On March 8, it was reported that former Massachusetts governor William Weld was exploring running against the president as a Republican, in part because of Trump’s “malignant narcissism.”1 What does that mean? And how would one determine whether President Trump suffers from this disorder?
What does “Malignant” Mean?
Erich Fromm was a psychiatrist in the United States who immigrated from Hitler’s Germany in the 1930s. He was a world leader in many aspects of mental health and diagnosis. In his 1964 book, The Heart of Man: Its Genius for Good and Evil, Fromm used this term for the first time when he identified the pathology of narcissism as having two types, “benign narcissism” and “malignant narcissism.”2
Fromm said that benign narcissism focuses on pride in one’s work, one’s effort. In the process of achieving something, the person has to stay in touch with the reality around the task in order to accomplish it. "The energy which propels the work is, to a large extent, of a narcissistic nature, but the very fact that the work itself makes it necessary to be related to reality, constantly curbs the narcissism and keeps it within bounds. This mechanism may explain why we find so many narcissistic people who are at the same time highly creative.”3
On the other hand, there is a malignant narcissism. This is not about achievement, but rather something the person thinks they inherently have that’s special, “for instance, his body, his looks, his health, his wealth, etc. ... Malignant narcissism, thus, is not self-limiting.”4 Fromm gives examples of many historical figures who had this type:
“The Egyptian Pharaohs, the Roman Caesars, the Borgias, Hitler, Stalin, Trujillo—they all show certain similar features. They have attained absolute power; their word is the ultimate judgment of everything, including life and death; there seems to be no limit to their capacity to do what they want. . . . They try to pretend that there is no limit to their lust and to their power, so they sleep with countless women, they kill numberless men, they build castles everywhere, they ‘want the moon,’ they ‘want the impossible.’”5
Malignant Narcissism Grows
The essence – and biggest danger – of malignant narcissism is that it keeps growing, like malignant cancer. Fromm wrote: “It is a madness that tends to grow in the lifetime of the afflicted person. The more he tries to be a god, the more he isolates himself from the human race; this isolation makes him more frightened, everybody becomes his enemy, and in order to stand the resulting fright he has to increase his power, his ruthlessness, and his narcissism.”6
Does This Fit President Trump?
Some mental health experts say “Yes;” some say “No;” and many say they can’t say because they have never done a clinical interview with him and so it would be unprofessional to state an opinion about his mental health. As a Licensed Clinical Social Worker, I am in the third group, so I will not be saying whether he meets this diagnosis or not. But I am clear that he has a high-conflict personality, which is a description of conflict behavior—extremely concerning conflict behavior—but not a mental health diagnosis. (See my other posts here for more on high-conflict personalities.)
Some Say Yes
John Gartner, Ph.D., is a psychologist who taught at Johns Hopkins University Medical School for 28 years. He says yes, the president has malignant narcissism, as follows in his chapter in the book Rocket Man: Nuclear Madness and the Mind of Donald Trump (2018):
“Trump suffers from malignant narcissism, a diagnosis [that is] far more toxic and dangerous than mere narcissistic personality disorder because it combines narcissism with three other severely pathological components: paranoia, sociopathy, and sadism. When combined, this perfect storm of psychopathology defines the ‘quintessence of evil,’ according to Fromm, the closest thing psychiatry has to describing a true human monster.”7
Gartner goes on to describe Trump’s narcissism (he knows “more about everything than anyone” and “has empathy for no one but himself”); paranoia (“his demonization of the press, minorities, immigrants, and anyone who disagrees with him, are all signs of paranoia”); sociopathy (“a diagnosis that describes people who constantly lie, violate norms and laws, exploits other people, and show no remorse”); and sadism (“He takes gleeful pleasure in harming and humiliating other people. He is undoubtedly the most prolific cyberbully in history.”).8
Some Say No
On the other hand, in February 2017, soon after Trump began his presidency, the psychiatrist who wrote the diagnostic criteria for personality disorders in the DSM-5 manual for mental health professionals, Allen Frances, said “No.” He points out that there are two threshold criteria (significant distress and/or impairment) for the diagnosis of all personality disorders, and that the president does not meet either one, so he does not even have narcissistic personality disorder itself, let alone the disorder of malignant narcissism:
“I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose a mental disorder.”9
He went on to explain that he does not show the distress one typically has with this disorder and that he has been quite successful at making money and getting elected President, so you can’t say that he’s socially “impaired.”
This does not mean that he finds the president’s behavior to be okay. “Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity, and pursuit of dictatorial powers.”10 In other words, his behavior may be bad, but that does not mean that he’s mentally ill.
What Can We Expect?
The benefit of seeing personality patterns of behavior is the ability to predict future behavior and make decisions about what we should do individually or jointly. This ability to understand personalities and predict their future behavior is important in all relationships, from romantic to the workplace, to electing leaders. I call this personality awareness.
If the president has malignant narcissism, then we can expect that he will become more and more isolated, his behavior will become more and more paranoid, and therefore more and more dangerous. If he does not have malignant narcissism and doesn’t even have a personality disorder of any type, as Frances has explained, it is still possible that he will pursue dictatorial powers but may be more stable and less dangerous.
A Wannabe King?
In my new book, Why We Elect Narcissists and Sociopaths—And How We Can Stop! I suggest that we should watch out for high-conflict politicians with a drive for unlimited power ("HCP Wannabe Kings"). It may be that this president does share a desire to have king-like control over the country that earlier malignant narcissists had, and that other authoritarian leaders around the world seem to share today. In the end, he may not be fundamentally different from these others, but our nation may be different, because of our built-in culture of democracy, our free press, and our legal restraints on power.
If he has a set of behaviors that grows in its dangerousness, then it would appear that it is malignant and that he needs to be reined in. If he accepts the limitations on his power imposed by Congress and the judiciary, and keeps an even keel psychologically without showing signs of distress, then perhaps he has no disorder and will not be dangerous. In either case, he has reached a point, after two years in office, when his behavior and personality has attracted the attention of many mental health experts and the public. This suggests that we should be concerned, regardless of whether he fits any particular mental health diagnosis.
1. Michael Isikoff, "Maverick Republican William Weld looks to run against Trump's 'malignant narcissism,'"Yahoo News, March 8, 2019.
2. Eric Fromm, The Heart of Man: Its Genius for Good and Evil (Riverdale, NY: American Mental Health Foundation; First published by Harper and Row, Publishers, New York, 1964), loc. 989 of 2243, Kindle.
3. Fromm, Heart of Man, 998.
4. Fromm, Heart of Man, 998-999.
5. Fromm, Heart of Man, 816.
6. Fromm, Heart of Man, 816-17.
7. John Gartner, “DEFCON 2: Nuclear Risk Is Rising as Donald Trump Goes
Downhill,” in Rocket Man: Nuclear Madness and the Mind of Donald Trump,
ed. John Gartner, Steven Buser, and Leonard Cruz (Asheville, NC: Chiron
Publications, 2018), 29.
8. Gartner, DEFCON 2, 29-30.
9. Allen Frances, "An Eminent Psychiatrist Demurs on Trump's Mental State," Letters to the Editor, The New York Times, February 14, 2017.
10. Frances, Trump's Mental State.