Last May, I wrote of my fear that our country could cave to an unstable autocrat and degrade into tyranny. Contributing to the effort to see Trump peacefully removed from power given his lack of fitness for duty, I marshalled the evidence that he likely has Antisocial Personality Disorder and suffers from paranoid delusions.
One year later, the downward slide into fascism only accelerates. Trump and his minions strive to place more and more brown people into concentration camps, as the president openly fantasizes about gaining absolute power.
Yet, I have less hope that my words and those of my colleagues in the National Coalition of Concerned Mental Health Professionals and the Duty to Warn movement will sway public policy. One of our political parties is spineless and complicit, the other is impotent.
However, there are reasons besides political policy for telling the truth about Trump’s psyche and the dangers it poses; more about that later. And another year furnishes many more data points, allowing me as a psychiatrist to write with far greater confidence about our president than I could even a year ago.
So today I am certain that our president meets full criteria for both Antisocial and Narcissistic Personality Disorder. However, the psychological construct of Malignant Narcissism, or Psychopathy, describes his psychology and behavior even better than these two diagnoses.
The concept of Malignant Narcissism, essentially synonymous with Psychopathy, was developed by two great mental health thinkers of the 20th Century, psychologist Erich Fromm and psychiatrist Otto Kernberg. (Interestingly, both were refugees from Nazism in the 1930s.) As formulated by them, Psychopathy has four key components: antisocial personality traits, Narcissistic Personality Disorder, paranoia, and sadism. So let me elaborate on how Trump displays all four of these.
Antisocial Personality Disorder (ASPD)
Using the gold standard for American practice, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), a person with ASPD must show compelling evidence of one of the following seven features. Going far beyond that minimum requirement, I’m going to show how Trump displays all seven.
First, a sociopath (the term for someone with ASPD) may engage in unlawful, criminal behavior. Despite Trump’s perseverative tweets of “no collusion” and “witch hunt,” the 20 criminal indictments issued by Mueller against Trump cronies indicate for all but the brainwashed that our president is a crook and traitor. Or look at his real estate dealings, signaling that Russian shell corporations and money laundering have been financing the tacky Trump lifestyle for over a decade. I’d urge you to read Yale historian Timothy Snyder’s essential The Road to Unfreedom, and see if you don’t come away completely convinced that our president is in bed with Putin and his thugocracy.
A sociopath typically lies profusely. Are 3200 falsehoods, by The Washington Post’s last count, enough for you? I’ve made a habit of reading Trump’s tweets daily, and one gets far closer to the truth by adding a “not” to whatever he belches out. Every day is opposite day in Trumplandia.
Impulsivity is another hallmark of the sociopath. Trump lacks coherent policies, as his off-the-cuff remarks take Congressional Republicans and members of his own cabinet by complete surprise. (Remember how Secretary of State Rex Tillerson learned he was out of a job?)
The person with Antisocial Personality Disorder is often irritable and aggressive. Here, we have reliable reports of Trump’s frequent angry outbursts in the White House. The celebrity who bragged of grabbing women by the pussy, and the candidate who urged followers to get violent with protesters, is now the president who posts violent Hillary-themed tweets and engages in phallic nuclear brinksmanship with Kim Jong-un over the size of their buttons.
Speaking of North Korea, Trump’s game-playing in the lead-up to his feckless summit shows another sociopathic symptom, a disregard for the safety of others. The president is also heedless of the consequences of his racist speechifying and its correlation with the rise in hate crimes in our country.
Next, sociopaths commonly exhibit irresponsibility in such areas as work obligations. The businessman with 3500 lawsuits for failing to pay contractors and employees is the president who spends more time watching Fox News sycophants than studying security briefings. One of his rare periods of media silence was the weekend Hurricane Maria made landfall on Puerto Rico, when Trump couldn’t be pulled away from a golf tournament.
Lastly, Trump displays a sociopath’s lack of remorse. Surprise, surprise, the candidate who famously asked Anderson Cooper why he would ever need to repent hasn’t suddenly grown a conscience. No apology ever arrived for saying there were fine people on both sides in Charlottesville. Per his equally nasty spokespeople Sean Spicer and Sarah Huckabee Sanders, his most offensive statements are just jokes or are willfully misinterpreted by his foes in the “fake news” industry.
