The Danger of Psychoanalysing Trump

OULC member and fifth year medic, Rob Sutton, critiques those on the Left who attack President Trump as mentally unfit. 

After over a year of frustration with the administration of President Donald J. Trump, attacks have increasingly turned from his policies to the man himself. In particular, commentators have begun to question the inner workings of Trump’s mind. In recent months, a series of articles have considered the idea of using a psychiatric label to explain his deeply unsettling approach to administration, with Democrats in Congress going so far as to consider creating a panel on Trump’s mental health.

There is a strong temptation to attempt to psychoanalyse the man who has so deeply divided his country, and who takes an approach to policy and diplomacy which seems erratic at best. In a time of political instability and moral turmoil, it is only natural to attempt to rationalise what we see. Yet there is a strong precedent for why such “armchair diagnoses” are best avoided.

Poor judgement and politically disagreeable actions are not the same as mental illness, and equating the two causes harm on many different fronts. Not only do we draw attention away from the genuine and numerous failings of the Trump administration, but just as worryingly, we also give a moral and political angle to the label of psychiatric illness.

By using psychiatric diagnoses to discredit our opposition we stigmatise people living with these conditions, and fail to recognise Trump’s remarkable talents in manipulating the media and those around him. And the underlying assumption of such attacks – that psychiatric illness is an immediate disqualification from high office – is an abuse of diagnostic labels, and deeply offensive to all those living with such conditions.

Current commentators are not the first to realise the potential that psychiatric labels have to score cheap points against political opposition. The history of armchair diagnosis is long, with a particularly notable example being the US presidential election of 1964.

During Lyndon B. Johnson’s campaign for election against his Republican opponent Barry Goldwater, Fact magazine published an article polling psychiatrists on Goldwater’s sanity. As negative campaigns go, it was devastating, with over 1000 psychiatrists (who had never met or formally examined Goldwater) indicating that he was “emotionally unstable” and unfit for office, thereby causing considerable damage by skewing public perceptions of the candidate.

The fallout from the poll resulted in an overhaul of the ethical guidelines of the American Psychiatric Association (APA), and led to a libel suit against Fact. The APA’s resulting “Goldwater Rule” stated that is was improper for members of the association to offer such diagnoses unless they had conducted a formal examination of the patient, and had been granted authorisation to make a statement.

But the damage had already been done, and the deep unease which the article generated among the American public about the Republican candidate effectively derailed Goldwater’s campaign, and contributed to a landslide victory for the Democrats in 1964. Despite the Goldwater Rule, pundits have continued to offer their opinions on the mental fitness of our political leaders.

In the case of Trump, the current vogue for many commentators is to speculate that he has a condition known as narcissistic personality disorder (NPD). NPD is a long-term psychiatric disorder, characterised by a strong need for the approval of others, feelings of grandiosity and a lack of empathy. On these grounds, Trump does appear to have some of the characteristics of NPD. However, it would be difficult to find any political leader who does not display these characteristics to some extent.

Our compulsion to apply this label is misguided because of a further diagnostic requirement. Like many of the personality disorders, diagnosis of NPD is very difficult to make, and even experienced clinicians are often reluctant to label patients. And a key feature of the diagnosis requires that the patient experiences significant functional impairment in their day-to-day activities.

As Dr Allen Frances, a Professor Emeritus of Psychiatry at Duke University and author of the original NPD diagnostic criteria, points out, even without formal examination, Trump clearly does not meet this condition, and so cannot be diagnosed with NPD: “Trump certainly causes severe distress and impairment in others, but his narcissism doesn’t seem to affect him that way.” Far from causing functional impairment, Trump’s behaviour and actions have raised him to the highest political office in his country. Effectively, this rules out a personality disorder.

As with many vulnerable communities, the way we use language is powerful and has the potential to cause harm through the associations we make. When we criticise the current administration’s policies, we are engaging in a discourse which is our right and which is required for the effective functioning of a democracy. But when we question the mental fitness of Trump without strong clinical backing, we risk turning such labels into terms of attack, and causing lasting damage to those living with a psychiatric diagnosis.

Despite the progress that has been made in de-stigmatising psychiatric illness through public awareness campaigns and patient education, the understanding that mental health issues are common and socially acceptable is fledgling. We must continue to educate people about these issues and remain alert to the risk that they become means to discredit our political opposition. In attempting to make such arguments for Trump’s impeachment without formal psychiatric diagnosis, we may cause lasting damage to members of our communities that we should be striving to support.

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