Malignant Narcissism: Mental Disorder or Metaphor
I want to use this morning’s blog both to demonstrate the role of argument in persuasion, but the veritable impossibility of employing that tool of argument to change the mind of a narcissist of the extraordinary dimensions of Donald Trump. On 15 February 2017 in the New York Times (A26), Dr. Allen Frances, an extremely eminent and highly regarded psychiatrist who is the epitome of scholarly care and judicious reasoning, wrote a letter (An Eminent Psychiatrist Demurs on Trump) criticising using the term “narcissism” to characterize Donald Trump as suffering from that mental disorder.
To the Editor:
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).
Bad behavior is rarely a sign of mental illness, and the mentally ill behave badly only rarely. 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.
His psychological motivations are too obvious to be interesting, and analyzing them will not halt his headlong power grab. The antidote to a dystopic Trumpean dark age is political, not psychological.
This was not your run-of-the-mill criticism. Frances chaired the task force that compiled the definitive Diagnostic and Statistical Manual of Mental; Disorders IV. (D.S.M. – IV). Frances was the member of the committee who also evidently composed the descriptive characteristics of “narcissistic personality disorder.” In his words, Trump “does not meet the criteria that define the disorder.” Frances insisted that Trump was not mentally ill.
I could try to get around his authoritative judgement by insisting that I am not using “malignant narcissism” as a professional psychiatrist – which I clearly am not – but using a term that was adopted by psychiatry from a far broader literature. And I will certainly defend my use of the term on that basis. But I also want to deal with Frances’ criticisms of the psychiatrists who also called Trump a narcissist with a mental disorder.
It is not as if Frances was defending Trump. He chastised Trump for his “grandiosity, self-absorption and lack of empathy.” He characterized the denunciation of Trump as appropriate for his “ignorance, incompetence, impulsivity and pursuit of dictatorial powers.” However, bad behaviour, he argued, is “rarely a sign of mental illness.” It is an insult to the mentally ill (mostly well-behaved and well meaning) who suffer “the distress and impairment required to diagnose mental disorder.” Further, and most importantly, Frances himself called Trump “a world-class narcissist.” Frances was not arguing that Trump was not a narcissist, but that his narcissism did not fall under the category of mental disorder because it did not produce the “distress and impairment” in the subject characteristic of a mental disorder.
Further, Frances denounced, in the same manner as my son had, name-calling. It is not clear in the letter whether the name-calling was the characterizing of Trump as narcissistic or the characterizing of his suffering from a mental disorder, but, from the context, and in order not to accuse Frances of contradicting himself, I believe it was evidently the latter. Labeling Trump as a narcissist may be alright, but naming him as a narcissist with a mental disorder is erroneous, not only because Trump does not suffer distress from his condition, but is, in fact, richly rewarded for it. Further, it suggests that psychiatry is an inappropriate response when the “antidote to a dystopic Trumpean dark age is political, not psychological.”
Rule 1 of rational argument: state the argument of the individual you wish to contend with accurately and fully.
Rule 2: consider alternate positions put forth by others.
One was put forth by W.J.T. Mitchell in the Los Angeles Review of Books that was published a day after Frances’ letter appeared. An earlier version had been presented in a lecture at the Université de Genève, 18 January 2017. The essay was called, “American Psychosis: Trumpism and the Nightmare of History.” It began with a quote from Friedrich Nietzsche’s Beyond Good and Evil: “Insanity in individuals is somewhat rare. But in groups, parties, nations and epochs, it is the rule.”
We are all, both the Trumpists and the anti-Trumpists, going through the long and dark nightmare of our collective soul. With Donald Trump’s election, we crossed the Rubicon into a new epoch. It is an epoch adumbrated in the film, Being There, though in a very different version. The epoch was predicted even earlier by H.L. Menken. “As democracy is perfected, the office of the president represents, more and more closely, the inner soul of the people. On some great and glorious day, the plain folks of the land will reach their heart’s desire at last, and the White House will be adorned by a downright moron.”
Mencken was a cynic and had great contempt for the “common man.” I share his prophetic view but not his reasoning. The fault is more institutional. When democracies reduce themselves to populist polities, as in Brexit, disaster will likely follow. America is even more prone to such a disaster. That is because America is a democratic monarchy and one day, a fool was almost certain to make the monarchical role primary and the presidential role and responsibility of governing second. As Mitchell wrote, when the combination of an oligarchy of the super rich joins forces with increasing inequality and the brew is fed by a new and innovative media, the conditions were created for the perfect storm.
Populism is not responsible government. Populism is not democracy, just its meanest expression. It reared its ugly head in the Brexit vote. We wait on pins and needles for the shoe to drop in the Netherlands, in Germany, but, most of all, in France. And we hope and pray that the example of the U.S. will dissuade enough voters in Europe to avoid the fatal edge of a cliff. For though the economic forces now favouring renewable energy may guarantee the eventual replacement of fossil fuels, will the victory come too late? Will Donald Trump as a climate change denier who appoints a fossil fuel lobbyist to head an agency responsible for monitoring the destructive effects of fossil fuels on our lonely and lovely green planet, do irreparable damage? Will the triumph of renewable energy sources have arrived too late?
