Rabbi Michael Lerner warns against psychoanalyzing/diagnosing Mr. Trump (or any political leader, for that matter), especially when such psychoanalysis is intended as a tool for opposition. He points out that it’s questionable to diagnose people without working with them for a long time in a therapeutic setting. Rather, he says, one should focus on actions instead of on the internal demons of one’s opponent. (Mr. Lerner lists other reasons as well. Read the whole thing.)

I’m inclined to agree. I get very uneasy when I read of a psychotherapist or other mental health professional diagnose a politician with a disorder.

Occam’s Razor can do some good here. If Mr. Trump is unstable, erratic, or unpredictable, his actions by themselves speak to how much we can trust him or how competent he is. Whether the diagnosis is right or wrong, we don’t need it.

Or mostly we don’t. Mr. Lerner’s warning is an “editorial note” to another piece, “Trump as Narcissist,” by Michael Brenner, also found at the above link.* Brenner makes several arguments that stand or fall on their own. But his key point is that Mr. Trump is a narcissist and we cannot expect the demands and incentives of the presidency to tame his narcissism.

That argument is marginally informed by whether Mr. Trump really and truly suffers from narcissism. If he does, there’s less hope that he’ll mature and grow into the presidency. If he doesn’t, there’s slightly more hope. And if a 25th amendment solution is at all in the offing, then maybe psychological unfitness is a way to invoke that process. (At the same time, I’m not sure we really want to invoke that process, and I am especially wary of admitting to that end testimony from mental health professionals who have not even met with Mr. Trump personally.) So…maybe diagnoses of the sort Mr. Brenner offers do some good after all.

But the argument that Mr. Trump will grow into the presidency doesn’t rely only on the proposition that he’ll become a better person. It also relies on the claim that our system of checks and balances might actually work and that the federal bureaucracy will do what bureaucracies do and somehow condition what Mr. Trump can accomplish. We may of course doubt whether any of this will happen or if it does, whether we’ll welcome what the country would look like afterward. (For example, I’m glad that Michael Flynn has quit the National Security Agency, but I also share Noah Millman’s concerns about the intelligence leaks that seem to have prompted his ouster.)

And for the record, I don’t believe there’s something epistemologically magical about the “months, or sometimes years” of working with a client that Mr. Lerner says is necessary to determine if a person suffers from a disorder. I acknowledge that the the diagnoser probably has to always base his or her decision on incomplete information. So maybe it’s not entirely fair for me to claim the public diagnoses lack sufficient information.

That acknowledgement, however, doesn’t change my mind that such health professionals are acting unprofessionally and to a certain extent dangerously in their public diagnoses. They’re contributing to a discourse in which mental illness is seen as something shameful or to be feared. To my mind they’re weaponizing techniques that originally were meant to help or at least understand people.

Such is not their intention, and it’s not everything that they’re doing. Some mental disorders and perhaps even “personality organizations” ought to disqualify a person from certain positions of responsibility, among them the presidency. When an apt case presents itself, then maybe these mental health professionals are doing a service in highlighting it. And as even Mr. Lerner notes, there is something to be said for noting certain “styles” of politics and cultural expression. He cites Christopher Lasch’s study of the American “culture of narcissism, and I could cite Richard Hofstadter’s essay on the “paranoid style” of American politics.

Maybe there’s no “pure” approach. Maybe some harm has to be done for a greater good. I will probably not convince these mental health professionals otherwise. But I urge them to at least acknowledge and more forthrightly address the dangers of what they’re doing.

*If you read Tikkun Olam a lot, you’ll find that Mr. Lerner often attaches editorial comments to essays he publishes but disagrees with.

Category: Hospital, Statehouse

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10 Responses to The madness of King Donald

  1. Jaybird says:

    The problem is that there is no shortage of stories that say something like “Donald Trump orders steak well done. With Ketchup!”

    So that’s out there coloring everything.

    Which makes something like “huh, Trump is showing the following traits…” into a transparent partisan attack.

    “Donald Trump is showing classic signs of Narcissism, Megalomania, and Crohn’s Disease.”

    The argument that, no, this isn’t an attack. It’s Science! is then undercut by stuff like “didn’t your outlet run a story on Trump eating steak with ketchup?”

    And by the time that “Donald Trump is screwing up with NATO” comes along, you can’t help but wonder if this is like that time that we disagreed with how Trump ate dinner or if it’s a case where Trump, for real, is screwing up with NATO.

    Because, quite honestly, it could be either.

