An ADHD Missile Crisis?

John Kruse
Jul 2 · 3 min read

President Trump’s response to Iran’s shooting down a U.S. drone in the Straits of Hormuz demonstrates the impulsivity that is a hallmark of his ADHD. Understanding that Mr. Trump exhibits a severe and inadequately treated case of ADHD allows us to make some sense of what otherwise appears to be a collection of disparate and bizarre behaviors. While other aspects of his character, including his widely noted narcissism, may contribute to what ideas his brain formulates, his ADHD shapes how his brain works: what enters his mind, and all of the thoughts and utterances that spew out.

Examination of the role that Mr. Trump’s ADHD plays in his decision making and other actions does not involve partisan politics or a critique of his policies themselves. You can support his approach of using threats to employ brutal force in order to coerce diplomatic concessions and still see how his ADHD hampers and undermines this strategy. You can support his avowed resistance to starting another invasive Middle East war while still seeing how his ADHD-driven behavior undercuts this game plan. Although his ADHD did not create his policies, ADHD contributes to his inability to reconcile the conflicting stances of isolationism and attempted maximal intimidation, and to clearly articulate his overall strategy.

Impulsivity characterized Mr. Trump’s decision to launch strikes on Iran, and then a counter-impulse led him to rescind this order a half hour later when he realized that scores of people might be killed by our strategic missile strikes. Still another impulse led him to announce these decisions to the world. Over the past week he has first changed the time line and then even denied the basic elements of this narrative, all delivered with impulsively blurted comments. If narcissism alone drove his actions, he would not be portraying himself as so poorly prepared, inconsistent, and impulsive. “I just saved us from disaster — caused by myself!” does not provide a particularly heroic story arc.

All of us act impulsively at times, but people with ADHD differ in the pervasiveness of their unpremeditated behavior. (People with the purely inattentive type of ADHD do not display this impulsivity.) The drone crisis provides not just one, but multiple examples of Mr. Trump’s impulsivity. Additional examples from the past week include his impetuous Twitter tirades against women’s soccer stars, as well as blurting out comments regarding the Democratic debates after publicly vowing he wouldn’t talk about them.

Mr. Trump’s reactions in the heat of the moment underscore how his ADHD set him up to be unprepared for this confrontation. His severe ADHD drives him to focus on the moment and discount future consequences. ADHD led him to disregard the ramifications of withdrawing from the Iranian nuclear treaty more than a year ago. He blurted out bellicose rhetoric while his ADHD blinkered him to the likely response of increased Iranian military aggression. ADHD contributed to his neglecting to ask about, or listen to, his advisors informing him of the lethal implications of launching a missile strike. While his administration forcefully promotes the development of hypersonic missile systems, which destroy targets a hemisphere away within minutes, our president, because of his ADHD, has trouble with life-or-death decisions embedded in our current technology.

Mr. Trump’s uncontrolled ADHD means that he will continue to subject us to his impulsive reactions. He will enter crisis situations unprepared because he hasn’t done his homework. And he will inflict his personal whims and agenda upon us rather than expending his energy on the significant events that unfold around him.

We should encourage him to find and comply with adequate treatment to address his ADHD. And as with all individuals with ADHD, adequate treatment does not just mean medications (which might be powerfully helpful), but social and structural interventions as well. In particular, this means keeping others in the decision-making loop who can help him review his plans, stifle his most intemperate outbursts, and redirect his attention to those tasks that strongly influence the lives of billions of people.

John Kruse

Written by

John Kruse MD, PhD, San Francisco psychiatrist, father of twins, marathon runner.

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