Trump and the Pathology of Narcissism
At 6:35 a.m. on the morning of March 4th, President Donald Trump did what no U.S. president has ever done: He accused his predecessor of spying on him. He did so over Twitter, providing no evidence and – lest anyone miss the point – doubling down on his accusation in tweets at 6:49, 6:52 and 7:02, the last of which referred to Obama as a "Bad (or sick) guy!" Six weeks into his presidency, these unsubstantiated tweets were just one of many times the sitting president had rashly made claims that were (as we soon learned) categorically untrue, but it was the first time since his inauguration that he had so starkly drawn America's integrity into the fray. And he had done it not behind closed doors with a swift call to the Department of Justice, but instead over social media in a frenzy of ire and grammatical errors. If one hadn't been asking the question before, it was hard not to wonder: Is the president mentally ill?
It's now abundantly clear that Trump's behavior on the campaign trail was not just a "persona" he used to get elected – that he would not, in fact, turn out to be, as he put it, "the most presidential person ever, other than possibly the great Abe Lincoln, all right?" It took all of 24 hours to show us that the Trump we elected was the Trump we would get when, despite the fact that he was president, that he had won, he spent that first full day in office focused not on the problems facing our country but on the problems facing him: his lackluster inauguration attendance and his inability to win the popular vote.
Since Trump first announced his candidacy, his extreme disagreeableness, his loose relationship with the truth and his trigger-happy attacks on those who threatened his dominance were the worrisome qualities that launched a thousand op-eds calling him "unfit for office," and led to ubiquitous armchair diagnoses of "crazy." We had never seen a presidential candidate behave in such a way, and his behavior was so abnormal that one couldn't help but try to fit it into some sort of rubric that would help us understand. "Crazy" kind of did the trick.
And yet, the one group that could weigh in on Trump's sanity, or possible lack thereof, was sitting the debate out – for an ostensibly good reason. In 1964, Lyndon B. Johnson had foreshadowed the 2016 presidential election by suggesting his opponent, Barry Goldwater, was too unstable to be in control of the nuclear codes, even running an ad to that effect that remains one of the most controversial in the history of American politics. In a survey for Fact magazine, more than 2,000 psychiatrists weighed in, many of them seeing pathology in Goldwater's supposed potty-training woes, in his supposed latent homosexuality and in his Cold War paranoia. This was back in the Freudian days of psychiatry, when any odd-duck characteristic was fair game for psychiatric dissection, before the Diagnostic and Statistical Manual of Mental Disorders cleaned house and gave a clear set of criteria (none of which includes potty training, by the way) for a limited number of possible disorders. Goldwater lost the election, sued Fact and won his suit. The American Psychiatric Association was so embarrassed that it instituted the so-called Goldwater Rule, stating that it is "unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination" of the person under question.
All the same, as Trump's candidacy snowballed, many in the mental-health community, observing what they believed to be clear signs of pathology, bristled at the limitations of the Goldwater guidelines. "It seems to function as a gag rule," says Claire Pouncey, a psychiatrist who co-authored a paper in The Journal of the American Academy of Psychiatry and Law, which argued that upholding Goldwater "inhibits potentially valuable educational efforts and psychiatric opinions about potentially dangerous public figures." Many called on the organizations that traffic in the psychological well-being of Americans – like the American Psychiatric Association, the American Psychological Association, the National Association of Social Workers and the American Psychoanalytic Association – to sound an alarm. "A lot of us were working as hard as we could to try to get organizations to speak out during the campaign," says Lance Dodes, a psychoanalyst and former professor of psychiatry at Harvard Medical School. "I mean, there was certainly a sense that somebody had to speak up." But none of the organizations wanted to violate the Goldwater Rule. And anyway, Dodes continues, "Most of the pollsters said he would not be elected. So even though there was a lot of worry, people reassured themselves that nothing would come of this."
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