Author Govert SchullerPosted on Categories Psychology During the 2015/16 US presidential primaries consensus emerged among health professionals [1], knowledgeable journalists [2,3,4] and those engaged in amateur diagnoses [5] that the psychological profile of then presidential candidate Donald Trump hovered somewhere between having a (curable) narcissist character trait of a malignant kind and suffering from (irreversible) Narcissistic Personality Disorder (NPD).
Making such a diagnosis has several ethical and legal aspects, especially the Goldwater Rule, which in the case of Trump brings out intriguing historical parallels.
First the diagnosis. In the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) the NPD is coded as 301.81 with 301 standing for the family of personality disorders and 81 for its specific member ‘narcissistic’. The definition is “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts as indicated by five (or more)” of nine different criteria.[6]
The Goldwater Rule is an ethical code in the mental health profession. On one side it prevents professionals from giving to the media a specific professional opinion about another person’s psychological health unless they have conducted an in-depth assessment through personal interaction and obtained the permission of the person in question to release its results. On the other side the rule allows professionals to share with the public their expertise about mental health issues, but have to do so in general terms.[7]
So they cannot say that a specific person has NPD, but they can say that political candidates are often narcissistic (which sometimes can be good), that narcissism comes in many gradations, and that there are nine diagnostic criteria for NPD, which they may discuss in detail. Meanwhile they will have to leave it to the reader to make up his or her own mind if these criteria are applicable to some public figure or not.[8] Other people are not bound by that rule but are reminded to be careful in using mental health diagnostic tools because their cavalier use can lead to the stigmatization of, and adverse reactions from, those diagnosed.[6,9] One expert warned that especially during hotly contested and emotionally laden political campaigns psychological and political evaluations tend to get confusingly mixed and that the public, including professionals, might fall for unnoticed subconscious reaction patterns (transference and countertransference in psycho-speak) which will cloud their judgements.[10]
The Goldwater Rule originated in the context of the 1964 presidential race between the republican candidate Barry Goldwater and democratic candidate Lyndon Johnson. [9,11] The magazine Fact sent a questionnaire to 12,000 psychiatrists, psychologists and psychotherapists with the main question if Goldwater was psychologically fit to be president. There were other questions and space was left open to make specific comments. 1,200 came back of which a whopping 50% responded in the negative, i.e. they did not think Goldwater was psychologically suitable to be president. Fact published the results with excerpts from the comments. Goldwater then sued the magazine for libel, which case he won because it was proven that the magazine had manipulated some of the comments to make Goldwater look more unhinged than the comments warranted.[12] The profession was embarrassed and instituted a rule to circumscribe what it can say about public figures, which then became known as the Goldwater Rule. Later analyses of the article indicated severe methodological problems with the ‘study’. [10]
But exceptions have been made in the case of foreign leaders like Qaddafi and Saddam Hussein, the former head of the IMF Dominique Strauss-Kahn, and a gaggle of terrorists and school shooters. And the possibility was raised for the justification to break the rule in case a politician would rise to “the level of a national threat”.[9]
Given the above mentioned caveats and given Trump’s policy proposals to deport twelve million illegal immigrants; “grab, grab, grab” from other countries the wealth he thinks is owed to the US; coerce Mexico to pay for a border wall, and threaten nuclear war if they don’t comply; close the borders to legitimate Muslim refugees; run the US like he runs his businesses, which means putting it in one or another kind of strategic bankruptcy; clamp down on free speech; his otherwise abysmal mastery of policy issues; and his callous attitude to women, minorities, journalists and other political candidates; he therefore poses, in my opinion, enough of a national and international danger that the whole world is entitled to a psychological assessment of this person to see if he can be trusted with handling the immense power inherent in the US presidency and not lead the world into some social, economic and/or nuclear disaster.
As some experts have already spoken, the public will have to do its homework.
Naperville, March 19, 2016.
Originally posted on Facebook.
Sources
[1]. Alford, Henry. “Is Donald Trump Actually a Narcissist? Therapists Weight In!” Vanity Fair. 11 Nov 2015.
[2]. Barber, Nigel. “Does Trump Suffer from Narcissistic Personality Disorder?” Psychology Today. 10 Aug 2016 [updated?].
[3]. Kluger, Jeffrey. “The Truth About Donald Trump“. Time. 11 Aug 2016.
[4]. Azarian, Bobby. “A neuroscientist explains: Trump has a mental disorder that makes him a dangerous world leader“. Raw Story. 18 Jan 2016.
[5].Konnikova, Maria. “Less Than Artful Choices: Narcissistic Personality Disorder According to Donald Trump“. Big Think. Early 2016.
[6]. “Diagnostic criteria for 301.81 Narcissistic Personality Disorder“. Behave Net.
[7]. “Ethics Reminder Offered About ‘Goldwater Rule’ on Talking to Media“. Psychiatric News. 18 May 2007.
[8]. “Robert Klitzman on Narcissistic Personality Disorder and Donald Trump“. Bioethics News. 7 Dec 2015.
[9] Friedman, Richard. “How a Telescopic Lens Muddles Psychiatric Insights“. New York Times. 23 May 2011.
[10] Stanley A. Renshon. The Psychological Assessment of Presidential Candidates. New York, NY & Oxon, UK: Routledge, 1998. Pp. 122-145.
[11] Klitzman, Robert. “Should Therapists Analyze Presidential Candidates?“. New York Times. 7 Mar 2016.
[12]. “Goldwater v. Ginzburg“. Case Text.
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