Joseph Sohm /
Source: Joseph Sohm /

The phenomenon of Donald Trump has led some to wonder about his psychological state of mind, and whether he would be an effective president. My analysis is: Donald Trump likely isn’t psychologically normal, in the sense of having hyperthymic temperament, which paradoxically could benefit him in some ways as a leader, though not the kind many of us would want. Hyperthymia also would explain many of his personal foibles. 

First, let’s put aside some simplistic notions. He’s not narcissistic, because that term doesn’t mean anything scientifically. It was a metaphor invented by Freud a century ago. It isn’t a scientific hypothesis. To the extent it can be studied scientifically, the concept of “narcissistic personality disorder” has been disproven in scientific studies. Experts realize that it is weak empirically. It isn’t “valid”, which means it doesn’t separate from other personality disorders as real diagnosis. (In fact, the DSM-5 personality disorders task force recommended that it be removed from the official diagnostic manual, but the APA Board of Trustees rejected that scientific recommendation. That's another story).

When people say Trump is narcissistic they just mean he has high self-esteem, and they don’t like him.   

But there is a psychiatric condition associated with high self-esteem, sometimes very high, and it is much better established scientifically than narcissism. 

Consider: He sleeps 4 hours per night, about half the biological norm. Yet he’s very energetic, creative, talkative. He talks about having not just high physical, but also sexual, energy. The question of his sexual behavior has become central to the campaign in recent weeks. If we take him at his word, and if these reports are true, all these symptoms reflect being sped up, above the usually normal range, in one’s feelings, thinking, and movement. That’s the definition of “manic” symptoms. (This doesn’t mean being delusional and thinking you’re Jesus Christ, just like “depressive” doesn’t mean you want to shoot yourself).

Based on his own claims, Mr. Trump’s self-description can be translated psychologically into mild manic symptoms, which in technical terms, is called “hyperthymia.” This is NOT a psychiatric diagnosis; you won’t find it in the psychiatric diagnostic manual. It is instead a personality state, related biologically to manic-depressive illness. And it isn’t normal.

Now, at one level, this is like saying he is tall, or that someone else might be thin. These are normal physical and psychological traits, and some of us are at the upper or lower ends. Mr. Trump is at the upper end of energy, creativity, extraversion, and what psychologists call “openness to experience”. These all occur with hyperthymia. 

Severe manic symptoms occur in manic-depressive illness, which I am not saying he possesses. But some inferences can be made based on scientific studies of that condition. Mild manic symptoms are associated with increased creativity, which would bode well for Mr. Trump in many ways as a leader, and is consistent with much of his business success. Mild mania is also associated with resilience to traumatic experiences; people with hyperthymia are less likely to develop post-traumatic stress disorder (PTSD) after a major trauma. This would bode well for facing up to the major stresses of the office of the presidency. 

There are some drawbacks too. People with manic symptoms show less empathy for others, compared with those who suffer depression, who have increased empathy.  You can draw inferences based on this observation, perhaps, for some of Mr. Trump’s policies, depending on your political viewpoint. Manic symptoms also are associated with impulsivity, an inability to hold back when one need’s to hold back, which many commentators have observed in Mr. Trump’s debate performances, as well as in other aspects of his life, such as his sexual behavior.

So how does it all add up? Does he have the "temperament" to be president? 

Is he "fit" to be president?

Put this way, it is a dangerous question, one that led the American Psychiatric Association to try to censor all psychiatrists from ever offering any thoughts on the topic. (See below.)

I would put the question another way: Does Mr. Trump's psychological profile strengthen or weaken him as a potential presidential leader? 

The answer is two-fold: First, there's more than one kind of temperament that can make you fit to be president. Second, it depends more on your political preferences, and it depends on what’s happening in the world. 

A few years ago, I published A First-Rate Madness, in which I argued that there are some positive benefits to manic-depressive illness.  In particular, many of our greatest  crisis leaders, like Abraham Lincoln and Winston Churchill, had a version of that condition. In contrast, some of our worst leaders, like Neville Chamberlain, were stable, personable, mentally healthy. Being “normal” is a drawback for crisis leadership, in times of great change. But in times of peace and prosperity, “normal” leaders do better, since all that is needed is moderation and caution at the helm.  Churchill was a miserable failure in the British Cabinet in peacetime prosperity in the 1920s, while Chamberlain was a great success. When war came, the reverse was the case. 

So there’s a dynamic between crisis and non-crisis periods, and between being mentally healthy/normal versus being somewhat abnormal. Manic-depressive leaders do best in crisis periods but mentally healthy/normal leaders do best in times of peace and stability. 

The question of whether Trump is the right man for the times is not really about whether he is psychologically “normal” or not, but whether we are in a time of the kind of crisis where a hyperthymic leader does best. One might argue that 2016 is much less a time of crisis than 2008, in the midst of the Great Recession and multiple Middle Eastern wars. If things are more stable than many believe, it could be that the hyperthymic leader would just cause more trouble, like Churchill in the 1920s, rather than solve the problems we have. In that case, Trump would be the wrong man for these times, and Hillary Clinton, who is more reliable and stable, would probably be a better leader. 

Usually, such questions are discussed with a stigmatizing attitude. The idea is that “mental illness” is bad or harmful; thus, if you dislike Trump, you question his sanity. If you like him, you resent any such pathologizing. The psychiatric profession, ironically, shares this discriminatory attitude; it’s claimed that one shouldn’t “diagnose” public figures, the assumption being that in doing so we would be criticizing that person. We psychiatrists feed into the public’s discrimination against psychiatric illness. 

What few realize is that a psychiatric condition could benefit a leader, as I described in First-Rate Madness. Research studies find that depression is associated with realism and empathy, and manic symptoms (fast thinking and high energy and activity) are associated with creativity and resilience to stressful events. 

There’s no known evidence that Trump ever had periods of clinical depression. If true, then all the above benefits of hyperthymic temperament have one negative flip-side. Depression is associated with increased empathy toward others; mania is the reverse, with decreased empathy toward others. The weakness of hyperthymia can be low empathy, especially for those who aren’t in the silent majority, like Muslims (including me), or those who haven't been in the halls of power, like women.  

So will Trump be a great leader? Possibly, if you want to follow where he wants to go. Probably not, for everyone else.    

PS: If you’re concerned whether my comments conflict with the “Goldwater Rule”, where the American Psychiatric Association has stated that psychiatrists should not “diagnose” public figures, I do not think it does, and further, I think the Goldwater Rule is questionable ethically and scientifically. See my posts on that topic here and here, and listen to my discussion of the topic on NPR this summer. Further, next year, at the meeting of the American Psychiatric Association annual meeting next May in San Diego, I’ve proposed a symposium, including three prior APA presidents, to discuss whether that rule is legitimate and/or should be revised. 

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