I have felt very surprised and saddened by what seems to be an overwhelming impulse by some of my colleagues to diagnose President Trump.  In my opposition to this trend, I have offended friends, even unintentionally solicited enemies among people with whom I thought I could have a reasonable conversation. 

Welcome to the Trump presidency. I can’t think of a more divisive time in our American history. The divisions are being enacted in so many ways, but it is especially painful to see my field split into camps about how and if we should use our authority and knowledge to label the President. 

Full disclosure. I don’t like Trump. I did not vote for him. I wake up in the middle of the night, still, all these months after the election, and I am worried about the future in a way that I have never experienced in my life time. 

In spite of all of this, I have held off on diagnosing Trump. I would be lying if there were not behaviors that made me wonder about the presence of certain traits. But my wondering in private or when talking with my friends is very different than telling the public he is unfit for office and using my platform as a psychologist to justify that. 

As we know, there are rules that should coerce us to keep our thoughts to ourselves. And I am not going to repeat that here. You all know what I am talking about. 

My reasons for not diagnosing this president from afar are the following in descending order of importance:

From what I have seen, the labels attributed to Trump are not accurate and do not take into account full nuances of behavior, environmental circumstances and the complexity of motives.  By the latter I mean, becoming and being president of the United States, which we could never understand if we have not been in this position. 

It is an embarrassment to our profession to be fighting in this public way. And let’s take a second to talk about statistics. The interrater reliability coefficient of personality disorders hovers around .30. That is low. And that means that even when we see someone in our offices we cannot agree about what kind of personality disorder someone has. 

Our diagnoses do not matter. What matters is behavior. And popularity. And we have tons of behavioral data that says something is not right. Politicians know this. The public knows this. There are factors well beyond our control in terms of how this presidency will go, and those factors have to do with poll numbers. If you are worried about when people who have power will influence change, just wait until the poll numbers drop and/or the Republicans lose power. Trust our electoral system. 

And this leads to my final point. Diagnosing Trump troubles me because we are not doing the thing that we tell patients to do all the time. We tell people to tolerate feelings of helplessness and ambiguity. We should do the same. By rushing to falsely organize chaos, we are, in fact, not allowing the public to decide for themselves how they view the President’s actions. Labeling what we can’t fully know could actually cause the public to lose trust in us. Further, if we sanction a public diagnosing of Trump, then where is the line? Are we going to use our labels every time someone upsets our political sensibilities?   

This is a terrifying time. I really want to urge my colleagues to harness all of the energy that they are using to post about Trump’s instability to instead fight, resist and to help those that are going to be hurt by the policies of this administration.   

Diagnosing is a convenient privilege.The real work of political change is a lot harder than a label.


About the Author

Tamara Greenberg

Tamara McClintock Greenberg, Psy.D., M.S., is an associate clinical professor of psychiatry at the University of California, San Francisco.

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