This post is in response to Petition Declaring Trump Mentally Ill Pushes for Signers by Suzanne Lachmann
(c) Stevemc
Source: (c) Stevemc

Many Americans, including many therapists, dislike our current President. They may be wary of Republican political and economic ideas like smaller government, less governmental regulation, and reform of health care and taxation. They may deeply distrust the man's personal style. They may experience intense anger when they see the President via the media or hear discussions about him on talk shows.  Do these concerns, however, justify signing a document that says that President Trump is mentally ill?

One consideration is the ethics of whether mental health professionals should be allowed to publicly declare mental health opinions about political figures. 

A second ethical issue is whether diagnosing someone whom you have not interviewed personally is legitimate. Debate on these issues has been lively.

This post addresses a third issue. How do mental health professionals define mental illness?

Below are mental illness definitions, culled from the internet

"Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Many people have mental health concerns from time to time.

"Mayo Clinic, Oct 13, 2015

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"Mental illnesses are health conditions involving changes in thinking, emotion or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities...Mental illness is treatable. The vast majority of individuals with mental illness continue to function in their daily lives."

American Psychiatric Association

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"A mental illness is a condition that affects a person's thinking, feeling or mood. Such conditions may affect someone's ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis...

A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment and lifestyle influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events like being the victim of a crime. Biochemical processes and circuits and basic brain structure may play a role, too."

List of mental illnesses on this website:

ADHD
Anxiety Disorders
Bipolar Disorder
Borderline Personality Disorder
Depression
Dissociative Disorders
Early Psychosis and Psychosis
Eating Disorders
Obsessive-compulsive Disorder
Posttraumatic Stress Disorder
Schizoaffective Disorder
Schizophrenia

NAMI (National Alliance on Mental Illness)

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"Mental illnesses refer to disorders generally characterized by dysregulation of mood, thought, and/or behavior, as recognized by the Diagnostic and Statistical Manual, 4th edition, of the American Psychiatric Association (DSM-IV)."

Categories of mental illness on this website: Depression, Anxiety, Psychotic disorders, Bipolar disorders

Note that anger is not listed on this website, nor in any editions of the DSM.

CDC (US Government Centers for Disease Control and Prevention)

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So is it appropriate for mental health professionals to proclaim that President Trump is mentally ill?

Trump clearly displays publicly observable off-putting behaviors.  One does not have to be a therapist, for instance, to judge that when President Trump speaks harshly about other political figures he is violating American norms for appropriate public, or even private, behavior. 

However, from my perspective, unattractive and culturally frowned-upon habits do not constitute mental illness. 

What about negative feelings like what motivate people to seek out a psychotherapist?  Are these mental illnesses? As I write in my book Prescriptions Without Pills, all people from time to time struggle with emotionally distressing situations and feelings.  These distressed states do not indicate mental illness any more than a broken arm would be a sign that a person has an incapacitating physical illness. As the psychological theorist Harry Stack Sullivan used to write, most people come to therapy because of problems in living, not because they are "mentally ill."

By contrast, when dysfunctional emotional and thinking patterns are of neuro-biological origin—e.g., chronic and/or incapacitating depression, bipolar illness, chronic intense anxiety, schizophrenia, etc.—these presenting problems are what I would consider to be true mental illnesses.

What about what the DSM (the diagnostic manual used by therapists) calls character or personality disorders? 

Many people function in ways that indicate emotional immaturity, insufficient interpersonal skills, or dysfunctional thinking, feeling and behavioral patterns.  In milder versions these dysfunctions maybe be considered personality or character styles.  Within the range of normal human character patterns are kindly folks and bullies, generous folks and selfish ones, happy folks and others who are more serious, socially agile folks and others who are socially clumsy, etc.

More dysfunctional versions may be diagnosed as personality or character disorders, much like deafness is an organ disorder—but not a physical illness. 

For instance, narcissistic personality disorder, borderline personality disorder, abusive personality, psychopathy, etc each involve excesses or absence of specific aspects of mental functioning—e.g., excesses of emotional reactivity, absence of empathy, or lack of ethical awareness.  Narcissistic individuals, for instance, have a handicap with regard to seeing and hearing others' concerns.  Individuals who get labeled as having a borderline personality disorder are handicapped with a hyper-reactive amygdala that causes them to be emotionally too quick to anger and/or depression.  Similarly, ADD is a pattern of attention deficits that cause difficulty maintaining mental focus and concentration.

These excesses and deficits are handicaps, much like blindness or deafness, rather than mental illness.

It is important to remember that people with these specific handicaps often have other arenas in which they function with normal or even exceptional talents.  Negative diagnostic labeling can be problematic if it labels, and thereby stigmatizes, the full person rather than the specific disability. 

For instance, a high proportion of successful entrepreneurs could be labeled as narcissistic. Yet it is their hypo-manic (high-energy) hyper-belief in their personal abilities that enables them to create businesses that employ thousands and produce new products that benefit millions.

Likewise, people with ADD often prove to be highly creative, that is, able to think in new ways about old problems. They also sometimes have strong intuitive wisdom.

Even bullies can be helpful in certain situations.  If I am walking on a dark street at night, I would prefer to have a bully beside me if a robber should attempt to attack me.

So is Trump mentally ill?  

You be the judge.......

And at the same time...

In addition to the question of whether Trump is diagnostically mentally ill, there is yet another question.  Should mental illness disqualify a person from holding office?

The book A First-Rate Madness by Nassir Ghaemi documents that President Lincoln suffered from severe depression most of his life.  So, for that matter, did Martin Luther King. 

The same book also documents that JFK suffered from Addison's disease which almost killed him several times, and which he kept at bay with steroids.  During a significant period of his Presidency, Kennedy treated his Addison's disease with overuse of testosterone-based anabolic steroids (like body-builders use). He used them to the point of becoming manic, including becoming erratic and error-prone in his judgment. He was known also to have used amphetamines, barbiturates, and cocaine analogues "not just occasionally but consistently over many years." (page 169). That is, he was a drug addict.  Is drug addiction a mental illness?

And then there's a fascinating book called Diagnosing Jefferson. The author, Norm Ledgin, offers persuasive information suggesting that Thomas Jefferson, author of the Declaration of Independence and a two-term President of the US, was on the autistic spectrum. Jefferson's multiple Asperger's traits included being so uncomfortable in social interactions that he rarely would speak in a group situation. That's why he wrote out the Declaration of Independence—so he wouldn't have to attend the gatherings discussing it.  Jefferson also was socially odd, chronically inappropriately dressed, and limited in many ways—and yet, undoubtedly a magnificent contributor to the birth of America.

As to President Trump, we shall see.

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(c) Susan Heitler, PhD
Source: (c) Susan Heitler, PhD

Dr. Heitler's latest book, Prescriptions Without Pills, offers new ways of understanding and relieving the "common colds" of emotional functioning—depression, anger, anxiety and more.  For therapists and for self-help.

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