While diagnoses of mental conditions under usual circumstances should be offered after a thorough mental health diagnostic interview by a mental health professional, we are facing a situation in the United States where the President elect, Donald Trump shows in his erratic behavior, apparent malevolent intent to destroy or debilitate valuable public institutions, and bizarre ideas about the functioning of American democracy a clear and present danger to the continuance of the American system of government and to the public at large, if he were to function as President in his current state. Using the tool of a formal diagnosis, a clinician meeting with someone like Trump would usually use such a diagnosis to inform a plan of treatment to attempt to resolve or make less troublesome (some or all) his symptoms and/or address the roots of the disorder itself.
As has been observed in some parts of the media, by clinicians privately, and by lay people, Trump produces on a daily and weekly basis utterances and actions that speak of a severe personality disturbance with few other plausible alternative explanations for the origins of these disturbed and disturbing behaviors and words. The personal characteristics of political leaders both in the area of mental health and in other areas of knowledge and competence can have a profound influence on how they act in office. We have no requirement in our governmental system that candidates undergo mental health testing, so it is left to the public to observe or not observe signs of mental disorder in candidates, we hope, in the time before an election.
Because of the “Goldwater Rule”, practicing mental health clinicians have forbidden themselves from “diagnosis from afar” and the 2016 campaign has been no exception for the organized representatives of mental health professionals. I believe this rule represents an over-reaction to what was in the early 1960’s a perhaps too-casual attitude by mental health professionals in expounding upon the mental health of public figures. Despite these self-inhibitions by professional clinicians, many in the media have observed Donald Trump’s relative erratic behavior and bizarre ideas and some have come up with mental health diagnoses that seem to be likely matches for the structure and dynamics of Trump’s personality into the future.
As I have almost a decade of training in mental health diagnosis and counseling, including a Ph.D. in clinical psychology, but do not currently have a practice in counseling or treatment (and therefore I am not holding myself here to the Goldwater Rule), I feel obligated to add what I observe, trying as much as possible to make my observations accessible to the general public, to officials, and to Trump himself. I will also try to be as transparent as possible regarding my own political biases to enable those who do not share these biases to put my views in context. Privately, clinician friends have told me that Trump sends off alarm bells throughout much of their community but they are constrained by the Goldwater Rule. As noted above, one doesn’t need to be a clinician to observe Trump’s lack of fitness for being President of the United States as well as the negative impact his campaign has had on public mental health.
Mental Health Diagnoses or Treatment are Not Stigma or Disqualifiers by Themselves
As someone who strongly believes in the value of mental health treatment where helpful, I do not believe that in the vast majority of circumstances, the assignment of a mental health diagnosis disqualifies someone from any particular job or acceptance by others as a friend, valuable member of their family, as a business associate, or a member of the community more generally. Diagnoses generally are there to help guide treatment, either by a clinician or by the person themselves in the form of self help. In the past, unfortunately, a personal history of mental health treatment and diagnoses have been used in American politics to disqualify candidates (for instance Edmund Muskie’s confession that he had been treated for depression) and this should never be the case as a spoken or unspoken rule, as it once was.
In fact, mental health diagnoses have become part of our popular culture, as people talk, for instance, about their “ADD” (attention deficit disorder), their “OCD” (obsessive-compulsive disorder), their “depression”, etc. whether or not they have ever qualified for that diagnosis by manifest behavior or their thinking. People are comfortable taking various prescription medications for mental illnesses such as depression, anxiety and even, schizophrenia, which used to be considered to be largely untreatable. There is at least currently an acceptance of mental health diagnoses as part of our culture.
A probably less well-recognized part of our culture regarding mental health is the personal ethics of getting treatment for a troubling mental disorder rather than simply “acting it out” or participating in a subculture that normalizes symptoms of mental disorder as cultural markers. As someone trained as a mental health professional and having undertaken personal psychotherapy, I am perhaps more attuned to the difference between recognizing and treating and not recognizing and not treating a mental disorder or even seeking counseling for a general self-diagnosed sense of unhappiness. There are also unfortunately a number of disorders where the person does not recognize their own psychopathology (mental suffering) and, often ends up imposing suffering on others and remains unaware of anything like suffering on their own part.
There are also serious deficits in the funding and sometimes delivery of the appropriate mental health services, so one cannot entirely hold responsible working- and middle-class people for not engaging in, for instance, an intensive psychotherapy or addiction treatment, which is unfortunately a luxury often limited to people with very substantial means or extraordinarily comprehensive health benefits. As Donald Trump has always been wealthy, he has never experienced a financial barrier to mental health treatment, if he had had the intention to seek it out. Any failure of his to seek remedies for his own mental disorder, is a choice by him and not a limitation in the accessibility of services.
