Is Donald Trump mad? (Asks Britain’s leading psychology writer)

But rather than moderate his behaviour to appear more presidential, Trump’s tone has become even more shocking and combative since his inauguration. Apart from what has been activated by his executive orders, people are hugely concerned by his use of Twitter to impart information and opinions, and the erratic style of his press briefings. He has accused the country’s most reputable news sources of lying and making up fake news; he claims he won the biggest electoral college since Ronald Reagan, in the face of the evidence; he’s repeatedly called out non-existent voter fraud; he’s singled out Sweden as an example of a country with problems with immigrants, then blamed the misinformation on a television programme he’d watched.

Even those who are traditionally his supporters are sounding worried. Fox News broadcaster Shepherd Smith – surely someone who would have been expected to come down on Trump’s side if he could – sounded confused and sceptical as he introduced a debate between various pundits. Facing the viewers he said: ‘It’s sort of our job to let you know when things are said that aren’t true – when that’s demonstrable – and there were a lot of them today: the biggest electoral win since Ronald Reagan, he says it over and over again, and every time he does it, it’s not true. We don’t get a straight answer on Russia. He says it’s a ruse. But it’s the reason he fired Mike Flynn. He yells at us for pointing it out, but it’s another untrue thing from the president of the United States.’

Now, five weeks into the presidency, lots of people have started to ask: could Donald Trump actually be mad?

Short of getting the man on the couch, any such suggestion is hard to prove, but that hasn’t stopped people trying. When it was raised during the campaign, most psychiatrists declined to comment on account of what’s known as the Goldwater rule. This refers to Barry Goldwater, Republican presidential candidate in 1964. American magazine Fact had asked more than 12,000 psychiatrists if politically conservative Goldwater was fit to become the president. Of the 2,417 who answered, 1,189 believed he was psychologically unsuited to the job calling him ‘paranoid’, ‘grossly psychotic’ and a ‘megalomaniac’. Some even provided diagnoses, like schizophrenia and narcissistic personality disorder.

After he’d lost the election, Goldwater successfully sued the magazine, but more importantly, in 1973 the American Psychiatric Association decreed that having professionals assess individuals without an actual consultation was unethical. This belief has stood for more than 40 years, but now some psychiatric professionals believe it should no longer prevail. If the President is mentally ill, surely they ought to say so?

On February 13, 35 psychiatrists, therapists and mental health practitioners signed a letter to the New York Times saying their silence up until that point had ‘resulted in a failure to lend our expertise to worried journalists and members of Congress at this critical time. We fear that too much is at stake to be silent any longer.

‘Mr. Trump’s speech and actions demonstrate an inability to tolerate views different from his own, leading to rage reactions. His words and behaviour suggest a profound inability to empathise. Individuals with these traits distort reality to suit their psychological state, attacking facts and those who convey them (journalists, scientists).

‘In a powerful leader, these attacks are likely to increase, as his personal myth of greatness appears to be confirmed. We believe that the grave emotional instability indicated by Mr. Trump’s speech and actions makes him incapable of serving safely as president.’

There have also been a number of petitions calling for action based on this sort of hypothesis. Psychologist John Gartner has garnered more than 25,000 signatures on change.org, calling for the chief executive to be removed from office on the grounds he is mentally ill and unfit to perform the duties of president. Gartner acknowledges that ‘armchair diagnosis’ is frowned upon, but told Forbes website, the Trump situation is ‘from a psychiatric point of view the absolute worst-case scenario … if I were to take the DSM (Diagnostic and Statistical Manual of Mental Disorders) and try to create a Frankenstein’s monster of the most dangerous and destructive leader and had freedom to create any combination of diagnosis and symptoms,’ Trump would be the result.

But as the words narcissistic personality disorder started to ring around the newsrooms, in weighed another expert who demured. Allen Frances, an emeritus psychiatrist at Duke University School of Medicine does not believe that Trump qualified for this psychiatric label.

As he wrote in Psychology Today, ‘Trump’s consensus diagnosis among amateur, at-a-distance diagnosticians is Narcissistic Personality Disorder. They have reviewed the DSM definition (which I wrote) and found him to meet all the criteria: grandiose self-importance; preoccupations with being brilliant and successful; feeling special and having to hang out with special people; requiring constant admiration; feeling entitled; being exploitive; lacking empathy; being envious; and being arrogant. Bingo. Trump is all this in spades.

