Shrinks against Donald Trump

I live in New York City, so I know plenty of psychiatrists. Since 2016, many of them have been talking about what their responsibilities are towards the public when it comes to Donald Trump. As anyone who’s gone for therapy, taken a Psych 101 class in college or, frankly, read a basic self-help book knows, Trump is a textbook fit for the description of a malignant narcissist. These are people who derive joy from manipulating or hurting others. They don’t have empathy, and enjoy inflicting suffering particularly on people who they believe have wronged them. And they don’t change.

This is a psychological type first identified by German psychologist Erich Fromm, a German Jew who fled the Nazi regime and settled in New York City. Fromm was the first person to coin the term “malignant narcissism” in 1964. He defined it as a personality in which an individual takes pride in their own characteristics versus achievements. Malignant narcissists are often frustrated by reality and seek to deny it. They have a sense of grandiosity. They are paranoid. It’s a personality type associated with mass murderers, sex offenders and — surprise, surprise — history’s most evil dictators.

While therapists usually refrain from diagnosing from afar, a group of 225 mental health professionals in the US took the unusual step last week of taking out a full-page ad in The New York Times to, as they put it, “warn the public that Donald Trump is an existential threat to democracy. His symptoms of a severe, untreatable personality disorder — malignant narcissism — makes him deceitful, destructive, deluded and dangerous.”

The ad was paid for by the Anti-Psychopath Pac run by George Conway, who used to run the Lincoln Project. It has poured millions into putting Trump’s mental health in the spotlight, via ads, billboards, voter education projects and so on. As their website puts it: “We have to stop this psychopath.”

The therapists who’ve called for a full mental health examination and declared Trump “grossly unfit for leadership” are breaking the Goldwater rule, which is a reference to Barry Goldwater, a former US senator and 1964 Republican presidential candidate who was called “psychotic” and “schizophrenic” as well as being compared to leaders such as “Hitler, Castro, Stalin” by psychiatrists who responded to a survey from Fact Magazine. Goldwater sued, and the magazine had to pay him $75,000.

While I have no problem with psychologists declaring Trump mentally ill, I do wonder if the bigger issue isn’t the people who’ve enabled him (from Republican leaders to wealthy elites more concerned with their tax rates than democracy). No one malignant narcissist can survive without a gang behind them.

In fact, one might argue that all of America is suffering from narcissistic personality disorder, since we tend to glamorise many of the hard-driving, goal oriented over-workers who fit somewhere on the narcissistic spectrum. The tendency to focus on the external, the short-term and the mean has of course been put on steroids by our use of social media (for a particularly sharp take on that, check out Julia Angwin’s latest piece in The New York Times.

I’ve argued since 2019 that psychology is in some ways the best lens through which to see the world today. So it is perhaps worth noting that while most mentally ill people can be treated, and are no more likely to be dangerous than the general population, malignant narcissists are, as the Anti-Psychopath Pac letter notes: “The very rare exception . . . Without question, malignant narcissists have been history’s most grandiose, paranoid, and murderous leaders. Inevitably, they escalate until they are completely out of control, ultimately destroying themselves and the nations they lead.” 

Peter, is this too dramatic a description of a second Trump presidency, should it come to pass? Or the correct diagnosis? 

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Peter Spiegel responds

Rana, I’m not a psychiatrist, but I am the son of two headshrinkers (a moniker my dad will just love me using in Swamp Notes). That may be why I’m a bit more troubled by mental health professionals diagnosing political candidates from afar than you are.

The reason the American Psychiatric Association amended its ethics guidelines to include the Goldwater rule was not to shield the profession from libel suits. It was because diagnosing someone with an illness by watching them on TV is not how medicine is done.

If we treat mental illnesses on the same level of physical illnesses — as we should — then pronouncing someone afflicted with a psychiatric disorder after observing them on the public stage is akin to deciding an All-Star shortstop has pulled a hamstring after watching them limp off the diamond. It’s possible, but you can’t know for sure without a doctor’s close examination. As the APA guideline states:

[I]t is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

The rule doesn’t preclude physicians from “shar[ing] with the public his or her expertise about psychiatric issues in general”, and when it comes to Trump, it is important to point out — as you have, Rana — his behaviour includes a lot of the tell-tale symptoms of malignant narcissism.

Anyone who has read Too Much is Never Enough, the searing memoir of the Trump clan by the ex-president’s psychologist niece, knows he was raised in a highly dysfunctional family. Mary Trump describes her uncle as having been raised by an overbearing and quasi-abusive father — a textbook cause of narcissistic personality disorders. 

But such speculation is just that: speculation. It may be fair game for armchair pundits, but mental health professionals need to heed their ethical code. Trump himself has violated so many societal norms that others in positions of authority appear to feel they need to counter him by throwing their guidelines out the window, too. It is an instinct that should be resisted. If responsible people start aping Trumpian behaviours, then all of society’s ethical and moral underpinnings will be under threat.

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And now a word from our Swampians . . .

In response to “Larry Fink is so wrong about 2024”:
“Fink is right when he says that over time it hardly makes a difference . . . for financial markets. In the past, whether a Republican or a Democrat president was chosen, the return on stocks remained more or less the same. Thirteen of the last 15 presidents have presided over annualised returns of between 10-17 per cent.

However, the geopolitical difference of the choice between the two candidates is enormous. A choice for Harris is a choice for bifurcation; a choice for Trump is a choice for fragmentation. Bifurcation will lead to a continuing break-up of the world in two spheres: the Chinese sphere and the US sphere . . . it is a step back from the globalisation of the past decades and [could] lead to a real cleavage.

Fragmentation however will put an end to 80 years of Pax Americana . . . In the case of Trump, this means isolationism, just like before the second world war . . . It would bring as well a catastrophic period of deglobalisation.” — Koen De Leus