This post is in response to Trump's Temperament: Not Narcissistic, But Not Normal by Nassir Ghaemi
Wikimedia Commons. By Donald Trump. Aug. 19, 2015 (cropped). Hillary Clinton by Gage Skidmore.
Source: Wikimedia Commons. By Donald Trump. Aug. 19, 2015 (cropped). Hillary Clinton by Gage Skidmore.

Now that the American election is over, and we have a new President-elect about whom at least half the U.S. population have very serious reservations and concerns, primarily on the basis of his perceived temperament and personality style, perhaps it is time at year's end to more carefully reflect upon these controversial concerns from a psychological perspective. Some mental health professionals, as well as non-clinicians like PT blogger and educator Alfie Kohn (see his post here) have publicly expressed concerns that Mr. Trump manifests a diagnosable mental disorder, namely Narcissistic Personality Disorder (NPD). Some have suggested that he is a sociopath, or, even more slanderously, a psychopath. Others, such as fellow PT blogger psychiatrist Nassir Ghaemi (see his post here), assert that President-elect Trump suffers, in his professional opinion, not from NPD (interestingly, Dr. Ghaemi evidently denies the validity and utility of such a psychiatric diagnosis in general) but rather from "hyperthymia," a term he employs to describe a temperamental tendency toward hypomania. To suggest that Mr. Trump suffers from some sort of biogenetically based Bipolar Disorder simply because he is, even at the advanced age of 70, still very energetic and apparently needs minimal amounts of sleep, seems to me a stretch at best based on grossly insufficient data. 

At the same time, Dr. Ghaemi holds that there is nothing ethically or morally wrong with diagnosing the President-elect (or other public figures) from afar. He and I (and the American Psychiatric Association) disagree on this point, though I would concur that, due to their extensive training and clinical experience, clinical psychologists (especially forensic psychologists) or psychiatrists possess sufficient expertise to proffer fairly accurate "educated guesses" in such cases. (Having said that, it must be noted that equally experienced and well-trained clinicians can and do differ frequently on the diagnosis of the exact same patient!) It could also conceivably be argued that, precisely because they possess such expertise, mental health professionals have some ethical responsibility to society to speak out on this subject, especially when that particular individual poses some potential threat to public safety. Nonetheless, in regard to diagnosing politicians, educated guesses are all they really are, since we usually are not privy and, therefore, lack reliable access to critically important diagnostic details such as mental health history, family history of mental illness, childhood history, previous and current substance abuse, past or present use of psychiatric medications, and other crucial factors necessary to arrive at an accurate and meaningful diagnosis. Not to mention the total absence of a formal face-to-face diagnostic interview, though there are certain forensic cases in which access to a full and detailed psychiatric history can suffice. (See, for example, my prior posts.)

Wikimedia Commons (public domain)
Source: Wikimedia Commons (public domain)

Given the unfortunate fact that labeling a person with a psychiatric diagnosis is still stigmatic here in America (and even more so in other countries around the world), which is one reason we hold a patient's diagnosis in strictest confidentiality, it would be reckless and irresponsible for any mental health professional to publicly assign such a diagnosis to a living political figure he or she has never met, spoken to, or personally evaluated. The only exception I can imagine might be in a scenario wherein a President-elect or one already in office suddenly becomes acutely psychotic or manic or profoundly depressed, for example, and refuses any form of mental health treatment. Under such circumstances, a remote psychiatric diagnosis and consultation by appropriate experts might be necessary in order to intervene effectively in this crisis. Typically, presidential candidates with a history of such serious symptoms would be eventually screened out by the campaign process, as occurred, for instance, in the case of former Democratic presidential candidate Michael Dukakis in 1988, though the question of whether a history of psychiatric hospitalization, medication or psychotherapy should automatically preclude a person from becoming President is debatable. However, short of such an extreme psychiatric emergency, the ethics of publicly diagnosing a President-elect from a distance is dubious at best, despite certain legitimate concerns observers may have regarding his or her temperament and personality traits. But, clearly, the temptation to do so is powerful, pervasive and compelling.

