By Hal Brown, MSW
I got my clinical degree from a cow college, Michigan State University, formerly Michigan Agriculture College, and it’s only a lowly Masters in Social Work. However during my 40 years as a clinician and a director of a rural mental health center I learned how to discern when somebody has lost touch with reality to the degree that they needed an inpatient psychiatric evaluation. (My bio)
Others with more lofty credentials and prestigious job histories than mine have been recommending the that Trump should be removed as unfit and dangerous under the provisions of the 25th Amendment or at least be evaluated by mental health professionals to determine his mental fitness to serve.
You’ve been reading articles by them for several years. I’ve also written lots of them here on Daily Kos but I think I avoided advocacy for invoking the 25th Amendment. It was not that this was politically highly unlikely, but because I didn't consider his being a malignant narcissist who, as Erich Fromm put it, had a "severe mental sickness" representing "the quintessence of evil” meant he’d be adjudged mentally incompetent in a formal psychiatric assessment. In the definition of malignant narcissism, of course there’s narcissism, plus antisocial personality disorder, sadism and paranoia. Of these only paranoia, if servere enough, falls into the realm of a psychosis.
For the past month there have been more and more articles by mental health professions who have been prolific so their names are familiar to many of you, and not so familiar ones, expressing growing alarm about the president’s behavior. The articles are often published several times every week and not only in he usual online media like Salon and RawStory but in USA Today, Vanity Fair, and other print and online media around the world. The links to the article below are on my blog.
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Going back at least three years, my compatriots in the world of mental health professionals going public about Trump’s dangerous psychopathology generally thought Trump already met the criteria for either being evaluated in a psychiatric facility, for having the 25th Amendment invoked, or both.
I wasn't quite so certain.
In my own writing I tried to make the case that Trump was a malignant narcissist, a sadistic bully, a liar, and a megalomanic and as such was not fit to be president. Still, trying to be objective, I thought it was a stretch to go from saying he was unfit and dangerous to our democracy because of his narcissism, sociopathy, and megalomania to being so impaired that expert evaluators doing an inpatient assessment would determine he couldn’t serve as president for medical reasons.
You can't be committed to a psychiatric hospital for being just evil. If you are evil and convicted of committing evil deeds then you go to prison.
You also can't be forced to have a psychiatric evaluation for breaking the norms Trump has broken. Breaking the norms he has already broken would not be enough. The Washington Post listed and described in depth the 20 norms Trump has shattered. They call Trump’s tenure in office The Abnormal Presidency.
1. Personally profiting from official business
2. Not releasing tax returns
4. Interfering in Department of Justice investigations
5. Abusing appointment power
6. Insulting allies while cozying up to authoritarians
7. Coarsening presidential discourse
8. Politicizing the military
10. Politicizing diplomacy and foreign policy
11. Undermining intelligence agencies
12. Publicizing lists of potential Supreme Court picks
13. Making far more false or misleading claims than any previous president
14. Abusing the pardon power
15. Using government resources for partisan ends
16. Making racialized appeals and attacks
17. Dividing the nation in times of crisis
18. Contradicting scientists
19. Derailing the tradition of presidential debates
20. Undermining faith in the 2020 election results
Only breaking the 20th norm suggests he has lost touch with reality if he truly believes he has won.
“If you count the legal votes, I easily win. If you count the illegal votes, they can try to steal the election from us.” On Saturday, hours after media outlets called the election for Biden, Trump tweeted: “I WON THE ELECTION, GOT 71,000,000 LEGAL VOTES.” (from the Washington Post)
If he believes that he really won the election for the reasons he puts forth he is delusional.
He’d have to be formally assessed to determine this. If he shows undeniable signs of having an acute psychotic episode in public such as talking to people only he sees would I go out on a very sturdy limb and say that I am certain he absolutely needs immediate hospitalization because then he is probably having a severe psychotic episode.
