A Mental Health Counselor’s Updated Views on Speculations About President Trump’s Mental Health
By Jeffrey Guterman
Speculations about the mental health of U.S. presidents are not new and have sometimes been justified. After he left office, it was learned that during the Watergate crisis Richard Nixon was depressed, drinking excessively and taking Valium, and talking to portraits of former presidents in the White House. President Reagan was diagnosed with Alzheimer’s disease after his second term, but it is assumed that he was afflicted with the progressive illness while he was still in office. All presidents have probably been called “crazy” in the colloquial sense by their political enemies. And some presidents have suffered from real mental illnesses, especially depression. For example, President Lincoln had a history of severe depression which was called melancholia in his era.
Mental illness, as in the case of Lincoln’s depression, does not necessarily preclude one from being an effective president and can be a strength. However, this is not the prevailing view with regard to those who speculate that Donald J. Trump has mental illness. Claims that Trump is mentally ill and therefore unfit for office are ubiquitous. The frequency and nature of these claims are unprecedented for a U.S. president in modern history and perhaps ever. There have been calls for Trump to be administered a neuropsychiatric evaluation, involuntarily if need be, and for the 25th amendment to be invoked. In a previous article, I reviewed speculations about President Trump’s mental health, shared my views about these speculations, and proposed what, if anything, can be done about this situation. Based on new information that I have since become aware of regarding Trump’s history and behavior, I present this updated article.
Trump engendered controversy long before he announced his candidacy for president which, in turn, has helped fuel speculations about his mental health. Such speculations escalated during his presidential campaign and especially when he was elected. A network of mental health professionals formed the Duty to Warn group which was described on its web site as “an association of mental health professionals and other concerned citizens who advocate Trump’s removal under the 25th Amendment on the grounds that he is psychologically unfit.” Psychologist Dr. John M. Grohol has noted, however, that a petition created by this group leaves a lot to be desired. The petition called for signatures from mental health professionals who agreed that Trump was “psychologically incapable of competently discharging the duties of President of the United States.” Dr. Grohol pointed out that not all of the individuals who signed the petition were mental health professionals and there was no way to verify the signatures on the petition. My multiple attempts to contact psychologist John D. Garner, the creator of the petition, to address its invalidity, were not answered.
Two recent books have significantly contributed to speculations that Trump is mentally ill. The first book is The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President edited by Yale psychiatrist Dr. Bandy Lee and published in October 2017. In this book, mental health professionals and other authors propose various and sometimes contradictory opinions about Trump’s behavior and mental status. For example, authors speculate Trump may have delusional disorder, dementia, narcissism, and sociopathy. The book was a bestseller on Amazon and The New York Times because, I suggest, it has confirmed biases many have that indeed Trump is mentally ill.
The second book, journalist Michael Wolff’s Fire and Fury: Inside the Trump White House, was published in January 2018 and made the question of Trump’s mental health and fitness for office an international story. In his book, Wolff provides accounts from White House staff that include descriptions of Trump as “a moron,” “a little child,” and “an idiot surrounded by clowns.” This book was also a bestseller on Amazon and The New York Times. Wolff’s book confirms for some readers that Trump is unstable and therefore unfit for office. Other readers have criticized the book for being not factual. Some of the quotes in the book have been denied by the people who Wolff attributed them to. Wolff also admits he did not interview Vice President Pence or anyone in the president’s cabinet for his book. Even if we accept claims about Trump’s mental health in the book, none of them were made by mental health professionals.
The media is replete with speculations about Trump’s mental health. Cable news has often covered the topic with political pundits who have little or no education in mental health and/or no training in the field. When mental health professionals weigh in, a majority of them tend to agree with the prevailing view that Trump has narcissistic personality disorder and that he is mentally ill. On social media, I have seen laypersons as well as mental health professionals describe Trump as having just about every condition or diagnosis imaginable, including substance abuse (e.g., Adderall, cocaine, Ritalin), delusional disorder, dyslexia, narcissistic personality disorder, various diseases caused by syphilis, and brain damage. Recently, George Conway, husband of Trump’s adviser Kellyanne Conway, has posted numerous tweets claiming that Trump has narcissistic personality disorder. This has, in turn, escalated speculations in the media about Trump’s mental health.
I suggest that Trump may have had and may still have several mental disorders, including Adderall abuse, frotteurism, and personality disorders. I am not providing diagnoses for Trump here but, rather, speculating that he may have met criteria set forth in the Diagnostic Statistical Manual of Mental Disorders, fifth edition (DSM5) for these conditions. The main reason it is dubious to say that Trump unequivocally has or has not had mental illness is because an in-person evaluation by a qualified mental health professional is required to formulate diagnoses. There are various reasons mental health professionals and laypersons make definitive diagnostic claims about Trump. Many people are ignorant about what mental illness is and what mental illness is not. It is also common to use a word like “crazy” in informal conversation without really meaning mentally ill.