Wikimedia Commons (public domain)
Source: Wikimedia Commons (public domain)

Indeed, during the campaigns and post-election, talk among pundits, surrogates, political commentators, and the contestants themselves took an appropriate yet troubling turn toward questioning the mental health of the candidates and, subsequently, the eventual victor. I refer to this development as troubling not because the matter of mental health is irrelevant to presidential politics--it clearly is relevant and must be seriously considered--but because the vast majority of those currently doing the "analyzing" and "diagnosing" of these public figures are not trained mental health professionals, but rather partisan laypersons. Nonetheless, now everyone, from news anchors to political analysts, seems to feel they are qualified to intelligently discuss subjects such as "sociopathy," "psychopathy," and, most notably, "narcissism." Suddenly, they are all armchair psychologists when it comes to analyzing various public figures and their confusing, offensive, concerning or questionable behavior. (Consider, for example, the recent "sexting" case of former Democratic Congressman Anthony Weiner.)

While it is completely understandable and natural to consider the psychology of not only presidential candidates but, even more importantly, our current President-elect, I find this phenomenon ironic, given the fact that the publicly perceived expertise and professional valuation of psychology, psychoanalysis and, to a lesser degree, psychiatry, has been severely eroded in recent decades, at a time when we obviously need psychology more than ever--not only here in America but around the world. One irony is that clinical psychologists (and psychiatrists) are traditionally ethically restrained from formally diagnosing and analyzing public figures, whereas non-professionals are free to speculate wildly about such issues as they wish, despite their total incompetence to do so. Moreover, one must wonder what good such speculation regarding the psychological makeup of a President-elect could be at this point, given the fact that, whatever his psychiatric symptoms, temperament, behavior and personality may be, it is impossible to prevent his inauguration in January. In this sense, a Trump presidency, for better or worse, is an inexorable part of both our collective fate and national destiny. But if we are going to be discussing the psychology of our newly minted President-elect here at PT, it is essential that we do so in a clinically well-informed, sophisticated, measured, unbiased and compassionate way. Toward that end, in the wake of one of the most contentious, juvenile, vulgar, vicious, divisive and deeply disturbing presidential elections in recent memory, let me contribute to this seemingly inevitable national conversation some of my perspective and experience as a seasoned clinical and forensic psychologist on the thorny subject of pathological narcissism specifically. Exactly what is it?

To begin with, we would do well to remember that Narcissistic Personality Disorder, like any other mental disorder or psychopathology, must, by definition, be a) statistically deviant from the norm, and b) associated with clinically significant distress, impairment or disability or with significant risk of negative consequences to self and/or others. Unlike other mental disorders involving depression or anxiety, for instance, personality disorders such as NPD (or Antisocial Personality Disorder) are less characterized by egodystonic subjective suffering than by suffering inflicted upon others, in the form of cruelty, verbal abusiveness, manipulation, deception, and, in more extreme cases, physical violence. (In my clinical experience, the narcissist does unconsciously suffer from his or her childhood wounds, and, ultimately, from the negative effects on interpersonal relationships engendered by his or her narcissistic defenses. It is commonly only at that critical point that the narcissist is most likely to seek therapy.)  Having said that, the fact is that narcissism is a pervasive, endemic aspect of contemporary life, and exists to varying degrees in each and every one of us. We all need some measure of healthy narcissism to get on in the world, which is related to self-esteem, confidence, sense of significance, etc. And most of us suffer to some extent from some pathological or neurotic narcissism as well. For example, a great deal of the destructive anger, rage and violence, the animosity between the sexes, and the hypersensitivity to any and all perceived political incorrectness besetting the collective American psyche, springs from pathological narcissism. We live increasingly, as sociologist Christopher Lasch said four decades ago, in a "culture of narcissism," one in which narcissism is idealized, worshiped, emulated and rewarded, whether in the world of business, the entertainment industry, or the political arena. Because of this and other reasons, not the least of which is a growing narcissistic tendency in parenting, narcissism has sadly been increasingly normalized in American culture in recent decades.