Narcissistic Personality Disorder (NPD)
For NPD, we’ll again turn to the DSM-5 to understand Trump’s extreme narcissism. The DSM-5 requires that five of nine criteria must be met to make the diagnosis. I’ll be less exhaustive here than with ASPD, showing how the president meets seven of the criteria.
First, someone with NPD typically has a grandiose sense of self-importance. Evidence for this trait in Trump overflows; let’s just consider how he describes himself as a “very stable genius,” despite an elementary school vocabulary and innumerable typos in his covfefe tweets. Or how about his belief that he deserves a Nobel Peace Prize, despite manifestly making the world a less safe place?
Trump is also preoccupied with fantasies of unlimited power. How else to explain his admiration for thuggish leaders like Assad and Duterte, or his recent utterance that he’d like to see Americans stand for him as they do for North Korea’s Kim?
The narcissist’s unquenchable desire for unwarranted admiration shone through in the sickening toadying by his cabinet at their televised first gathering. We hear about it in the reports that his advisors highlight flattering news items in his daily briefings. We saw it in the coverage of his whirlwind visit to Puerto Rico last October, when he asked the island’s congressional representative to repeat some of her flattery to him, so all of the media present could hear it again.
Trump’s sense of entitlement comes through in his hate speech against the mainstream media (“the enemy of the people”), which has the gall to write truthful, negative things about his conduct and its consequences. And how about his outrage towards James Comey, who wouldn’t promise him undiluted loyalty? Our “law and order” president thinks he should be able to pardon himself (not that he’s broken any laws, mind you).
His interpersonal exploitation and lack of empathy are seen in the fact that everyone, including his children, only matter to him as a means to his own betterment, not for any intrinsic worth they have as human beings. Lastly, his envy crystallizes in his fixation on Obama and his hatred of Justin Trudeau, knowing that he will never possess their substantive charisma or earn the affection of good citizens as these two leaders have.
Paranoia and Sadism
After antisocial personality traits and a diagnosis of NPD, the third defining component of the psychopath is paranoia. We observed this early in Trump’s presidency, with his conviction that the popular vote was fraudulently stolen from him, and his assertion that President Obama had wiretapped his NYC residence. It continues with his unilateral initiation of a trade war with allies like Canada and Germany, framed by his assertion that these countries are laughing at us. His choice of media sources also speaks volumes; no investigative journalism for him, but rather the deluded conspiracies of the National Enquirer and Info Wars.
The fourth trait of sadism can fairly be said to define Trump and his presidency. The celebrity who body-shamed Rosie O’Donnell and former beauty pageant contestants, whose catchphrase was a demeaning “you’re fired,” has unsurprisingly carried his misconduct into the Oval Office.
His abusive name-calling (Lying Ted, Crooked Hillary, Crying Chuck Schumer, Liddle Bob Corker, Crazy Mika) shows an immature cruelty that would be unacceptable on a kids’ playground. The continued chants of “lock her up,” egged on by him at his rallies, are unfit for a democracy.
Here again, his admiration of Rodrigo Duterte (and his extrajudicial killings) and Bashar al-Assad (turning his country into a vast killing field) reveals the murderous potential of Trump. His loathsome policy of separating immigrant children from their parents is trauma on a massive scale, which only a man devoid of empathy and reveling in psychological torment could enact.
Why Precise Labels Matter
Hopefully, my gathering of the evidence has convinced you that our president is unquestionably a psychopath, a malignant narcissist. My data presentation is hardly exhaustive, so I’m quite sure my readers can come up with many other examples of Trump’s statements and misconduct that could further bolster my case.
It’s now fair to ask why naming our president a psychopath matters, and I can come up with three key reasons. First, in an age of rampant lies, we need to be wholly honest. In the immediate shock of Trump’s election, it was enough to vaguely posit that our new president was dangerous and make a long list of his concerning traits. But now that we’ve had more time to collect our thoughts and far more data, mental health professionals have a public obligation to use our training and knowledge to speak out with clarity.