Some people also insist that Trump and others are mentally ill despite a lack of evidence because they want it to be true. Labeling someone as mentally ill confirms one’s bias that there is something wrong about that person whether it is true or not. It fills the need for an explanation of what one deems as behavior that is deviant from cultural and social norms. Mislabeling a person as mentally ill may distract from factors that are relevant to an individual’s behavior. In the case of Trump, doing so may distract from his criminality and the need for political, rather than medical, action in order to bring about change.
We all have biases. I am anti-Trump, yet I see no basis to say Trump definitely has a mental illness. Maybe Trump has a mental illness. Maybe he doesn’t. Again, my view is we do not know for certain without, first, conducting a thorough in-person mental health evaluation. The Goldwater rule set forth by the American Psychiatric Association (APA) in 1973 and affirmed in a recent statement from the professional organization, calls for “physician members of the APA to refrain from publicly issuing professional medical opinions about individuals that they have not personally evaluated in a professional setting or context.” I am a mental health counselor, not a psychiatrist. Hence, I am not required to adhere to the Goldwater rule. Regardless, this does not preclude me from speculating that Trump may have met criteria for mental illnesses.
A common claim is that Trump is “delusional” and “out of touch with reality.” For example, psychiatrist Bandy Lee stated in an interview that Trump “seemed further to lose his grip on reality by denying his own voice on the Access Hollywood tapes.” I was surprised to read this assessment from a psychiatrist given Trump’s history of lying. Trump’s denial does not prove or even suggest he had lost his grip on reality. The term delusional is sometimes used to mean that one is making statements that are untrue. However, this is not how delusional is typically defined in the field of mental health. In mental health, a delusion refers to a belief that is false, psychotic and usually held by one person.
Some people have erroneously pointed to Trump’s claim that his inauguration was the most well-attended in U.S. history as an example of a delusion. Anyone who has followed Trump through the decades knows he is a liar, a conman, and a conspiracy theorist. However, this was a lie — not a delusion — created by Trump and perpetuated by his then press secretary Sean Spicer. Trump’s proclivity for conspiracies can be traced back to his relationship with his lawyer and mentor Roy Cohn in the 1970s. Cohn had a penchant for conspiracies and introduced Trump to Roger Stone. In 2011, Trump began expressing doubts that President Obama was born in the U.S. And the rest is history.
The most frequent diagnosis ascribed to Trump is narcissistic personality disorder. It has also been suggested that he has malignant narcissism and sociopathy, but neither of these are listed in the DSM5. If we accept that the DSM5 criteria for narcissistic personality disorder are valid, then it is hard to refute that Trump has this condition. The problem is that the DSM5 diagnosis of narcissistic personality disorder does not tell us much that is unique about the person. Millions of people in the world meet the DSM5 criteria for this diagnosis. A personality disorder is a chronic, relatively stable and fixed condition that begins in early adulthood, continues throughout the lifespan, and it is not necessarily a mental illness unless it becomes exacerbated by stress, another mental disorder, or other factors. Like most DSM5 diagnoses, narcissistic personality disorder lacks scientific validity, clinical utility, and inter-rater reliability. Moreover, the criteria for narcissistic personality disorder are based on deviations from cultural norms rather than an illness that can be identified through objective (i.e., independent) tests. Thus far research on individuals who have been diagnosed with narcissistic personality disorder has not conclusively identified brain anomalies that can reliably be attributed to this condition.
It has also been speculated that Trump is in cognitive decline and that he has early onset dementia. This speculation may have some merit because Trump’s father was diagnosed with Alzheimer’s disease and some decline in cognitive function is age-appropriate for anyone at age 71. On October 12, 2017, Trump neglected to sign a healthcare executive order until Vice President Pence told him “Mr. President, you need to sign it.” On December 6, 2017, the White House attributed Trump’s slurred speech to his being thirsty. These and other cases do not prove that Trump has significant cognitive decline let alone early signs of dementia or Alzheimer’s disease. We may learn after he leaves office, like we did with President Reagan, that indeed Trump had Alzheimer’s disease. We may learn this while he is still in office, but I doubt it. For now, we can only speculate.
I suggest that Trump may have met criteria for frotteuristic disorder (also called frotteurism). The term frotteurism is derived from the word frotteur which comes from the French verb frotter meaning to rub. Frotteurism is classified in the DSM5 as a paraphilia, a disorder characterized by recurrent sexual fantasies and urges involving objects, the suffering or humiliation of oneself or one’s partner, or children or other nonconsenting persons. According to the DSM5, criteria is met for frotteurism if for a six-month period an individual has experienced recurrent and intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person, they have acted on these sexual urges, or the sexual urges or fantasies have caused them marked distress or interpersonal difficulty. On the basis of claims by women that Trump touched their private parts without their consent, Trump may have had frotteurism.