  2. gregiank says:

    Ughh yeah the diagnosing stuff drives me crazy. Just don’t do it. It’s unethical and impossible to do. Just don’t. Talk about actions and behaviors: exactly. Getting into diagnosis will mess things up for patients who need unbiased diagnosis, not stuff mixed in with politics.

  3. Stillwater says:

    Diagnosing Trump, as it’s usually done, seems to me to be a purely academic exercise. “Hey, he’s got narcissistic personality disorder!” (I actually think he does, but whateves.) The correct political response should be: So? What are his policy proposals? Politics ought to be about policy, not the medical conditions of the people proposing them.

    Unless of course the medical condition points at the likelihood of an outcome so apocalyptically gruesome that medical intervention is absolutely required to ensure the safety of all women, men and children across the globe. 🙂

  4. Thanks, all, for your comments. I think I should acknowledge, more than I did in the OP, how darn tempting it is to make such “diagnoses” (even though I am not a mental health professional).

    I’ll also note that I’ve checked out from the library (but have read only the intro) a book about psychpathy, the last section of which discusses some public figures and whether or not they are or might be psychopaths. These are public figures, but most of them aren’t politicians. I.e., the stakes are lower than with whoever is president of the US. And yet, I wasn’t and am not particularly inclined to criticize the endeavor. In part, that’s because the editor of the book makes the standard warning about “remember that the authors are working from secondary evidence so take this all with a grain of salt.”

    tl;dr: I don’t practice what I’ve just preached.

    (In case you’re interested, the book is Ellsworth Lapham French, ed. THINKING ABOUT PSYCHOPATHS AND PSYCHOPATHY, 2006.)

    • In part, that’s because the editor of the book makes the standard warning about “remember that the authors are working from secondary evidence so take this all with a grain of salt.”

      I should have added that at the end of the day, I don’t think such disclaimers, by themselves, are sufficient. The public diagnoser ought more diligently confront the contradiction than just repeating well-worn caveats, as if it’s a mantra that absolves one from all wrongdoing. (And for all I know, the authors in that book do. Again, I’ve read only the introduction.)

  5. Dr X says:

    Originally posted in the wrong thread, I’ve moved a comment here where it belongs. Sorry about that.

    Lerner is wrong about diagnosis. There is no general rule or even typical length of time required to make a diagnosis. Diagnosis is incremental, but sometimes the most important elements of diagnosis are evident in minutes. In other cases, diagnosis is a much more lengthy process.

    Here’s a different point of view on the so-called Goldwater rule.

    There are public figures who are easily diagnosed based on observation over time. I understand that diagnosis from afar can be abused, but flat-footed observation of troubling behavior is a form of diagnosis. We can say, for example, that a person lies, brags, cheats, is course, is crude etc. Saying those things is giving a behavioral diagnosis. And based on that sort of diagnosis, people will make implicit or explicit assumptions about the meaning and implications of those observations. Inferring meanings and implications of observed behavior is the rest of the diagnosis.

    Saying that someone like me can observe behaviors, but not comment on the meaning and implications of those behaviors (while everyone else does) is like saying that a professor of literature, shouldn’t be able to comment on the meaning of a written paragraph because she knows much more about literature than other people do. Or she can comment, but she must do so in a way that feigns ignorance, while the ignorant need not feign ignorance.

    In this election, many esteemed diagnosticians came forward and shared their observations because it’s so obvious in this case, and they consider the danger so great. These diagnosticians have a lot that they can tell you about the meaning and implications of what you’re seeing.

    While pundits were saying “he doesn’t mean this or doesn’t mean that, he’ll pivot after the nomination, or he’ll pivot after the election, these diagnosticians were saying “no, a pivot will not occur. A pivot cannot occur. Here’s why…”

    Pundits who said a pivot would occur were conducting their own diagnoses. They were just very bad at it. They were bad in the way that a poor reader is bad at reading comprehension.

    You can listen to analyses from clinicians and accept or reject them. People do this all the time when experts present their views. It happens when scientists speak out on matters of public policy. Would we want to silence scientists because they might be wrong and people might take their views seriously, or do we want the best informed observers to present their views on matters of great public importance? If the best informed disagree, all the better. You can hear different arguments and judge for yourself.

    Here’s the circumstance in which diagnosis at a distance should not occur. When conducting a formal clinical assessment, including treatment recommendations and plan, you need a patient in front of you so that you can explore all of the details of the patient history, symptom profile, symptom geneses, the nuances of personality, and the life circumstances of the patient, so that a specific treatment tailored to that patient is possible. The idea is to maximize treatment benefit and avoid harm caused by avoidable treatment errors.