Wikimedia Commons (public domain)
Source: Wikimedia Commons (public domain)

Psychoanalyst Heinz Kohut, who modified and expanded Freud's original ideas on narcissism, suggests that pathological narcissism is an arrest or distortion of normal, pre-Oedipal development, during which the infant's natural, healthy, primitive or "primary narcissism" is deficiently dealt with or unempathically "mirrored" by the primary caretakers--in most cases, the parents, but particularly, the mother. This so-called "narcissistic wounding" or frustration results in the neurotic perseveration of unresolved infantile narcissism into childhood, adolescence and adulthood. Thus, narcissism in adults may represent a form of "healthy" narcissism either never allowed adequate expression or gratification during childhood or overindulged and insufficiently moderated and socialized, and hence, never outgrown. It is in this sense that the pathologically narcissistic person's often petulant behavior is akin to that of a spoiled or rejected little boy or girl who insists upon having everything their own way, even if that means intimidating, lying and cheating to get it. Or to the profound dread of being hurt, rejected or abandoned again. Indeed, the fatal self-absorption of the mythic self-absorbed young man Narcissus, from whom the clinical term narcissism was derived, is designed to fend off potential rejection via the hostile or aggressive rejection of others. Such neurotic narcissism may manifest somewhat differently in men and women. For instance, a similar depiction of a more passive, subtle yet equally defensive neurotic narcissism can be found in the Grimm's fairy tale Little Briar Rose, better known to most Americans as the female adolescent, Sleeping Beauty.

Face-saving is another central aspect of pathological narcissism: the concerted, sometimes frantic or desperate effort to preserve one's public persona at all costs. As C.G. Jung observed, we all need a persona, a sort of mask or costume or role we play, in order to participate in society. But problems occur when we become overidentified with our persona, when it becomes too one-sided, imbalanced and rigid. In pathological narcissism, this is precisely what has happened: the persona--which has to do not only with what we try to project outwardly to the world but, even more fundamentally, with how we wish to see ourselves--has become a shallow "false self," one which conceals and compensates for what Jung called the shadow. (See my prior post.) We all have a shadow, a dark, unconscious side consisting of those "negative" (or sometimes even repressed positive) parts of our personality we reject, disown, and deem socially or morally unacceptable, reprehensible, evil or dangerous: sexuality, aggression, inferiority feelings, vulnerability, love, healthy narcissism, and the desire for power, for example. In pathological narcissism, this grandiose persona compensates for repressed feelings of inferiority, vulnerability, weakness, smallness, neediness, and must be maintained, preserved and vigorously defended against all challenges. Such compulsive face-saving takes the form of exaggeration, manipulation, or careful parsing of the truth, fibbing, fabrication, prevarication, or outright lying when the narcissistic persona is somehow threatened from without or within. In some cases, such elaborate fabrication, lying, and self-deception can attain almost delusional, and, therefore, semi-psychotic proportions, with the person being utterly convinced of the veracity and reality of his or her self-serving falsification. (See my prior post.)  In those individuals whose severe pathological narcissism eventually leads to engaging in immoral, unethical or criminal behavior, a condition I call "psychopathic narcissism," the lying becomes at least as much about avoiding assuming responsibility and evading the legal consequences for their evil deeds, considering themselves smarter than or "above the law."

