The word “crazy” is deployed in many contexts in our society, often in a manner that implies abhorrent behavior must be linked to mental illness. Throughout Donald Trump’s presidential campaign, and the early weeks of his presidency, it has proven nearly impossible to traverse social media — or press coverage of the president — without encountering language that describes Trump as “insane,” a “lunatic” or clinically narcissistic. Some have even argued that it’s “okay” to assess a public figure’s mental health from a distance, despite longstanding psychiatric standards that prohibit such speculative diagnoses. The ethics that prohibit such diagnoses have, however, had little effect on public narratives that depict Trump as being “insane.”
Comedian and daytime talk show host Joy Behar recently urged celebrity psychiatrist Dr. Phil McGraw to join that chorus by diagnosing Trump with Narcissistic Personality Disorder, during an interview on the ABC talk show “The View.” McGraw declined.
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Psychologist John Gartner, a part-time assistant professor of psychiatry at Johns Hopkins University Medical School, has publicly stated that Trump has “a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States,” diagnosing him with “malignant narcissism.” Gartner has gone so far as to create a petition, which encourages mental health care professionals to cosign his assessment, and demand Trump’s removal on the basis of his supposed mental health problems. The petition has accrued 17,479 signatures, though it’s unclear which of these individuals are mental health care professionals, since many did not fulfill Gartner’s request that all signatories list their psychiatric credentials.
However, not all psychiatrists are jumping on board with the narcissism diagnosis. One such skeptic is Dr. Allen Frances, who wrote the clinical criteria for Narcissistic Personality Disorder. Frances was the chair of the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV Task Force and of the department of psychiatry at Duke University School of Medicine, in Durham, North Carolina. He is currently a professor emeritus at Duke University. Frances, whose criteria for narcissism are still used today, has stated that Trump does not meet those criteria, and has been outspoken in his critiques of efforts to pathologize Trump from a distance. After firing off a series of tweets that once again stirred attention around his arguments, Frances agreed to talk with Truthout about the controversy, and why characterizing Trump as mentally ill is downright dangerous.
Your recent comments on Twitter provided a profound interruption to the “insanity” narrative that’s been spun around Trump, both in the press and on social media. Can you talk a bit about your role in creating the diagnostic criteria for narcissism?
I wrote the criteria in 1978 for the DSM-III, and it’s the same criteria used for the DSM-V today. I was actively involved in the creation of DSM-111 and DSM III-R. I was chair of the task force for the DSM-IV, and I have been openly critical of DSM-V.
As a writer who’s been open about my own struggles with mental illness, I’ve always found characterizations of Trump as being “crazy” or “narcissistic” troubling. But those of us who’ve objected have found it nearly impossible to interrupt the “insanity” narrative. Can you talk about why you’ve chosen to be outspoken on the subject?
It’s an insult to people who have real mental illness to be lumped with Trump. Most people with mental illness are well-meaning, well-mannered and well-behaved. And Trump is none of these. Trump is bad, not mad. And when bad people are labelled mentally ill, it stigmatizes mental illness.
Can you explain why Trump doesn’t fit the criteria for narcissism?
In order to qualify for a mental disorder you not only have to have the personality features, you also have to have clinically significant distress or impairment caused by them. Trump causes distress, but there is no evidence that he experiences it. And instead of being impaired by his narcissistic behavior, he is rewarded for it, to the extent of being elected president of the United States.
Why do you think people feel the need to pathologize Trump? Do you think it’s rooted in a need to distance ourselves from his behavior?
I think people are understandably terrified by the very grave threat Trump presents to American democracy, our relation to other countries and — scariest — global warming. People are appalled at Trump’s policies … are searching for any avenue to discredit him, but the focus of attack should be on the egregious ignorance and unfairness of the policies and on the incompetence, self-absorption and impulsiveness of the man — not on the losing struggle to prove he has a mental illness. Psychiatric name-calling is the least effective way to win an argument.
I think that it’s very important that Trump and his policies be de-legitimized. But it’s unwise to do it on the basis of being mentally disordered. It’s important to attack his policies in every possible way, but misdiagnosing him as mentally ill distracts from what should be a laser-like focus on how bad his actions and policies are. Trump requires a full-court political response, not a phony medicalization.
Given Trump’s extreme positions — which are already inspiring violence — it’s struck me as especially dangerous that people are labeling his behavior as being the product of mental illness. It seems like a manifestation of historical amnesia, given that entire populations have, at times, been led to commit atrocities, amid flurries of brutal politics. Do you think our refusal to recognize that shadow side of human potential could harm efforts to thwart Trump?
I see Trump as a wannabe Mussolini, but not nearly as smart and much more impulsive, and therefore more dangerous. The way out of this is not psychiatric; it’s political. If there is any patriotism left in the GOP, it will stop exploiting Trump, and begin opposing the many things he is doing that are harmful to our country. Rather than psychiatric name-calling, everyone who recognizes the danger of Trump must do everything possible to reduce the political dominance of the Republican party, which is enabling his dangerous behavior. So, the focus should be on demonstrations now, and on the 2018 and 2020 elections.