Neal Allen

OUR PRESIDENT IS CRAZY

The president is crazy, and no one is allowed to write about it. The news-reading public is held hostage by a Catch-22 that is a relic of psychology being seen as a department of medicine. It goes like this: Psychological behaviors reflect forms of sickness. They are pathological. Only credentialed healers (psychologists and psychiatrists) are allowed to diagnose pathologies. Here comes the Catch-22: Credentialed healers are forbidden by codes of ethics to diagnose at a distance. So public figures who do not submit themselves to examination by credentialed healers cannot be officially diagnosed as being crazy.

Journalistic norms buy into this notion. James Fallows of the Atlantic writes about it as a taboo against “medicalizing” political decision-making. It troubles him. Journalists aren’t credentialed healers; ipso facto they aren’t allowed to use the terminology of psychology or attribute even the most basic human motivations to political action. The best they can do is, “Trump seems to have a penchant for authoritarian leaders.”

So the credentialed healers can’t talk about Trump’s pathological narcissism, and nor can the journalists. Which is why we’re watching a crazy man take the helm of the presidency, and we don’t read about it.

Meanwhile, a growing underground (the stuff that appears on Twitter) consensus is showing up that Trump suffers from Narcissistic Personality Disorder. This is the terminology that the credentialed healers use. It is the label for a constellation of symptoms that are described in the diagnostic bible known as DSM-5.

First misconception: Doesn't Narcissistic Personality Disorder just mean someone is really really narcissistic? No. It means someone is ONLY narcissistic. Forget thinking about it as a spectrum that has Harry Truman at one end and Richard Nixon on the other. Every president on that spectrum lived in a normal reality. They had their faults: Nixon was more paranoid, Clinton needier of love, Carter more sanctimonious, Reagan more distant. But they weren’t crazy. Trump lives in a separate reality. It doesn’t have any relationship with the rules of social behavior that the rest of us spend a lot of time trying to obey.

You can look up NPD in the DSM-5 and get a bunch of symptoms. They are the minimally necessary noticed behaviors and thoughts needed to diagnose, agreed to by a consensus of credentialed healers. It’s a sad list, with prominent characteristics of extreme grandiosity, extreme lack of empathy, and extremely impulsive reactivity. But it doesn’t tell the whole story. The DSM-5 is useful only insofar as we are in a therapeutic system, with diagnosis aimed at treatment. It’s too clinical to be inserted directly into political discourse.

Still, it would be helpful if journalists agreed among themselves that the diagnostic criteria for NPD accurately reflected Trump’s behaviors. It might be helpful for journalists to be instructed on NPD by credentialed healers who then let the journalists make up their own minds whether Trump has it.
Then journalists would be ready to break through the “medicalization” barrier that Fallows speaks of. I think it would be a process requiring two more steps:

1. Agreeing that his NPD influences his decisions as much or more than global diplomacy norms, political principles, human rights standards, or any of the codes of ethics that underlie political action. This would be based on the evidence, of course.

2. Finding the right way to talk about the influence of NPD on Trump’s decision-making. The model of diagnosis-treatment has nothing to do with Trump’s and our stake in the social compact. It isn’t a medical disease now for us; it’s a social danger. I prefer calling what Trump has pathological narcissism, which doesn’t imply adherence to the DSM-5 point of view. I’m not trying to be a doctor; I’m trying to describe what caused Trump to do that in that circumstance. (In this article, I’m being provocative here by also calling him “crazy,” because people need to first wake up to this not being a new normal. It’s a new abnormal.) The journalist has to take a courageous step: It’s time to see where and when Trump’s NPD is influencing his decisions, based on the same kind of guesswork and evidence that goes into all pundit second-guessing.

Misconception two: We’ve seen this before and didn’t need to break down the “medicalizing” barrier then, so why now? No. This idea that journalists have that “I’ve seen everything” is dangerous because it overlooks that the decision-making pattern in NPD is not like any other kind of political decision-making. People with NPD are rare. And most of them come and go so quickly in people’s lives – they’re very bad at retaining relationships – that you typically don’t even know when you’re in the presence of one. We haven’t seen this before. This isn’t everyday narcissism that can be found in virtually all seats of power, and that all of us exhibit in some way or another. This is a mind that is only and always narcissistic.

Here’s an example of where journalists and credentialed healers might part ways in describing Trump’s behaviors. Where the doctors talk of lack of empathy, journalists might more appropriately describe a lack of ethics. They’re actually the same thing. From a social or political view, a code of ethics is fundamentally the rules of empathy. All codes of ethics at root are variations on the golden rule. The golden rule is the description of empathy as an external, social value: Treat another as you would treat yourself. It is because seeing others as equals is unavailable to pathological narcissists that they pooh-pooh ethical constraints. Trump deep down does not understand what a conflict of interest is. The political dialogue changes if we see that Trump can’t see the same reality everyone else does.

We are naturally shy of calling people “crazy” or diagnosing them with severe mental illness. Part of our shared humanity is that we are taught to feel sorry for people who are suffering or different. But he’s the president-elect. That isn’t “word salad” when he speaks off the cuff. It’s the ramblings of an uninformed, chaotic mind that is vested only in self-aggrandizement. We need to take baby steps, I suppose, to get to say those things. But it's well past time to start telling the truth about the president's damaged mind.
-Neal Allen
neal@ordinarybeing.com