It is near impossible to speak meaningfully about pathological narcissism without acknowledging and discussing its close connection with the conscious or unconscious striving for power. (We all seek some sense of power and control in life, but the narcissistic personality is consumed, possessed and driven by this excessive need.) As is so commonly seen in APD, people who suffer (or more aptly, make others suffer) from NPD seek to assert power and control over others, albeit in somewhat more subtle ways. Nonetheless, this morbid power drive can be quite compulsive and unrelenting, motivated by an unquenchable need to overcome profound feelings of powerlessness, stemming usually from childhood. This pathological pursuit of power can be expressed in a broad spectrum of behaviors: from cruelly teasing or bullying a younger sibling, to inflicting physical suffering on insects or family pets, to the abduction, torture, sexual abuse, and sometimes horrific killing of innocent victims by psychopaths. When such individuals seek and successfully attain to positions of power in industry or politics, the results can be catastrophic, since it is especially in the pathologically narcissistic and power-hungry person that "absolute power corrupts absolutely."

Diagnosing well-known power-hungry politicians like Adolf Hitler (see my prior post), celebrities such as O.J. Simpson, cult leaders like Jim Jones or David Koresh, or infamous criminals like Charles Manson from a distance is a difficult business, even for experts. Obviously, analyzing or profiling the personality of such a shadowy, enigmatic and elusive figure as Osama bin Laden (now deceased), for example, is an equally difficult task. Nevertheless, in a paper presented at the 25th Annual Scientific Meeting of the International Society of Political Psychology in 2002, Dr. Aubrey Immelman, associate professor of psychology at Minnesota's St. John's University, did just that. Plugging bin Laden's known biographical data into a personality profile using the second edition of the Millon Inventory of Diagnostic Criteria (MIDC), Immelman concluded that "Bin Laden's blend of Ambitious and Dauntless personality patterns suggests the presence of Millon's ‘unprincipled narcissist' syndrome. This composite character complex combines the narcissist's arrogant sense of self-worth, exploitative indifference to the welfare of others, and grandiose expectation of special recognition with the antisocial personality's self-aggrandizement, deficient social conscience, and disregard for the rights of others." Elsewhere, Immelman diagnosed Osama bin Laden--as did psychiatrist Dr. Jerrold Post, the renowned CIA political profiler-- a "malignant narcissist" : a term based on psychoanalyst Otto Kernberg's (1992) conception of malignant narcissism, the core components of which are pathological narcissism, antisocial features, paranoid traits, and destructive aggression. A similar psychological profile could also arguably be attributed to Hitler, Manson, Jones, Koresh, and many others. (See my prior post.)

Presumably, most individuals who seek to lead others and to partake in the power and status of doing so, such as cult leaders and presidential candidates, are at least partly motivated, often unconsciously, by their need for so-called "narcissistic supplies." We all need some of this. But for the narcissist, this need is never-ending and constant. He or she can never get enough, and is therefore, always seeking more attention, compliments, publicity, adoration, power. But the crucial question we must ask is always one of degree: Is someone's narcissism neurotic, and, if so, to what extent? Does it veer over into the realm of the sociopath? Or the psychotic? Does his or her narcissistic vulnerability, hypersensitivity and resulting reactive rage tend to drive the person to impulsive, vindictive, petty, retaliative speech or acts? Or to suffer (and make others suffer) from a fundamental lack of empathy? An unwillingness or inability to recognize or identify with the feelings or reality of others? Is he or she overly arrogant, grandiose, self-centered, or interpersonally exploitative, taking advantage of others in order to achieve her or his own selfish desires? And perhaps most importantly for a potential leader of a powerful nation like the United States: Does it potentially impair his or her capacity for mature, measured, rational judgment and decision-making? Under stress or in response to provocation, slight, insult or emotional injury, will the person remain a reasonable adult or will he or she be temporarily taken over or possessed by a narcissistically wounded, frustrated, petulant, irrational little boy or girl, lashing out impulsively against the perceived perpetrator in a fit of primitive, vengeful, raging retribution? This fundamentally human yet, in NPD, exaggerated, talionic response poses perhaps the greatest danger in any political leader. Will he or she be able and willing to place their own narcissistic needs secondary to the needs and best interest of the American people and the world at large? Narcissistic grandiosity, impulsivity, feelings of entitlement, lack of empathy, inadequate conscience, combined with the susceptibility toward narcissistic rage in reaction to perceived insults or threats and an unrelenting need for revenge or retaliation leading to a paranoid worldview. Each by itself can influence and impair rational judgment significantly. Cumulatively, they can cause a world leader to commit his or her country to fatefully calamitous and irreversible courses of action. 