Donald Trump’s Mental Disorder and the Job of President of the United States
It is unfortunate that Donald Trump, despite winning the Electoral College vote though not the popular vote, seems to have a particular type and severity of mental disorder that it appears will make him an extremely destructive President for American governmental institutions, for other public institutions like a free press, as well as for the hundreds of millions of Americans that will be effected by government actions and policy. Donald Trump’s mental state appears to be not simply part of the range of diversity of personality types and neuroses but appears to be extreme and in part enabled in its continuance by the financial wealth he inherited and still now possesses.
Furthermore, it appears as though, Donald Trump has not undertaken either any treatment or, at least, adequate treatment for that mental disorder and seems, in fact, to use the symptoms of that disorder to confuse and disorganize his political opponents, his political supporters as well as institutions that have a mission to, at least in part, serve the public. Trump has always had the financial means to address his apparent mental disorder, so is at this late point in his life, personally culpable for its effects on others. Unfortunately for the American public and public institutions and possibly for Trump himself, Trump appears to have the type of mental disturbance that is mostly predatory on others, including unsuspecting or only partially-suspecting voters who pulled the lever for him in November.
Trump’s personality and the mental disturbances that seem to bedevil him incline him more, as a politician, to become a corrupt dictator or autocrat rather than a President of a constitutional republic and democracy like the United States. While Trump cannot in the next few months impose his disordered personality on the American system of government all by himself, with the help of a compliant Congress and judicial branch, Trump may be able to remake American institutions to suit his distorted view of the world and of human relationships. At that point, the American experiment in democratic self-government would have come to an end, in part because of the public’s and politicians’ lack of awareness of the effects of extreme mental disorders on public life and their combination with immense political power.
While it is considered disqualifying to compare anybody to Adolf Hitler and his rise to power, Trump’s personality and utilization of popular discontent appears to have some resemblances to Hitler’s “malignant narcissism”. Hitler, a dreamy failed artist and returning veteran from World War I, capitalized on the sense of betrayal and wounded national pride that engulfed Germany after the First World War and the (unfair) terms of the Treaty of Versailles. He created a political fantasy world for himself into which he invited Germans that was predicated on a revenge fantasy for the “slights” of World War I and the hardships of the Great Depression. Hitler would have been unable to rise to absolute power in Germany of the 1930’s, without a shot being fired, had their not been the consent or acquiescence of the existing German government and social institutions. Those results were disastrous for Germany, Europe, and the world more generally. It appears that Trump, who apparently was an admirer of Hitler’s speeches. aspires to absolute power rather than leadership constrained and guided by a constitutional, legal order.
Via the 2016 electoral campaign, the American public at large has been exposed through Trump to a level of psychopathology (mental disturbance) that is usually only observed in clinical, law-enforcement or prison settings. The stream of negative words, actions, and emotions that Trump has communicated to the American people by an at-first unsuspecting mass media connected with and seemed to support many Americans’ dissatisfactions and therefore turned into votes for Mr. Trump. Despite the support he won in the voting booth vs. his opponent Hillary Clinton, Mr. Trump appears to be behaviorally and emotionally under-developed for a grown man, especially a man of 70 years who is supposed to become the leader of American government.
Trump’s speaking style was, in the context of the sanctioning public ground of mass media political coverage, “new” and different to the public and they thought he was “honest” because of this newness and his lack of a filter, yet reassured by the familiarity of the Trump “brand”. Several large media corporations, such as NBC and Fox, had already “bought into” the Trump brand, so they allowed his disturbing and disturbed stream of consciousness to reach the public without comment for many crucial months during the early part of the campaign.
However taken in context of his personality and what his likely actions as President will be, the picture become alarming and it appears that few in the media have had the tools to clearly describe for the American public what the ramifications would be for such a personality to wield the massive political powers of the American Presidency. People in general do not know people with the severity and type of mental disorder that Trump has, though they thought they did “know” him via his TV persona and his, somewhat familiar, salesman’s style of talking.
I also accept and have supported myself that the American public wanted something different than what was on offer by mainstream candidates and that applying a (in its particulars, disqualifying) mental health diagnosis to Trump does not in anyway suggest that the dissatisfactions and anger that motivated support for Trump should be dismissed or “diagnosed away”. I campaigned for Bernie Sanders in the Democratic primary and I am of the view that expressing dissatisfaction with American political institutions and their apologists is necessary for them to be improved or even fully transformed for the better. In fact, some of my own recommendations regarding change in laws and governmental institutions, especially as regards climate change would go further than what Sanders might have enacted. However there is a difference between on the one hand proposing constructive change, recruiting people’s conscious and logical minds, and the predatory exploitation of discontent to win power and, then likely increase one’s own wealth and power or the wealth and power of a select group of cronies.
