Eddy asks “what does that mean? And how would one determine whether President Trump suffers from this disorder?”
In the article, he describes the differences between the viewpoints Duty to Warn's Dr. John Gartner and Dr. Allan Francis who takes credit for writing the diagnostic criteria for narcissistic personality disorder.
Dr. John D. Gartner is the clinical psychologist who founded the Duty to Warn group and put a petition online urging the removal of President Donald Trump under the provisions of the 25th Amendment. Gartner makes his case for diagnosing Trump as a dangerous malignant narcissist.
The counterpoint to this comes from Allen Francis, MD, the psychiatrist who wrote the criteria for diagnosing a narcissistic personality disorder in a patient. He believes Trump can be "appropriately denounced for his ignorance, incompetence, impulsivity and his pursuit of dictatorial powers." In interviews, he has said that Trump’s behavior may be bad, but that does not mean that he’s mentally ill.
Allen Francis who, along with Maria Oquendo at the APA (the association that requires a medical degree for membership) opposed the Duty to Warn group’s making a public diagnosis of the president, the latter cited the Goldwater Rule as a rationale for psychiatrists not diagnosing anyone publically unless they had examed them and had their permission. Along with John Gartner, forensic psychiatrist Bandy X. Lee, MD, is the most interviewed and quoted mental health professional about Trump’s being psychologically unfit for office. Here’s a recent interview with her: “ Expect ‘An Acceleration Of The Chaos’ With Trump In 2019.” In the article, she addresses the issue of the Goldwater rule. She does not diagnose Trump. Rather she expresses alarm at his behaviors and says:
We can only expect the dangerousness to worsen and accelerate. If we had any concern at all about national security, or even the survival of the human species (given the technological powers that are invested in the president), with this level of mental instability, with greater dangers to come because of the impending [special counsel’s] investigation reports, without sufficient containment of the president, I believe removal would be in order. All of this could be answered more precisely with an evaluation, of course, but I think Trump has shown enough to demonstrate he is in no state to continue his presidency for another two years.
Just yesterday, Salon published “Yale psychiatrist: Trump's "lack of conscience" makes the president "capable of criminal activity — Because he never addresses the source of his inner emptiness, it remains ever unfilled," Dr. Bandy X. Lee argues."
The viewpoint of Allen Francis, despite his having written the diagnostic criteria, isn’t universally accepted in the mental health community. For example, this is from t TRUMP’S PATHOLOGY IS ALSO HIS BRAND, By Stephen J. Ducat, Ph.D., in The Psychoanalytic Activist.
Allen Frances, a former editor of the DSM, argues against the tendency of some inside and outside the mental health field to apply diagnostic categories to an understanding of Trump. He insists that because Trump’s personality traits do not seem to bring him suffering and have made him quite successful, this militates against evaluating him in terms of psychopathology. However, in taking this position, Frances illustrates one of the many weaknesses of the DSM, a pseudo-empirical insurance coding guidebook of little clinical utility.
In this case, he ignores a central feature of personality disorders – their ego-syntonic nature. In other words, the behavior of such patients is untroublingly congruent with how they want to see themselves. This is especially the case with narcissism. Furthermore, it is not that “successful” narcissists, like Trump do not suffer distress. Rather, it is that their psychic pain is hidden behind the central preoccupations that mark their character: a ceaseless obsession with zero-sum status competition, a desperate Sisyphean pursuit of admiration that is never satisfied, and an unrelenting series of vendettas against those who have questioned his greatness. Like most narcissists, Trump would never seek treatment for his character – not because he doesn’t suffer, but because he locates that suffering in the failures of others to affirm his most grandiose self-image.
Eddy concludes:
I suggest that we should watch out for high-conflict politicians with a drive for unlimited power ("HCP Wannabe Kings"). It may be that this president does share a desire to have king-like control over the country that some of these earlier malignant narcissists had and other authoritarian leaders around the world seem to have today. In the end, he may not be fundamentally different from these others--but our nation may be different, because of our built-in culture of democracy, our free press, and our legal restraints on power.
If he has a set of behaviors that grows in its dangerousness, then it would appear that it is malignant and that he needs to be reined in. If he accepts the limitations on his power imposed by the congress and the judiciary, and keeps an even keel psychologically without showing signs of distress, then perhaps he has no disorder and will not be dangerous. In either case, he has reached a point after two years in office that his behavior and personality has attracted the attention of many mental health experts and the public. This suggests that we should be concerned, regardless of whether he fits any particular mental health diagnosis.
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(I was one of the first members of Gartner's Duty to Warn group. I have expressed my own views about the dangerous psychopathology of Donald Trump in the past on Daily Kos and more recently in “Trump’s CPAC rant: Cornucopia of psychiatric diagnosis” and in “Trump’s sadistic, malignant narcissism.”)