Why news media speculation over Trump’s mental health needs to stop

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Susan Molchan, MD, is a psychiatrist in the Washington, DC area, who also has worked as a scientist at the National Institute of Mental Health.

 

Donald Trump victory speech“With each passing week he displays the classic symptoms of medium-grade mania in more disturbing forms: inflated self-esteem, sleeplessness, impulsivity, aggression and a compulsion to offer advice on subjects he knows nothing about.”New York Times columnist David Brooks

“American psycho: Is Donald Trump clinically deranged?” — a New York Daily News op-ed headline

“Tens of thousands of people are calling for Donald Trump to be examined by doctors for narcissism – and a Harvard medical professor thinks they are right,” a U.K. Independent story

Heated rhetoric and name calling have become standard for presidential elections in this country. But this year’s election also has seen a profusion of news stories and op-eds with psychiatric conjecture applied to Republican candidate Donald Trump, such as the Brooks piece above. A California Congresswoman’s “#DiagnoseTrump” hashtag on Twitter isn’t helping matters, either.

As a psychiatrist, I have to ask, is this speculation fair?

Mental illness causes serious distress and suffering to a lot of people and their families. It prevents them from living their lives to the fullest, and for too many, leads to ending their lives. And a pervasive stigma attached to mental illness keeps too many from seeking the help they need.

Although we have no way of knowing if Trump suffers in some way from this sort of distress, he has no public history of it, and he certainly has functioned very well for himself.

Labeling him as mentally ill does a disservice to those who deal with mental illness, as pointed out by Dr. Allen Frances in the Huffington Post. Frances is the former chairman of psychiatry at Duke University, and chairman of the DSM-IV Task Force, the group that formulates the book of official psychiatric diagnoses, and others.

Most people with mental health problems, as Dr. Frances says, are “nice, polite, well meaning, decent people.” Granted, many of us might be hard-pressed to say the same of Trump, given his crass words and behavior over the last few months, much less his history of cheating others, extreme self-interest, and racist and sexist comments.

Why this further stigmatizes people with mental illness

As humans, when we see unusual or upsetting behavior, we want to understand it and explain it. When it’s something offensive to us, or is exhibited by someone we don’t like or don’t agree with, we may call that person names.

Given the stigma of mental illness, one variation of name-calling is to say they look  “manic,” “bipolar,” have a “personality disorder,” are “mentally unfit,” “unstable,” or “deranged” —  all terms that have been hurled at Trump recently. (Some of these also have been used for Hillary Clinton, too, though less often.)

Mental health professionals spend years in training and spend hours interviewing those with problems to discern “a diagnosis,” essentially a label that gives us some idea about what may help an individual.

The ‘Goldwater Rule’ and armchair diagnosis

We can’t begin to discern a person’s psyche from a television screen. It’s unprofessional for psychologists or others in the mental health field to comment on a public figure’s “diagnosis” or supposed health problems, and journalists should keep this in mind if any “professionals” offer such opinions.

This armchair diagnosis isn’t new. It was common enough–and problematic enough–that decades ago clinicians agreed to stop doing it.

“Since 1973, the American Psychiatric Association and its members have abided by a principle commonly known as ‘the Goldwater Rule,’ which prohibits psychiatrists from offering opinions on someone they have not personally evaluated,” notes a recent APA blog post by president Maria Oquendo.

“We live in an age where information on a given individual is easier to access and more abundant than ever before, particularly if that person happens to be a public figure. With that in mind, I can understand the desire to get inside the mind of a Presidential candidate,” Oquendo writes.  “I can also understand how a patient might feel if they saw their doctor offering an uninformed medical opinion on someone they have never examined.”

It’s all politics in the end

Trump is a highly functioning man who appears to have reached the epitome of success in our material and capitalistic society. He has shown himself to be extraordinarily talented at exploiting and manipulating people. That doesn’t mean he’s grappling with a mental illness–but it does mean he’s got what some might say are the skills to be a politician.

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Comments (36)

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Jeanne Lenzer

August 8, 2016 at 12:41 pm

Much as I like and respect both Susan Molchan and Allen Frances, on this one I must disagree. If he isn’t the epitome of sociopathy, I dunno who is, and I think it’s healthy for people to see his behavior as deranged and sociopathic, and to name it and decry it. Just because some mentally ill people are mean-spirited and volatile liars doesn’t mean all people with mental and emotional problems are – we can make the distinction.

