Okay, so Trump is full-tilt bozo. Now what?

I wrote a longer version of this article this past summer which I pitched to a number of magazines but had no takers.  My guess is that the media does not want to confront Trump for what he truly is: a dangerous sociopath.

Let’s cut to the chase.  Donald Trump has a diagnosable mental disorder, that is not conducive to treatment, and as a result of his condition he is a danger to others.

Many people have noted that time has not been good to Donald Trump’s once handsome good looks, suggesting some truth to the adage, “An ugly personality destroys a pretty face”.  And it is Trump’s personality that has many mental health professionals concerned.

So what is it about Trump that reveals he has a maladjusted personality resulting in behaviors that are harmful to others?  The answer is that Trump meets essentially all of the criteria and indicators for narcissistic personality disorder and antisocial personality disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.  These individuals display a persistent pattern of dysfunctional thoughts and behaviors that shape the way they perceive themselves and influences their interactions with others.

Although Trump has not had a clinical evaluation, many mental health professionals agree that he has put himself into the public spotlight long enough and thoroughly enough to determine he meets criteria for these diagnoses.  Additionally, there is extensive developmental history as reported by family members and close acquaintances to support this assessment.  For example, the recent book by Trump’s niece, Mary L. Trump, herself a psychologist, provides family history and anecdotal information to help in making sense of Donald Trump’s mental state.  Mary Trump asserts that her grandfather Fred Trump created a “malignantly dysfunctional family” where relationships were cold, distant, and unnurturing, and based on who was useful and who could be taken advantage of.  Mary Trump stated that she often heard Trump family members use racist and antisemitic slurs.  Mary Trump also recorded her aunt, Maryanne Trump Barry, who said, “he has no principles; you can’t trust him” and described him as a liar who may have had someone else take his college entrance exams for him.   

Most people would agree Trump is a narcissist.  Diagnostically, narcissists are self-absorbed individuals who often display a sense of entitlement and who exaggerate their achievements and abilities.  They believe they are superior to others, take advantage of others, are envious of others, and lack empathy.  Narcissists are difficult to live with; their marriages often fail because it is an unequal relationship where the narcissistic partner needs all of the emotional attention while not responding to the emotional needs of the other.  And it is a relationship built on a lack of trust because the narcissist will lie, shift blame, and assume the role of victim when problems in the relationship occur.  As in Trump’s case, narcissists with high levels of grandiosity are more likely to engage in extramarital affairs and their marriages are more likely to end in divorce.

To feed his ego, Trump has filled his presidential cabinet, advisory positions, and White House staff with sycophants.  Someone who also craves attention, such as Anthony Scaramucci, lasted as White House Communications Director for just ten days.  And it can be postulated that narcissistic envy is at the heart of Trump’s love-hate relationship with Dr. Anthony Fauci, who polls show people trust more than Trump in regard to information about the COVID19 pandemic. 

According to the Brookings Institute, 85% of the top officials in the Trump administration have resigned or have been fired in the first three years of his administration, more than any President in U.S. history.   From a political perspective, he’s “drained the swamp”, but replaced it with a cesspool.  From a psychosocial perspective, much of this can be traced back to Trump’s fragile ego, constant need for affirmation, and inability to sustain healthy interpersonal relationships. 

Trump also ticks off all of the indicators for antisocial personality disorder (ASPD), which includes a disregard for right and wrong, persistent lying to take advantage of others, disrespect for others, using charm to manipulate others, dishonesty, impulsivity, lack of empathy, poor or abusive relationships, and failure to consider negative consequences or learn from them. The more colloquial term for someone with ASPD is a sociopath.  And sociopaths are more likely to engage in criminal behavior, so it should not come as a surprise that Trump has been named in over 3,000 lawsuits.

Some of the clinical indicators for narcissism and sociopathology overlap, for example, grandiosity, lack of empathy, and impulsive behavior are associated with both diagnostic categories, but with ASPD, the behaviors are toxic to others, such as aggression, emotional and psychological abuse, as well as criminality.  Metaphorically, a narcissist is like someone who starts trash can fires to get attention.  A narcissistic sociopath is like someone who starts a house fire, calls the fire department, and receives praise for getting firefighters to the house in time to save some, but not all of the occupants. 

If Trump’s narcissistic and anti-social behaviors resulted in just a personal problem, therapy may help.  However, this will not work with Trump because, while the behaviors are dysfunctional, at a personal and immediate level, they do work for him.

Donald Trump has attained the highest political office in the United States, which also provides him with a leadership position on the world stage.  A charismatic leader, he enjoys the adulation of millions of white, conservative Americans.  And enabled by a passive and scared Republican Party, Trump is able to break norms, rules, and the law and not be held accountable.  Regardless of his multiple dysfunctional behaviors, Trump is like a kid in the candy store, where he can gorge to his heart’s delight without repercussions or consequences.  From a clinical perspective, although his behaviors are unhealthy, they actually work quite well for him.  

