W

hen pundits and political opponents warn that President Trump “is not mentally equipped” for the office he holds, that he might have “a psychiatric condition unfolding,” or that he could simply be “crazy,” it has little more credibility than the small hands/small [other anatomy] pseudo-medical assertion that the nation was treated to during the Republican primaries last year.

Two dozen mental health experts believed they could do better, and the result is the highly anticipated book, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President,” which officially goes on sale next week.

The title’s reference to “danger” is crucial, for it opens the door to analyses that might otherwise violate a longstanding diktat from the American Psychiatric Association. Although its Goldwater rule prohibits APA members from commenting on the mental characteristics and possible mental disorders of public figures, psychiatrists have an even higher duty, some argue: a duty to warn, called the Tarasoff doctrine.

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Remaining silent, Drs. Judith Herman and Bandy Lee contend in their prologue, would violate the public trust when a president “shows signs of clear, dangerous mental impairment” as, they believe, this one does. Most of the chapters dig into those “signs” and make the case for Trump’s mental impairment — with gusto.

Unfortunately, while the book validates the suspicions of much of Blue America and might feed efforts to bolster the 25th Amendment in a way that could remove Trump from office due to mental incapacity, it missed a chance, however slim, to speak to anyone whose mind isn’t already made up on everything Trump.

Those suffering from “Trump anxiety disorder,” as one chapter calls it, will have no trouble accepting that the president exhibits malignant narcissism, a sociopathy, paranoia, a delusional detachment from reality, and more. But any readers who treat all those as provocative hypotheses would have benefited from an examination of alternative explanations of Trump’s behavior — that it’s done for political gain, for example — and a head-on discussion of whether professional medical opinions can be clouded by ideology.

“No definitive diagnoses [of Trump] will be possible,” writes Lee, the book’s editor and an assistant clinical professor at Yale School of Medicine. But in making the case for warning she nevertheless calls him “mentally compromised,” citing “furious tirades, conspiracy fantasies, aversion to facts, and attraction to violence” as well as “delusional levels of grandiosity, impulsivity, and the compulsions of mental impairment.”

Other mental health experts describe Trump as showing signs of a “delusional detachment from reality” (saying the sun came out as he began his Inauguration Day speech, for example), and of “a hypomanic temperament” (restless, impatient, easily bored, supremely confident, impulsive, and risk-taking with a minuscule attention span).

Trump is “an extreme present hedonist” like most children, argue Philip Zimbardo and Rosemary Sword of

Dangerous Case cover image
St. Martin's Press

Stanford University, meaning he lives in the moment “without much thought of any consequences of [his] actions or of the future” and says “whatever it will take to pump up his ego and to assuage his inherent low self-esteem, without any thought for past reality.”

Being sent away to military school at age 13, Zimbardo and Sword contend, led to “arrested emotional development,” perhaps a factor in what they see as Trump’s hedonism, and a “pubescent default setting when confronted by others.”

Trump’s chief motivations, they write, are self-aggrandizement and self-defense. The latter is constantly in play because he is “paranoid [and] hypersensitive,” and because of underlying low self-esteem (characteristic of extreme narcissists). As a result, he strikes back at critics with the hyperaggressive reaction of a cornered wolverine — as he did in a tweet about “dumb as a rock” Mika [Brzezinski] “bleeding badly from a face-lift.”

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In short, “the most powerful man in the world is also the bearer of profound instability,” writes the eminent psychiatrist Robert Jay Lifton, who did pioneering research on everything from Hiroshima survivors to Nazi doctors.

The psychological characteristics the experts see in Trump are not necessarily mental disorders, however. Narcissism, for instance, which many of the authors say characterize Trump to an unprecedented degree, is a personality trait, and one that almost all previous presidents and many current leaders in business and academia share to some degree, points out psychologist Craig Malkin of YM Psychotherapy and Consultation. Steve Jobs likely had narcissistic personality disorder, he writes, and it arguably “galvanized Apple’s engineers into developing the iMac, the iPod, and the iPhone.”

But Trump’s “malignant” version of the disorder poses a grave danger, Malkin contends, because it could cause him to lose touch with reality: To be admired and perceived as a winner, extreme narcissists “bend or invent a reality in which they remain special despite all messages to the contrary,” he writes.

