Everybody knows that Donald Trump is mentally disturbed. His mental illness is hiding in plain sight. Someone who can never admit a mistake or show remorse or guilt is unbalanced. Someone who frequently brags and demeans others is emotionally insecure and volatile. And someone who appears to lack empathy invariably has something missing inside. No one has to go out on a limb to know that these things are true.
When I say that “everybody knows,” I realize that that isn’t literally true. Many people seem to like and admire Trump, and likely believe that critiques of his psychological stability originate from the liberal media and his political opponents. Instead, when I say that “everybody knows” Trump is disturbed, I’m saying you don’t need to be a trained psychiatrist or psychologist to believe that he is riddled with extreme emotional conflicts that hamper his ability to be a responsible leader. You just need some combination of common sense, intuition and empathy. Most psychotherapists understand their clients with just such tools. In this sense, analyzing Trump’s mind is almost as easy for the lay person as for the so-called expert.
For example, is anyone surprised that someone who smiles and clowns around all the time might be hiding depression or sadness? Or that a bully might secretly feel weak and scared? Or that a braggart is likely defending him or herself against feelings of insecurity or inferiority? Or that an abuser might have been abused as a child? These inferences don’t require speculative diagnostic leaps or specialized psychiatric knowledge, but are knowable through the ordinary emotional intelligence that guides us in normal social life.
We’re put-off by the braggart because we sense he has an urgent need to show off and turn us from peers to admirers. It isn’t hard to assume that braggarts must be secretly insecure, so much so that they need to constantly proclaim the opposite. A coach in the National Basketball Association, Greg Popovich, nailed what everyone already knew when he said of Trump, “This man in the Oval Office . . . thinks he can become large by belittling others.” Like Popovich, people need to trust their perceptions and intuitions about what makes Donald Trump tick.
Given the huge amount of information we have about Trump — his over 30,000 tweets, biographies, long record of public life, frequent leaks about the inner workings of the West Wing, etc. — certain common sense inferences about his mental state are easy to make. For example, Trump seems unable to tolerate guilt or remorse, refusing to ever admit a mistake or failure. He never said anything sexist, his administration is never chaotic, his response to the devastation in Puerto Rico scores a “10,” and, naturally, he never said anything to insult a Gold Star widow or give license to white supremacist groups after Charlottesville. Nothing is ever his fault — ever. Why is that? Do we really need shrinks to tell us that Donald Trump seems unable to tolerate any feeling of failure, guilt, or shame? I think that most of us intuitively understand that when people compulsively and defensively justify themselves in response to any hint of failure or criticism, they’re allergic to feelings or insinuations that they have done or said something “bad,” something disappointing, something imperfect. And the intensity of Trump’s defensiveness must, of course, be a measure of the degree to which these underlying negative feelings feel intolerable.
The resulting picture of Trump’s psychology can be simply and readily drawn by any observer. This is a man who cannot tolerate feelings of inferiority, helplessness, shame and/or guilt and reflexively and compulsively responds to any inkling of these feelings by exaggerated public displays of their opposite. People don’t need to defer to so-called “experts” to know this.
Most psychotherapists believe that this need to exaggerate the opposite of a painful, troubling feeling is probably inherent in mental functioning. All of us, not just Trump, go out of our way to reduce the threat of distressing feelings and beliefs. We seek psychological safety, which is often temporarily found in the defensive, but reassuring, assertion of attitudes that directly negate what really most troubles us. This is why we often find abuse in the childhoods of adult abusers. Traumatic feelings of helplessness experienced as a child are later denied and negated by the abuser exercising his or her power to abuse someone else. Similarly, it wouldn’t surprise most people to know that people who are extremely extroverted on the outside might be secret introverts.