Maia Szalavitz

August 8, 2016 at 2:30 pm

Amen, Jeanne!! It’s absurd for psychiatrists to be diagnosing him from afar as *not* having a personality disorder— that violates the Goldwater rule, too, surely? The reality is that antisocial personality disorder, the extreme of which is sociopathy, is a disorder that is impossible to destigmatize because it is *defined* by behaviour that is callous and harmful to others. One cannot have sociopathy and be a nice person, although it may be possible to “outgrow” callous and antisocial traits. Since Trump is in his 70s, I think we can rule out maturing out, however.

Susan Molchan

August 8, 2016 at 3:47 pm

Appreciate the comments of both Jeanne & Maia and I see what you mean, but I’m talking about professional diagnoses, which have different meanings/definitions than “sociopathy” in the more generic sense. Someone with “Antisocial Personality Disorder” for ex, (& believe me I could do w/o DSM & all these labels & the whole psych industry but there it is) must by definition be feeling significant distress or impairment in his life. Trump certainly doesn’t seem to be distressed, petty temper tantrums aside. He’s adapted himself v well to the world into which he was born and taken full advantage of his situation (yes, to the detriment of others–which makes him a bad, though not necessarily a mad man–as the Huff Post piece noted)

Marina Needham

August 8, 2016 at 6:01 pm

Susan, I totally agree with you! Yes, he might be a text book narcissist, but I would not give him a diagnosis. He is not looking for treatment anyway and does not appear in distress.

Maia Szalavitz

August 9, 2016 at 7:33 am

I still disagree— significant distress over the condition is not part of Hare’s diagnostic checklist for psychopathy (used these days as synonymous with sociopathy), otherwise, no one would ever be diagnosed with it and there are many who do not have significant negative consequences since they are protected by being rich. Of course, it’s true that Hare’s criteria do not make up a formal DSM diagnosis, but they are considered valid and reliable enough to be the basis of quite a significant body of research.

Lynda Hiatt

August 9, 2016 at 9:18 am

Thanx

Steven Meyerson

August 9, 2016 at 9:18 am

Since the author is a psychiatrist, I can understand her reluctance to “diagnose”. As an internist, I would be loathe to diagnose pneumonia based on hearing a patient cough on the phone. That being said, Donald Trump does demonstrate some well-recognizable characteristics that are typical of persons with the “diagnosable” mental illnesses. I think it’s reasonable to point out these traits to help the public understand the nature of his personality, get a sense of what makes him tick, and make some projections as to how he would behave as president. .

Steve King

August 9, 2016 at 9:25 am

What’s always amazing to me is how many lay people who make these psychiatric diagnoses fail to note an important diagnostic criteria required for the diagnoses of virtually all the mental disorders in the DSM: that the symptoms cause marked impairment in functioning. We have had the often ludicrous contention that essentially everyone has a mental disorder based on the DSM without noticing that if this was true, society would have collapsed long ago.
New York Times columnists on a number of occasions have said Trump has narcissistic personality disorder but not one has pointed how his functioning has been impaired. Considering that he has done what only one other person in American history has done, capture the presidential nomination of a major party without any political or military experience, it seems he’s doing pretty well for himself.
And if as some have said that he is a sociopath, essentially a lifetime disorder, what does that say about all those people such as the Clintons who have befriended him or the governments that have made deals with him. Yes, I know socipaths can be charming deceivers but it sure would bother me if our government is being run by people who could be so easily deceived.

Robert Dillon

August 9, 2016 at 9:29 am

People on Wall Street who caused so much pain and economic ruin in this country were certainly criminals behaving as such but protected as stated above by wealth, as is the Donald. A gang-leader in a prison also functions very well in his environments. Does that make him not a sociopath? Or a narcissist? The fact that we do not see remorse or regret from the harm caused is circumstantial evidence. Is the public qualifies to be diagnosing anyone? No. But anyone who puts themselves out there as a presidential candidate invites such examination. Now the results come in and this is what you get. The court of public opinion , which is not scientific, but the collective insight of thousands of sentient beings amounts to some pretty powerful neuronal activity, and some pretty damning circumstantial evidence supporting pathology in Trumps case anyways. Karma. DSM V is an invention of the Insurance companies (indirectly) anyways, people do not neatly fit in little diagnostic boxes.

Saul Levine, MD

August 9, 2016 at 9:33 am

I agree with Drs. Molchan and Allen, but we are free, nay, have a responsibility, to use valid adjectives to accurately describe “Der Trumper’s” vivid personality traits, which manifest ignorance, bullying, meanness, lying, egoism, narcissism, pomposity, disrespect, lack of empathy, hypersensitivity, impulsivity, racism, misogyny, and other such delightful human frailties.