However, the issue is not just whether Donald Trump’s condition as a malignant narcissist can be characterized as a mental illness, but also whether collective behaviour can be characterized as mass psychosis. Describing a condition as “madness” by Mitchell is not just a rhetorical tool. He put it forth, not to describe a mental illness, not to get shafted on the end of an épée, but to analyze a way of thinking, a mental state, a collective psychology rather than an individual mental illness.
I will return to our collective mental state in a subsequent blog, but I want to focus in this blog on Donald Trump’s mental state. Is that state an illness? Mitchell quotes Freud to assert than an individual’s mental state invariably involves others – models, helpers, opponents. We cannot separate the two. But, unlike Mitchell, I think it is best to start with the individual, with Trump rather than Trumpism. Subsequently, I will delve more deeply into the paradox of men and women, who are otherwise decent, hard-working, moral and, most of all, reasonable, becoming victims of “amnesia, ignorance and delusion.” Whereas Mitchell seems to see Trump as simply the purveyor of an image that mirrors a collective madness, I see him as a magnet and stimulant of that madness. And that is not saying the same thing in different words.
Let me go back to the issue of whether the primary error in depicting Trump’s characteristics is not whether he possesses those traits, but whether they add up to a mental illness. The collective Michael Brenner (MB) – https://mail.google.com/mail/u/0/?hl=en&shva=1#inbox/15a57040fcb2acc7 – argues that the man in the oval office is unhinged. MB makes that argument in all deference to Allen Frances, but in sharp disagreement with him. He does so on the basis of the following five arguments:
- Trump’s personality is almost a perfect fit for the profile of a narcissistic personality disorder;
- One does not have to suffer distress or impairment to be diagnosed with that disorder, and that criterion is not mentioned in DSMIV;
- Though pain and discomfort may accompany such a disorder on the individual “suffering” that disorder, those conditions are also not necessary conditions for such a diagnosis;
- Though many and perhaps most mentally ill individuals do no harm and cause no distress to others, this is not the case with psychotics or with narcissism of the gargantuan proportions of Donald Trump; they impose pain and discomfort on others;
- Narcissism is the one condition that most clearly causes acute distress for others because the strategies devised protect the self at the expense of others.
I think these arguments are persuasive. Donald Trump’s condition is a mental disorder. On the other hand, it is also, as I will argue, not a treatable condition. It a condition unworthy of attention to the “sufferer” as distinct from most mental conditions. Donald Trump neither demands of us nor is he deserving of sympathetic care. His narcissism alone is more than sufficient to protect him from abuse directed at him by others.
So why call it a mental disorder if we not only cannot but will not even attempt to treat it? Further, disorder conveys chaos, disarray, confusion and a question arises whether Donald Trump creates that disarray and disorder, simply mirrors it or more radically acts out the collective psychosis of our age?
As with many things, the devil is in the details. In the next blog, I will offer the characteristics of this state, which I also contend is a disorder. For that narcissism is not only an expression of a disordered mind, but is also a stimulant, adding to the disorder at large. One sign of that disorder is that Trump would not listen to, could not follow if he did listen, and would reject out of hand all four positions set forth in this blog, which includes my own. In the next blog, I will try not only to specify that Donald Trump’s disorder does not allow him to listen to arguments and contrary views, but why he characterizes all such arguments as personal attacks.
Neither Frances, nor Mitchell, nor MB nor I would regard our differences as personal attacks, but instead treat them as arguments and expressions to be debated and resolved in a rational universe. Donald Trump does not belong to that universe and is incapable of being persuaded of anything. Deviation from his path, sometimes, but never persuaded. That is why the real issue is not Trump, but those caught up in the mass psychosis and how they can be persuaded to abandon Trump.
With the help of Alex Zisman
 Michael Brenner does not exist in actuality. It is, rather, the nom de plume for a loose association of persons who share a perspective on the world of politics and a sensibility about cultural matters. They are of diverse background and profession. The consortium’s members came together by happenstance. There is no organization nor is there a physical location for an electronic hub… The associates’ insistence on absolute anonymity is due to more than their innate modesty. They hold the firm belief that what counts are the thoughts and ideas rather than persons. In addition, there is some consideration being given a run for the White House in 2020 by the “legend” of “Michael Brenner” – if an appealing individual can be found to assume the persona. High name recognition would be crucial to offset Ivanka’s immense popularity and her lock on the primate vote. (From a communication received 12 February 2017)
it is necessary to distinguish the two meanings of the word “disorder”. There is the common usage which I believe Howard has well outlined here, and the so-called technical usage a “medical” disorder. A disturbance in the teleologically expectable function of some system. With all due respect to Dr. Allen, I also as a psychiatrist, must disagree with the distinguishing about whether or not Trump has a “mental disorder”. The concept as it applies to narcissism is, after all, a construction and does not exist anywhere in nature. A committee has decided that certain criterial quality as a disorder and so in the epitome of circularity we decide that if certain criteria are not met it is not a disorder. On the other hand, the term “malignant narcissism” is descriptive and only too appropriate a term for Trump.