Let us look to forensic psychology for further clarification. Consider, for example, the high-profile criminal cases involving Casey Anthony, Joran van der Sloot, and Jodi Arias. (See my prior posts.) It was difficult not to note certain similarities in the demeanor (if not alleged crimes) of these three attractive young murder defendants. How can we make sense of their seeming lack of profoundly human, universal feelings like empathy, guilt, remorse or shame? Though, as with public figures such as politicians, I (nor any other mental health professional) cannot provide a detailed and accurate psychological evaluation of defendants (or since convicted former defendants) without having first formally examined them myself, there is clearly much to learn from observing these tragic cases. So let us sum up what little we do know and consider what these murder cases might have in common and what they can tell us about the malignant nature of narcissism and its vicissitudes.

Most importantly, for the sake of this present discussion, is the strong correlation between the problems of narcissism, sociopathy, and evil. Perhaps most frightening to face is the fact that such evil deeds could potentially be committed by anyone, given the right or wrong set of circumstances. (Recall, for example, the classic psychology experiments by both Milgram and Zimbardo demonstrating this sobering fact, as well as the atrocities ignored and committed by ordinary German citizens during the Holocaust, a phenomenon Hannah Arendt has dubbed the "banality of evil." ) Each of us harbors the innate capacity for evil. This includes, of course, our current presidential candidates. Yet we prefer for obvious reasons to deny that disturbing reality, choosing instead to unconsciously project that potentiality for evil behavior, the so-called shadow, onto others--the devil, political opponents, parties, movements, groups, foreign governments, terrorists, immigrants, minorities, religions--rather than consciously acknowledging it in ourselves. For some politicians, a consciously chosen moral, religious or spiritual persona can serve to mask an unconscious and dangerous dark side, capable of expressing itself destructively in various forms, such as sexual indiscretions or political dirty tricks which must be covered up and denied when discovered. Or much worse.

When does pathological narcissism become sociopathic? To begin with, it is important to note that, by definition, sociopathy or Antisocial Personality Disorder is a pervasive, pronounced pattern of disregard for and deliberate violation of the rights of others occurring regularly since at least the age of fifteen (DSM-5). Moreover, current diagnostic criteria includes "failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest," "deceitfulness," "reckless disregard for safety of self or others," and, maybe most tellingly, "lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another." A strong sense of conscience is missing. Moreover, as stated in the diagnostic manual of the American Psychiatric Association, the sociopath or psychopath can be disarmingly charming, "excessively opinionated, self-assured, or cocky." There is often a marked history of irritability, anger, rebelliousness, and verbal or physical aggressiveness. (In children and adolescents, this problematic pattern of behavior can be clearly evidenced in Conduct Disorder, the presence of which is a prerequisite for diagnosing APD beyond the age of 18.) Whenever we see some chronic pattern of illegal or destructive behaviors combined with the absence of remorse and appropriate affect, we are likely witnessing, at the very least, what we refer to as "antisocial traits."

