Wikimedia Commons by Caravaggio.
Source: Wikimedia Commons by Caravaggio.

We now have a bestselling book titled The Dangerous Case of Donald Trump (here) about President Trump's presumed psychiatric condition, comprised of 27 essays from prominent and distinguished psychiatrists, psychologists, and other mental health professionals. Contributors include luminaries like psychiatrist Robert Jay Lifton, and Stanford psychologist and PT blogger Philip Zimbardo. Do they have the right or perhaps even the professional responsibility, as they believe, to insert themselves into the political process by remotely diagnosing the President? Is there, as they contend in the book, a "duty to warn" the American public and the world about the perceived potential dangerousness of Donald Trump's personality and presidency? (I have already addressed some of these key questions in a prior post.)

According to a fascinating 2006 psychobiographical study by Duke University Medical Center of 37 former U.S. presidents' lives, a stunning 50 percent of them suffered from some sort of diagnosable mental illness, including major depression, bipolar disorder, substance abuse, and anxiety disorders—many manifesting symptoms during their presidential tenures. (See this PT blogger's post.) The list includes some of our greatest presidents, like Thomas Jefferson and Abraham Lincoln. So, clearly, merely manifesting a mental disorder does not, in and of itself, disqualify someone from serving as president. Or from doing it well. It is, rather, the various particular psychopathologies cited collectively by this book's contributors and other concerned clinicians—narcissistic personality disorder, antisocial personality disorder, delusional disorder, dementia, etc.—and attributed to Mr. Trump from afar that is at issue here.

Narcissistic personality disorder—which, in my view, exists on a spectrum the more severe pole of which is sociopathy or what I have previously termed psychopathic narcissism—is one of the more popular and predominant diagnoses attributed to Donald Trump by mental health professionals in the book, here at PT, and by others who have observed his behavior both before and during his presidency.  Assuming Mr. Trump, who had sufficient support and popularity to win the presidency, meets full diagnostic criteria for this personality disorder—which, in the absence of a thorough face-to-face evaluation by a seasoned diagnostician is somewhat speculative—this begs the questions: What makes the narcissistic personality so irresistibly attractive to certain people? What renders some individuals especially susceptible to the narcissist's considerable charms? And why do those who fall under the narcissist's spell support whatever he or she says or does without question?

Pathological or malignant narcissism is something that manifests by a matter of degree, ranging from the relatively harmless narcissism of self-absorption and self-aggrandization to the extreme toxic narcissism of the predatory psychopathic narcissist. Narcissists, who not unlike psychopaths or sociopaths, know how to effectively manipulate people through flattery, lying, conning, and deception, can be legendarily charming, making them highly attractive to adoring others. Narcissists desperately need such adulation from others, and go to great lengths to incessantly seek such "narcissistic supplies." And those that actively adore them, fulfilling and feeding the narcissist's insatiable appetite for attention and adulation, need the narcissist as much as the narcissist needs them. It is a symbiotic relationship. So who are they? 

Such fanatic followers suffer from a profound sense of inferiority, frustration, emptiness, meaninglessness, and powerlessness. They feel small and insignificant. In the success, celebrity, and grandiosity of the narcissistic personality, they perceive someone who expresses and embodies the exact opposite of these negative feelings about themselves. They need desperately to lionize, admire, and worship the narcissist, which is precisely what makes them so willing to permit themselves to be deceived and manipulated by the narcissist. These individuals live vicariously through the narcissist, reveling in his or her celebrity as if it was their own. These people need the narcissist in order to feel better about themselves and their own seemingly insignificant existence. For them, the narcissist fulfills the psychological (sometimes spiritual) role of a savior or messiah. 

Psychologically speaking, consciously or unconsciously, we all seek a messiah. This archetypal tendency can be seen as an expression of what existential therapist Irvin Yalom refers to as the universal hope for an "ultimate rescuer": an omnipotent force or being that unconditionally loves and protects us from the vagaries and vicissitudes of existence in ways similar to those of a good parent. Someone who will save us from the burden of our existential aloneness, freedom, and responsibility. Belief in and blind allegiance to such a messiah figure allows us to slough off our freedom and personal responsibility, placing it instead into the hands of the savior. It is a way of staving off our sense of despair, helplessness, and hopelessness. It also permits us to feel better about ourselves by dint of the chosen association with the grandiosity of the messianic authority, becoming a kind of vicarious narcissistic defense mechanism.