Could the Trumpian version of Nixon bombing Vietnam “to impress his friends,” as one historian put it, be sharing secret Israeli intelligence with Russians, as Trump did in May, or, more ominously, starting a war in which he’d emerge victorious?

It’s probably too much to ask that psychiatrists be politically neutral about Trump, since almost no one is, but because so many chapter authors call for his ouster (he “has proven himself unfit for duty”) and make non-medical assertions (“Trump is a profoundly evil man” and his election “is a true emergency”), it raises the obvious question of whether professional analysis has been influenced by personal ideology.

Lee asked one psychiatrist who is a Republican and thinks the president is dangerous to contribute to the book, she said in an interview, but he declined. Moreover, therapists recuse themselves from cases if they feel their personal feelings would get in the way of their professional judgment, she said, and “while a politician may see the world as liberal versus conservative, and Democrat versus Republican, the health professional will primarily see the world as health versus disease, and life versus death. This supersedes everything else.”

It’s unfortunate that so few of the experts even consider whether the Trumpian behaviors they deem pathological might instead be crafty and calculated. Psychotherapist John Gartner’s “Mad? Bad? Or All of the Above?” takes a stab at this, but for almost all other contributors it’s a blind spot, made all the more glaring because political reporters have done terrific work explaining how Trump’s seemingly crazy behaviors serve his political ends.

To take some examples too recent for the book, were Trump’s speech and tweets demanding the firing of athletes who take a knee during the national anthem “extreme present narcissism,” attempts to whip up his base, or a ploy to distract from the Republicans’ latest failure to repeal Obamacare? Was the “Little Rocket Man” appellation for North Korea’s dictator a sign of Trump’s “pubescent default setting,” red meat for his supporters, or a tactic drawn from the madman theory of leadership?

The mad-or-bad conundrum is especially acute when it comes to Trump’s professed (in tweets and speeches) beliefs in conspiracies (Antonin Scalia was murdered; Obama had a Hawaiian official killed to hide his Kenyan birth; Ted Cruz’s father was involved in President Kennedy’s assassination). Is it paranoia, evidence of delusional thinking, or shrewd incitement of the ill-informed and gullible who feel left behind and at the mercy of forces they don’t understand?

The theorizing would be entertaining if the subject were, say, a Shakespearean character and not the man with his finger on the nuclear button. The short chapter by Trump’s “Art of the Deal” ghostwriter Tony Schwartz is so surreal (“facts are whatever Trump deems them to be on any given day” because “his aim is never accuracy; it’s domination”), it should be in an Ionesco play.

But this is not theater. Which brings us back to the book’s stated purpose, fulfilling psychiatrists’ “duty to warn.” The contributors appear to believe that doing so will make a difference. Malkin, for instance, writes that Trump’s election, which he calls “a catastrophe,” might never have happened if psychiatrists “had told the public the truth” rather than being gagged by the Goldwater rule. It’s a charming notion.

Sharon Begley, a senior science writer for STAT, has written extensively about President Trump’s mental health in a series called State of (Trump’s) Mind. She is the author of “Can’t Just Stop: An Investigation of Compulsions.” 

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  • This review gets a couple of things wrong in my opinion. 1) Is that Trump’s characteristics are intertwined with personality, but they are STILL pathological because we have an entire range of disorders called personality disorders that are pathological. So…not sure how a personality based diagnosis is somehow nullified because it’s personality related. Also in no way is his behavior somehow not indicative of a mental illness because it seems to be at times practical. Personality disorders almost all arise as a pathological way to get needs met. So just because his actions seem to have some of political expidiency attached to them, doesn’t mean they are not signed of mental illness because that is exactly how mental illness (personality disorders) work haha!

  • What is amazing is that somebody like Trump with obvious issues can take the highest office ! Where are the checks and balances?!

  • North Korea is a sovereign state or country, as such has a right to protect itself from exterior forces, other than if this country acts or attacks another country is and able to take what steps it chooses to protect it self.
    It is doubtful NK, would attack the Imperialist countries owing to the size of there country and problems of supplies for war, NK, would be aware of this and the main threat is not NK, but exterior forces whom are the most likely to desire war.