So, there can be a very fine line dividing narcissism and sociopathy, a line which can be crossed over at any time. The sociopath lives on the far side of this line, having bitterly turned against society, repeatedly and often impulsively engaging in illegal activity resulting in multiple arrests, lying, manipulating, conning, deceiving, and aggressive, vindictive behavior aimed at undoing or repaying a hurt and avoiding being "pushed around" by others, particularly by legitimate authority figures. The narcissist, on the other hand, is better adapted to the culture, functions at a higher level, is often financially and socially more successful, skirts the law more skillfully, typically avoiding an arrest record, chooses to work within the system, outwardly accepting rather than rejecting society, yet still plays by his or her own self-serving and rebellious rules, unceasingly seeks admiration and stimulation, and may be no less vindictive and persistent, albeit sometimes more subtle, in getting even for the smallest of perceived slights. Criminal defendants like Casey Anthony (now acquitted), Joran van der Sloot (now convicted), and Jodi Arias (now convicted) typically tend to be so detached and dissociated from their own humanity that they are clueless as to what they really feel and how their inappropriate and selfish behavior is perceived by others. They appear to be heartless, depraved monsters devoid of all human caring and decency. Bad seeds. But behind their extremely effective facade, mask or persona, hides a hurt and angry little girl or boy running destructively amok in the world. Sociopaths, like narcissists, are, as I have elsewhere argued, primarily made, not born.

As Joran van der Sloot's now public psychological evaluation from prison suggests, the person suffering from, and cruelly causing others to suffer from such psychopathic narcissism, is fundamentally an immature, selfish, self-centered, resentful and raging child inside a powerful adult body. They are angry with their parents, angry with authority, angry with God, angry with life. They have been hurt, abused, emotionally wounded, deprived, overindulged, spoiled, abandoned or neglected in various ways--some grossly and some much more subtly--and are still bitterly lashing out against life and others. Against society. Against authority. When you have a pissed-off five or ten-year-old with poor impulse control living in an adult body, with the freedom and power and resources to do just as he or she pleases, you have an extraordinarily dangerous person capable of the most heinous, and, in the case of world leaders, cataclysmic evil deeds. Such angry, vindictive, embittered, opportunistic, impulsive and sometimes aggressively predatory people see the world as their personal playground, and for some, everyone in it as their next potential victim or conquest. To quote convicted mass murderer Charles Manson, the poster boy for such evil or antisocial tendencies : "I'm still a little five-year-old kid." (See my prior post on the "inner child.")

Finally, a sense of "narcissistic entitlement" is characteristic of both narcissistic and antisocial personality disorder, albeit perhaps for slightly different reasons: for the sociopath, such as Manson, the sense of entitlement stems from feeling that the world owes them for having been so rejecting, whereas the narcissist's sense of entitlement stems mainly from compensatory feelings of grandiosity, superiority and specialness. A feeling of guilt and conscience is typically lacking, especially in sociopathy. And both share in common a distinct lack of empathy with their fellow man, being unwilling or unable to feel compassion toward, nor identify with, the emotions and needs of others, beyond a relatively superficial level of relating. Such grossly inhumane attitudes and behaviors come mainly from a combination of compensatory grandiosity and a schizoid-like detachment from their own feelings.The immense narcissism of criminal defendants like Casey Anthony, Jodi Arias, Joran van der Sloot, O.J. Simpson, Drew Peterson, and so many others, convinces them that they possess superior intelligence and, therefore, can ultimately outsmart the system. This narcissistic grandiosity regarding their intelligence (which, in my experience, is overestimated and not necessarily commensurate with standardized intelligence testing) can be seen in Jodi's seemingly arrogant and haughty pre-trial proclamation that "no jury will ever convict me." In the same way that van der Sloot's reported compulsive gambling reflected a grandiose, narcissistic overconfidence that he could single-handedly beat the casino system.