While a definitive diagnosis of Trump is impossible without a diagnostic interview in person, as well as psychological testing, I will offer at the end of this piece a hypothesis that is strongly supported by publicly available facts. I will build the diagnosis via describing Trump’s manifest traits that are disqualifying for him to be President. This order of presentation is to discourage a fetish of a diagnosis as an explanatory model for Trump’s disturbance and the dangers his disturbed personality represents.
Donald Trump’s Disqualifying Traits
- Extreme Narcissism/Megalomania – As has been discussed a number of times in the press, Donald Trump appears to have the constant need to sustain a grandiose conception of himself and the objects associated with him (like his buildings) bordering on megalomania. Such a degree of narcissism, a false-self shielding a much realer and more prosaic “true self” is associated with, at the same time, a thin-skinned vulnerability, as is both typical in general of people with extreme narcissism and typical of Trump. While it must be said that to be a successful entrepreneur, business leader or political leader it requires considerable narcissism, Trump’s narcissism has appeared for decades to be excessive and dysfunctional for both his business enterprises (in which he has often failed or barely “succeeded” in a sometimes disreputable or parasitic way) and in the social interactions, which apparently are so wounding to him that he is now politically motivated largely by hatred and revenge. Trump’s extreme narcissism will be disastrously dysfunctional in his public role as political leader and chief administrator of the Executive Branch of the US federal government. Despite having such a personality for many decades, Trump still does not understand how detrimental this trait has been to him, leading one to suspect that he has never consistently sought the often painful, long-term psychotherapy that is the only treatment known to ameliorate such a high degree of narcissistic disturbance. Many of the traits below are parts of the this central trait of Trump’s, an overblown grandiose conception of himself, at odds with his own reality, let alone the reality of ordinary Americans and the leadership they need at this time.
- Sadism/Vengefulness/Pettiness – It has been remarked upon for years that Trump is a particularly petty and vengeful individual, who holds grudges for years. It also appears as though Trump savors the idea of revenge and the entire enterprise for him of becoming President, rather than live the rest of his life comfortably as a very rich man, may very well be motivated by an intense and long-lived desire for revenge on people he views to be unjustly admired, such as President Obama, or who have scorned him in the past. The process by which he has picked cabinet members, for instance, seems to have been designed to humiliate others, as much or more as a means to select the most qualified individuals to run various government departments. Such negative traits should be immediate disqualifiers for someone who is the Commander in Chief of the most powerful arsenal the world has ever seen, given the possibility that such vengefulness could be used to start possibly civilization-ending wars as well as persecute or imprison internal critics or protestors.
- Inability to Abide by Laws/Lacking Understanding of Rule of Law/Sociopathy – An apparent outgrowth of Trump’s extreme grandiosity, is that he has little grasp of the framework of laws that govern US society, let alone the actions of the President of the United States. In other words, Trump is so grandiose that he thinks that he is “bigger than” the laws of the land. Having always been very rich and litigious, Trump has been able to escape legal sanction and live “above the law”, including exempting himself from taxation for a number of years. Unfortunately the press and his opponent have for reasons that are unclear have allowed Trump to escape publishing his tax returns, again being able to live “above the law”. During the 2016 campaign he threatened his opponent, Hillary Clinton, indirectly with assassination, threatened to put her in jail if he won (which he says he has “relented” upon), and has recently shown that he has no conception of how the First Amendment works in his call for those who burn the flag to be stripped of their citizenship, a right that has been twice been upheld as Constitutionally protected by the Supreme Court. Trump has therefore a sociopath’s understanding of the law, a sociopath being a person who cannot internalize rule of law and demonstrate an effective conscience vis-à-vis other people. During Trump’s business career he has been sued or himself sued some 3500 times and most recently settled out of court rather than face a likely fraud conviction in the Trump University case. Trump’s history as a businessman has indicated that he as often acted as a predator on his suppliers and creditors, short-changing them. Trump’s ruthlessness as a businessman may, with a very indulgent standard of business ethics, be viewed as an asset in a hard-scrabble business world but become, when paired with the monopoly powers of the federal government, an invitation for massive abuse and even transformation of the US government into a personal or family fiefdom. If Trump were allowed to continue to act as President in the sociopathic manner in which he has become accustomed in his business practices, this would negate the entire 240-year American project built upon rejection of absolute power of monarchs or their equivalent.
