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.
“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.