In 2016, Katie Johnson reported that Trump raped her when she was age 13 at the mansion of Jeffrey Epstein, a billionaire who has been convicted for sex with minors. Johnson instituted a lawsuit against Trump, but then dropped the case. Currently, a federal appeals court panel is moving to unseal court documents pertaining to a plea deal for Jeffrey Epstein that was approved by then prosecutor Alex Acosta and now Trump’s Secretary of Labor.
A 2016 article in the Daily Beast reported that in the 1990s, Trump “used to host parties in suites at the Plaza Hotel when he owned it, where young women and girls were introduced to older, richer men.” An unnamed source from this article said that some of the girls were as young as 15. According to the DSM5, pedophilic disorder (or pedophilia) is characterized by intense sexually arousing fantasies, urges, or behaviors involving prepubescent or young adolescents under age 13. It is diagnosed when people are at least 16 years and five years older than the minor who is the target of the fantasies or behaviors. It is unclear if Trump has met criteria for pedophilia, especially considering that the targets of his alleged contacts with minors were not below age 13. Nevertheless, if he did engage in sex with a 13-year-old as alleged, this is a sex crime and he should not be exonerated whether he did or did not meet criteria for pedophilia.
Finally, I suggest that Trump may have had Adderall abuse and he may still be afflicted with this disorder. In a 2018 comedy routine, Noel Casler stated that he worked for Trump’s television show The Apprentice. During his routine, Casler said of Trump: “He’s a speed freak. He crushes up his Adderall and he sniffs it cause he can’t read. So, he gets really nervous. So, he has to read cue cards. I’m not kidding. This is true.” I had thought Trump’s frequent sniffing, often manifested during his public talks, was a nervous tic, but it may be attributable to his snorting Adderall. In 1982, Newsweek also obtained records that report Trump was diagnosed with a “metabolic imbalance” by Dr. Joseph Greenberg, an endocrinologist. According to these records, Dr. Greenberg reportedly prescribed diethylpropion, a stimulant similar to an amphetamine and Trump stopped taking it in 1990.
Trump’s legacy will be defined, in part, by speculations that he was unstable and unfit for office. I have always thought it would be unlikely that he will ever voluntarily submit to a mental health evaluation or that he will be forced to have one until he had his first annual medical examination as president on January 11, 2017 by White House physician Dr. Ronny Jackson. On January 16, 2018, Jackson provided a report in which he said that Trump is overweight and that he could benefit from lowering his cholesterol, improving his diet and beginning an exercise regimen. The report also stated that Trump was administered a cognitive screening tool at the president’s request. He scored 30 out of 30 on the Montreal Cognitive Assessment (MoCA). According to Dr. Jackson, Trump showed no signs of dementia and overall the president was in “excellent health.” Referrals were not made to neurology or psychiatry. Dr. Jackson reported that Trump explicitly requested the cognitive screening to allay concerns that he has dementia. If speculations about Trump’s mental health persist, someday Trump might agree to an evaluation by a psychiatrist, psychologist or other mental health professional. But I doubt it.
It is unlikely Trump will ever be removed from office through the 25th amendment of the U.S. Constitution. Anyone who knows its protocol understands it is a high bar. First, the Vice-President and a majority of Trump’s cabinet must declare Trump no longer capable of performing his duties. Next, Trump may dispute this finding. And the process goes on. Mandatory mental health evaluations for Trump have been proposed. Dr. Bandy Lee stated there are doctors and legal groups who have said they would help involuntarily commit Trump if the White House reports he becomes an immediate danger to himself or others. Dr. Lee notes that lawyers have volunteered to file for a court paper so White House security staff would cooperate with such an intervention. However, she has also acknowledged: “But we have declined, since this will really look like a coup, and while we are trying to prevent violence, we don’t wish to incite it through, say, an insurrection.”
Psychologist Dr. Grohol suggested it may be a good idea for all U.S. presidents to be required to have an annual mental health evaluation. There are all sorts of considerations for such mandated mental health evaluations, including lack of reliability of mental health evaluations and how to proceed if evaluations find a candidate unfit. Nevertheless, these proposals do not apply to Trump. Claims that Trump is “unfit” for office are also vague because they do not necessarily address the question of mental illness. It is possible that Trump’s mental health diagnosis or diagnoses, if he has one or more, will ever be known, and the odds of Trump being removed from office due to his mental status are minuscule. And mental illness is not in itself a reason to remove a president from office. Many individuals function effectively with a mental illness.
Rather than merely speculate if Trump has mental illness, I suggest that people who oppose him focus their efforts on political action to block his initiatives. Some readers may disagree with my political opposition to Trump. However, I suggest there may also be value in considering if Trump has mental illness because if he does it could have significant implications and potential consequences for the United States and the world.
Jeffrey T. Guterman, Ph.D. is a mental health counselor in Fort Lauderdale, Florida.