- Inability to Face Truths/Tell the Truth/Attack on Truth-telling – While it is joked that politicians lie every time they move their lips and can never be trusted, there are degrees to which is the case. Trump, despite appealing to voters and the public as if he were a truth-teller and the opponent-Establishment politicians were the liars, he has been in the 2016 campaign the most prolific and habitual liar as shown by numerous fact-checking organizations, with some studies showing that Trump lies or partially lies 70% of the time, an unheard-of percentage in a political figure. Trump aggressively disputes his own mendacity, projecting his own propensity to lie as an anticipatory move onto others, and seems unable to face the fact that he cannot face the truth. Via his counterattacks, he creates an alarming “hall of mirrors” in which he attempts to trap other people. Furthermore governments, outside of elected officeholders are sources of reliable factual information on many topics, as information gathering is one of the functions of government (tax records, land surveying etc.). Trump seems intent on following policies that aggressively undermine the ability of governments to collect and publish scientific information about, for instance the global climate, as well as to curtail the transparency of government operations by making favorable coverage a condition of journalists’ access to government officials like his Administration.
- Persistent Sense of Entitlement to Gingerly, Laudatory Treatment/Immature Emotionality– Related to Trump’s strained relationship with the truth, Trump regularly complains about negative portrayals of him by the media. Trump seems to believe that the only “true” portrayals of him are those that glorify or do not criticize him, which counterindicates that he will be able to handle the inevitable conflicts with political opponents domestically or with foreign powers. Trump is prone to posturing as a “man’s man” but at the same time cannot “take” mild criticism and complains with childish whining publicly about such treatment or issuing veiled or open threats to critics who simply have a different view than he.
- No Stable Public Agenda for Governing/Pure Oppositionalism – In the United States and around the world there are differing opinions about government policy and how much government is desired in the ideal society. The custom of most mainstream political actors is usually to present government as either the counterweight to excesses of capitalism (Big Government) or as a neutral referee in competitions between people and businesses (Limited Government). In the United States, the “neutral referee” position has dominated in both major political parties for the past 20 years. Trump appears to have no stable allegiance to any idea whether his own or others about how government should function, which is highly unusual in someone who has flirted with politics on and off for many decades. Before the election, Trump successfully appealed to the “caretaker” role of government while shielding it from Republican criticism by aggressive posturing and racist exclusionary rhetoric. Trump promised voters that he would shield the social programs upon which his elderly voters depend. Since the election however, Trump has instead assembled a cabinet that is most obviously a collection of very rich people with little interest in the ‘caretaker” role of government. Also Trump seems to have selected figures because they were uniquely unqualified to do a job. For instance, his pick of Rick Perry for Secretary of Energy seems to be designed to little more than shock, as Perry was unable during the campaign to remember the name of that Department. This is what clinicians call “oppositionalism” and indicates that the person is driven by the desire to defy, to provoke a reaction from others, rather than any internal plan they have.
- Apparently Unchecked Avarice/Egocentric View of the World Trump in addition appears to want to further his own naked self-interest and those of his ultra-wealthy family and cronies, with little allegiance, for instance, to the political “supply-side” ideal that is the typical justification for such an idea (i.e. “trickle-down economics”). While Americans are free to choose in the voting booth, the transition from pre-election to post-election Trump is so dramatic as to suggest either vast personal instability and/or criminal-level intent to exploit the offices of President after having fooled the public to vote for him. Trump’s egocentrism and already manifest expressed interest in continued personal financial gain as President, in combination with a compliant Congress and judiciary, could also lead to an end to the American Republic and a reversion to something like a monarchy or aristocracy, against which American colonists rebelled in the 18th Century Trump will likely attempt to tailor government to suit his financial and other needs without allegiance to any of the animating ideas that inspired the foundation of the American republic.
- Self-Idealization of the Role of The Leader – During his campaign, Donald Trump portrayed himself to his followers as a man possessing extraordinary, almost magical abilities. He could do little to explain why he said he had these abilities to work wonders as a potential President, only that he was “do-er” and would achieve things. His rhetoric departed from long-standing traditions in all democracies to defer to legal process and the institution of laws and policies as the means by which government action for the people is achieved. Trump rather echoed the rhetorical position of various “strong-men” in less developed countries. The use of this rhetoric and Trump’s lack of understanding of or emotional or ethical investment in government institutions indicates that using the powers already vested in the Presidency plus a compliant Congress, Trump seems to want to amass dictatorial powers violating the letter and the spirit of the US Constitution.