Andrew Johnstone

August 9, 2016 at 9:34 am

If we’re going to be fair or objective about this, then why the stark absence of speculative diagnoses when it comes to our current narcissist-in-chief, or Hillary Clinton….???
Both are just as clearly ‘pathologic’ as Mr. Trump, but the journalists have totally different attitudes depending on if they agree with the politician’s agenda. THAT is what is despicable, and frightening – if we can’t have objective journalism, fine, but don’t pretend it is objective – just admit that you have a political bias if you want to play that game.

Marcus DeSio M.D.

August 9, 2016 at 9:37 am

I find that anyone diagnosing any type of physical or mental disability based on their opinion only, without in depth examination of the individual, are professionally incompetent and appropriate action on their license should be executed. Sure, you can think he ( Trump) acts inappropriately at times, but the Clintons are just as ” sociopathic”, so is your current President and most of them before. The media has abused their responsibility to fairness and honesty for several years and is getting worse, an opinion is posted as fact and because of the Internet, it is spread as such. But the individuals initiating these attacks, and the media editors are interested in just the economics of doing their dirty deed. Any medical professional commenting on the sanity of an individual should lose their license for violating that person’s privacy rights and unprofessional behavior, yes even candidates have basic human rights.

Nicholas Cummings

August 9, 2016 at 9:46 am

Watching Trump on TV, certain clinical terms pop into my mind, but I try to keep them to myself because I have not evaluated him, and, of course, if I did, professional ethics would still require silence for other reasons. On the other hand, he clearly appears to be a real [Bleep] and I am free to say so, despite my self censorship in this setting. Unfortunately, a large portion of the public appears to LIKE a real [Bleep.] Maybe offering diagnostic opinions is an attempt by some mental health professionals to leverage their opinions beyond the level of influence they would have by simply labeling him a [Bleep] and pointing out his wildly inconsistent policy statements and fact-free claims.

david sherer

August 9, 2016 at 9:47 am

I disagree. He displays many characteristics of narcissistic personality disorder with a fresh helping of borderline personality thrown in for good measure.

Ed Whitney

August 9, 2016 at 10:09 am

Armchair psychiatric DSM diagnoses should not be made, even by psychiatrists. Very well. But voters should look at this candidate’s actual behavior as captured on numerous video clips and realize that what they see is what they will get if he is elected in November.

Presidents must be able to handle criticism without having to respond to every critic with a counterpunch. One candidate has this ability; the other does not. We see this with our own eyes. One candidate revoked the press credentials of the Washington Post from covering his campaign after being criticized once by that organization; the other candidate has never touched the press credentials of Fox News after repeated denunciations of her character and abilities. We need not make any diagnoses; we need only realize that present behavior predicts future behavior. Perhaps businessmen can be sensitive to criticism and fire those who engage in it; the same is not true of presidents.

Twice in a matter of days he insulted fire marshals in Colorado Springs and in Columbus, Ohio when they enforced occupancy limits at venues he had booked for his campaign events. In each case, the fire marshal was a professional expert doing his job; in each case, Donald Trump said that they were Democrats working for Hillary. In Columbus, Trump pointed to the very large room in which his event was taking place and point out that it could hold more than 1000 people. The fire marshal pointed out that occupancy limits depend not only on the size of the room but on the number of exits, and that some of the exits from that room were blocked due to ongoing construction. To Trump, this did not matter; the only thing that mattered was that he was not getting what he wanted, and that the judgment of the fire marshal was politically motivated.

I do not need to make a diagnosis in order to conclude that a man who does this with expert fire marshals will do the same thing in the White House situation room if there are military experts who inform him that something he wants to do will yield bad outcomes if attempted on the field of battle. He will think that they are trying to restrain him out of unsavory motives. He will think that it is all about him.

It has nothing to do with making armchair diagnoses; it has to do with realizing that we are being given a crystal ball in which we can see what we would see again and again if we have a President Trump endowed with the power to make decisions that affect the lives of all of us and our posterity.

Christy Thomas

August 9, 2016 at 10:25 am

I certainly understand the need of the mental health professional to refrain from making anything that sounds like an official diagnosis of Mr. Trump. I would suggest, however, that because of Trump’s extensive media exposure and the large number of books/articles written about him by first-person observers, it is probable that no more information could be gleaned about the state of Trump’s mental health through private conversation. The real issue facing the US public: are we close to electing as POTUS a seriously mentally unstable man? This thin-skinned, apparently sans a normal conscience, vengeful man could, by virtue of his position at President, start the kind of war that will assure the destruction of most of the population centers of the world. The public deserves better than this. People need to speak out.

