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Concerned therapists break silence to warn the public
A few mental health professionals were concerned about my last blog, "Does Donald Trump Have Narcissistic Personality Disorder? Their concern was that American Psychiatric Association's guidelines warn clinicians they should not diagnose public figures.
I've pointed out that I am not a therapist but one many journalists who have explored whether Trump has a personality disorder characterized by grandiosity; an expectation that others will recognize one’s superiority; a lack of empathy, lack of truthfulness, and the tendency to degrade others. If clinicians cannot explore these things, thank goodness that journalists can.
However, his continued popularity has some concerned prominent clinicians ignoring the "Goldwater rule," which declares it unethical for psychiatrists to comment on an individual’s mental state without examining him personally and having the patient’s consent to make such comments.
"That mental-health professionals are even willing to talk about Trump in the first place may attest to their deep concern about a Trump presidency" writes Henry Alford in a November 11 edition of Vanity Fair. His psychological profile Donald Trump Actually a Narcissist? Therapists Weigh In! (link is external)quotes a variety of clinicians who are confident that the billionaire's high profile and documented history of grandiose behavior makes the diagnosis obvious.
Following are some of their comments.
“Remarkably narcissistic,” said developmental psychologist Howard Gardner, a professor at Harvard Graduate School of Education.
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“He’s so classic that I’m archiving video clips of him to use in workshops because there’s no better example of his characteristics,” said clinical psychologist George Simon, who conducts lectures and seminars on manipulative behavior. “Otherwise, I would have had to hire actors and write vignettes. He’s like a dream come true.”
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“He’s very easy to diagnose,” said psychotherapist Charlotte Prozan. “In the first debate, he talked over people and was domineering. He’ll do anything to demean others, like tell Carly Fiorina he doesn’t like her looks. ‘You’re fired!’ would certainly come under lack of empathy. And he wants to deport immigrants, but [two of] his wives have been immigrants.
“There is help available, but it doesn’t look like the help people are used to. It’s not insight-oriented psychotherapy, because narcissists already have insight. They’re aware; the problem is, they don’t care. They know how you’d like them to act; the problem is, they’ve got a different set of rules."
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Licensed clinical social worker Wendy Terrie Behary, the author of Disarming the Narcissist: Surviving and Thriving with the Self-Absorbed, said, “Narcissists are not necessarily liars, but they are notoriously uncomfortable with the truth." (The article notes that Trump positions himself as a possible savior to the economy despite the fact that four of his companies have declared bankruptcy.)
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“Textbook narcissistic personality disorder,” echoed clinical psychologist Ben Michaelis. “This man is known for his golf courses, but, with due respect, who does he think works on these golf courses? Mr. Trump’s bullying nature—taunting Senator John McCain for being captured in Vietnam, or saying Jeb Bush has “low energy”—is in keeping with the narcissistic profile.
"Regardless of how you feel about John McCain, the man served—and suffered. To degrade people is really part of a cluster-B personality disorder: it’s antisocial and shows a lack of remorse for other people. The way to make it O.K. to attack someone verbally, psychologically, or physically is to lower them. That’s what he’s doing.
“He’s applying for the greatest job in the land, the greatest task of which is to serve, but there’s nothing about the man that is service-oriented. He’s only serving himself.”
1. I'm sure we have never had a narcissist as President before!!!
2. The words below were written by Richard A Friedman, M.D.
In 1973, the A.P.A. defined a set of requirements for communicating with the media — the Goldwater rule — stating that psychiatrists can comment on mental health issues in general, but that it is explicitly unethical for them to offer a professional opinion about an individual without directly examining that person and getting his or her permission to comment.
So it would be fine for a psychiatrist to say that someone who experiences hallucinations and delusions appears psychotic, but to offer a diagnosis of schizophrenia would cross the line.
The distinction between general description and diagnosis may seem like splitting hairs. But for two reasons, the Goldwater rule is just as important today as it ever was.
First, it is intellectually dishonest for a mental health professional — or any physician — to give a diagnosis without examining the patient. A professional opinion is supposed to reflect a thorough and rigorous evaluation of a patient and all relevant clinical data obtained under the protection of strict confidentiality. Anything short of that misleads the public about what constitutes accepted medical practice and invites distrust of the profession as a whole.
Second — and especially timely as we enter another presidential campaign — the Goldwater rule prevents the misuse of medical authority as a political weapon to denigrate an opponent.
