of
mid-August, Trump lied or misled, often with vigor
and in the face of opposing evidence, over 1,000
times since taking office. Narcissistic personality
disorder also doesn’t explain Trump s eagerness for
violence. There are endless examples of this. Trump
emphatically yelling that he would pay the legal fees
of supporters if they physically attacked protesters
at his rally. Trump expressing nostalgia for a time
when protesters got “carried out on a stretcher.”
Trump publicly encouraging police to use excessive
force. The list goes on.
These kinds of dedicated dishonesty and malice,
our casual survey of clinicians say, is likely caused
by a malignant antisocial personality disorder. A
person with antisocial personality disorder has a
long pattern of disregard for the rights of others.
They are impulsive, aggressive and demonstrate
F
not
IL L U S T R A T IO N B Y E L IZ A B E T H C O N S ID IN E
moral turpitude.
So aren’t narcissistic personality disorder and
antisocial personality disorder also mental illnesses?
Yup. Personality disorders are common; affecting
about 9 percent of us. But the symptoms are
substantially different from “severe and persistent”
mental illnesses, such as depression or bipolar
disorder. People with personality disorders are
rarely psychotic and know right from wrong, but
their behavior can be confounding and inexplicable.
There’s no cure, the disorder is lifelong, treatment
successes are difficult, and without full participation
in treatment, misbehavior does not change.
Narcissistic personality disorder is in the Diagnostic
and Statistical Manual (DSM), a text used by
clinicians to define clusters of symptoms as
illnesses, with some suggestions, but treatment
success is highly unlikely.
Trump is responsible for his words and actions,
and it is highly unlikely he will change them.
Expertise is required to determine whether
Trump has these disorders, or whether he just has
characteristics. A skilled counselor over time could
help regardless. But who cares? If he’s anything like
most other narcissists, it’s unlikely Trump will seek
psychological help. Without extensive treatment,
Trump’s behavior won’t change. So whether he has
an illness or not is moot. It’s just not relevant.
(Note: Our informal survey says it’s much more
likely Trump colleagues and family members will
seek professional explanations for his behavior than
he will engage with treatment. None of the
clinicians we spoke with had heard of a 71-year-old
man engaging in treatment for narcissistic
personality disorder.)
The pundits and political scientists, overlooking
that Trump has bad judgment, use “mental illness”
as a demeaning and derogatory cudgel. And here’s a
real downside to the pundit’s accusation of mental
illness. Being called mentally ill doesn’t affect
Trump; he doesn’t care. But the association
demoralizes people struggling with mental illness. It
reveals a public association between people with
mental illness and people who are dangerous,
irrational, belligerent, cruel and sadistic. Words
developed by professionals and patients get
distorted; a desperation to name what is happening
overpowers critical engagement. Stigmatizing
language used to criticize Trump undermines
conversations about getting help for mental illness
in the future.
When facing chaos and uncertainty, it makes
sense to grab for words and meaning. Constant
antisocial behavior, a complete disregard for others’
well being, gratification from harming people is
inconceivable to many people. For anyone who
experiences empathy, who feels guilt for harm they
may have caused, it is difficult to accept that
another person may not experience these things.
Because connection to other people is fundamental
to our various understandings of shared humanity, a
break from that can be confounding and terrifying.
That fear and lack of understanding is then
compounded with the person in question having
massive political power.
But saying this disconnect is a mental illness that
is similar to other mental illnesses is inaccurate and
might stem from several underlying popular beliefs.
The fantasy of the pundits, and what drives the
accusation of mental illness is that illness is at fault.
If illness is at fault, maybe Trump can be treated,
and once treated he will cease to be a constant
global threat.
Inversely, mental illness can be a cop-out for
what cannot be fixed. In feeling helpless, people
turn to mental illness as a stand in for what is
obscure, uncontrollable, dangerous and hopeless.
Both lines of thought center mental illness in a
way that is misguided and harmful. Trump is not a
patient. He must be held accountable for the
excessive power he holds in a system that facilitated
his rise to power. He is the last person who should
be granted the leniency of potential change.
Ultimately, the DSM is a broad descriptive tool
designed to help name and treat disordered
thoughts, behaviors, mood regulation, and more.
The DSM is not an imaginary document to use as a
scapegoat for a sociopolitical climate that allowed a
billionaire who ran openly on a platform of bigotry
to be elected. The DSM can’t extend to a dynamic
of once-fringe iterations of white supremacy being
institutionalized alongside Trump’s ascension to
office. Diagnosing an individual from a distance only
does so much in the face of larger social
pathologies. And besides, if the diagnosis can’t go
past restating the behaviors it seeks to describe,
the diagnosis doesn’t reveal any underlying cause
people might suspect. The diagnosis is the behavior.
The behavior is bad judgment. We knew that. That’s
why we looked for the diagnosis. That’s it. We’re
back where we started.
Trump gets gratification from all the attention his
bad behavior brings, with no real negative
consequences. His claim that he could shoot people
and not be held accountable is exactly right. Like a
spoiled child manipulating his foolish parent, Trump
gets his way. The fixation on Trump’s character, the
fixation on the TV personality that always keeps us
on our toes, is a feedback loop. His excessive media
attention and power is not new, but it is certainly
more dangerous than before, and further dodging
narratives about accountability isn’t going to help.
♦ Trump causes harm in material ways: whom he
hires, whom he empowers, where his money goes,
the policies he endorses and the rash decisions he
makes.
The simple, indisputable truth is Trump has bad
judgment. He’s displayed bad judgment in his
selection of advisors and appointees. Bad judgment
led him to insult a dozen world leaders, his
congressional delegation, people of color, people
with disabilities, women, a neverending list of
transgressions. It’s caused him to be defeated in
political and legislative battles. It’s caused high
instability.
It’s a simpler definition, but with bad judgment,
everyone is an expert.