The question is not whether the President is crazy but whether he is
crazy like a fox or crazy like crazy. And, if there is someone who can
know the difference, should this person, or this group of people, say
something—or would that be crazy (or unethical, or undemocratic)?
Jay Rosen, a media scholar at New York University, has been arguing for
months that
“many things Trump does are best explained by Narcissistic Personality
Disorder,” and that journalists should start saying so. In March, the
Times published a
letter by the psychiatrists Robert Jay Lifton and Judith L. Herman, who
stated that Trump’s “repeated failure to distinguish between reality and
fantasy, and his outbursts of rage when his fantasies are contradicted”
suggest that, “faced with crisis, President Trump will lack the judgment
to respond rationally.” Herman, who is a professor at Harvard Medical
School, also co-authored an earlier
letter to President Obama, in November, urging him to find a way to subject
President-elect Trump to a neuropsychiatric evaluation.
Lifton and Herman are possibly the greatest living American thinkers in
the field of mental health. Lifton, who trained both as a psychiatrist
and a psychoanalyst, is also a psychohistorian; he has written on
survivors of the atomic bombs dropped on Japan, on Nazi doctors, and on
other expressions of what he calls “an extreme century” (the one before
this one). Herman, who has done pioneering research on trauma, has
written most eloquently on the near-impossibility of speaking about the
unimaginable—and now that Donald Trump is, unimaginably, President, she
has been speaking out in favor of speaking up. Herman and Lifton have
now written introductory articles to a collection called “The Dangerous
Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess
a
President.”
It is edited by Bandy X. Lee, a psychiatrist at the Yale School of
Medicine who, earlier this year, convened a conference called Duty to
Warn.
Contributors to the book entertain the possibility of applying a variety
of diagnoses and descriptions to the President. Philip Zimbardo, who is
best known for his Stanford Prison
Experiment,
and his co-author, Rosemary Sword, propose that Trump is an “extreme
present hedonist.” He may also be a sociopath, a malignant narcissist,
borderline, on the bipolar spectrum, a hypomanic, suffering from
delusional disorder, or cognitively impaired. None of these conditions
is a novelty in the Oval Office. Lyndon Johnson was bipolar, and John F.
Kennedy and Bill Clinton might have been characterized as “extreme
present hedonists,” narcissists, and hypomanics. Richard Nixon was, in
addition to his narcissism, a sociopath who suffered from delusions, and
Ronald Reagan’s noticeable cognitive decline began no later than his
second term. Different authors suggest that America “dodged the bullet”
with Reagan, that Nixon’s malignant insanity was exposed in time, and
that Clinton’s afflictions might have propelled him to Presidential
success, just as similar traits can aid the success of entrepreneurs.
(Steve Jobs comes up.)
Behind the obvious political leanings of the authors lurks a conceptual
problem. Definitions of mental illness are mutable; they vary from
culture to culture and change with time. The Diagnostic and Statistical
Manual of Mental Disorders is edited every few years to reflect changes
in norms: some conditions stop being viewed as pathologies, while others
are elevated from mere idiosyncrasies to the status of illness. In a
footnote to her introduction, Herman acknowledges the psychiatric
profession’s “ignominious history” of misogyny and homophobia, but this
is misleading: the problem wasn’t so much that psychiatrists were
homophobic but that homosexuality fell so far outside the social norm as
to virtually preclude the possibility of a happy, healthy life.
Political leadership is not the norm. I once saw Alexander
Esenin-Volpin, one of the founders of the Soviet dissident movement,
receive his medical documents, dating back to his hospitalizations
decades earlier. His diagnosis of mental illness was based explicitly on
his expressed belief that protest could overturn the Soviet regime.
Esenin-Volpin laughed with delight when he read the document. It was
funny. It was also accurate: the idea that the protest of a few
intellectuals could bring down the Soviet regime was insane.
Esenin-Volpin, in fact, struggled with mental-health issues throughout
his life. He was also a visionary.
No one of sound mind would suspect Trump of being a visionary. But is
there an objective, value-free way to draw the very subjective and
generally value-laden distinction between vision and insanity? More to
the point, is there a way to avert the danger posed by Trump’s craziness
that won’t set us on the path of policing the thinking of democratically
elected leaders? Zimbardo suggests that there should be a vetting
process for Presidential candidates, akin to psychological tests used
for “positions ranging from department store sales clerk to high-level
executive.” Craig Malkin, a lecturer at Harvard Medical School and the
author of “Rethinking
Narcissism,”
suggests relying on “people already trained to provide functional and
risk assessment based entirely on observation—forensic psychiatrists and
psychologists as well as ‘profilers’ groomed by the CIA, the FBI, and
various law enforcement agencies.” This is a positively terrifying idea.
As Mark Joseph Stern wrote in
Slate in response to last December’s calls for the Electoral College to
un-elect Trump, it “only made sense if you assumed as a starting point
that America would never hold another presidential election.”
Psychiatrists who contributed to “The Dangerous Case of Donald Trump”
are moved by the sense that they have a special knowledge they need to
communicate to the public. But Trump is not their patient. The phrase
“duty to warn,” which refers to a psychiatrist’s obligation to break
patient confidentiality in case of danger to a third party, cannot apply
to them literally. As professionals, these psychiatrists have a kind of
optics that may allow them to pick out signs of danger in Trump’s
behavior or statements, but, at the same time, they are analyzing what
we all see: the President’s persistent, blatant lies (there is some
disagreement among contributors on whether he knows he is lying or is,
in fact, delusional); his contradictory statements; his inability to
hold a thought; his aggression; his lack of empathy. None of this is
secret, special knowledge—it is all known to the people who voted for
him. We might ask what’s wrong with them rather than what’s wrong with
him.
Thomas Singer, a psychiatrist and Jungian psychoanalyst from San
Francisco, suggests that the election reflects “a woundedness at the
core of the American group Self,” with Trump offering protection from
further injury and even a cure for the wound. The conversation turns, as
it must, from diagnosing the President to diagnosing the people who
voted for him. That has the effect of making Trump appear normal—in the
sense that, psychologically, he is offering his voters what they want
and need.
Knowing what we know about Trump and what psychiatrists know about
aggression, impulse control, and predictive behavior, we are all in
mortal danger. He is the man with his finger on the nuclear button.
Contributors to “The Dangerous Case of Donald Trump” ask whether this
creates a “duty to warn.” But the real question is, Should
democracy allow a plurality of citizens to place the lives of an entire
country in the hands of a madman? Crazy as this idea is, it’s not a
question psychiatrists can answer.