    There’s a further discussion to be had about the meaning of the word diagnosis in this context, as well as a discussion of what should meaningfullly constitute a diagnosis of mental illness. We can get into that if anyone wants to discuss mental illness, personality disorders and personality organization. The term mental illness is tossed around too freely, IMO and I wouldn’t classify someone like Trump or any other politicians I can think of as mentally ill.

    • Thanks for the thoughtful reply. There’s a lot for me to chew on here, so I’ll just offer a few brief thoughts.

      I don’t mean to suggest that people ought not to comment on behaviors and what those behaviors might mean. I believe it’s possible to look at behaviors and analyze them without having to go the extra step of diagnosing (although I do understand from your addendum that “diagnosing” might be the wrong word here). In that sense, a mental health professional has the same right as anyone to comment on what public officials do.

      Am I then suggesting mental health professionals also refrain from giving us the benefit of their professional perspective? I guess from my OP, my answer is yes, for the most part. However, I must concede you have a pretty strong point and on reflection, I shouldn’t say that. I do agree that whether or not Mr. Trump will pivot or mature into the presidency is at least partially related to whether he’s a narcissist. Perhaps that leaves room for a mental health professional to make comments on behavior and based on their professional knowledge.

      In that case, maybe my claim that such professionals were acting “unprofessionally” was wrong. However, whether the “unprofessional” depends in part on the norms of the profession. If those norms don’t allow for such public commentary, then perhaps those statements are “unprofessional.” And for all I know, the norms do allow for that type of commentary. I had thought they didn’t, but I don’t know.

      You have a point with your analogy to a professor of literature. The analogy to the scientist speaking out on matters of public policy, however, is a bit more challenging for me. Any policy that is informed by the relevant discoveries and theories of science needs the perspectives of scientists, but a scientist, qua scientist, is unlikely to have the knowledge of how public policy works or any special authority to tell people what inconveniences they must accept or what good things they must sacrifice to attain a given policy goal. Whether that applies to what some mental health professionals are saying about Mr. Trump–I’m not sure. It’s probably relevant to whether he’ll “pivot,” but it seems less relevant (though not irrelevant) to whether existing institutions and separation of powers will check him or at least condition what he does.

      I realize from your addendum, and from other things you’ve written on this topic, that the words “diagnosis,” “disease,” and “illness” probably ill-suit us when we’re talking about personality organization or about (extreme) narcissism or psychopathy or character disturbance (I realize I’m throwing a lot of terms around here without having the type of deep knowledge that an expert has). There’s also a problem with my statement in the OP about Trump potentially “suffering” from narcissism. Maybe narcissistic personality disorder or other forms of character disturbance really are more about the choices and behaviors an individual engages in.

      I do think, though, that those types of qualifications about how we use such terms speak to the potential danger of mental health professionals, speaking as mental health professionals, about a public figure’s alleged character disturbance.

      We probably disagree on a lot here, and we’ll probably never agree fully on this. I’m not even sure I can pin down exactly why this commentary about Mr. Trump bothers me so much. However, I do appreciate your commenting and offering your perspective, and I certainly need to think more about this.

  6. Dr X says:

    Just a clarification, the Goldwater Rule is applies to psychiatrists who are members of the American Psychiatric Association. Psychiatrists are not required to belong to that association. Clinical Psychologists are not bound by the rule. The American Psychological Association urges cautiousness when commenting on public figures. Essentially, take care to draw from professional literature, knowledge, training and experience, and don’t suggest a professional or personal relationship with a person where none exists. I have no problem with that standard.

  7. Dr X says:

    I should add that psychologists are pretty circumspect about commenting publicly on matters like this, and this election is the only time I recall any coming forward to comment e.g., Howard Gardner at Harvard, Dan McAdams at Northwestern. McAdams wrote at length, but was especially reserved in his speculation.

    What I have seen in the past is an assortment of “therapists” of questionable credentials running at the mouth.

    • I might like to look up McAdams to see a “reserved” speculation. I should say that I certainly don’t mean to lump you in with the Oprah-appearing types of professionals that we see so often on TV.

      I also think Mr. Trump poses a different challenge from what Goldwater would have had he won in 1964. (Here I’m talking as someone informed about history and not about psychology.) I think Goldwater would likely have “pivoted” from his more extreme-sounding statements (like using nuclear weapons in Vietnam). On the non-pivot-worthy (for him) matters he would have at least had a principled stand (though one I disagree with) and probably wouldn’t have changed his views on a dime.

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