An Eminent Psychiatrist on Trump

Dr. Allen Frances, professor emeritus of psychiatry and behavioral sciences at Duke University Medical College, who served as chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV (D.S.M.-IV), on 2.14.17 sent a letter to the New York Times in which he addresses questions about Donald Trump’s mental state. (SeeAn Eminent Psychiatrist Demurs on Trump’s Mental State.)

Frances is addressing a debate about whether Trump is mentally ill (Andrew Sullivan, The Madness of King Donald) or is simply a lifelong conniver who has profited from his misconduct (Eric Posner, Is Trump Mentally Unstable?)

Dr. Frances concludes that Trump’s behavior is worse than a person with mental illness, that Trump shows no signs of distress from his “grandiosity, self-absorption and lack of empathy” (as a clinically-ill person would), and so suggesting Trump is mentally ill only stigmatizes those who suffer from properly-diagnosed conditions.

The full text of letter appears below (emphasis mine).

To the Editor:

Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.

Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.

Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy. It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).

Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.

His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.

ALLEN FRANCES

Coronado, Calif.

Needless to say, I’ve neither the ability nor inclination to diagnose Trump; the better course is to defer to the judgment of those properly trained for this work (as Allen Frances surely is).

Frances’s point, however – that Trump’s “psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab” – seems profoundly right. The Ancients, with a sense of psyche but without the insights of modern psychiatry, yet would have been able to understand Trump well. We are right to see him as they would have, and as Dr. Frances does, and to conclude that the “antidote to a dystopic Trumpean dark age is political, not psychological.”