• Chaos in the White House fuels discord amongst the experts.

In the several days since psychologist John Gartner posted a petition on Facebook declaring that Donald Trump must be removed from office because he has “a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States,” more than 18,000 psychologists, psychiatrists, and other mental health professionals have signed their agreement.

Although the petition has no legal power and it may be the beneficiary of timing more than tactics — it was posted mere hours before Trump issued a highly contentious executive order banning immigrants from some Muslim countries — it has made public what many have been saying privately for some time. And by doing so, it is exposing a large and growing rift within the mental health community.

In contention are three significant and intertwined issues. Can Donald Trump or any public figure be deemed to have mental illness, even based on specific, well-publicized criteria reflecting observable behavior? Is it ethical or appropriate for mental health professionals to venture into public acts of diagnosis? Is psychology a suitable instrument for addressing issues of governance?

Gartner, a psychologist in private practice in Baltimore and New York, author of a psychobiography of Bill Clinton, and a former instructor in psychiatry at Johns Hopkins, contends that Trump “manifestly” meets the DSM-published criteria for at least three personality disorders: narcissistic personality disorder (NPD), antisocial personality disorder, and paranoid personality disorder. They are a “toxic brew” that in his view not only make Trump “dangerous” but add up to “malignant narcissism,” not a diagnosis formalized in the Diagnostic and Statistical Manual but a label coined by the German-born psychologist and psychoanalyst Erich Fromm.

What makes it possible to diagnose Trump, says Gartner, is that the DSM, version 5 of which is in current use, puts pathology in the realm of the observable. It describes problematic behaviors, not possible motivations. For example, “when Trump declares that he knows more about ISIS than the generals, he is displaying grandiosity,” one of the criteria for narcissistic personality disorder. Or when he instructs the National Parks Service not to display photographs showing empty bleachers during the inaugural parade, he is making obvious his need for admiration.

Bad as NPD is, what makes Trump especially dangerous, Gartner contends, is his antisocial nature, manifest, he alleges, in such DSM-5 criteria as impulsiveness, deceitfulness (his use of aliases such as John Barron on recordings voicing support for his activities), and failing to obey laws and norms (refusal to show tax returns). “We’ve never had an antisocial president,” says Gartner. “What it means is that there are no guardrails for us.”

It is widely regarded as unethical — a violation of the so-called Goldwater Rule — for mental health experts to offer a professional diagnosis of any person they have not personally examined. The rule was established in 1973 by the American Psychiatric Association and is still in force today. Although psychologists are not expressly forbidden from making public pronouncements about the mental health of public figures, the American Psychological Association has affirmed the rule and psychologists generally abide by it.

But Gartner argues that the mental health community has an obligation to protect the public that overrides the Goldwater Rule, and that even in the short time since the inauguration, Trump has proved himself “a clear and present danger.” What’s more, he believes the Goldwater Rule is no longer relevant because it was established before the DSM made diagnosis behaviorally based. “We don’t need to interview Donald Trump to get reliable information. We have a lot of data based on his actions. The DSM is not a hard book to read. Trump’s lying has been documented publicly in The New York Times.

The Goldwater Rule is as valid as ever, insists Steven Berglas, a Los Angeles psychologist and executive coach and consultant. What’s more, he says, Gartner’s petition is a flagrant misuse of the DSM. “You cannot discern from public behavior whether a person’s behavior represents an authentic personality style or is choreographed.” How do we know, he asks, that Trump isn’t “throwing paint balls at the wall, creating chaos so that he can dial it down later to get what he wants.” In fact, he points out, the President seems to be behaving quite rationally in that he is fulfilling his campaign promises.

“I specialize in narcissists, says Berglas. “Many effective leaders are narcissists. Diagnosis is not a cudgel to be tossed around in anger.” And in fact, he believes that doing so is a disservice to the field. The DSM is meant to guide treatment and referrals, and it loses value when it is applied to diagnosis at a distance. He thinks the DSM should come with a warning label: Don’t use this at home.

Calling Gartner’s petition “a temper tantrum,” Berglas insists that keeping out terrorists the wrong way does not warrant calling Trump mentally ill. And the fact that Donald Trump mocked a reporter is deplorable but doesn’t mean he’ll be faster to press the nuclear button.

“Donald Trump is a thoroughly inadequate human being,” Berglas insists. “That is a matter of relevance to the electorate. Why isn’t honesty important to voters?”

And that is one of the many criticisms that psychiatrist Allen Frances levels at the “well-meaning but misguided effort” to declare Donald Trump mentally ill. “Donald Trump is evil — bad not mad — and incompetent. He is a threat to democracy.” His fitness for office should be addressed politically, not psychologically, Frances says.

“I wrote the criteria for personality disorders,” says Frances, professor emeritus at Duke. The public diagnoses being bandied about are inaccurate and “miss the point,” he argues. They ignore the criterion that symptoms must be causing distress and impairment. “Donald Trump causes distress to others, not to himself. He is rewarded for his behaviors.”

There is sickness, Frances contends, but he believes it is in society in general. “We are ignoring real existential threats — of overpopulation, of climate, of inequality.” The cure for this illness, he believes is political activism and electing officials who can be trusted to face “the real problems.” Those most in a position to diagnose are, with the exception of the petitioners and those on the media circuit, sitting out the question of the year.

Source: Hara Estroff Marano, psychologytoday.com/us/blog/brainstorm/201701/shrinks-battle-over-diagnosing-donald-trump