About the title: Decompensation is a term used in mental health which simply means “get worse” and I should have explained this… “Decompensation” is a term used by mental health professionals to refer to episodes during which a person's existing mental-health or psychiatric disorder deteriorates, for a time, to include symptoms that are unusually severe. In psychology, the term refers to an individual's loss of healthy defense mechanisms in response to stress, resulting in personality disturbance or psychological imbalance. (From a Google search)
By Hal Brown, MSW
Yesterday I asked if there was anything left to write about Trump’s dangerous psychopathology here, and whether Daily Kos readers wanted to read more about it. Half of those who took the poll said they did.
Here’s a follow-up to that diary. Dr. John Gartner, the fonder of the Duty to Warn group was the first to publicize the conclusion that Donald Trump was a malignant narcissist and published an article explaining this in USA Today back in 2017. I agree with him.
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What Is Malignant Narcissism?
While there is only one official diagnosis for narcissists, there are different types of narcissists, and narcissism comes in varying degrees of severity, including grandiose narcissists, who require excessive praise and attention, and vulnerable narcissists, who tend to have a lot of anxiety and need a lot of supportive attention.
Among the variants of narcissism, malignant narcissists are by far the most damaging. This subset contains the general traits of NPD, including regular egocentricity, but also some antisocial traits and even a sadistic streak as well as a poor sense of self and lack of empathy. There is often some paranoia involved with malignant narcissism as well. From VeryWell Mind continued here
The more narcissistic a person is the more prone they are to have a severe negative reaction to what is called a narcissistic injury:
A Narcissistic injury is conceptualized as a perceived threat to a narcissist’s self-esteem or self-worth. Narcissistic injury (or narcissistic scar) is a phrase used by Sigmund Freud in the 1920s; narcissistic wound and narcissistic blow are further, almost interchangeable terms. The model underlying the construct suggests that narcissistic injury occurs when a narcissist feels that their hidden, "true self" has been revealed. This may be the case when the narcissist experiences a "fall from grace", such as when their hidden behaviors or motivations are revealed, or when their importance is bought into question. from Wikipedia
I compare Donald Trump to Richard Nixon when he knew his presidency was over. Nixon for all his faults reacted within the realm of normality when he knew he would have to either resign or be impeached. He had a grief reaction. His diagnosis would probably have been clinical depression exacerbated by alcohol abuse. If Nixon sought psychiatric treatment there a good chance he would have been prescribed an anti-depressant which would have eased his distress and he’d be provided with psychotherapy as well. His doctor would have tried to stop him from drinking since alcohol is a depressant.
There's no treatment that has been shown to be effective for those with combination of psychiatric disorders included in malignant narcissism that Trump has.
I expect that if Donald Trump decompensated even more than he has already we will see one or a combination of the following psychiatric reactions to the growing awareness that he has lost. I list these below more or less from the least to the most severe. The more severe reactions, numbers 11-16, are the least likely. These disorders are actually quite treatable, unlike the two Cluster B personality disorders that afflict him (narcissistic and anti-social) which are not amenable to treatment.
Ironically, the more severe his reaction the more treatable he’d be. He could go into a psychiatric hospital, be stabilized on medication, and return to his baseline condition with several weeks before the end of his term.
We are already seeing some of these but they could get worse.
- Avoidance and non-psychotic denial
- Easily distracted
- Impaired judgement
- Defiance of norms (more pardons, appointment of unqualified people to position, etc)
- Not able to evaluate negative consequences of decisions
- Delusional and paranoid ideas not at the level of psychosis
- Narcissistic rage at setback and towards enemies (article) leading to...
- Extreme narcissistic rage triggered by minor upsets in addition to rage attacks against perceive enemies leading to...
- Uncontrolled rage attacks for no discernible reason
- Manic behavior (not psychotic)
- Manic symptoms extreme enough to be part of bipolar psychosis
- While this is not in character, he could experience various levels of depression from minor to debilitating major depression
- Delusional level denial (a psychosis — up until Jan. 20 if he believes he will be inaugurated)
- Paranoia (psychotic — for example, unseen forces are out to get me, the CIA has bugged the White House, physical manifestations he attributes to sonic waves directed against him)
- Acute psychosis (auditory and or visual hallucinations)
- Catatonic state (one of three types)
I would also consider the chance that the stress he is under will impair his immune system, put a strain on the heart, and lead to physical illness. Stress can also cause psychosomatic symptoms. He could have cardiac or gastro-intestinal problems or symptoms.
Stress can also have a detrimental effect on coordination. It can make people clumsy. I can see Trump seriously injuring himself with a slip and fall as he tries to dance to another Village People hit “Macho Man” which would be a well deserved karmic kick in the keister for him.
On the political side, It is possible that if Trump needed to be hospitalized for a psychiatric episode the 25th Amendment would be enacted and Pence as acting president might pardon him assuming he'd have the authority to do so. Then if it was before Jan. 20th and Trump was discharged he would serve out his term.
Related:
Addendum
You can watch Macho Man being played whenTrump visited India here.