DonkeyHotey / Flickr Donald Trump Portrait...
DonkeyHotey / Flickr

It’s not often that psychological diagnoses become the stuff of everyday conversations, but these aren’t ordinary times. 

(In the interest of full disclosure, I’m a clinical psychologist in private practice, with a background that includes work in inpatient hospitals and prisons.) 

Before the age of Trump, there was an understanding that mental health professionals were not to publicly comment on perceived or presumed psychological problems of elected officials, known as the ‘Goldwater rule’, after the late Barry Goldwater. (For more on the history and recent discussion of the Goldwater rule, see here.) With Trump’s installation in the White House, the concerns over offering opinions of public figures that a professional has not personally evaluated have given way to the simple reality that Trump is so obviously severely mentally ill and mentally unfit to serve as President:

Q: Who are the National Coalition of Concerned Mental Health Experts?

A: We are a group of mental health professionals who have come together after a Yale ethics conference, which led to the instant bestseller, “The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President.” We seek to alert lawmakers and the public to the dangerousness of the current president before an irreversible national or international crisis occurs. We represent more than the 27 in the book: we now number in the hundreds, and expect soon to number in the thousands or tens of thousands.

Q: What is our mission?

A. We are dedicated to sharing our knowledge for the purpose of warning and protecting national and international well-being and security.  We are currently consulting with government officials who seek our expertise. We bring our scientific information, clinical expertise, and practical experience to understanding and handling this situation, with the goal of offering solutions and hope.

Q: What is a mental health professional’s Duty to Warn?

A: Most states have laws that either require or permit mental health professionals to disclose information about patients who may become violent. Those laws are receiving increased attention following recent mass shootings, such as those in Aurora, Colo., and Newtown, Conn. A New York law enacted January 15, 2013, makes it mandatory for mental health professionals to report when they believe patients may pose a danger to themselves or others. New York’s law also allows law enforcement to remove firearms owned by patients reported to be likely to be dangerous.

How best to describe Trump in psychological terms? Many professionals (and non-professionals) have offered diagnoses, but one has entered public discourse more than others, and it is in my view the most accurate: Malignant Narcissism

What is Malignant Narcissism [MN]? The best overview I’ve come across is found in a seven year old article in a not especially well known journal from Croatia, Psychiatria Danubina :

Malignant Narcissism: From Fairy Tales to Harsh Reality

Mila Goldner-Vukov & Laurie Jo Moore

University of Auckland Faculty of Medical and Health Sciences, Manaaki House Community Mental Health Service

Psychiatria Danubina (2010) Vol. 22, No. 3, pp 392–405

In MN destructive aspects of the self and the expression of aggression become idealized (Rosenfield,1971). People with MN give the appearance of being self-sufficient and successful. Covertly, however, theyare fragile, vulnerable to shame and sensitive to criticism. Failure to succeed in grandiose efforts results in prominent mood swings with irritability, rage and feelings of emptiness. People with MN are driven by an intense need for recognition. Inwardly, they are deeply envious of people who have meaningful lives. They are adaptive, capable of consistent hard work and of achieving success. However, their work is done primarily to gain admiration and their intellect is strikingly shallow. They are often materialistic and ready to shift their values to gain favour. They are prone to pathological lying. In the realm of love and sexuality they are charming, seductive and promiscuous, but unable to develop deep relationships. When not involved in narcissistic pursuits, they are cold, unempathetic, exploitative and indifferent towards others. Disturbing feelings of inferiority, self-doubt,boredom, alienation, emptiness and aimlessness underlie their persona (Kernberg 1984). (pg. 393, emphasis added)

If one does not see these features in Trump, one is deliberately choosing not to see them.

And if one does not see his imminent dangerousness of such a person in command of the armed forces, and especially our nuclear arsenal— because of the utter unpredictability and irrationality of his lashing out— then one is simply a fool.

We’ve heard numerous times that there are safeguards in place, that he is surrounded by ‘adults in the room’, but that presumes the rationality and competence of his cabinet, advisers, Congress, and the Pentagon. Very little of the events of the last year give us any reassurance that the ‘adults’ have any authority, or desire, to deter Trump in anything he chooses to do.

Through whatever political or legal means it is accomplished, this person must be removed from office as soon as possible.

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This is a Creative Commons article. The original version of this article appeared here.


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