14 Apr, 17 | by Iain Brassington
The speculation about Donald Trump’s mental health that was doing the rounds earlier in the year seems to have died down a bit. That’s to be expected; like it or not, his Presidency is now part of normal life. But I’ve been lagging in my blogging here, and so it’s only now that I’ve got a moment to mention in passing an op-ed article about Trump in the New Scientist that appeared just after I posted last on the topic. (February. I know, I know.)
It’s by Allen Frances, and it takes issue with what he calls “armchair diagnosis” of the president. He’s right to say that there’s something disquieting about armchair diagnosis: “psychiatric diagnosis is already done far too casually and inaccurately in medical and mental health practice. Armchair diagnosis further cheapens its currency.” However, I do wonder whether we ought to pay some attention to whose armchair it is. Often, it’s an armchair occupied by the genuinely ignorant, or the spiteful. That’s the internet for you. Accusing someone of being mentally ill or having a personality disorder on this account may be simply mistaken; or it may be intended as a jibe, the subtext of which is that there’s something shameful about having a mental health problem. But not every armchair is the same: as Frances’ article admits, a letter with 35 signatories who work within the mental health field appeared in the New York Times. That letter may be misguided, or ill-motivated. But it is by people who, presumably, know a thing or two about the topic. Their armchair is not my armchair.
But there’s something else about the piece that’s just nagging away at me. I don’t know a heck of a lot about mental health, but (and maybe that’s why) there’s a passage in the article that strikes me as being just strange:
But the main [reason for opposing armchair psychiatry] is the inaccuracy of the narcissistic personality disorder (NPD) diagnosis: Trump may be a world-class narcissist, but this doesn’t make him mentally ill.
I wrote the criteria for NPD for the Diagnostic and Statistical Manual of Mental Disorders, which guides mental health diagnosis in the US and beyond. These require not only that the personality features be present, but also that they cause clinically significant distress and impairment. Trump appears to cause severe distress in others (rather than experiencing it himself) and has been richly rewarded (rather than punished) for his self-promoting and self-absorbed behaviours.
[…] We must avoid the frequent mistake of confusing mental illness with bad behaviour. Most people who lie, cheat and exploit others are not mentally ill, and most mentally ill people do not commit dishonourable acts.
There’s a few things that are a bit odd about this. more…