Being an abnormal president, even being worthy of a case study in an abnormal psychology text book doesn't mean he could be committed and stay hospitalized until he was no longer symptomatic. It would depend which chapter he’d fit into in my hypothetical abnormal psychology text book (for example 6 and/or 7 on the right) and how severe the manifestations of the diagnosed disorder or disorders were.
It would appear just from what we have seen that Trump might be either so untethered from reality that he’d be committed for treatment because he was manifesting symptoms of a delusional disorder, which is a psychosis other than schizophrenia, and/or he could be suffering from a mood disorder. If he has a mood disorder, he may also have delusions and severe mood swings. People with bipolar disorder can also have psychotic symptoms. reference If he has a mood disorder he could be manic, deeply depressed, or vacillate between the two states. This would render him dysfunctional and unable to perform the duties of president.
Assessment and treatment for all of the above requires inpatient psychiatric assessment and treatment until the symptoms are remediated.
We just don't know because he hasn't been professionally evaluated. No matter the credentials and experience of those saying Trump is mentally unfit, this is all speculation even though it is based on a huge amount of observation. We are all making educated guesses.
The only mental health professional who has ever known Trump personally is Mary Trump, and she hasn’t done a formal assessment of him. Even she doesn't suggest in her article from Nov. 8th in The Guardian titled Mary Trump on the end of Uncle Donald: all he has now is breaking things and subtitled The president will be having ‘meltdowns upon meltdowns’, according to his niece, who sees poetic justice in the lies and cheating now coming back to bite him that the meltdowns upon meltdowns she predicts (and which it is reported he is having) are severe enough to require inpatient assessment.
Until the election was called for Joe Biden I doubt Trump would have been adjudged to meet the various criteria on the evaluative bar set by psychiatric hospitals to determine he was too dangerous to serve as president.
“Merely” being a malignant narcissist, which includes being a sociopath who enjoys inflicting pain on others, a megalomanic, and someone who lies incessantly wouldn’t be enough unless he actually believed outrageous falsehoods. He would have to be unable to differentiate between what is real and what isn’t. In jargon the level of impaired reality testing is a measure used to determine whether a patient is severely ill enough have treatment mandated.
There are various psychiatric diagnoses that he would have to present to justify his continued hospitalization to receive treatment. Not being in a position to evaluate him except based on his behavior since losing the election I would say that psychiatrists might end up diagnosing him as suffering from a delusional disorder, a mood disorder, or a combination of bot. I do not know. He may just be suffering from narcissistic rage attacks. This does not mean he is psychotic.
True delusional disorders are consider quite rare reference but then Trump is an unusual case. They fall under the general category of psychosis. They are different from untreated schizophrenia or bipolar disorder in that people with this diagnosis can often function reasonably well in parts of their lives that don’t relate to the delusion.
The disorder used to be called paranoid disorder because those who had it often thought they were being followed, poisoned, deceived, loved from a distance, or conspired against. Only the later might apply to Trump but because he is consumed with the belief he is the victim of a conspiracy. If true, I think the examining clinicians would decide that this was enough to keep him hospitalized until he could be successfully treated.
It is possible that if Trump was hospitalized tomorrow he’d be discharged in a few weeks.
“Newer medications — called atypical antipsychotic drugs — appear to be more effective in treating the symptoms of delusional disorder. These medications work by blocking dopamine and serotonin receptors in the brain. Serotonin is another neurotransmitter believed to be involved in delusional disorder.” reference
The treatments for mood disorders included medication, psychotherapy, and in severe cases of depressive mood electroconvulsive therapy (ECT).
It is quite possible that if Trump was hospitalized today that new totally different seeming man presenting a calm demeanor and a reasonably presidential personal would emerge a few weeks later as he’d be stabilized on education.
He might be able to make rational decisions and accept defeat with a modicum of dignity,
How would his supporters react seeing a mellowed out Trump who seemed to be a normal person?