Frances - Twilight of American sanity a psychiatrist analyzes the age of Trump

With belated thanks to Joe Francesmy late (and, in his own humble way, great) father, who taught me how to see through blowhards like Trump and how simple it is to be happy

The iniquity of the fathers will be visited on the children and the childrens children, to the third and the fourth generation.

Exodus

As democracy is perfected, the office of the president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their hearts desire at last, and the White House will be adorned by a downright moron.

H. L. Mencken

A human being is a part of the whole, called by us universe, a part limited in time and space. He experiences himself, his thoughts and feelings as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty.

Albert Einstein

Insanity in individuals is somewhat rare. But in groups, parties, nations, and epochs, it is the rule.

Friedrich Nietzsche

It is comforting to see President Donald Trump as a crazy man, a one-off, an exceptionnot a reflection on us or our democracy. But in ways I never anticipated, his rise was absolutely predictable and a mirror on our soul.

Early in the recent U.S. presidential campaign, a producer invited me to appear on a national television program to analyze Trumps psychology and provide him with a psychiatric diagnosis. It might have been fun. Trump and I were born around the same time and grew up within a few miles of each other in Queens, outside Manhattan. I had casually followed his lifelong quest for media attention, finding his misadventures and constant self-promotions cute, in a repulsive sort of way.

But I had to decline the invitation. First off, I saw no evidence that Trump had a mental disorder and, even if I did, the American Psychiatric Association has a useful ethics policy that explicitly prohibits the armchair diagnosis of politicians. It goes back to the 1964 presidential election. Liberal psychiatrists had taken cheap shots at Barry Goldwater, the radical right-wing Republican candidatepublicizing their diagnosis that he was too mentally ill to be trusted with the nuclear button. They had no right to use professional credentials to medicalize their political beef with Goldwater, and I had no desire to register my political disapproval and personal distaste for Trump via psychiatric name-calling. When, instead, I jokingly offered to express my purely laymans opinion that Trump is a classic schmuck, the producer quickly replied that this wasnt the least bit newsworthyeveryone already knew it. I laughingly agreedbut, as it turned out, we were both dead wrong.

To everyones amazement (probably including his own), Trump was elected president of the United States. The blustery, bullying bravado that served him so well on reality TV and on the campaign trail is a disastrous disqualification in Americas commander in chief. In his own inimitable way, Trump bragged that, once president, he would become more Presidential than anybody other than the great Abe Lincoln... he was very Presidential, right? But Trump can never be anything but Trump. We have had our share of dumb presidents, impulsive presidents, lying presidents, ignorant presidents, narcissistic presidents, bellicose presidents, conspiracy theory presidents, and unpredictable presidentsbut never before has one president so fully embodied all these reprehensible traits. And never before have the institutions of American democracy appeared so fragile in the face of autocratic attack. Trump has scared so many people that six dystopian classics have suddenly jumped to the top of Amazons bestsellers list (Orwells 1984 and Animal Farm, Huxleys Brave New World, Sinclair Lewiss It Cant Happen Here, Margaret Atwoods Handmaids Tale, and Ray Bradburys Fahrenheit 451).

Trumps mental health (or lack thereof) is a trending topic on the Internet; on cable news programs; in magazines and newspapers; and most hilariously on Saturday Night Live. And political pundits, politicians, and comedians pored over the so-called Bible of Psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM), and reached the consensus that Trump suffers from Narcissistic Personality Disorder. Soon many psychologists and some psychiatrists (compelled by a perceived higher calling of national interest) chimed in to break the restriction against diagnosing politicians at a distance. Numerous patriotically worded petitions were initiated. A typical one, garnering more than fifty thousand signatures, declared, We, the undersigned mental health professionals, believe in our professional judgment that Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States. And we respectfully request he be removed from office according to article 4 of the 25th amendment of the Constitution.

I wrote the criteria for Narcissistic Personality Disorder that first appeared in DSM-III and are still in use in DSM-5, the most recent edition. Trumps amateur diagnosticians have all made the same fundamental error. They correctly note that the disorders defining features fit him like a glove (grandiose self-importance; preoccupations with being great; feeling special; having to hang out with special people; requiring constant admiration; feeling entitled; lacking empathy; and being exploitive, envious, and arrogant). But they fail to recognize that being a world-class narcissist doesnt make Trump mentally ill. Crucial to the diagnosis of Narcissistic Personality Disorder is the requirement that the behaviors cause clinically significant distress or impairment. Otherwise, many, if not most, politicians (and almost all celebrities) might qualify. Trump is a man who causes great distress in others but shows no signs himself of experiencing great distress. His behaviors, however outrageous and objectionable, consistently reap him fame, fortune, women, and now political powerhe has been generously rewarded for his Trumpism, not impaired by it. Trump is a threat to the United States, and to the world, not because he is clinically mad, but because he is very bad.

I hate it when psychiatric diagnosis is so carelessly misused to mislabel as mental illness every conceivable example of simple bad behavior. I was heavily involved in the preparation of DSM-III and in charge of the preparation of DSM-IV. This burdens me with the responsibility to keep psychiatric diagnosis as honest and as accurate as possible. Most mass murderers are not mentally ill. Most terrorists are not mentally ill. Most rapists are not mentally ill. Most dictatorial rulers are not mentally ill. Most obnoxious boobs are not mentally ill. Most liars arent mentally ill. Most conspiracy theorists arent mentally ill. And theres no evidence that Trump is mentally ill. Trumps boorish manners, vulgar speech, and abusive actions make him a national embarrassment and the worst of all possible role models (perhaps there should be a PG-13 rating on all Trump appearances to protect our children from his bad influence). He diminishes America, reducing its greatness. But none of this makes him mentally ill.

There are three harmful unintended consequences of using psychiatric tools to discredit Trump. First, lumping him with the mentally ill stigmatizes them more than it embarrasses him. Most mentally ill people are well behaved and well meaning, both of which Trump decidedly is not. Second, medicalizing Trumps bad behavior underestimates him and distracts attention from the dangers of his policies. Trump is a political problem, not meat for psychoanalysis. Instead of focusing on Trumps motivations, we must counter his behaviors with political tools. And, third, were Trump to be removed from office, his successors (Pence and Ryan) would probably be much worsemore plausible purveyors of his very dangerous policies.