What Is Mental Illness? Does Trump Have One?

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 therapists 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..."

"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...."

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...."

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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The bottom line: It's all pretty vague.

Like physical illness, mental illness mostly depends on whether or not someone can function at home and at work, and with or without pain.

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

President 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.

At the same time, unattractive and culturally frowned-upon habits do not constitute mental illness. And someone who has managed well enough to get himself elected as President of the United States is clearly functional.

By contrast, chronic and/or incapacitating depression, bipolar illness, chronic intense anxiety, schizophrenia, etc.—these presenting problems are genuine mental illnesses. The seriousness of these problems is cheapened when the term mental illness is slung about as a label for someone with different political views and a tendency to talk provocatively.

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. These bad habits generally constitute 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. Still, it would be a stretch to label personality disorders as "mental illness" just as deafness is not a physical illness.

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. Similarly, ADD is a pattern of attention deficits that cause difficulty maintaining mental focus and concentration.

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

It is important to remember that people with 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?

No.

Hmmm...

And at the same time...

There is an additional relevant question. Should strong personality traits, emotional distress, or mental handicaps 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. And quite possibly President Carter.

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, addicted to a drug that did cause truely disordered mental and emotional functioning. Yet to many of us, President Kennedy was a great hero.

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 democracy and America.

As to President Trump ...

Ken Stern, a former CEO of National Public Radio, in his new book Republican Like Me: How I Left the Liberal Bubble and Learned to Love the Right, explains that most of the media has been feeding America a negatively skewed view of Trump along with negative characterizations of the "deplorables," the people who hold more conservative viewpoints. Insistence that Trump is "mentally ill" can be regarded as part of this contemptuous discrediting of others whose beliefs differ from theirs.

As I have written in an earlier blogpost, contempt endangers relationships. The enshrining of contemptuous views of Trump and those who support him bodes ill for America. This hostile stance of half of the country toward the other half may prove as or far more dangerous for the mental health of our nation than the sometimes abrasive personality style of President Trump.

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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.