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Personality Disorders

Power and Personality Disorders

Are mental health professionals right to speak out about President Trump?

the white house/flickr
Source: the white house/flickr

President Trump’s behavior over recent months has been unorthodox, even by his standards. He has encouraged scientists to investigate the idea of injecting disinfectant. He has admitted to taking a drug which has no proven benefits and encouraged other Americans to do likewise. He has presided over the clearing of peaceful protestors with rubber bullets and gas, in a manner more befitting of a dictator rather than the head of a democracy. He has propagated a series of conspiracy theories that appear ever more outlandish and irrational.

Many observers struggle to make sense of the President’s behaviour. A recent theory is that his tendency towards magical thinking — not facing up to the reality of problems and believing that they will magically disappear of their own accord (as illustrated by his response to the coronavirus) — is the result of the early influence of Norman Vincent Peale. Peale was the author of one of the first self-help books The Power of Positive Thinking, which emphasized the importance of positive thinking. Trump heard Peale speak as a child and described him as ‘the greatest speaker I think I’ve ever witnessed.’

However, according to some mental health professionals, the truth of the matter may be more simple. A large number of American psychologists, psychiatrists, and other mental health professionals have stated their belief that the president suffers from a personality disorder. Yale psychiatrist Bandy Lee leads the World's Mental Health Coalition, which has brought together thousands of mental health professionals to warn of the danger of the president’s mental condition. The psychologist John Gartner leads a similar organisation, Duty to Warn, which states that Donald Trump “suffers from an incurable malignant narcissism that makes him incapable of carrying out his presidential duties and poses a danger to the nation.” In 2018 Gartner started an online petition to remove Trump from office because of his personality disorder, which was signed by over 70,000 mental health professionals. Most recently, a Washington, D.C.-based psychologist Vince Greenwood has written a lengthy paper making a detailed case that Trump is a psychopath. Most recently, the President's niece, Mary Trump, has added her professional opinion that Donald Trump suffers from a range of disorders.

In other words, according to these mental health professionals, Trump’s magical thinking is not the result of the influence of Norman Vincent Peale but of a personality disorder which means that he is unable to process negative information which might dent his grandiose self-image. His followers might like to see his self-confidence and ruthlessness as expressions of the strength of mind which leaders should possess, but they are simply facets of a personality disorder which renders him incapable of self-doubt or empathy. According to this interpretation, Trump’s unusual behaviour — such as grandiosity, obsessive self-interest, magical thinking, acute sensitivity to slights — can only be understood in the light of his personality disorder. Such traits may seem puzzling until we recognise them as symptoms of malignant narcissism.

The Goldwater Rule

One issue with the comments of the above mental health professionals is the "Goldwater Rule." This is the American Psychiatric Association’s principle that it is unethical for psychiatrists to voice their professional opinion about public figures whom they have not examined in person. It arose after psychiatrists questioned the mental fitness of Senator Barry Goldwater in 1964.

The Goldwater Rule has undoubtedly dissuaded many mental health professionals from speaking out. However, others have decided that their duty to warn the public takes priority over the rule. Are they right to do so?

Firstly, it is important to note that the Goldwater Rule is specific to the American Psychiatric Association. It does not apply to all mental health bodies. For example, the American Psychoanalytical Association has stated that "it does not consider political commentary by its individual members an ethical matter."

Secondly, while the Goldwater Rule is an important safeguard against "armchair psychiatry," it may not apply in all cases. It was designed to prevent psychiatrists from voicing their opinions in a haphazard, uninformed way, without proper assessment. However, the psychologist Vince Greenwood argues that, in the case of Trump, "his life history is so well documented that a thorough assessment does seem possible…We can observe every day which psychopathic traits Trump manifests in his behavior. The highly regarded Hare Psychopathy Checklist enumerates 20 of them. By my count Trump clearly demonstrates 16 of the traits and his overall score is far higher than the average prison inmate."

Psychotherapist Elizabeth Mika (co-author of The Dangerous Case of Donald Trump (in which 37 mental health professionals voice their concerns) agrees, stating that ‘We have more evidence of Trump's character disorder — data from his biography, his own statements, those of people close to him, and observable behavior — than we could ever gather from any of our patients in a clinical setting.’

There are also ethical considerations about the Goldwater Rule itself. In an article in The Journal American of Psychiatry and the Law, Jerome Kroll and Claire Pouncey argue that the Rule contravenes an individual’s right to speak their conscience, and sets up a conflict between a person’s role as a private citizen and as a professional figure. They argue that there are ‘legitimate reasons for providing thoughtful education to the public and voicing psychiatric concerns as acts of conscience.’


In a recent article, I described the concept of "pathocracy" — developed by the Polish psychologist Andrew Lobaczewski — which explains the strong association between political power and personality disorders. Political power holds an extremely strong attraction for people with personality disorders such as psychopathy and malignant narcissism. And due to their ruthless self-interest and insatiable hunger for dominance, such individuals inevitably attain positions of power. When governments are dominated by people with personality disorders, they become pathocracies.

People with personality disorders such as malignant narcissism can be charming and charismatic. When they become politicians, members of the general public are often taken in by them. The egotism of pathocrats is mistaken for ‘standing up’ for the nation; their impulsiveness is mistaken for decisiveness; their lack of empathy is mistaken for strong-mindedness. Since mental professionals are amongst the small proportion of the population who can detect personality disorders, they surely have a responsibility to share their concerns. When scientists become aware of imminent natural disasters like earthquakes, they have a duty to let us know about them. In the same way, when social scientists such as psychologists become aware of imminent political disasters, they surely also have a duty to alert the public. As Elizabeth Mika puts it, the Goldwater Rule "leads to an absurd situation where those most qualified to opine on the president's obviously compromised mental health and its calamitous effects on America and the world are the least able to do so."

Since so many other countries have suffered under the leadership of pathological tyrants, the United States could always count itself lucky that — due to the democratic processes and principles set up by the founding fathers — it was spared the excesses of pathocracy. In 2016, this apparently changed. One of the characteristics of pathocrats is that they despise democracy and do everything they can to undermine it. But hopefully democracy will remain strong enough to stop pathocracy taking a complete hold. And mental health professionals can — and even have a duty to — contribute to this effort.

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