President Donald Trump has a personality
disorder that we’re not supposed to talk about, and that makes
me furious. The Goldwater rule, an ethical norm from the 1960s
that forbids psychiatrists and psychologists from diagnosing
public figures they haven’t been able to evaluate in person, has
gagged the most knowledgeable among us from speaking freely. A
man with no impulse control and no chance of improvement is
shooting his missiles all over, not to mention targeting
vulnerable populations at home. The world is in a panic while
the doctors worry that he’ll sue.
Beyond compounding the crisis of public ignorance, the
moratorium is a reflection of the way professional norms are all
too often wielded to protect predators and silence women. The
media’s dispiriting willingness to roll over and let old white
men dictate the boundaries of legitimate conversation and
expertise has to end.
Trump benefits immeasurably from the Goldwater rule, which was
put in place because Sen. Barry Goldwater, the 1964 Republican
presidential nominee, sued a magazine called Fact, which
solicited diagnoses of him during the election campaign. Trump
normally has to buy his victims’ silence himself, but this gift
came for free. Since he will never allow an independent
evaluation of his competence, the American Psychiatric
Association and its members have kept quiet.
But why insist on a diagnosis? If labeling him is the main
obstacle to talking about Trump’s disorder, let’s ditch it. When
I asked my psychiatrist about the issue, he admitted that
diagnosing personality disorders is “squishy” at best. Mental
illness often blurs the lines between nature and nurture, and
diagnosis is both an art and a science.
There are blunt criteria set out in the “Diagnostic and
Statistical Manual of Mental Disorders,” or DSM-5, but they
require finessing in person. Diagnosing personality disorders
may come down to — hold onto your hat here — how the person
makes you feel. Are you a shadow in their presence? Do they show
remorse or consideration for others? Do they seek to manipulate
and distort reality? Imagine real-life vampires who have conned
you into thinking it’s natural for them to suck the life out of
you. It’s understandable that people are cautious about labeling
such a person.
Our inability to diagnose has led to de facto censorship on the
subject. For purposes of saving the republic, all we need to
know is that our president is delusional, dangerous and
incurable. He’s a 70-year-old con man who relishes violence,
abuse of power and deception. He will never, ever change.
The silence was broken last week by several
renowned psychiatrists at a Duty to Warn conference organized by
Dr. Bandy Lee. She has formed a coalition of more than 800
mental health professionals who believe that Donald Trump is
dangerous to the health and safety of their patients. Dr. Lee is
working in conjunction with Dr. John Gartner, whose online Duty
to Warn petition has already accumulated more than 52,000
signatures from fellow mental health professionals.
Though Lee’s town hall meeting was initially sponsored by Yale’s
School of Medicine, Department of Psychiatry and School of
Public Health, they all bailed out before the event, leaving
Lee, a Korean-American woman, to run the conference alone.
Despite the positive coverage of her conference, Lee told New
York magazine that she has become a pariah in her department.
This is not an accident: The academy and professional
associations are old boy’s clubs that respond to challenges to
their authority by circling the wagons.
Take Allen Frances, for example, who wrote a letter to the New
York Times objecting to “fevered speculation” by the media and
other psychiatrists. The irony of Frances marking “narcissism”
as his personal territory is lost on him. The problem with
Trump, he states with unearned certainty, is political, not
psychological. He fails to address why it can’t be both. Instead
of wrestling with the complexity of the issue, with one stroke
he moves to delegitimize the evidence as irrelevant.
It’s reminiscent of George Orwell’s essay, “Lear, Tolstoy and
the Fool.” An aging Tolstoy rants that “no unhypnotized observer
could read [‘King Lear‘] to the end” and enjoy it. Orwell
skewers Tolstoy’s religiosity, noting that his aim in old age
was to “narrow the range of human consciousness.” Tolstoy misses
the obvious parallels between himself and Lear, another powerful
egotist undone by his own deranged attempts to control his
legacy. As Orwell observes, Tolstoy “does not know just what he
misses in Shakespeare, but he is aware that he misses something,
and he is determined that others shall be deprived of it as
well.” Autocrats aren’t good at letting go.
Ignoring Trump’s disordered behavior is as absurd as excising
“King Lear” from world literature because Tolstoy says we
should. There are some professionals who genuinely don’t think
the president is mentally ill, but as a lawyer, I know that
professional associations exist to protect their members, often
at public expense. We wouldn’t be throwing the baby out with the
bathwater if the American Psychiatric Association weren’t so
concerned about its members’ liability. Don’t tell me that the
Cheeto Emperor is streaking down Fifth Avenue but that because
he put on matching socks this morning, we can’t notice that he’s
naked.
I’m not a mental health professional so I’m not bound by their
ethical considerations. I am a patient, though, and I’ve been in
and out of therapy since early childhood, partly because
depression runs in my family but also due to the chronic trauma
of growing up in the grip of someone with a severe personality
disorder. One of my earliest memories is of playing Operation
seated on the floor of the court-ordered therapist’s office.
Consider the virulent anxiety Trump has inflicted on the entire
planet, and then imagine the force of its impact within the
confines of a home.
I wanted to weep when the New York Times shushed Ruth Bader
Ginsburg for warning us about Trump’s existential threat. When
the Los Angeles Times’ editorial board wrote recently that it
could never have anticipated the train wreck of the Trump
administration, I screamed in frustration. Those of us who have
had our lives derailed by abusers like Trump know exactly how
much damage they can do.
How many abusers with personality disorders thrive because men
like Allen Frances don’t know with certainty what sick people do
behind closed doors? Even where there is evidence, it’s excluded
under arbitrary standards. “He said, she said” is not a standard
of equality in a patriarchal system. Just ask Elizabeth Warren.
Meanwhile, how can Trump’s illness be irrelevant when his
delusions are shaping our reality? He’s commanding the United
States military absent a moral code, while insisting that he’s
more infallible than the Pope. How soon until we hear about
Mar-a-Lago, the Florida Vatican?
There are those who will say that this discussion further
stigmatizes the mentally ill. Not all mental illness is created
equal. Speaking for myself, my crazy can be disabling at times,
but I’ve learned to manage it over the years with therapy and
medication. I am grateful that I can afford them both. The vast
majority of mentally ill people, like the homeless veterans who
populate our streets, are peaceful people who go about their
lives internalizing their pain rather than projecting it onto
others. These people deserve compassion and care, not
mistreatment.
We cannot say the same for Trump. He makes every disturbed
feeling our problem. He’s like the guy in a gangster movie who
sits down for a poker game, the tension escalating until a
throwaway joke about his tiny fingers causes him to stab
someone’s hand to the table.
As a serial predator, Trump looks at people like a lion eyes a
herd of antelope. Does the lion care which antelope he eats for
dinner? No. He’s an equal opportunity abuser, as Ivanka would
say. But he’s lazy. Why challenge himself with the head of the
pack when there are a few lagging behind who can’t put up much
of a fight? His administration reeks of social Darwinism. Who
can forget Donald Trump Jr. dehumanizing refugees as Skittles?
Now that we’ve put Trump at the top of the figurative human food
chain, let’s not allow the ignorance surrounding mental illness
to flatten an urgently needed discussion. We cannot ignore his
pathological need to dominate while he provokes Kim Jong-un and
refuses to shake Angela Merkel’s hand. It’s not that Trump
doesn’t want to behave — he simply cannot. Like Lear wandering
in the storm, we have blinded ourselves to the obvious, and the
results could be catastrophic. |