- Misrepresentation of Self to the Public – As suggested above, Trump, who has faced a number of fraud charges as a businessman, seems to have misrepresented himself quite significantly during his campaign, especially as regards his concern about government corruption and his attention to the welfare of ordinary Americans rather than a select few cronies of the President. While there are some continuities between what Trump told the electorate before the election and thereafter, there seems to be enough of a misrepresentation, in combination with other characteristics of Trump as described above, to suggest that Trump’s penchant for perpetrating fraud will express itself quite dangerously during his Presidency. In fact, Trump himself has been telling crowds on his “Thank You Tour” lately that his campaign was a ruse, in a way that, at least for the time being, listeners are not sure how to react to these confessions that his words are mostly fabrications, intended to have an effect rather than communicate ideas or establish durable relationships with others.
- Modeling Destructive, Socially-Inappropriate Speech and Behavior/Poor Judgment – There are varieties of ideas about what constitutes a good person in the United States but generally older people, like Trump, as well as political leaders and celebrities are expected to represent models of good behavior to younger people and to “fans”. Trump, on a regular basis, displays rude and inconsiderate behavior as well as a lassitude about matters of respectful maintenance of personal relationships and comportment that are to say the least unusual in a man of his age and position. The above-mentioned confessions in his “Thank You Tour” that he had employed a ruse to win the Presidency were examples of poor judgment, not only for the original act of duplicity, but also the not-contrite confession of the act to those whom he had apparently fooled. Trump’s remarks about a number of women during the campaign were hateful, insulting, socially regressive and harmful to women’s rights and safety. Trump has already triggered an epidemic of bullying, which has created an atmosphere of hostility in schools and universities. Trump has during his campaign and likely in the occupation of the Presidency will continue to produce unusual and undesirable behaviors that will influence young people and their moral development in a negative manner. None of these behaviors are remotely fitting for the President of the United States.
Trump’s Tentative Diagnosis
While I am of the belief that diagnoses are overrated as explanatory tools, I have made references to Trump’s mental disorder so will deliver a hypothesis that could only be confirmed by, as written already above, a diagnostic interview and perhaps a full battery of psychological tests.
Trump from almost every appearance seems to have, in the nomenclature of the DSM-V a severe “Cluster B” personality disorder with unknown co-occurrence of other disorders, such as perhaps hypomania or other mood disorders. Trump’s Cluster B personality disorder is to a large extent narcissistic with antisocial features (meaning sociopathic/psychopathic). The features of his apparent narcissistic and antisocial personality are outlined in the above description of his traits. He also shows considerable sadism and might qualify for the ICD-10 – Other specific personality Disorder – Sadistic, a diagnostic category that still remains controversial for, ironically, reasons of political correctness. Unfortunately those with these disorders are unlikely to seek treatment for themselves, as they tend to prey on others rather than look to change themselves and their behavior.
Though not a formal diagnostic category, Trump seems to have strong representation of the four characteristics of the “Dark Tetrad” associated with “evil” people: sadism, narcissism, psychopathy/sociopathy, and Machiavellianism. This cluster of personality traits is associated with hardened criminals and Internet “trolls”.
All of these descriptions point to Trump not being fit, in his current state to faithfully execute the responsibilities of leading the executive branch of the US federal government.
Plans of Actions
There are a number of possible resolutions to the difficulties posed by Trump’s mental health issues that would prevent him from imposing these on the American people via wholesale refashioning of government to fit his disordered personality.
- Trump Seeks Intensive Psychotherapy – This is not likely to happen and those with Trump’s type of disorder have generally a very poor prognosis. However, if, and this is unlikely, Trump were to undertake this treatment in seriousness, this would be a positive sign for him and possibly for his Administration. There would be no guarantees that he could become a more law-abiding and effective President via such a psychotherapy. People with the type and severity of personality disorder that Trump appears to manifest usually undertake treatment under duress and lack the internal interest in sincere engagement with the psychotherapeutic process. The possibility of the patient “defrauding” the process of change within such a mandated or chosen-under-duress psychotherapy is very high.
- Electors Decline to Vote For Trump (available until December 19th, 2016) – The electoral college system does provide one out for electors to decide to switch from the candidate they were pledged to vote for to choose another candidate or take some as yet unspecified action. The two outcomes here are:
- Electors vote for someone other than Trump
- Electors call for a popular re-vote
- The Congress Decides to Enforce Laws Regarding Conflict of Interest/Presidential Powers – Congress, now dominated by the Republican Party, could decide for the good of preserving American governmental institutions, to sanction and restrain Trump in those areas where possible. If he continues to break laws, they would need to seek his impeachment to preserve the United States as a Constitutional republic.
In all, the future of the American Republic is now at stake, unfortunately requiring insights into and understanding of a man who has one of the more insidious characters possible. I hope to have provided some of those insights here to guide decision-making.