Confusing Trump’s behavior with mental illness unfairly stigmatizes those who are truly mentally ill, underestimates his considerable cunning, and misdirects our efforts at future harm reduction. And the three most frequent armchair diagnoses made for Trump — narcissistic personality disorder, delusional disorder, and dementia — are all badly misinformed.
Trump is an undisputed poster boy for narcissism. He demonstrates in pure form every single symptom described in the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for narcissistic personality disorder, which I wrote in 1978. But lots of successful people are extremely narcissistic without being mentally ill — think most celebrities, many politicians, and a fair percentage of writers, artists, lawyers, doctors, and professors. To qualify for narcissistic personality disorder, an individual’s selfish, unempathetic preening must be accompanied by significant distress or impairment. Trump certainly causes severe distress and impairment in others, but his narcissism doesn’t seem to affect him that way.
My long experience with psychiatric diagnosis has taught me a recurring and painful lesson: Anything that can be misused in the DSM will be misused, especially when there is an external, nonclinical reward for doing so. We decided to include narcissistic personality disorder in the DSM-III 40 years ago purely for clinical reasons. We never imagined it would be used as ammunition in today’s political warfare.
Allen Frances, M.D., was chair of the Department of Psychiatry and Behavioral Sciences at Duke University and also chaired the task force responsible for revising the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. He is the author of “Twilight of American Sanity: A Psychiatrist Analyzes the Age of Trump” (William Morrow, September 2017).
Allen Frances is a psychiatrist who wrote the rules for diagnosing personality disorders in the Diagnostic and Statistical Manual of Mental Disorders. The DSM is the No. 1 tool mental health professionals have for making diagnoses.
Frances, a professor emeritus at Duke, doesn’t mince words about what he thinks of mental health professionals who are now using the DSM to diagnose President Donald Trump with a mental disorder. “What’s going on is bullshit,” he says
“Everyone has a personality,” Frances says. “It’s not wrong to have a personality; it’s not mentally ill to have a personality. It’s only a disorder when it causes extreme distress, suffering, and impairment.”
Trump’s willingness to lie and endless self-promotion are traits that have, so far, worked out largely to his advantage. He’s president of the United States, after all.
Psychologists don’t have such a rule, and Frances — who supports the Goldwater Rule and generally thinks mental illnesses are overdiagnosed — worries that when the petitioners and others call Trump mentally ill, they stigmatize people with psychological problems. They can also distract from the more objective criticisms you can make of his presidency. “Call him a liar, call him evil, call him a threat to democracy, call him impulsive, call him ignorant — these labels are all absolutely true — but saying he has a mental disorder doesn’t really add force to the argument,” Frances says.
Dr. F. Perry Wilson: You authored the DSM criteria for narcissistic personality disorder. This is something that many people have attributed to President Trump. You are not one of them. Do you stand by the assertion that he does not have this disorder?
Dr. Allen Frances: Well, Trump is absolutely a world-class narcissist. He has every criteria met except for two. **In addition to having the features of being grandiose, unempathic, self-involved, selfish, all the things that go into being Trump, you have to have distress or impairment, significant distress or impairment. **
Trump is a man who causes immense distress in others, but doesn’t seem to experience it very much himself. Although he’s created tremendous impairment for our country and for his business colleagues, he, himself, has been very well rewarded in politics and also in business for being a narcissist. I think that it’s reckless for people to attribute the damage he’s causing to mental illness. He’s much more bad than mad.
To lump Trump with the mentally ill is a tremendous insult to them. It stigmatizes them. Most people who are mentally ill are well meaning and well behaved, and really fine people. Trump is none of those. So that when we confuse mental illness with bad behavior, we, first of all, insult the mentally ill, and secondly, we underestimate just how evil Trump is and how dangerous.
This is a joke, right? That diagnosis was built on the work of hundreds of people over many decades
https://www.statnews.com/2017/09/06/donald-trump-mental-illness-diagnosis/
https://www.vox.com/policy-and-politics/2017/2/10/14551890/trump-mental-health-narcissistic-personality
https://www.youtube.com/watch?v=QdaBsfu44ps
Is that enough proof for you, or do you need angels to descend from the heavens to confirm what all these journalists are saying?