SANDY OESTREICH

August 9, 2016 at 10:27 am

…maybe so, but my professional guess is that Trump seems to fit the model of a sociopath/psychopath because of his public persona :
lies; manipulates facts to his benefit, then retracts; disparages others, even the most vulnerable (babies, the disabled); threatens others; shows no accountability or sensibilities about his statements; shows no compassion and steals without compunction or remorse, etc etc.
Mr. Trump probably would not recover even with the most expert help.

Mary Marros

August 9, 2016 at 10:27 am

Narcisstic, manipulative, egotistic, charming etc.-seem to be common attributes for most politicians.

Ann Jameson

August 9, 2016 at 10:34 am

What sort of medical professional makes diagnoses about serious conditions without having examined the patient and performed tests to verify or exclude certain potential illnesses? Perhaps those who make a diagnosis based on op/ed columns and/or statements made by talking heads on TV go out into their back yards and burn the bodies of small creatures and then analyze the residue including bones? I thought we were centuries away from ‘reading the bones’. But based on comments here, perhaps we haven’t progressed as far as expected. On the other hand, why have office visits with mental health providers: just send a video of yourself or family member or friend and get a diagnosis by return email.

Peter Herring

August 9, 2016 at 10:35 am

I agree that armchair psychological diagnosis is impossible, likely harmful, and possibly dangerous. On the other hand, saying that Donald Trump functions very well for himself (alone – my add) is a dangerous condition far too prevalent in this society. Whatever the root cause of his actions, it is his actions we should fear.

Peter Glickman, MD

August 9, 2016 at 10:38 am

I think the medical community needs to step up to the plate here and insist that all presidential candidates undergo a complete psychiatric evaluation before being allowed to run. It’s all well and good for us to sit back and opine one way or another, but it’s all meaningless to the outcome unless we take a stand for the validity of what we do. Is Donald Trump mentally ill? Let’s call for an independent examination. We might have averted some huge mistakes in the past if this had occurred. Anybody in our leadership willing to call for this?

Kenneth Gorelick MD

August 9, 2016 at 11:15 am

“Mental illness” does not seem to mean “psychiatric disorder” in common usage today. For example, people who commit mass murders as in Sandy Hook, Orlando, San Bernardino, Paris, Brussels, or Germany, are called “mentally ill” in the papers and politicians call for more funding for mental illness. However, I doubt that any of those murderers would have been diagnosed with a mental disorder that would have put them at risk for committing homicide.

Similarly, Trump is a bizarre person but on exam he would be unlikely to be diagnosed with any disorder that would disqualify him from the presidency.
People are way too quick to apply the term mentally ill to those who are extremely destructive without considering the possibility that “being evil” can be real by itself without any exculpatory medical condition.

EDWARD HINES

August 9, 2016 at 11:24 am

Those of us who practice medicine in fields other than psychiatry would never make a diagnosis without the objective data such as ecg, lab work, imaging and or biopsy results. Those who have practiced for many years almost always have an initial impression after a cursory exposure to a patient. That impression is often correct but sometimes totally wrong. I would guess that every physician has an opinion in their field of expertise and some are willing to voice their initial impression. So if a psychiatrist is willing to voice their impression, not a diagnosis, without a thorough evaluation, those of who are not in the field, should take that opinion into consideration..

Fausto Lucignani

August 9, 2016 at 11:35 am

From the pure medical POV, I agree with Dr. Molchan. We should not label Donald Trump as a mental case. However, let’s for a moment imagine that the entire American society would act similarly to Trump, would Dr. Molchan categorize the people as behaving normally? The fact that the billionaire is so different from the rest of his countrymen, makes him mentally and emotionally abnormal.

Maya Bates

August 9, 2016 at 12:20 pm

As someone with the paperwork, and years of experience in working with those with mental health issues…I see your blog as a way to “normalize” Mr. Trump. If he is or is not successful financially , means nothing at this juncture. Mr. Trump has indeed shown signs of various Personality Disorders, not the least of which is Narcissistic Personality Disorder. I don’t believe one needs to spend years studying Mr. Trump to see these warning signs. The uproar is that he is vying for an extremely important position. ..and the question must certainly be “Is he qualified…has he the skills and temperament for this position”? And the answer is not that he has done well financially…the answer, quite simply, is no, he does not…IMHO…

Cher Anderson

August 9, 2016 at 1:52 pm

I understand the stigma of mental illness, but if someone that could potentially have control over our lives, is acting like he has some serious issues, it’s a true concern and should be looked into. Personally I think anyone going to be accepted in an important government position like that should be physically and mentally examined to make sure they are well enough for office. For example, if someone has bipolar, they should be doing well on meds consistently.
I also think it’s normal & ok with us calling this out because of the great concern his position as President could affect our lives.

