Fevered media speculation about Donald Trump’s psychological motivations and psychiatric diagnosis has recently encouraged mental health professionals to disregard the usual ethical constraints against diagnosing public figures at a distance. They have sponsored several petitions and a Feb. 14 letter to The New York Times suggesting that Mr. Trump is incapable, on psychiatric grounds, of serving as president.
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. 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).
This is surely a good cautionary word, but I have some questions, and the primary one is: How does Dr. Frances, who has not examined Trump and has probably never met him, know that Trump “does not suffer from the distress and impairment required to diagnose mental disorder”? What empirical knowledge does he have about Trump’s distress or lack thereof? Frances claims that “Mr. Trump causes severe distress rather than experiencing it,” but surely it is possible for a person to cause and experience distress? It seems to me that if you can violate the Goldwater Rule by claiming that someone you have not examined definitely has a disorder, you can also violate it by claiming that someone you have not examined definitely does not have that disorder. Dr. Frances seems just as overconfident as the people whose letter he’s responding to.
