With some regularity, President Trump has been accused of being mentally ill. Here at From Insults to Respect, we’re going today to take a discerning look at this. We’ll begin with some pieces that appeared in the media, and then see if we can move ahead to make our own informed personal decision.
The Washington Post Article
This week in The Washington Post, Ed O’Keefe wrote an article titled, “Bernie Sanders calls Trump a ‘pathological liar’; Al Franken says ‘a few’ Republicans think Trump is mentally ill.”
What are the specifics that led to this determination? According to Senator Sanders,
“When somebody goes before you and says that 3 to 5 million people voted illegally … nobody believes that. There is not a scintilla of evidence to believe that, what would you call that remark? It’s a lie. It’s a delusion.”
In the same article, Senator Franken explains his statement about what he heard from Republicans:
“In the way that we all have this suspicion that — you know, that he’s not — he lies a lot, he says things that aren’t true, that’s the same thing as lying, I guess.”
Having read this article, I came away thinking that there are people who are very sympathetic with what the two senators were trying to say. At the same time, it is also conceivable that the president knows full well that he is lying but he is using it as a strategy.
Perhaps he has come to believe that many of his most ardent supporters actually believe him when he lies, and it is the media who are telling the lies. The president may also believe that others of his supporters don’t care that he lies because they believe business folks always exaggerate as they promote their goals, and that Trump is just promoting causes that match their values. Many Americans may therefore see his behavior not as a sign of mental illness, but simply that he is a shrewd businessman. Finally, the president may believe that there are other supporters who don’t like it that he lies, but believe that his opponents lie as well. They therefore cancel out this negative, and rely instead on one or more hot button issues such as abortion, immigration, burdensome regulations, health care, etc., for throwing their support behind him. The president may believe that this group, when combined with those who believe his lies, and those who accept lying as part of doing business, provides him a worthwhile calculated risk that he will have enough support to achieve his personal goals. After all, it worked well enough to get him elected.
Let’s move on now to take a look at three psychiatrists that object to calling Trump mentally ill.
A Fox News Article
Recently, Fox News published an article by Dr. Keith Ablow titled, “Relax, Trump is Stone Cold Sane.” This doctor is a psychiatrist and a paid member of the Fox News Medical A-Team.
“I should note that nothing I am saying should besmirch the reputations of men like President Abraham Lincoln or Sir Winston Churchill, both of whom are said to have fought the ravages of major depression or bipolar disorder. One was instrumental in ridding America of slavery. The other was instrumental in saving the world from tyranny. Mahatma Gandhi, by the way, also reportedly suffered from depression. Psychiatric illness does not, a priori, disqualify a person from rendering extraordinary service to mankind.”
So, according to Dr. Ablow, if you can become a country’s leader you can still be mentally ill. If that is the case, why then does Dr. Ablow claim that Trump is not mentally ill? It is because, “neither Lincoln nor Churchill nor Gandhi led a nation after becoming a business sensation and television star.”
Hmmm. Well, let’s keep this thought in mind as we move on to hear what another psychiatrist has to say.
Dr. Allen Frances’s Opinion
In the February 14, 2017 edition of the New York Times, there appears a letter to the editor titled, “An Eminent Psychiatrist Demurs on Trump’s Mental State.” The author of the letter is Dr. Allen Frances. In his opinion, “It is a stigmatizing insult to the mentally ill (who are mostly well behaved and well meaning) to be lumped with Mr. Trump (who is neither).”
Dr. Frances goes on to say in part:
“Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. Psychiatric name-calling is a misguided way of countering Mr. Trump’s attack on democracy. He can, and should, be appropriately denounced for his ignorance, incompetence, impulsivity and pursuit of dictatorial powers.”
Wow, pretty strong words. As we reflect on this for a few minutes, let’s move on to take a look at one more psychiatric opinion on this subject before we seek to draw our own conclusions.
Dr. Richard A. Friedman’s Opinion
Dr. Friedman’s opinion piece appears in the February 17, 2017 issue of the New York Times. There he tells us that it is unethical for psychiatrists to diagnose mental illnesses in people they have not examined and whose consent they have not received. However, psychiatrists can pretty much get around this principle by describing the common characteristics of a particular mental illness and then say how they might explain Mr. Trump’s behavior. According to a Huffington Post article, several mental health professionals have used this very approach to strongly suggest the president is mentally ill.
Dr. Friedman then tells us, that even if a doctor did diagnose President Trump as mentally ill after a thorough exam, it doesn’t mean he couldn’t be fit to be president. He then concludes:
“So the nation doesn’t need a shrink to help it to decide whether President Trump is fit to serve, mentally or otherwise. Presidents should be judged on the merits of their actions, statements and, I suppose, their tweets. No experts are needed for that — just common sense.”
I fully agree with Dr. Friedman’s conclusion. But it leaves us still up in the air with regards to whether or not President Trump is mentally ill. Let’s see if it makes sense for us to make this judgment for ourselves.
So, Is He, Or Isn’t He?
Most doctors would object to untrained individuals making this type of determination, arguing that this should be left to mental health professionals. Dr. Friedman argued that only by a thorough examination of a patient, a detailed history and all relevant clinical data can such professionals determine if someone is, or is not, mentally ill. This sounds like a pretty thorough way to make a decision as important as this, but from speaking to patients over the years, I’m under the impression that they have been given a so called diagnosis simply by having a discussion with a mental health professional for less than an hour, and often in less than twenty minutes.
The latest version of the DSM, which is used by mental health professions to make this type of determination, states:
“Although no definition can capture all aspects of all disorders in the range contained in the DSM-5, the following elements are required:
“A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognitive, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning. Mental disorders are usually associated with significant distress in social, occupational, or other important activities. An expected or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.”
Notice how broad this definition is. It makes mention of a “disturbance” that reflects a “mental dysfunction in the individual.” The DSM definition doesn’t direct us to any reliable or valid way too assess functioning. The process described in the DSM for assessing the subjective notions of “disturbance” and “dysfunction in the individual” is left to the clinician who decides if these are “clinically significant.” Thus, it provides clinicians an opportunity to include anything that benefits their set of values.
Many clinicians have a financial interest in deciding whether or not their clients have a clinically significant condition. When they judge that their clients’ conditions are significant, they indicate this on the third party intake forms and this allows them to continue to see these clients and to get paid for additional visits. On the other hand, clinicians who work in an underfunded community government clinic that is being swamped by those seeking to access mental health services might apply a more stringent standard for what constitutes a mental disorder. Thus, we can hypothesize that this type of clinical judgment may often be based on financial self-interest or clinic treatment capacity than one based on principles of science.
Let us look a little more at the DSM’s attempt to draw distinctions between what is a mental disorder and what is not. According to the DSM, certain socially deviant behavior and conflicts are not mental disorders, although they may be. If the deviance or conflict results from a “dysfunction in the individual,” then a mental disorder exists in the individual. How does one make this type of distinction? Can it be done in some recognized precise manner? In practice, this too is left to the subjective judgment of the clinician that can be biased by financial interests and the capacity of his or her clinic. Might it also be influenced by political points of view as well?
Upon reading the DSM, we find that there is no documentation that people, whether they are clinicians or not, can reliably and objectively distinguish between those who have mental disorders from those who do not. That’s the current state of making determinations about who is and who is not mentally ill. In that light, we must decide for ourselves whether it is useful at all to pathologize human experiences, or is it ever wiser to drop the mental illness descriptors and to stick to more specific behaviors, attitudes, levels of functioning, and our personal values.
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.