Donna Holeman

August 9, 2016 at 4:46 pm

Does pathological lying without guilt bring question to Hillary’s mental health stability? It took five years, several hospitalizations, four doctors and twp therapists to properly diagnose a family member with schizoaffective disorder.. Only then were they able to balance the medications and
therapy to help him lead a normal life. TV diagnosis may end in a lawsuit.

Ann Jameson

August 9, 2016 at 6:37 pm

Is it possible to convince those who are so sure of their ‘ability’ to diagnose someone they do not know, have never met, never spent any time with, that they are wrong either in their diagnosis or in their surety or even in their attempts to do such things? It seems impossible.

“Nothing is so firmly believed as that which is least known”. Montaigne

Anna Bishop

August 9, 2016 at 7:09 pm

So because people study for years to learn how to diagnose, and others with no training see the disorder plainly, we should all pretend to be blind to psychopathology. I see. To allow those experts their exalted positions we should play dumb. Well, I hate to break the news to those tender egos, but it’s the issue of an overly tender ego that brings us here today. A man is running for the highest office in the free world whose issues are so obvious as to be low hanging fruit. Perhaps these experts might do better to spend less time telling us how we shouldn’t recognize the obvious and more time finding a way to pass legislation demanding psychiatric examinations for Presidents of the United States. You know, like the kind we give to the average meter maid on the street in order to be hired for the job. Absolute power corrupts absolutely. Do we really want to act like nothing is wrong?

But don’t worry. The professionals need not say a word. We lay people will say it for them.

antonio acosta

August 9, 2016 at 9:29 pm

It is interesting that no one seems to have any concern about the other Presidential candidate: The one who has a history of making repeated false statements and has a sense of entitlement as well. Both would fit similar criteria for a psychiatric label. One is more blunt, but the character flaws are quite evident in the other one as well. Anyone who supports collectivist / statist policies has serious issues as well.

Philip Kruper

August 10, 2016 at 6:15 am

I believe Dr. Cumming’s diagnosis is the most accurate!

Steven Brenner

August 10, 2016 at 12:32 pm

I agree throwing around mental health diagnostic terms is off base, especially by reporters, journalists and people who are not qualified to make a mental health diagnosis.
Actually, if a health professional makes mental health diagnosis on a public forum without having actually interviewed the person or performed procedures which would ordinarily be associated with a health professional making a diagnosis, there could possibly be grounds for a malpractice suit.
I’m not a lawyer, but know that confidentiality is essential in any situation involving patients, especially when any issue of mental health is involved.
People in the media may have first amendment protection from the constitution, but even there, matters of confidentiality with reference to health concerns would be an issue of privacy, and violation of privacy is a very serious matter and has constitutional protections as well.
Certainly, public figures such as presidential candidates are in a different category from ordinary persons, but they do have a right to privacy with reference to some issues, one of them being health concerns.

Laurel Northup MD

August 10, 2016 at 3:54 pm

I have been gratified and relieved to see that most, by far, of the diagnosing of Trump’s “mental illness” I’ve seen in the media is not done by my fellow psychiatrists, who like me no doubt have reactions and speculations they are keeping discreetly to themselves or voicing in non-clinical terms. The public comments I have seen ignore such subtleties as the distinction between traits and disorders and between internalizing disorders, which typically cause distress to oneself, and externalizing disorders, which cause distress to others but typically not to oneself. Language usage blurs the distinction between behavior that is morally/ethically reprehensible and repellent and that which is technically diagnosable as mental illness. There should be — and many people have found — a way to say someone’s behavior strikes us as really wrong without invoking psychiatric diagnosis, which is best reserved for the clinical context.

Christine Polke

August 12, 2016 at 7:04 am

From a professional point of view, I agree with with Susan Molcan.
But the important question we should ask is a different one. Is there any legal action possible to force Mr. Trump to be professional examined for a possible mental disorder before the election?

Stephen Cox, MD

August 22, 2016 at 4:16 pm

I agree with Dr. Glickman. Both candidates should be evaluated by an independent, unaffiliated Psychiatrist and Internest/Family Physician. One comment noted Trump has functioned well so far and does not seem to be a threat to himself. My concern is the potential threat to the rest of us and the world. Dictators and tyrants through history did not always seem to be dangerous until they assumed power.

Stephen Cox, MD

August 22, 2016 at 4:30 pm

You must be satisfied that Hitler was not required to have a mental health evaluation before assuming power. Why do we currently require a health evaluation without a thorough psych component ?