As mentioned earlier, we all manifest some measure of narcissistic traits, since none of us have had perfect parents or upbringing. A great deal of what neurotic narcissism disguises--and few if any of us are fully free from it--is our unresolved childhood anger, resentment or rage. But when narcissistic tendencies take over and permeate or possess the entire personality, becoming an enduring pattern of perceiving, relating to, and thinking about the world and oneself, and exhibited in a wide range of social and personal contexts since early adulthood that deviate significantly from the cultural norm, we are dealing with Narcissistic Personality Disorder. Unfortunately, as we Americans are now living in an increasingly narcissistic culture, pathological narcissism is becoming more the acceptable and even envied norm rather than a deviation. While narcissistic personality disorder is different from, say, a psychotic disorder or "mental illness" such as schizophrenia, or a mood disorder such as major depression or bipolar depression, in the sense that it tends to be much less debilitating and subjectively painful, it can be seen as frequently underlying, informing or co-occurring with these and many other psychiatric disorders, including sociopathy or Antisocial Personality Disorder, which can be understood as an expression of pathological narcissism in extremis. It could be argued that the primary distinction between narcissistic and antisocial personality disorder is primarily one of degree.

Obviously, no presidential candidate or President-elect will ever be perfect. None of us are, though we naively tend to seek and expect such perfection in our leaders. The notion that a person can attain or possess some state of perfectly balanced mental health is a myth. As Freud understood, we are all neurotic to some extent. This seems an inescapable aspect of the human condition. We are all capable of cruel, destructive, evil behavior. But, nevertheless, the psychology and personality style or character of our politicians must always be carefully considered when deciding whether to turn over to them the awesome power and responsibility of the Presidency. Moreover, the mental health and stability of a sitting President must be carefully and regularly monitored for significant signs of underlying or acute mental disorder. Should we demand that political candidates for our highest offices submit to a formal psychological evaluation? For instance, we routinely psychologically screen and evaluate those individuals who wish to serve as police officers in this country. Can we afford not to do so with our presidential (or vice-presidential) candidates? While this solution is probably impractical, it appears that we instinctively understand the need for such psychological assessment, and can take some comfort knowing that there fortunately is a similar vetting process already prudently built-in to our political system, in the form of the intense scrutiny and thorough investigation of a candidate's background, character and behavior throughout the prolonged pre-election campaign process. Such extreme exposure and scrutiny is designed to reveal, not unlike a standardized personality test or "stress interview," each candidate's character, especially when seen under severe duress or pressure. This grueling process gives all Americans, and billions of observers around the globe, ample opportunity to at least superficially assess each candidate's character, and mental health in general, for themselves prior to voting or not voting for him or her. No task could have been more important during this or any electoral process. Nor now, when the next President of the United States has been elected.

But how psychologically sophisticated is the average American? Alas, not very (with the notable exception of perceptive PT readers, of course!). During the long course of the latest presidential campaign, voters and citizens of the world were provided concrete examples of each candidate's core character, which both attempted to highlight and use against the other, and made a decision either based on or despite what they saw. Or refused to see. As psychologists know, the best predictor of future behavior is past behavior. Therefore, we Americans should not be at all surprised nor shocked by the post-election and pre-inauguration actions (inappropriate tweets, telephone calls and public comments, potential conflicts of interest, not to mention Mr. Trump's reported rather haughty refusal to receive daily intelligence briefings based on what appears to be an exaggerated estimation of his own intelligence) of the winner of this down and dirty, temperament-centric contest. The American people have spoken, and their collective wishes and so-called wisdom have been made clear. Change was wanted, and change is what we will have. As the old saying goes, be careful what you wish for. And fasten your seat belts. We could, as a country, be in for a very bumpy ride in 2017 and beyond. Diagnosis or not, as a psychologist and U.S. citizen, based on what I have observed thus far regarding his personality style, lack of sophistication, experience, erudition and eloquence, his impulsivity, petty and childish vindictiveness, hypersensitivity, grandiosity, defensiveness, poor judgment and inappropriate behavior, I have my own profound concerns and trepidations about a Trump Presidency. Someone with the track-record, temperament, willfulness and drive of President-elect Donald Trump can potentially achieve some great things in public office. On the other hand, based on these same personality factors, his presidency could be an unmitigated disaster. Or possibly a bit of both. As we celebrate this joyful holiday season and the birth of a New Year, we must hope for the best but prepare for the worst.

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