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Misdiagnosing Trump with Narcissistic Personality Disorder: an Example of Confusing Bad Behaviour with Mental Illness

Anandita Lidhoo


“Everyone has a personality,” says Allen Frances,the psychiatrist responsible for the rules for diagnosing personality disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). “It’s not wrong to have a personality; it’s not mentally ill to have a personality. It’s only a disorder when it causes extreme distress, suffering, and impairment.” He is referring to the recent buzz around Trump’s mental health- the change.org petition with over 70,000 signage's, or a professional analyses on the Atlantic magazine and even Twitter. The discussion revolving around his possible narcissistic personality disorder has become the subject of news and media.

The petition, started by clinical psychologist John Gartner, stirred the most public interest. This is possibly because for the first time, a medical health professional was so vehemently and publicly against a president keeping post while suffering from an array of mental illnesses. Frances, however, believes “what’s going on is bullshit,” arguing that while Trump may satisfy certain criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for Narcissistic Personality Disorder (NPD), the story is much bigger than that.

To diagnose a mental disorder, a key criterion that must be satisfied is that the disorder affects the patient’s life in a negative manner. Some of the complications that come with NPD are depression and/or anxiety, trouble at school or work, strained (or lack of many) relationships, drug or alcohol misuse, and thoughts of suicide. Frances explains that people with NPD will, at some point in their lives, experience a crash of some sort, even if they won’t be able to recognize it themselves- familial abandonment, loss of job, and their “bubble of grandiosity will burst.” They will be tormented by feeling like they cannot function or move up in the world.
However, the President is seen to have a supportive, loving family, suffers from no visible signs of depression or anxiety, and claims to be satisfied with his overall economically and politically successful life.

It is understandable that many diagnose him with a disorder from what they can see, but this disobeys the Goldwater rule, which states that psychiatrists are disallowed from making judgements about a public figure’s mental health from afar. Not only is this practice unethical, it is also very dangerous, given how broad the DSM-5 criteria can be, providing opportunity for diagnostic inflation. Since Donald Trump is a controversial political figure, most of the public may not appreciate his policies and behavior, thus making professionals more prone to giving biased opinions. While well-meaning professionals are thus expressing concern over Trump’s position in the government, they are unknowingly stigmatizing many mental illnesses by using them as insults. This causes public to associate mental disorders with bad behavior, which, for most of the mentally ill, is just untrue. Such errors in judgment can hamper the current struggle of normalising and demystifying mental illnesses to encourage healthy dialogue.

It is imperative to draw the line between a strong personality and a mental disorder. Allen Frances, concerned about the practice of clinical psychology, reminds the public, “Trump is not mad, he’s just bad.”

References:
  1. Frances, A. (2017, December 22). An Eminent Psychiatrist Demurs on Trump's Mental State. Retrieved December 18, 2018, from https://www.nytimes.com/2017/02/14/opinion/an-eminent-psychiatrist-demurs-on-trumps-mental-state.html
  2. Frances, A. (2012, December 2). DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes. Retrieved December 18, 2018, from https://www.psychologytoday.com/intl/blog/dsm5-in-distress/201212/dsm-5-is-guide-not-bible-ignore-its-ten-worst-changes
Wilson, F. P. (2017, September 6). Misdiagnosing Trump: Doc-to-Doc with Allen Frances, MD. Retrieved December 18, 2018, from https://www.medpagetoday.com/psychiatry/generalpsychiatry/67728

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