Donald J. Trump has been so outrageous during the first few months of his

presidency that more and more mental health practitioners, including psychiatrists,

are weighing in on the subject of Trump’s diagnosis. Psychiatrists are even joining

in the conversation despite the longstanding ‘GOLDWATER Rule “ which was

instituted after psychiatrists engaged in a diagnostic frenzy during the 64 election;

the basic rule is that psychiatrists shouldn’t make psychological formulations

on public figures whom they have not personally attended. Obviously, the uniqueness

of Trump is demonstrated by the growing numbers of clinicians who feel compelled,

almost duty-bound, to express their opinions.

A letter to the editor in the February 14 NY Times clearly has a “ this is the definitive

word” tone to it as the author, after stating that he wrote the criteria for the DSM

narcissistic personality disorder, states that Trump doesn’t have that condition because

“he does not suffer from the distress and impairment required to diagnose mental

disorder.” I must admit that I have issues with that criterion, because looking back

on my 50-year career as a psychiatrist, I have certainly diagnosed many people who

were oblivious to any personal sense of distress as they rampaged through life as

manics, psychotics, or character disorders. Maybe a more useful topic to address rather

Than to condemn “amateur” diagnosticians might be to analyze why Trump has galvanized so

many mental health clinicians to speak publicly.

A more focused approach to understanding the Trump phenomenon from a mental health

perspective would be to hone in on Trump’s repeated use of projection in his speeches.

Can anyone forget the expressions “crooked Hillary” or “lying Ted”, used repeatedly

and apparently with devastating effects? Projection involves the attribution to another

person traits or thoughts or feelings harbored by the self, but they are so internally

“unwanted” that they must be projected. Projection is thought to be a psychotic

mechanism, not an intentional conscious strategy . Given that Trump has been

performing on the public stage trying to win an election (and now trying to hold onto

his office) one could understandably argue that this mechanism of attributing self-

perceived inner weaknesses to others is just a strategy.

I’m not so sure of that, given the automaticity of Trump’s turning to this mechanism,

now even after he has won the presidency ( or, has been handed the presidency).

There are clearly intra-psychic inadequacy demons disturbing a man who desperately

fights with the press over the size of his inaugural crowd compared to President

Obama’s? As for whether he lies or projects, how do we explain that all of these patterns

have escalated since he has taken office and has secured the position he sought? It

seems indisputable that Trump’s calling Hillary Clinton or Ted Cruz liars given his

outright lying (which now is finally confronted by the press) is preposterous and

clearly emanates from the mind of a disturbed person who cannot tell a lie from

the truth, and wants forcibly to make everyone else join in the delusion.

Another element to the identification of projection as a mechanism to examine;

Trump over the past few weeks has “beat down” the issues of his family involvement

In the running of his businesses (rather than real divestment) and more importantly,

Important tasks in the running of this country. This is the emergence of a paranoid

family seizing control of the nation’s management. His daughter, sons, and son-in-law

have no capacity to provide neutral and especially informed counsel to this president.

This is all there, plain as day, for us to see. I agree with the demurring psychiatrist

who firmly states that the solution to Trump is political, but the urgency to finding

that solution is heightened, in my opinion, by facing up to the fact that the country

has turned, cynically and nihilistically, to a disturbed charismatic man who operates

on the notion that his personal responsibility is never in play, that there’s always

another individual or group to blame.

Typing While Black welcomes this guest blogger!