When pundits and political opponents warn that President Trump "is not mentally equipped" for the office he holds, that he might have "a psychiatric condition unfolding," or that he could simply be "crazy," it has little more credibility than the small hands/small [other anatomy] pseudo-medical assertion that the nation was treated to during the Republican primaries last year.
Two dozen mental health experts believed they could do better, and the result is the highly anticipated book, "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President," which officially goes on sale next week.
The title's reference to "danger" is crucial, for it opens the door to analyses that might otherwise violate a longstanding diktat from the American Psychiatric Association. Although its Goldwater rule prohibits APA members from commenting on the mental characteristics and possible mental disorders of public figures, psychiatrists have an even higher duty, some argue: a duty to warn, called the Tarasoff doctrine.
Remaining silent, Drs. Judith Herman and Bandy Lee contend in their prologue, would violate the public trust when a president "shows signs of clear, dangerous mental impairment" as, they believe, this one does. Most of the chapters dig into those "signs" and make the case for Trump's mental impairment - with gusto.
Unfortunately, while the book validates the suspicions of much of Blue America and might feed efforts to bolster the 25th Amendment in a way that could remove Trump from office due to mental incapacity, it missed a chance, however slim, to speak to anyone whose mind isn't already made up on everything Trump.
Those suffering from "Trump anxiety disorder," as one chapter calls it, will have no trouble accepting that the president exhibits malignant narcissism, a sociopathy, paranoia, a delusional detachment from reality, and more. But any readers who treat all those as provocative hypotheses would have benefited from an examination of alternative explanations of Trump's behavior - that it's done for political gain, for example - and a head-on discussion of whether professional medical opinions can be clouded by ideology.
"No definitive diagnoses [of Trump] will be possible," writes Lee, the book's editor and an assistant clinical professor at Yale School of Medicine. But in making the case for warning she nevertheless calls him "mentally compromised," citing "furious tirades, conspiracy fantasies, aversion to facts, and attraction to violence" as well as "delusional levels of grandiosity, impulsivity, and the compulsions of mental impairment."
Other mental health experts describe Trump as showing signs of a "delusional detachment from reality" (saying the sun came out as he began his Inauguration Day speech, for example), and of "a hypomanic temperament" (restless, impatient, easily bored, supremely confident, impulsive, and risk-taking with a minuscule attention span).
Trump is "an extreme present hedonist" like most children, argue Philip Zimbardo and Rosemary Sword of
Stanford University, meaning he lives in the moment "without much thought of any consequences of [his] actions or of the future" and says "whatever it will take to pump up his ego and to assuage his inherent low self-esteem, without any thought for past reality."
Being sent away to military school at age 13, Zimbardo and Sword contend, led to "arrested emotional development," perhaps a factor in what they see as Trump's hedonism, and a "pubescent default setting when confronted by others."
Trump's chief motivations, they write, are self-aggrandizement and self-defense. The latter is constantly in play because he is "paranoid [and] hypersensitive," and because of underlying low self-esteem (characteristic of extreme narcissists). As a result, he strikes back at critics with the hyperaggressive reaction of a cornered wolverine - as he did in a tweet about "dumb as a rock" Mika [Brzezinski] "bleeding badly from a face-lift."
In short, "the most powerful man in the world is also the bearer of profound instability," writes the eminent psychiatrist Robert Jay Lifton, who did pioneering research on everything from Hiroshima survivors to Nazi doctors.
The psychological characteristics the experts see in Trump are not necessarily mental disorders, however. Narcissism, for instance, which many of the authors say characterize Trump to an unprecedented degree, is a personality trait, and one that almost all previous presidents and many current leaders in business and academia share to some degree, points out psychologist Craig Malkin of YM Psychotherapy and Consultation. Steve Jobs likely had narcissistic personality disorder, he writes, and it arguably "galvanized Apple's engineers into developing the iMac, the iPod, and the iPhone."
But Trump's "malignant" version of the disorder poses a grave danger, Malkin contends, because it could cause him to lose touch with reality: To be admired and perceived as a winner, extreme narcissists "bend or invent a reality in which they remain special despite all messages to the contrary," he writes.
Could the Trumpian version of Nixon bombing Vietnam "to impress his friends," as one historian put it, be sharing secret Israeli intelligence with Russians, as Trump did in May, or, more ominously, starting a war in which he'd emerge victorious?
It's probably too much to ask that psychiatrists be politically neutral about Trump, since almost no one is, but because so many chapter authors call for his ouster (he "has proven himself unfit for duty") and make non-medical assertions ("Trump is a profoundly evil man" and his election "is a true emergency"), it raises the obvious question of whether professional analysis has been influenced by personal ideology.
Lee asked one psychiatrist who is a Republican and thinks the president is dangerous to contribute to the book, she said in an interview, but he declined. Moreover, therapists recuse themselves from cases if they feel their personal feelings would get in the way of their professional judgment, she said, and "while a politician may see the world as liberal versus conservative, and Democrat versus Republican, the health professional will primarily see the world as health versus disease, and life versus death. This supersedes everything else."
It's unfortunate that so few of the experts even consider whether the Trumpian behaviors they deem pathological might instead be crafty and calculated. Psychotherapist John Gartner's "Mad? Bad? Or All of the Above?" takes a stab at this, but for almost all other contributors it's a blind spot, made all the more glaring because political reporters have done terrific work explaining how Trump's seemingly crazy behaviors serve his political ends.
To take some examples too recent for the book, were Trump's speech and tweets demanding the firing of athletes who take a knee during the national anthem "extreme present narcissism," attempts to whip up his base, or a ploy to distract from the Republicans' latest failure to repeal Obamacare? Was the "Little Rocket Man" appellation for North Korea's dictator a sign of Trump's "pubescent default setting," red meat for his supporters, or a tactic drawn from the madman theory of leadership?
The mad-or-bad conundrum is especially acute when it comes to Trump's professed (in tweets and speeches) beliefs in conspiracies (Antonin Scalia was murdered; Obama had a Hawaiian official killed to hide his Kenyan birth; Ted Cruz's father was involved in President Kennedy's assassination). Is it paranoia, evidence of delusional thinking, or shrewd incitement of the ill-informed and gullible who feel left behind and at the mercy of forces they don't understand?
The theorizing would be entertaining if the subject were, say, a Shakespearean character and not the man with his finger on the nuclear button. The short chapter by Trump's "Art of the Deal" ghostwriter Tony Schwartz is so surreal ("facts are whatever Trump deems them to be on any given day" because "his aim is never accuracy; it's domination"), it should be in an Ionesco play.
But this is not theater. Which brings us back to the book's stated purpose, fulfilling psychiatrists' "duty to warn." The contributors appear to believe that doing so will make a difference. Malkin, for instance, writes that Trump's election, which he calls "a catastrophe," might never have happened if psychiatrists "had told the public the truth" rather than being gagged by the Goldwater rule. It's a charming notion.
Sharon Begley, a senior science writer for STAT, has written extensively about President Trump's mental health in a series called State of (Trump's) Mind. She is the author of "Can't Just Stop: An Investigation of Compulsions."