IS TRUMP A CLINICAL NARCISSIST?

In an October 12 column, Jennifer Senior of The New York Times argued that President Trump is a pathological narcissist. One letter-writer responds to Senior's assertion by quoting the man who defined narcissistic personality disorder for professionals:

To the Editor:

Jennifer Senior seeks to malign Donald Trump by claiming that the president suffers from narcissistic personality disorder. There’s only one problem with her assertion.

The psychiatrist who wrote the defining clinical characteristics for narcissistic personality disorder, Dr. Allen Frances, said this in a letter to the editor two years ago: “Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them.”

Dr. Frances was chairman of the task force that wrote the Diagnostic and Statistical Manual of Mental Disorders IV, widely considered to be psychiatry’s “bible,” so his credentials are unassailable.

Michael J. DiStefano
Jamestown, R.I.

But Dr. Frances didn't say that Trump isn't a narcissist. Here's what he said in that letter, at somewhat greater length:

Most amateur diagnosticians have mislabeled President Trump with the diagnosis of narcissistic personality disorder. I wrote the criteria that define this disorder, and Mr. Trump doesn’t meet them. He may be a world-class narcissist, but this doesn’t make him mentally ill, because he does not suffer from the distress and impairment required to diagnose mental disorder.

Mr. Trump causes severe distress rather than experiencing it and has been richly rewarded, rather than punished, for his grandiosity, self-absorption and lack of empathy....

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.

So Dr. Frances also "seeks to malign Donald Trump" -- just not with a diagnosis of narcissistic personality disorder. His reason for this is that Trump "does not suffer from the distress and impairment required to diagnose mental disorder," a point he elaborated on in a 2017 interview with Dr. F. Perry Wilson.

Frances: Well, Trump is absolutely a world-class narcissist. He has every criteria met except for two. In addition to having the features of being grandiose, unempathic, self-involved, selfish, all the things that go into being Trump, you have to have distress or impairment, significant distress or impairment.

Trump is a man who causes immense distress in others, but doesn't seem to experience it very much himself. Although he's created tremendous impairment for our country and for his business colleagues, he, himself, has been very well rewarded in politics and also in business for being a narcissist. I think that it's reckless for people to attribute the damage he's causing to mental illness. He's much more bad than mad.

Even his interviewer questions whether Trump is being excluded inappropriately.

Wilson: ... I think you're making the argument that if you're the president, you have done pretty well for yourself -- which most of us would agree with -- but it reminds me of Nixon's famous quote when he said, "If the president does it, it's not illegal." Can the president have a mental illness or by the virtue of his success, does that take mental illness off the table?

Dr. Fances counters by saying that, yes, it's possible for a leader to have mental illness -- Abraham Lincoln and Winston Churchill were clearly depressives.

But I think Dr. Frances is ignoring Trump's own distress and impairment. He seems to have no real friends. He clearly doesn't love his wife or most of his children. He's angry all the time -- has Dr. Frances looked at Trump's Twitter feed? For love, he holds campaign rallies in which he does insult comedy for an an hour and a half. Would Dr. Frances argue that a successful comic can't have a mental illness? (That would be news to most comics.)

Dr. Francis regards Trump as unhealthily narcissistic, though, as he says in the interview, we should more properly regard Trump as "completely irresponsible, quite ignorant, impulsive, insulting, corrupt, self-serving ... a trickster and a conman." Dr. Francis has since asserted that "Trump is as destructive a person in this century as Hitler, Stalin, and Mao were in the last century. He may be responsible for many more million deaths than they were." (He subsequently explained on Twitter that he was referring to Trump's opposition to action on climate change.)

So, in Dr. Frances's view, Trump is a narcissist, just not a sick one -- and he's also extremely unfit to be president and a danger for the world.

Close enough.