‘But they ignore the further requirement that is crucial in defining all mental disorders — the behaviours also must cause clinically significant distress or impairment.

‘Trump is clearly a man singularly without distress and his behaviours consistently reap him fame, fortune, women, and now political power. He has been generously rewarded, not at all impaired by it. Dismissing Trump as simply mad paradoxically reduces our ability to deal with his actions.’

But it seems narcissistic personality disorder is only one of the disorders that have sprung to the minds of people who think he is mentally ill. Some commentators have noted that Trump’s father had Alzheimer’s and posited that he has inherited it. However, according to Professor Nick Fox, honorary consultant neurologist at the Institute of Neurology, in London, most cases of Alzheimer’s are not inherited.

Another angle comes from physician Dr Steven Beutler writing in The New Republic. He points out that many conditions ‘exhibit their first symptoms in the form of psychiatric issues and personality changes. One condition in particular is notable for doing so: Neurosyphilis.’

Untreated syphilis, 30 or so years after the initial infection can lead to ‘irritability, loss of ability to concentrate, delusional thinking, and grandiosity. Memory, insight, and judgment can become impaired. Insomnia may occur. Visual problems may develop, including the inability of pupils to react to the light. This, along other ocular pathology, can result in photophobia, dimming of vision, and squinting. All of these things have been observed in Trump. Dementia, headaches, gait disturbances. And patchy hair loss can also be seen in later stages of syphilis.’

It may sound like a low blow to accuse the president of the United States of harbouring an untreated sexually treated disease. But Beutler uses Trump’s own quotes, on Howard Stern’s radio show about his promiscuity during the 80s – a period when syphilis cases were rapidly increasing in the US. ‘I’ve been so lucky in terms of that whole world,’ he told Stern in 1997, referring to his dating life the decade prior. ‘It is a dangerous world out there – it’s scary, like Vietnam. Sort of like the Vietnam era. It is my personal Vietnam. I feel like a great and very brave solider.’ An incredibly analogy from someone who avoided the draft during the actual Vietnam War.

This month we’ve also learnt that even at the Kremlin people are wondering what’s going on in Trump’s brain. According to former deputy foreign minister Andrei Fedorov a seven-page psychological dossier is being prepared in advance of the first meeting between Putin and Trump. Preparations are normal, but focusing on the mental state and the personality of a world leader is more unusual.

If you are on social media such as Twitter and Facebook you will wonder what we did before the Trump ascendancy, so overwhelming is the response to every news morsel. Its almost fun for people to pile in there, though the tone may risk getting Trump-like as people attack the man – pompous, aggressive, entitled – more than his message. By leaping to say he’s ‘crazy’ we drop to his level, but also we demean anyone struggling with mental health issues. This is one of the reasons that professional associations suggest practitioners hold back. It could also weaken clients’ trust in their therapists.

All of this is, anyway, a long way from any certainty about what is up with President Trump. As Richard Friedman professor of Clinical Psychiatry at Weill Cornell Medical College pointed out in the New York Times, 10 presidents of the US showed signs of mental illness while they were in office. ‘You can be psychiatrically ill and be perfectly competent, just as you can be mentally healthy but totally unfit.’

An actual diagnosis comes via a thorough examination of a patient, a detailed history and all relevant clinical data, which, as Friedman says, can’t be done remotely. ‘Narcissism, for instance, isn’t the only explanation for impulsive, inattentive and grandiose behaviour. Someone could be suffering instead from another clinical problem like attention deficit hyperactivity disorder; the abuse of drugs, alcohol or stimulants; or a variant of bipolar disorder, to name just a few…. To label public figures with mental illnesses, it is not just unethical – it’s intellectually suspect. We don’t have the requisite clinical data to know what we are talking about.’

Which leaves us where exactly?

We shouldn’t look away when we think Trump is acting ‘like a madman’. We should look even more closely. He’s not a lovely chap, that’s for sure, but what he is saying is the key detail. Not the wild-eyed stare, but the words, the plans, the bans, the proposals, the treaties, the rows. As Friedman wrote: ‘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.’

Louise Chunn is the founder of find a therapist platform welldoing.org. She is former editor of Psychologies magazine