Take, for example, Trump’s habitual lying.  Lying as a characteristic associated with narcissism and an antisocial personality disorder results in someone who is comfortable in taking advantage of others: a conman, cheat, hustler, fraud; all words used to describe Trump in regard to his business practices and in his exploitive relationship with political supporters.  And in large part, that is because lying works for him.  Whereas all politicians frame and distort information to reinforce their supporter’s preexisting biases, for Trump, lying is a win-win situation.  The more absurd the comment, like buying Greenland, the more likely it will be broadcast and repeated and the more the press questions his statements, the more he claims the (liberal) press is conspiring against him.  Thus his narcissism is nourished and his lying reinforced. 

However, having someone with a disturbed personality at the helm of the nation has consequences.  Early into his presidency a number of psychiatrists and psychologists predicted he would behave erratically with potential harmful results for our country.  These same mental health professionals wondered how Trump would react in a crisis.  Would he display a stable temperament, utilize the help and expertise of others for the country’s betterment, and display a decision making process based on evidence rather than whim?  It is now apparent that, based on a lack of empathy, a penchant for dishonesty, and a bottomless need for admiration, Trump is incapable of effective national leadership. 

Trump’s narcissism was in full view early into the pandemic when he chastised governors for not thanking his administration and him personally for providing the states with personal protective equipment.  He made it a point to specifically call out Michigan governor Gretchen Whitmer, calling her half-Whitmer, because she complained about the government’s slow response in coordinating and shipping PPE to the states.  A concern since confirmed by the House Oversight Committee which may have resulted in unnecessary deaths. The fact that he needs his ego stroked in the midst of a national health crisis, and in doing so would demean someone, should raise alarm bells about his mental stability.

Throughout the pandemic, Trump has continually minimized the seriousness of the virus.  Perhaps most significantly, Trump has undermined the authority of the CDC’s leadership as the public health authority on the pandemic.  In large part, this appears to be due to the CDC getting more recognition for their efforts, attention and praise he feels should be his.  Needing to present himself as an expert in his own right, he touted the drug hydroxychloroquine as a prophylactic even though there is no evidence it protects against getting the virus. 

A president may have to make a decision that will place Americans in harm’s way, such as ordering troops into war.  However, in Donald Trump we have a president who, motivated by narcissism, a lack of empathy, and a proclivity for lying, has done things which have directly cost people their lives, i.e. as a consequence of his mental state he has proven himself to be a danger to others.

Okay, so if Donald Trump is, in the phraseology of the late Robin Williams, full-tilt bozo, now what?  First and foremost, the American people need to know that the President of the United States has a mental disorder and that the outcomes of his behaviors are detrimental to their safety and the wellbeing of our nation.  In that regard, the media, particularly network news organizations have failed to stress this problem and report on Trump’s behaviors from this perspective.  For example, in addition to fact checking when Trump tells a lie, it should be noted that the reason he lies is due to a personality disorder and not just for political gain. 

Even though Trump was not reelected, he will continue to be a powerful enemy of the Constitution and our democracy.  Last month (Oct. 2020) House Speaker Nancy Pelosi indicated she might call for hearings as a prelude to removing Trump under Article XXV, Section 4 of the Constitution.  This section broadly outlines the steps for transferring the powers of the President to the Vice President due to the President’s inability to fully discharge the duties of his office.  Typically this is for physical health problems, but it can apply to mental impairment as well.  Given that he can still engage in a lot of mischief and malfeasance in the two months left in his term, moving forward with such hearings may not be a bad idea.  This would educate members of Congress as well as the public about any apparent mental health issues that impede Trump’s ability to fulfill his duties; behaviors and actions taken to feed his narcissism and sociopathology. 

We can speculate all we want, but only a comprehensive psychiatric examination by licensed clinicians will refute questions about Trump’s mental capacity.  Thus, Congress might need to petition a judge to order Trump to undergo a psychiatric evaluation.  If Trump refused to cooperate with a judge’s order, he could be committed against his will. 

When I talk to people about the past three years under Trump’s presidency, they often respond that they feel like they’ve been through an emotional wringer.  That is exactly what you would expect when someone in a position of leadership has a disturbed personality.  Relationships are caustic.  People are treated as objects to be manipulated and taken advantage of rather than with empathy and understanding.  Feeding your ego is an addiction.  Blaming and shaming is the basis for interactions with others.  Taking advantage of systems, including breaking the law, is okay if you can get away with it.  Issuing directives to demonstrate power is better than working cooperatively with others.  And creating division is a useful tool to disrupt productive discourse.  However, just because the man residing in the White House is mentally unstable doesn’t mean the entire country has to be mentally unhealthy as well.

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