You are at a party with friends when the host announces you should all play a game.
“The rules are simple,” he says. “I’ll give you a list of characteristics and you tell me what name comes to mind. Here goes.”
1. a resistance to accept blame or criticism
2. a lack of empathy
3. a grandiose sense of self-importance
4. feelings of entitlement
5. a preoccupation with fame, attention and praise
6. excessive emphasis on displaying beauty and power.
Somewhere between descriptors three and four most guests have come up with a name.
By the time the last characteristic is cited there is unanimity.
The person being described is none other than Donald Trump, our 45th president.
I suspect that most of you reading this arrived at the same conclusion.
The six above-listed characteristics are described in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
The symptoms describe a malady known as Narcissistic Personality Disorder.
There is a debate in psychiatric circles as to whether one can diagnose a person without having personally met the individual.
This is relevant today because of a letter which appeared in the New York Times in February 2017.
The last line read: “We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.”
Signatories to this letter included 16 M.D.s and seventeen PhDs.
While no one questions the academic qualifications of these gentlemen and ladies, none of them had interviewed the President.
This leads to consideration of what is known as the “Goldwater Rule,” and here, some historical perspective is useful.
The 1964 presidential race pitted arch-conservative Barry
Goldwater against incumbent Democrat Lyndon B. Johnson. The Democrats wished to cast aspersions on
Goldwater’s mental stability so they hired the advertising firm of Doyle, Dane, Bernbach to make their point. The resulting ad was the most effective in the history of political advertising. Known as “The Daisy Ad” it depicted a young girl picking petals from a flower and counting down from ten. The next image is of a nuclear blast.
The not so subtle message was that if Goldwater were elected, his instability and warmongering propensity would mean the end of the world. Although there was little truth to this, Johnson won in a landslide. Nine years later, the American Psychiatric Association adopted the “Goldwater Rule” which warned against “diagnosis from a distance.” There is no denying the efficacy of a face to face meeting between the person being assessed and a therapist, but how essential is this?
I maintain that in today’s world with cameras and smart phones capturing every word we utter and every move we make, there is ample evidence upon which to judge a candidate’s sanity. In addition, we have a president who twitters in the wee hours of the morning providing us with daily evidence of his being “unhinged.” Just this past weekend, he regaled us with a story about Trump Tower being “bugged” by his predecessor President Obama. How many lies must be told and how many insults hurled before we can say with certainty that Trump is a liar, a bully, and yes, mentally ill?
A phrase comes to mind. “If it looks like a duck, swims like a duck and quacks like a duck, then it probably is a duck.” This test implies that we can glean much from observing behavior and that the Goldwater Rule may no longer be relevant.
The argument has been made that it is unethical to judge a patient whom you haven’t met. Dr. John Gartner who has taught psychiatrists at Johns Hopkins Medical School for over 20 years maintains that the truly unethical position is to ignore Trump’s pathological behavior. Is there anyone naive enough to think that the man who refuses to let us see his tax returns would consent to sitting down for a “face to face” with a therapist?
Health-care professionals are not the only ones who have assessed Trump as unfit.
Journalist George Packer writing in the Feb. 27, 2017 issue of The New Yorker states that Trump’s disability isn’t laziness or inattention. “It expresses itself in paranoid rants, non-stop feuds carried out in public and impulsive acts that can only damage his government and himself.”
Discussing a White House news conference, Packer writes: “He rambled on for nearly an hour and a half…flung insults at reporters…and…congratulated himself so many times and in such preposterous terms…that the White House press corps could only stare in amazement.”
In fairness, there is another point of view.
Dr. Allen J. Frances is the man who wrote the definition of narcissism for the American Psychiatric Association, yet he is on record stating that “Trump isn’t crazy.”
In a “Psychology Today: piece, he stated that “in defining all mental disorders — the behaviors also must cause clinically significant distress or impairment. “
To make his point, Frances alleges that Trump’s “behaviors consistently reap him fame, fortune, women and political power.”
But can’t the same be said about Adolph Hitler, and no one alleges that he wasn’t insane.
If Trump’s success in the business world is an indicator that he is sane, why not, at long last, establish his worth by releasing his income tax returns?
If successful with women, why three wives and who knows how many mistresses?
As to political power, he may be the most powerful world leader at this time, but I do not believe he will survive four years in office and I am not alone in this belief.
Conservative columnist David Brooks writing in the New York Times on January 31, 2017 said “It will not be surprising in the slightest if his term ends not in four or eight years, but sooner, with impeachment or removal under the 25th amendment.”
I’m convinced that, sooner or later, Republicans will come to their senses, overcome fear of retaliation, and put our country before partisan politics.
Maybe, someday, we will agree with Dr. John Gartner that that “narcissism is an untreatable personality disorder…no one can ever tell the malignant narcissist he is wrong.”
Or as Robert Kagan writing in the Washington Post suggests “One wonders if Republican leaders have begun to realize that they may have hitched their fate and the fate of their party to a man with a disordered personality.
Extensive research leads me to agree with the many mental health experts who believe Donald Trump suffers from narcissism, an incurable aberration, which will ultimately lead to his downfall.
All conciliatory efforts that we “work with” him make no sense. He will not modify his behavior because he can’t. No one can predict the date of his downfall, but Winston Churchill’s words may apply. “Now this is not the end. It is not even the beginning of the end. But it is the end of the beginning.”
Dr. Hal Sobel