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5/01/2019

Expert Opinion: Donald Trump Does Not Have a Mental Disorder

Never before in history have so many commentators prefaced their remarks about a President by saying: “you’d have to ask a psychiatrist” or “I’m not a psychologist.”

I am a psychologist. During the course of a 40 year career, I practiced as a criminal forensic specialist, visiting clients in jails, prisons and asylums, and testifying as an expert witness.

Having worked primarily in the context of active criminal proceedings, I look at diagnostic questions more critically than clinicians credentialed in academia.  

President "My Sick Idea" Trump 
The most prominent voice in the Diagnose-Donald-Now Movement - aside from George Conway, derisively known as Mr. Kellyanne Conway - is that of Bandy X. Lee, respectfully known as a Yale psychiatrist. In 2017, she published essays from 27 assorted mental health experts under the title: “The Dangerous Case of Donald Trump.” 

In Dr. Lee’s book, a number of the experts bandy about words that are associated with different forms of mental illness, but it remains a discussion about character, personality type, temperament, judgment and behavior. Mr. Trump was excoriated on those grounds, but no diagnostic hypothesis emerged. More importantly, no distinct and unequivocal symptom of mental disorder was described. 

The observations offered by these experts involve “psychological character evidence,” which in some cases can be admitted in Court for a legal purpose - a diagnosis not necessarily required. 

The bulk of my work involved competency and sanity cases, where a specific diagnostic question must be answered: is the relevant impairment the result of a psychiatric illness (a “disease, disorder or defect” under the law) or is it the result of something else?  The psycho-legal question to be answered is binary: mental disorder, yes or no?

No one has suggested that the President displays symptoms of psychotic thought disorder such as loose associations or hallucinations. And despite living in a world of alternative facts, he is not obviously delusional. Narcissistic grandiosity is not the same as an actual “delusion of grandeur,” and besides, too many other people share his contrived beliefs. 

With respect to the President’s “high energy” presentation, his agitation is nothing like a case of major affective disorder or manic illness. Psychologist John Gartner (one of the 27 experts) cautioned against drawing that conclusion, noting that a “hypomanic temperament” is not the same as clinical hypomania. 

Absent symptoms of a formal thought disorder or a major mood disturbance, the binary answer would be: No, Trump does not have a mental disorder. 

With respect to the President’s narcissism, a personality style is not a DSM personality disorder unless it causes clinical distress or dysfunction - no matter how malignant the character traits. In any case, a personality disorder is not a psychiatric illness. "Sick ideas" are not the same as "crazy thoughts."

With respect to the President’s judgment, there seems to be no evidence that Trump’s IQ falls anywhere above the mean. He does not have a sophisticated vocabulary, or advanced comprehension and reasoning abilities. He has apparently not mastered any formal body of knowledge. 

The intellectual demands of the Presidency are such that if an unstudied person of average IQ tried to do the job, they would naturally end up looking like a moron. That has nothing to do with mental disorder. If an assertion is foolish, we should simply assume it was produced by a fool.

My view is that a “serious inquiry about this man’s condition of mind” (George Conway’s words) should take into account the following considerations.

1. The range of aberrant thought and repulsive behavior that can be explained by personality traits is vast. However, a character pathology is not a mental illness. A psychopath might have sick ideas and twisted motivations and still be judged perfectly sane. 

2. Narcissism and sociopathy (i.e., psychopathy) are two sides of the same coin. The psychopath cares nothing about others. The narcissist cares only about himself.

3. No matter how brilliant the scam or how perfect the crime, psychopaths are typically rather dumb. Exploiting fear or desire in others requires only a limited skill set (mostly interpersonal), but brain power not so much. At the very least, most sociopaths seem to think they will never be caught and that others can always be blamed. They are generally not smart enough to know that you can’t fool all of the people all of the time. 

For those who wonder about the President’s condition of mind, George Conway offered his lay opinion: “it’s nuts, it’s a disorder." 

In the President’s defense, I would disagree with the second half of that statement. 



Copyright, Paul G. Mattiuzzi, Ph.D.