It Is Time to Say It: Trump Is Mentally Ill

I was about to write that for the good of the nation and the world it is high time that someone in psychiatry or psychology break the Goldwater Rule and diagnose Donald Trump’s mental illness — not to feed jokes but to grapple with a profoundly serious and dangerous situation. Now someone has.

Dr. John D. Gartner is a psychologist and part-time professor of psychiatry at Johns Hopkins. He diagnosed Trump with malignant narcissism. Quoting U.S. News:

Gartner acknowledges that he has not personally examined Trump, but says it’s obvious from Trump’s behavior that he meets the diagnostic criteria for the disorder, which include anti-social behavior, sadism, aggressiveness, paranoia and grandiosity. Trump’s personality disorder (which includes hypomania) is also displayed through a lack of impulse control and empathy, and “a feeling that people … don’t recognize their greatness.
“We’ve seen enough public behavior by Donald Trump now that we can make this diagnosis indisputably,” says Gartner. His comments run afoul of the so-called Goldwater Rule, the informal term for part of the ethics code of the American Psychiatric Association saying it is wrong to provide a professional opinion of a public figure without examining that person and gaining consent to discuss the evaluation. But Gartner says the Trump case warrants breaking that ethical code.

Here is a piece Dr. Gartner wrote last year about Trump. In a Politico piece about the impact of Trump’s behavior in world affairs, he said this:

Malignant narcissism is an untreatable personality disorder, for the simple reason that no one can ever tell the malignant narcissist he is wrong. Anyone who questions a malignant narcissist’s judgment is immediately dismissed as an idiot or attacked as a threat. Anyone who questions their ruthless tactics is belittled as soft and naive. It’s not accidental that Trump has said “my primary consultant is myself.”.

Malignant narcissim, which is not listed in the DSM, was coined by Eric Fromm in 1964. According to Wikipedia, Fromm described it as “‘severe mental sickness’ representing ‘the quintessence of evil’. He characterized the condition as ‘the most severe pathology and the root of the most vicious destructiveness and inhumanity’.”

It is not hard to cherry-pick other familiar traits of the syndrome from Wikipedia’s article: paranoia; “regressive escape from frustration by distortion and denial of reality;” “a disturbing form of narcissistic personality where grandiosity is built around aggression and the destructive aspects of the self become idealized;” “an absence of conscience, a psychological need for power, and a sense of importance (grandiosity);” “joyful cruelty and sadism;” “some of them may present rationalized antisocial behavior — for example, as leaders of sadistic gangs or terrorist groups…with the capacity for loyalty to their own comrades.”

The Wikipedia article explains the difference between malignant narcissism and narcissism:

A notable difference between the two is the feature of sadism, or the gratuitous enjoyment of the pain of others. A narcissist will deliberately damage other people in pursuit of their own selfish desires, but may regret and will in some circumstances show remorse for doing so, while a malignant narcissist will harm others and enjoy doing so, showing little empathy or regret for the damage they have caused.

Note also that malignant narcissism and psychopathy are sometimes used interchangeably. If you’d like score Trump against the 20 Hare Psychopathy Test characteristics:

  • glib and superficial charm
  • grandiose (exaggeratedly high) estimation of self
  • need for stimulation
  • pathological lying
  • cunning and manipulativeness
  • lack of remorse or guilt
  • shallow affect (superficial emotional responsiveness)
  • callousness and lack of empathy
  • parasitic lifestyle
  • poor behavioral controls
  • sexual promiscuity
  • early behavior problems
  • lack of realistic long-term goals
  • impulsivity
  • irresponsibility
  • failure to accept responsibility for own actions
  • many short-term marital relationships
  • juvenile delinquency
  • revocation of conditional release
  • criminal versatility

Now, of course, that’s only Drs. Wikipedia and Web. And we’ve heard here from just one psychologist. I believe it is vital that we hear a debate among experts to get some measure of consensus about what drives Trump.

Journalistically, I argue that we must test hypotheses about Trump and his unprecedented behavior against the evidence we gather from reporting. One theory is that he is a kleptocrat, a crook; he does what he does for greed and personal enrichment. Another is that he is in the pocket of Putin because of blackmail or some odd devotion. Another is that he is in the pocket of the white nationalists who staff offices near him and that he is their convenient fool. Another is that he is power-mad. Another is that he is insane.

We do not yet know enough to reliably conclude which of these is sufficient explanation for his behavior. But we do know that his behavior is not normal and is dangerous. Thus it is critical that we try to explain it.

Some of these hypotheses, once proven satisfactorily, could trigger impeachment. The final hypothesis — insanity — would trigger the 25th Amendment and a complex procedure for isolating someone unfit for office from that office (see Section 4).

I have long feared that Donald Trump is unfit for office and I believe he is proving that fear to be correct after only one week in office. Certainly there are many Americans who agree with me. But that is insufficient cause to take official action. We need to inform Congress and the courts — on whom we now depend — so they may act as a check on his power and fitness. Whether he is corrupted or compromised or mentally ill — or all three — journalists with help from experts and doctors must bring evidence to the people and their representatives.

Thus I am grateful to Dr. Gartner for having the courage to open the discussion. For the good of the nation, I argue that other psychologists and psychiatrists have a moral obligation to join now, discussing diagnoses (and, yes, there is more than enough exposure to his behavior to enable that) and their implications given the man’s high office and unbridled power.