As a psychotherapist, more than a few folks have asked me to diagnose Donald Trump. Most of my colleagues report receiving similar requests. The man’s niece, Mary Trump, a clinical psychologist, has written a salient book (Too Much and Never Enough) about what she views as the dangerous psychopathology of her uncle. What’s more, many rational people who served in Trump’s administration, most now departed, continue to raise alarms about the mental status of their former boss. Most recently, even many of those still in the White House claim he is unhinged.
Professional associations representing mental health providers generally discourage us from diagnosing from a distance. Accurate diagnosis usually requires a thorough clinical interview and, sometimes, psychometric and neurological tests. So, merely observing a politician’s public-facing persona leaves out a lot of important information about their mindset and behaviors; the so-called back story.
However, Trump has proven an exception. For one, his steady stream of tweets over the past four years offers a revealing look into his mental state, emotions, thought processes and personality. For another, his off-script comments, which are the norm, remain consistent with the self-absorbed tone of the tweets he issues all hours of the day and night. The conclusion? This is not an act or a pretense. It’s who he is. Given the ugly transparency of Trump’s mindset, legions of mental health professionals have weighed in on this man’s mental status.
Malignant Narcissist
The most common diagnostic label they assign him is Narcissistic Personality Disorder of the “malignant” variety. This variant involves an extremely virulent brew of narcissism, antisocial behavior, aggression, impulsivity and, with some, even sadism. As Mary Trump makes clear in her book, folks with this dysfunction prove toxic to people and organizations in their midst and are quick to dehumanize and attack anyone they perceive as critical or adversarial. Empathy, which is a primary ingredient in the social glue binding us together as families, communities and nations, is totally absent in these persons. In its place is an unwavering focus on their self-interest, and the deleterious cost to others be damned.
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Now, yours truly is not a fan of psychiatric diagnoses. For one, studies show how subjective and inaccurate they can be and how clinicians apply them inconsistently. What’s more, our culture utilizes diagnostic labels as a thinly veiled form of name-calling, a professional-sounding way to be nasty. Nonetheless, there are instances where what looks, acts and sounds like a duck is actually a duck, and when it comes to the Donald, this applies. He does, in fact, consistently and brazenly exhibit all the symptoms associated with malignant narcissism. If you think I’m being partisan, rest assured I would say the same about a Democrat in the White House displaying this kind of off-the-rails behavior.
It will come as no surprise that malignant narcissism, which is a type of personality disorder, is very tough to treat. The only form of talk therapy with any chance, and it’s slim, is called Dialectical Behavior Therapy, but to be effective, the client must recognize they have a problem and be open to addressing it. That’s a stratospherically high bar to clear with a malignant narcissist. For example, in one study, folks with this condition were given group therapy that involved interacting with people who had been victimized by their kind. The goal was to instill empathy in them for victims of their hurtful behaviors. However, rather than learning empathy, the subjects used these sessions to refine their skills at manipulating others to advance their self-interest. So, if you’re waiting for Trump to come to Jesus, so to speak, forget about it. A lightning strike might do it, but not psychotherapy.
When it comes to diagnosing malignant narcissists, I recall when I was taking a course in psychopathology in graduate school. The professor concluded our term by telling us there was one other important diagnostic category we had not covered in class that all mental health providers needed to know.
To quote him: “Then, there are assholes.”
For more, visit philipchard.com.