    • Mr. donwreford, with all due respect to your opinion, your use of the word “Imperialist” tells a lot about your vision of the world.

      Please note that, nowadays, the size of countries is less important than it was in the past. Knowledge is more important than natural resources, and knowledge is produced in small places such as classrooms and laboratories.
      What really scares the North Korean ruler, is not an external threat, but the fear of being toppled someday by his own people, when they realize that South Korea became sucessfull because of 50 years of freedom, something that inexists in North Korea.
      This dangerous nuclear proliferation Mr Jong Un is playing with, may end up in a tragedy for the world.
      I contribute to the IPPNW (International Physicians for the Prevention of Nuclear War) because, as a medical doctor, I know there are no medical resources able to save people from radiation after a large scale use of nuclear weapons.
      The mechanical destruction such weapons do, however immense, is nothing compared with the irreparable poisoning they produce for ever. Chemistry plays in the molecular level, while nuclear war poisoning comes from the submolecular level, i.e atomic level. Chemistry has no ability to solve this.
      So the threat posed by North Korea must be taken seriously. NK is contributing to nuclear proliferation. Its not something to be taken lightly, believe me.

  • I’m unsure of which side the columnist is writing from. Either the book hits the spot, or it misses the target. She presents “less dire” theories, but at the same time portrays Trump as a manipulative, dishonest egoist, a step away from sociopathy. So, even if you are a dyed in the wool Republican, do you really want a character like that anywhere near the nuclear button?

    • Presidents Clinton, Bush and Obama allowed North Korea escalate into a nuclear power.
      How can one make the rulers of North Korea stop this spiral?
      By concentrating on Mr Trumps personality you avoid the real threat.
      This was the reason candidate Clinton lost the election: a campaign focusing on smearing the other candidate image, instead of discussing the real politic issues.

    • I am a dyed-in-the-wool American, Ms Cameron-Dow, and have voted for candidates from both parties over the years. I think you misunderstand why a large number of people voted for Trump. It is a misunderstanding that many people are making. Succinctly, over the past 50 years politicians from both major parties have caused laws to be passed that have turned this country into one that is completely unrecognizable to people who were alive 50 years ago, regardless of whether they agree with the change. Some of those people like the changes, but many are horrified at them. Those of the latter group saw an opportunity to vote for someone who seemed to be of a completely different nature than those who had been elected over the past half-century. Those people jumped on the opportunity to vote for that difference. So, there isn’t any single issue or even any “group” of issues that compelled them to vote for Trump. It was the opportunity to vote for someone who would, figuratively speaking, slap people like Mitch McConnell, Chuck Schumer, Lindsey Graham and Hillary Clinton right across the chops! Then tell them to shut up and sit down and proceed to do what needs to be done. Honestly, I think most Trump supporters (I’m a Ted Cruz guy, myself) like Bernie Sanders better than Mitch McConnell.

    • Mr Pierce, don’t underestimate the insight of non-Americans. Who you vote for is your business, and who any of you think will make the best president is entirely the business of America. Clinton, Ford, Obama, and Trump have not been set there to serve anyone other than Americans, but it’s also true to say that when America sneezes, the rest of the world catches cold. Although I live on the other side of the equator and the other side of the Atlantic from America, and although the Pacific and the Indian Ocean lie between my country and North Korea, the danger that not one, but two unbalanced individuals have the power to plunge the planet into a nuclear winter must disturb everyone – American, European, African, Asian or Australian. Who you elect as president, whatever your vision was for his term of office, the reality that your country is under the leadership of a man who may be a sociopath becomes a problem affecting the whole world. If Trump were to restrict his activities to America’s problems, stays away from any international involvement and above all, does not meddle with the military, then we might all breathe a little easier. But that’s not what your CIC is there for, is it? He is expected to meddle with the military, with international relations, with foreign policy and with America’s war readiness, isn’t he? So I repeat the question; do you feel comfortable with a purported sociopath having access to the launch codes? Because I don’t.

