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 where do these definitions lead with regard to the question of whether it is appropriate for psychologists and other mental health professionals to sign a document that proclaims 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, while dysfunctional and despicable, do not constitute mental illness.

Mental illness versus emotional issues, skill deficits, and dysfunctional personality patterns

As I write in my book Prescriptions Without Pills, all people from time to time struggle with negative emotions like anger, anxiety and depression. These emotions usually arise in response to difficult life bumps.  They may be magnified by sensitivities developed from earlier life experiences; they can be intensified also by certain patterns of thinking.

Clients come to a therapist's office also for help managing challenging home and work situations such as a hyper-critical boss, marital difficulties, and parenting issues.

Is emotional distress, such as the feeling that motivates my clients to seek out a psychotherapist, the same as mental illness? 

The wording here is complex.  Mental illness is not the only alternative to mental health.  Sometimes the alternative to mental health is emotional distress.  Distress, like physical pain, can be a helpful sign of a life bump, that is, of a problem in living.  Just as physical pain can indicate that you have just received a bee bite, and a bee bite is not an illness, emotional distress can indicate a problem rather than an illness.

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 true mental illnesses. 

That at least is how I use the term mental illness.

What about character issues and personality disorders? 

There's another category of mental health issues.  Sometimes people function in ways that indicate emotional immaturity, insufficient interpersonal skills, or dysfunctional behavioral patterns.  While these are problems that psychotherapists address, they are not mental illnesses. They may be emotional challenges, mistaken habits, handicaps, dysfunctional character patterns, etc, but they generally are not illnesses.

In milder versions these dysfunctions maybe be considered personality problems or character styles

More dysfunctional versions may be diagnosed as personality or character disorders.  Each of these disorders refers to deficits in specific areas of functioning.

  • Narcissistic personality disorder, borderline personality disorder, abusive personality, psychopathy, etc each involve excesses or absence of customary aspects of mental functioning—e.g., excesses of anger, absence of empathy, or lack of ethical awareness.
  • Narcissistic individuals, for instance, have a handicap with regard to seeing and hearing others' concerns. 
  • Borderline individuals are handicapped with a hyper-reactive amygdala (and therefore are emotionally hyper-reactive).
  • Psychopathic individuals have insensitivity to ethical dimensions.  They therefore do actions that harm others without experiencing guilt, shame or remorse.
  • Asperger's is a syndrome characterized in part by repetitive odd speech patterns, a tendency to hyper-focus on specific interests, and difficulties reading social interactions. 
  • ADD is a pattern of attention that involves difficulty maintaining mental focus and concentration.  It also tends to include excessive impulsiveness.

These excesses and deficits can be considered handicaps, much like blindness or deafness. 

Note that one person can have deficits in multiple areas. For instance, people with borderline personality patterns may also tend to be narcissistic, and also may show patterns of psychopathic-like disregard for moral dimensions of their actions.

At the same time, 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. 

The information technology industry, for instance, is filled with people whose Asperger-like social skills may be limited and yet whose work abilities as programmers and therefore contributions to society are invaluable. 

Similarly, 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.

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

Dr. Heitler's latest book, Prescriptions Without Pills, offers non-medication options for relieving the "common colds" of emotional functioning.

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