Malignant narcissists are messianic precisely because of their massive grandiosity. But it is essential to note that this narcissistic grandiosity is a compensation for and massive defense against the very same deeply seated feelings of inferiority found in the narcissist's followers. The narcissist has almost invariably been deeply wounded, betrayed, abandoned, neglected, rejected during childhood, and spends his or her adult life trying to fend off such feelings via the constant acquisition of narcissistic supplies the same way the person suffering from addiction seeks out the substance despite the negative consequences for doing so. They seek, crave and often attain—due in no small part to their drivenness as well as sometimes native talents—success, celebrity, wealth, status, and power. These are the drugs to which the neurotically narcissistic person is totally addicted. These "drugs" serve to medicate and numb the narcissist's underlying feelings of failure, inferiority, despair, rejection, and unlovability. 

In this sense, the narcissist—or we could technically say, the ego—has found a way of defending against such feelings or, in other words, defeating and transcending them. He or she has succeeded in transmuting painful feelings of inferiority into grandiosity, something the average person does not do except in fantasy. Such compensatory defenses, however, are, by definition, neurotic. Pathological. Grandiosity serves to keep inferiority feelings unconscious and at bay. In extreme cases, such grandiosity becomes psychotic, expressing itself in the form of paranoid delusions about being God, Jesus, the savior or messiah. But, paradoxically, this chronic repression makes the narcissist exquisitely vulnerable to such unconscious inferiority feelings, especially when tweaked by various forms of narcissistic injury or wounding, such as being disrespected, insulted, or thwarted. "Thin-skinned" some might say. When these inferiority feelings are inevitably stimulated by such daily events, the narcissist reacts not by acknowledging and accepting such "negative" affects, which, as corroborated by at least one recent study conducted at U.C. Berkeley (here), would be psychologically healthy, but rather by experiencing and expressing, directly or indirectly, narcissistic rage, thus further defending against becoming conscious of these uncomfortable feelings of inferiority to which we are all subject at times.

This is why narcissists compulsively create and perpetuate their own version of reality, twisting and distorting information to suit their own purposes. To preserve and protect their own persona, as C.G. Jung called it. Not only to maintain their self-image in the eye of the public but their own grandiose image and inflated assessment of themselves. And this is why those who admire them or seek their own narcissistic supplies by being around them, also partake in this peculiar reality. All of this requires significant levels of self-deception.

Folie a deux is an idiomatic French expression meaning "craziness of two." This syndrome was formerly referred to diagnostically in the American Psychiatric Association's DSM-IV-TR as Shared Psychotic Disorder, one of the several types of psychosis. (It is no longer considered a distinct psychiatric disorder by DSM 5, being instead subsumed under Other Psychotic Disorder.) It is essentially a delusional disorder. How common is this condition, what causes it, and what can it teach us about the nature and perils of self-deception?

A delusion is, by definition, a psychotic symptom: a fixed, false, irrational conviction not comporting with objective reality but clung to vehemently nonetheless. Shared Psychotic Disorder refers to the onset of such a delusional state of mind in someone as a consequence of close relationship with another person already suffering from psychosis. Yes, in this sense, psychosis can be communicable. This relatively rare mental disorder illustrates two vital truths: Psychosis—contrary to the conventional mainstream view—is most often not merely the manifestation of biochemical aberration or a "broken brain," but a fundamentally psychological phenomenon. And, as such, it demonstrates the dangerous degree to which the human mind is capable of massive self-deception. It proves the awesome power of psychology. None of us are beyond deceiving ourselves. We do it all the time. Such self-deception, which in its most extreme and pathological forms we deem delusional, is much more pervasive than most imagine.