    • Ms. Cameron-Dow;

      I have learned over the years never to underestimate anyone, or any situation. I simply make my best effort to think through what I believe is the right course of action, then to think through, as best I can, what I believe my competition will think and/or do regarding that same situation. One might view life situations as a chess match. Some people are better at strategy than others. However, one can never know when a fortuitous event may intervene.

  • A day in Cort that is what people believe so they can explain their point and logic. The odd thing they do not want to recognize is that to get to cort 90% of work has been done already. Individuals also think that seeing a therapist is like going to confess to a priest. They will confess to something irrelevant and the therapist will will give them absolution.

  • Dear LARRY W PIERCE,
    Your opinions are simply that. The clinicians commenting here and, more to the point, in the book The Dangerous Case of Donald Trump, are well considered professional opinions based on established science.

    On the other hand, your defensiveness tells me quite a bit about you, LARRY W PIERCE. Good look with your life.

    • I apologize Ms Frankewicz,

      I did not fully understand that in order to have a well-researched, pointed opinion about an important profession or nebulous idea put forth by people who cannot spell or clearly state their case, one had to have random letters placed after their name. Please accept my atonement for this oversight.

  • So Larry W you have had the pleasure of sitting and talking to Trump. Don’t think you have but you reserve the right to judge him as OK and you also reserve the right to question anyone else, what ever their qualification is, that does not agree with your opinion and their ability to voice it. What qualification do you have that gives your voice more relevance. It appears that your value system is in line with Trump and as such you either fear to be judged as he is or it could be a sign of self questioning and you do not want your public persona to be judged in the same way. Recognition of your denile is the first step in getting help.

    • I did not say that I had any connection with Trump whatsoever. Please read the words as they are written if you are going to comment. I have no interest in Trump other than entertainment. My comment was to someone who acted as though she could make a definitive determination about him by what she had read and heard him say on the political stump. That is absurd.

  • The author makes a mistake common to nonclinicians, the idea that somehow “evilness” cannot be equated with a mental disorder. In reality, sociopathic conditions have long been a part of the Diagnostic and Statistical Manual. The concern is not that Mr. Trump has a simple Narcissistic Personality Disorder, but rather that he meets the new criteria for Antisocial Personality Disorder with Psychopathic Features (DSM-5, 761-765). The researcher Dr. Robert Hare has spent a lifetime documenting the distinct behavior and abnormal brain structures of psychopaths. This is a well documented condition within the field of psychology. My colleagues trained in psychoanalytic approaches prefer the term Malignant Narcissist. Unfortunately, they assume that reporters and the public will understand that this is not simply a way to say “really severe” narcissist when it is actually a well-developed model of disturbance first used by the great Erich Fromme. Wiki correctly defines it as “a psychological syndrome comprising an extreme mix of narcissism, antisocial personality disorder, aggression, and sadism.[1] Often grandiose, and always ready to raise hostility levels, the malignant narcissist undermines organizations in which they are involved, and dehumanizes the people with whom they associate.[2] ….[It] could include aspects of …paranoia. …The terms malignant narcissist and psychopath are sometimes used interchangeably because there is little to clinically separate the two.” Those of us trained in phenomenological diagnosis know that our president’s history and behavior check a multitude of boxes on tools designed to help with objective assessments. Traits such as pathological lying, sexual promiscuity, early behavior problems, anger at minor slights, boredom proneness, high attention seeking, dramatic hand gestures, and a tendency to disorganized speech patterns have nothing to do with political orientation. But they are markers for psychopathy. For the safety of the country, the 25th Amendment should be invoked so that proper medical, psychological and neurological work ups can be completed.

    • Larry W. Pierce -FBI profilers do it every day. Stop living in the dark ages. We don’t do diagnosis by simply asking what is wrong anymore. The great Robert Hare’s advice on the completing the Psychopathy Cehecklist–“The information for each category must be carefully drawn from documents such as court transcripts, police reports, psychologists’ reports, and victim-impact statements, and not solely from an interview, since psychopaths are superb liars” Trump has given us plenty of raw data.

  • Nora it is obvious you are not a professional and you think Trump is great, now be good or Santa will leave a lump of coal. Trump in a way can not be evaluated even face to face since he is delusional and a lier and has the mental ability of a bucket of … and that is being generous.

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