Howard Covitz and Hal Brown have been writing about Donald Trump on Daily Kos for many months.
Introduction by Howard Covitz:
I am a psychoanalyst and author of a very lengthy treatise on Narcissism ... Oedipal Paradigms in Collision (with an even embarrassingly longer title) and many other published scribbles on Narcissism doesn't want to be "misconscrewed" ... he agrees ... So, please ... no misconscrewing, Boobie! It's not my point ... rather, I'd say ... "there are many kinds of "you-name-its" who demand total submission and compliance” from those who fall under their domain ... there are not few psychoanalysts who do, for instance. You've treated folk for a long time and, I suspect, agree. Adamizing, however ... naming it, as Adam does in Genesis: This is a dog ... this is a pussy ... this is a roo and this is a snail ... naming things, alone, doesn't do it. I have kept many a psychotic and many a narcissist and one embezzling sociopath out of jails and out of hospitals without them harming anyone. But ... I've been playing this tune even before Dr. John Gartner opened Duty to Warn, as you recall. I don't need the name ... the diag-gnosis ... Instead, I needed on 8th Ave to know whether the crazy lady had the intent and the inclination and the ability and the opportunity "to cut my dick off," which would have made my NAAP Board Meeting, that day, at NPAP or the Adler Institute (I can't recall which) "a difficult sit." Herr Drumpf has shown himself as threatening and inclined to hurt others, and 10's of millions of souls gave him the opportunity and the ability to do so. Why name it? ... Dat's vhat I'm trying to say! No more ... no less. It's all about risk.
Introduction by Hal Brown:
So, let’s talk about it…...
Howard Covitz, Ph.D., Clincial Psychologist and Psychoanalyst
It's all Greek to me: Diagnosis? "Can somebody help me?" Naming things from their constituent parts? OK ... I do think psych-folk (MD,PhD,LCSW,LP,...) can point to those areas which likely intrude on thinking appropriate to a complex task?
I've been consistently against choosing a Dx ... Mostly, because our taxonomies ... like DSM ... are so easy to refute and are by no means consensually OK. I can't believe I'm alone in thinking DSM sucks. I keep going back to attempts to "consider the risk" based on the job.
Years ago, I was walking to a meeting in the Village from the Train Station at 33rd. As I got out, a crazy person ... a woman began dancing around me on 8th Avenue, taunting me with a repeating chorus "I'm gonna cut your dick off ..." I told her that we could discuss this when I returned from my meeting Downtown. She said "OK ... but I'll be here when you get back." I thanked her for understanding.
8th Avenue can be like that and on the same walk, a man threatened me and another tried to pick me up, complimenting my Birkenstocks. None of them were armed ... all seemed pretty severely character disturbed. None of them posed a danger ... none of them had power over me.
Fitness to serve is not measured by degree of illness, to my way of thinking, but by specific ways of thinking coupled with armed-potential to do harm.
At a (psychoanalytic conference) talk last week a member of my audience said: "only predictor is past behavior ... he hasn't killed anyone yet."
I don't know what the crazy street lady would've done if she had an AR-15. But at that point, I wouldn't be worried about her Dx, as I'm not worried about the people who are psychotic who walk into my office; they do have to leave their AR-15's at the outside door.
A POTUS has powers that include but don't stop at the aftermath of keying in nuclear codes. They include ability to affect health and wellness ... education ... the air we breathe. I think we need to focus, somehow, on these Presidential Activities of Daily Living. I think I can sign onto (Duty to Warn founder Dr. John D. Gartner’s suspicion of Malignant Narcissism .... in that I think most folk who display DJT's behaviors are functioning without being connected to their sociopathy in a way that allows them to control it and are lacking in healthy Narcissism, ie, compensating with Grandiosity and the Need to Depreciate All Others.
But disarmed? DJT has plenty of space to walkabout the top floors of "The Tower" in his PJ's and Slippers and Towers have long-served this purpose, anyway.
Hal Brown, MSW, Clinical Social Worker
Let’s leave out psychiatric diagnosis for now.
Consider the utility of medical diagnosis.
Except as a last resort, would anyone want to be treated for psychical symptoms with their medical team having an accurate diagnosis? We know on some occasions this has to be done when a diagnosis can’t be pinned down but the patient is suffering.
Everyone knows the sense of relief when a physician finally put a label on symptoms which have been worrying you. Obviously you are relieved when the doctor says that whatever it is can be treated or cured. However, along with proving your fears to be well-founded, there’s relief that you finally know what’s wrong.
We’ve known for decades the power of the placebo not just for psychosomatic disorders, but for disorders that have a well- established physical causation. We know they work for pain and inflammation, and possibly aide in the healing process. We know that surgery can be conducted using only hypnosis.
Recently there have been eye-opening placebo studies where they were effective even when the patients were tod they were taking a sugar pill.
The mind-body and body-mind connections are truly amazing.
Okay? This being said, how is a psychiatric diagnosis different?
First, we know that no matter what kind of therapy a clinician employs some patients report getting better. Studies seem to show that certain therapists seem to have better results than other therapists. My opinion, which is based on experiences with my clients and the clients of my staff and friends, is really a cliché: it’s the personality of the therapist and the client-therapist relationship that makes the difference.
Now, what is the utility of psychiatric diagnosis (except in Rx treatment) besides insurance billing?
My answer with some exceptions (psychosis, major depression, dissociative disorder, PTSD, phobias, Asberger’s ) is that for how you do therapy it probably doesn’t make much difference.
So what use is it?
Aha!
The primary use in clinical practice is to diagnosis potentially dangerous people. I think it has use in screening law enforcement job candidates and convicts up for parole.
This brings us to Donald J Trump and diagnosing him from a distance rather than just pointing to his aberrant and dangerous behaviors.
By explaining why malignant narcissism is his diagnosis we can add the gravitas, acumen, and reputation of our profession to sounding the alarm, not to the patient but to both the public and to the powers that can remove him from office.
Howard Covitz
If this is in defense of dsm type diagnoses, I suppose I'd prefer that you said that.
Here, somewhat like the parole situation you mention, is not a matter of diagnosing for treatment ... that in your response is to my way of thinking a non sequitur. And there, in Dxing for Tx, I still am interested in a quintet of concerns.
1. What behaviors or attitudes are we seeing.
2. Are they intrusive to functioning.
3. What personality or relational structure underlies the behaviors.
4. Is it treatable?
5. Should it be treated?
DSM has chosen a behavioral thoroughly nonexplanatory system for communication between treaters and third parties and for a common nomenclature for research purposes. Instead, it is often invoked as THE system. John's use of Fromm's Malignant Narcissism is not inconsistent with the behavior we've seen in DJT. But, as I've been suggesting in our long-term discussion, the salient question is whether there is risk of danger apparent in Drumpf's behavior.
Amen, Brother Howard, amen!
……
If I may addendum ... ummmm .... as an ex-prof. of Statistics ... the cluster analytic statistics that dsm and other nosologies have used are notoriously poor when frequency in the gen. pop. is small.