When do outlandish statements by a political personality cross over from merely disagreeable to outright pathological? More directly: Does Donald Trump’s undeniable self-regard, aggressive attention seeking, and inability to admit error suggest that we’re dealing with not just a shameless self-promoter but someone in the grips of a personality disorder — a mental illness?
Many political commentators have responded to Trump’s seemingly unique rise by resorting to distinctly medical language. Trump’s ghostwriter Tony Schwartz says that, were it up to him, he would now rename the bestselling The Art of the Deal as The Sociopath.
Other writers quote tweets as evidence for Trump’s "narcissistic personality disorder." Indeed, when it comes to narcissism, one clinical psychologist told Vanity Fair last fall, "He’s so classic that I’m archiving video clips of him to use in workshops because there’s no better example."
The American Psychiatric Association’s ethical guidelines forbid its members from diagnosing public figures from a distance. (This so-called Goldwater rule was introduced after numerous psychiatrists publicly pronounced Barry Goldwater unfit for the presidency.) In the Atlantic, James Hamblin — an MD but not a psychiatrist — acknowledges these ethical constraints but goes on to remark that "certain extenuating circumstances seem to make this exercise worthwhile."
He then embarks on linking definitions from the latest edition of the Diagnostic and Statistical Manual to Trump’s public statements and private correspondence. When the DSM-V cites "antagonism" as a personal trait necessary for a diagnosis of "antisocial personality disorder," Hamblin cites Trump’s extended feuds with journalists such as Fox’s Megyn Kelly, BuzzFeed’s McKay Coppins (who dared to call the Mar-a-Lago hotel "slightly dated"), and Vanity Fair’s Graydon Carter (co-coiner of "short-fingered vulgarian").
The New York Times columnist Maureen Dowd has used her creative license to imagine Trump institutionalized after an election he loses — though he thinks he won. He ends up being ushered by orderlies into "impulse control/delusion reduction therapy."
While bizarre statements and extreme personality traits make a pathologizing impulse understandable, it is ultimately misguided. It’s counterproductive for our understanding and treatment of mental illness — and it doesn’t help us achieve our political aims, either.
Undermining the scientific legitimacy of psychology
For professionals, diagnosing public figures from afar undermines the value of expertise and of the instruments used to diagnose. A structured clinical interview — private and anonymous — along with reliable and valid questionnaires allows clinicians to collect data and compare responses to others.
The reliability of such procedures is based on sound science. Perhaps one day we will be able to diagnose a disorder from a set of tweets, but for now, a structured clinical interview and other standardized instruments are the ones with the most solid scientific foundation.
When a clinician diagnoses Trump from his public statements, she is undermining the science of the mind — just as a doctor who claimed he or she could diagnose diabetes or multiple sclerosis or cancer by just looking at my behavior and public statements would undermine the trust in the scientific basis of their discipline.
Public behavior offers clues for a psychiatrist or psychologist — indeed, medical maladies such as diabetes or cancer have outward signs as well — but every time a clinician diagnoses from afar, he detracts from the scientific credibility of his field.
But let’s say you aren’t a licensed clinician. Why shouldn’t you let loose, calling Trump insane, deranged, mentally ill — whatever you want? Even if you are not a clinical professional, you should refrain from pathologizing Trump, because using terms for mental illness to denote morally outrageous acts, poor judgment, or the crass statements of an Olympic-class jerk stigmatizes mental disorders and undermines efforts to alleviate suffering.
Saying "he’s crazy" as a stand-in for "I find those personality traits insufferable and those statements reprehensible" reinforces the link in the public’s mind between mental illness and moral failing.
But mental illness is about medical issues, not moral failure. That’s an argument that advocates for the mentally ill have had to make for decades. The millions of people with mental illness in this country are more likely to be victims of crime than perpetrators, more likely to be the bullied than to be bullies.
A political attack with collateral damage
Implying that Trump’s toxic personality results from mental illness may well stigmatize him, but it also leads to needless collateral damage to people with psychiatric problems.
And one can oppose a politician just as strongly without the language of mental illness as with it. The 50 Republican national security leaders who signed a recent letter opposing Trump called him "dangerous" and alarmingly ignorant. When describing his temperament, they said he "lacks self-control and acts impetuously"— statements describing behavior, not mental health.
There’s also a basic misunderstanding at the heart of all this diagnosis-from-a-distance. Hallmarks of any mental disorder include dysfunction and suffering. We all get sad, but only some of us are unable to get out of bed, hold a job, or maintain relationships because of depression.
And Donald Trump certainly does not seem to be suffering. He eats well, sleeps regularly, and holds gainful employment. (We won’t know just how gainful until he releases his tax forms.) He seems to have a supportive family. His doctor claims his physical health is excellent. He is singularly successful in his current chosen profession, having won the presidential nomination of what was once a major US political party. He is accomplished, and claims to be healthy and happy.
Letting our political culture off the hook
Efforts to label Trump with a mental disorder let us off the hook in thinking about the kinds of personalities our culture rewards — and about the state of our politics. The very traits that many claim are toxic and dysfunctional have not only failed to harm him but have contributed to his success.
His grandiosity and bombast make him an entertaining media personality. His aggressiveness has brought him better real estate deals. Some are offended by his arrogance, but it’s gained him approval among his supporters.
It might be comforting to think that Trump’s long-running intimations that President Obama is a foreigner, or has secret sympathy for terrorists, are the product of a delusional mind. But in fact, these statements tap into a potent undercurrents on the American right. (It has also earned him lavish attention from major news networks.)
Diagnosing Donald Trump singles him out in a way that absolves his fellow citizens. Even if he continues his abysmal polling, at least 30 percent of the people in this country are likely to vote for him this fall, many enthusiastically so.
This support says more about our politics, and our citizens, than it does about Donald Trump’s psychology. As Sarah Kendzior aptly describes it in a recent piece on "Donald Trump’s America," whether Trump wins or loses, the America of his supporters will likely remain "suffering, anxious, and violent."
Trump’s arrogance and aggressive personality fits with his arrogant and aggressive political solutions. His angry bullying appeals to people who are angry and feel they need a bully "on their side." The success of the dark narcissistic elements of Trump’s personality depends on the dark nationalistic forces of our current politics.
But political problems demand political solutions, not medical ones. To put a fresh twist on a phrase used by President Obama in a recent speech: "Don’t diagnose. Vote."
Cedar Riener is associate professor of psychology at Randolph-Macon College. Find him on Twitter @criener.