Consider the ordinary example of some heated conflict with a spouse, lover, relative, or close friend. How is it that after the fact, each participant can have a completely contradictory version of what happened? Objectively speaking, first A happened, then B occurred, then C was said, D followed, etc. But what if the objective facts or our own behavior don't comport well with how we see ourselves? We distort the facts to support our particular point of view and to sustain our beliefs about the kind of person we are or want to be. When the objective facts threaten the ego and its integrity, we experience what social psychologists call "confirmation bias," a kind of cognitive dissonance known more recently as "Morton's Demon." We dismiss certain facts incompatible with our myth of ourselves in favor of other less threatening and more corroborative ones. We twist the truth. And we become convinced of the veracity of this twisted truth. And we do all this unconsciously. We don't even know we're doing it! This goes beyond mere "cognitive distortion," resulting in a radical rewriting of history and reality for the purpose of preserving our precious self-image or persona. In its most extreme form, such self-deception can lead to certain delusional beliefs symptomatic of psychosis. This illustrates clearly the powerful unconscious cognitive component of psychotic disorders of various kinds. And those at play in the pathologically narcissistic personality.

While such cases are extreme, this sort of symbiotic dynamic is present in most relationships to some extent, with partners regularly entering into and supporting the subjective reality of the other. Even when that necessitates deceiving themselves to do it. Evidence of this can be commonly seen in co-dependent relationships in which the severity of abusive behavior or substance abuse or mental illness in one person is minimized by the other. This insidious self-deception occurs not only in couples but in families, friendships, groups, religious cults, political parties, and entire countries. Cognitive dissonance leads us to disregard or negate all that could contradict our cherished self-image or insult our personal or collective narcissism. So the truth we see is highly selective, serving to reinforce primarily our experience of ourselves as good, kind, honest, religious, spiritual, loving, etc. Or, in some cases, confirmation bias or Morton's Demon can even lead to the rejection of positive qualities which seem incompatible with one's deeply entrenched negative view of oneself, thus destructively perpetuating it.

Notably, when the individuals in a folie a deux are eventually separated, the person who adopted the other's delusional beliefs typically no longer exhibits psychotic symptoms, while the original and more dominant delusional partner (the "inducer" or "primary case") remains psychotic. Why is that? It is due partially to the fact that the person who takes on another's delusional system is somewhat more psychologically intact compared to the inducer to begin with. Therefore, when removed from the delusional inducer's direct influence, they no longer fully partake in nor endorse his or her distorted subjective reality. Indeed, they may have passively or even lovingly joined with the other for the sake of solidarity and support in his or her delusional version of reality precisely so as not to abandon or be abandoned by the other.

A concrete illustration of this dynamic can be seen in cults of various kinds, in which passive followers fanatically internalize the charismatic leader's grandiose and paranoid delusions. If and when susceptible followers leave the cult, these symptoms tend to diminish over time. Often gifted with the ability to influence and motivate the masses through the power of oration, manipulation, and apocalyptic vision, such leaders, as psychologist Henry Murray observes, become the "incarnation of the crowd's unspoken needs and cravings." Such inflated individuals see themselves as prophets, saviors, messiahs. But they are false prophets. At the same time, much like the mythic figures of the Antichrist in Christianity, Armilus in Judaism, and Masih ad-Dajjal in Islam, they are in fact not merely false prophets, but, even more perniciously and fatefully, they become the very embodiment of evil and perpetrators of grotesquely evil deeds. Think Charles Manson, Jim Jones, David Koresh, Adolf Hitler, Osama bin Laden, Abu Bakr Al-Baghdadi, North Korean dictator Kim Jong-Un, and others. The denial or refusal to recognize this insidious form of evil, a self-deceptive state of mind existential psychologist Rollo May referred to as pseudoinnocence, renders one highly susceptible to manipulation.

In truth, we all deceive ourselves about a great many matters, from bad behavior, to how we feel, to the ever-present existential fact of death. Such self-deception is fundamentally related to Freud's broad conception of the unconscious--the unknown aspects of our psyche—and specifically to Jung's notion of the shadow: those unacceptable traits and tendencies in ourselves we hide from both others and ourselves. This very capacity to deny our own selfishness, fears, cruelty, and complicity in evil—unconsciousness—is itself a treacherous sort of self-deception. Which is why growing gradually more conscious during the course of psychotherapy can be a shocking, painful and sobering process. Jung noted the therapeutic importance of consciously tolerating the "tension of opposites" we today term "cognitive dissonance," and that such unadulterated confrontation with the truth about oneself is almost always initially experienced as an insult to or defeat of the ego—a devastating blow to our narcissism. No wonder we so fervently resist this process. It takes considerable courage and commitment to be brutally honest with oneself. But it is precisely this willingness to stop our chronic self-deception and face the truth that finally sets us free.

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