This frankness will allow all of us to comprehend what we’re dealing with, to understand our societal prognosis, if you will. Knowing that our psychopathic president is in the august company of Muammar Gaddafi, Joseph Stalin, and serial killers, we can dispense with the fantasy that the Oval Office will somehow make him behave presidentially.
Instead, we can accept the truth that the key to managing a psychopath is containment and damage minimization. This is why the mid-term elections are so important, and why the continued protest and light-shining on this administration’s vile policies remain necessary.
Accepting that Trump is a psychopath will also buttress our own mental health. As I wrote last week, it is exhausting and traumatizing to live under the rule of a psychopath. However, just as there is power in a therapist helping a client to realize that her husband is abusive – and to overtly deploy the word abuse – I think there is something paradoxically empowering in acknowledging our current national predicament.
Possible Objections or Drawbacks
Reviewing the potential objections to truthfully labeling Trump a psychopath should further underscore why taking this step is so important. Hopefully, no one with even a dollop of integrity and critical thought is still dragging out the lazy argument that diagnosing Trump stigmatizes everyone who suffers from mental illness. Let’s all say it together again in unison: Trump’s psychopathy is not a stand-in for all mental illness, and those who struggle with a psychiatric disorder run the same gamut of virtue and villainy as those fortunate enough to be free of mental illness.
Some will contend that making public pronouncements about the mental health of public figures violates the “Goldwater Rule,” formulated in 1973 by the American Psychiatric Association (APA). Rather than rehash this debate, I will refer readers to my previous columns that tackled this in detail. Even better, you may want to peruse Friday’s editorial in Psychology Today, penned by my brave colleague, Bandy X. Lee, M.D., calling upon the APA to modify their antiquated, unscientific gag rule.
Others may argue that it is careless to diagnose a public figure from afar, without interviewing him. However, diagnosing someone with Antisocial Personality Disorder, Trump’s DSM-5 diagnosis that should cause the greatest alarm, is seldom done primarily through interviewing the patient. For obvious reasons, sociopaths are not keen to have themselves labeled as such and will misrepresent themselves to the interviewer. The diagnosis therefore is typically, largely made through collateral sources, such as information from concerned family members or legal records. A parallel process is occurring when I confidently assess Trump by way of his speeches, media appearances, and biographical sources.
(By the way, this is in stark contrast to nearly every other psychiatric diagnosis that I’ve encountered in my 24 years as a psychiatrist. On a weekly basis, I have new patients introduce themselves by saying, “I think I’m bipolar.” Much of the time, their self-assessment is correct. Contrarily, only once has a patient told me he thought he was a sociopath, and bless his sensitive soul, he was wrong.)
A greater personal concern to me is that mental health allies may fear I’m going too far in my pronouncement of Trump’s psychopathy, causing our movement to lose respectability. However, time is not on our side here. Doing the math, it took nine years for the APA to issue their 1973 Goldwater Rule, since the triggering offense occurred during Barry Goldwater’s 1964 run for the presidency. In the face of Trump’s ongoing dangerousness, we can’t vitiate our public statements while we await the slim possibility that the APA might see the error of their ways.
By contrast, I’m losing no sleep over alienating Trump’s supporters. Since 90% of Republicans still think Trump is doing a heckuva job – since they flare indignantly when Sarah Huckabee Sanders is refused a meal, but don’t bat an eye at her lies about children in cages – I have no hope of persuading them of any logical, humanistic, data-supported proposition. I have buried and sat shiva for the fantasy that Congress or Trump’s cabinet would invoke Section 4 of the 25th Amendment due to his mental unfitness for duty.
Now, my biggest hope is that speaking out like this might nudge young and minority voters to turn out for the midterms. With a psychopath in the Oval Office and the current batch of thumb-twiddling enablers in Congress, our best hope for this country’s future is a shift in Congressional control, while using our keyboards and taking to the streets in protest.
Photo credit: from the 2018 Women’s March in Missoula, Montana, licensed under the Creative Commons Attribution-Share Alike 4.0 International license.