COMMENTARY | The stigmatizing language undermines real talk about mental health; Trump's problem is bad judgment
For 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 not a mental health professional, but” and somehow don’t bother to ask a mental health professional’s opinion.
However, Trump’s bad judgment doesn’t matter whether he has a mental illness or not.
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 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’ wellbeing, and 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 advisers 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.
Meredith Mathis and Jason Renaud are with the Mental Health Association of Portland.