It’s commonly reported — and evident to most of us — that when Trump feels insulted, he hits back twice as hard. He has felt insulted by, and therefore attacked, Hillary Clinton, Barack Obama, senators Mitch McConnell and John McCain, James Comey, Jeff Sessions, North Korean leader Kim Jong-un, Australian Prime Minister Malcolm Turnbull, Mexican president Enrique Pena Nieto, various federal judges, the New York Times and Washington Post, CNN, NBC, Arnold Schwarzenegger, Rosie O’Donnell, Meryl Streep, the mayor of San Juan, Puerto Rico, Secretary of State Rex Tillerson, and recently, a congresswoman friend of a Gold Star mother — to name just a few. But saying he “hits back twice as hard” almost glorifies Trump as a pugilist rather than describing an extreme reaction to extremely painful, even intolerable feelings of guilt and shame that unfortunately accompany the inevitable imperfections and failures of life, particularly of political life. That Trump finds imperfection and failure intolerable is hardly a wild professional speculation, but instead reflects the common sense awareness that sometimes people avoid negative feelings by exaggerating their opposite.
This universal psychological tendency poses a problem if it is too extreme or compulsive. Trump, for example, seems unable to not strike out if he is made to feel even a little bit of shame, guilt, or failure. Such a reflex makes friendship, collegiality, compromise, or diplomacy impossible — significant problems in a chief executive. An ordinary person afflicted with such a reflex would likely suffer social isolation, problems working with others, difficulties parenting, and an inability to be intimate. For a president within reach of the nuclear football, this reflex can obviously have much more catastrophic consequences.
When I argue that Trump’s psychopathology is hiding in plain sight and that it is easily discerned using common sense, I mean to argue that, while having the imprimatur of mental health professionals’ diagnostic skills is useful, it is not necessary for understanding Trump’s emotional life. A professional might use a diagnostic label such as narcissistic personality disorder to describe him, but the label doesn’t add much to the notion, easily seen by lay people, that Trump inflates his power and importance to cover up a deep-seated sense of inferiority and insecurity. In fact, this latter insight tells us more about what makes Trump tick than the label does.
As far as diagnostic labeling of Trump is concerned, the diagnosis most often used to describe him — narcissistic personality disorder — is easy for a lay person to apply. You need only to refer to the bible of psychiatric diagnosis, The Diagnostic and Statistical Manual of Mental Disorder, or DSM, and look up the label that most seems to fit — in this case, the narcissistic personality — and read the criteria. The fourth edition of the DSM says that someone has this disorder if he or she meets five of the following seven criteria:
- Has a grandiose sense of self-importance
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty
- Believes that he is “special” and unique and can only be understood by other special or high status people
- Requires excessive admiration
- Has a sense of entitlement
- Is interpersonally exploitive
- Lacks empathy.
Trump obviously qualifies. You just check the boxes and you have yourself a diagnosis. The DSM-IV tells you that Trump suffers from 301.81, narcissistic personality disorder. No inferences or speculations are required.
The problem is that once you’ve reached the diagnosis, you have to understand what this means and how it might help you predict his behavior. To do this, however, you must invariably return to the model of mental functioning described earlier in which people are understood as striving to feel safe from distressing feelings and beliefs by emphasizing their opposite. Using this paradigm, it’s then possible to predict, for example, that every time Trump is defeated or one-upped, whether by Congress, the media, or a foreign power, he will be powerfully compelled to strike out. Given the power he has, it is at these moments that Trump will be most dangerous and most likely to act recklessly and without regard for limits or reality.
So what’s all the fuss about this thing called the Goldwater Rule, the ethical principle passed in 1973 by the American Psychiatric Association, ratified later by the American Psychological Association, that enjoins mental health professionals from offering a professional opinion about public figures they have not examined in person, and from whom they have not obtained consent to discuss their mental health in public statements? A recent book, Duty to Warn, persuasively argues that there is a higher ethical principle that supersedes the Goldwater Rule — namely, therapists’ responsibility to protect potential victims from the harm posed by someone suffering from an obvious mental illness. Twenty six mental health professionals show in detail how Trump’s psychiatric illness poses just such a threat to the public, rendering as morally suspect any refusal to warn people about the danger posed by his disorder.
Psychotherapists of all stripes have legitimate expertise in treating people with mental disorders. But as far as weighing in publicly about politics, therapists are at their best when describing psychological dynamics that lie just beneath the surface in ways that everyone can relate to. In this way, most therapists use a sophisticated form of common sense.
Mental health professionals surely have a duty to warn and have access to an enormous amount of information upon which to diagnose Trump. But the truth of the matter is that lay people — all of us, in fact — do not need specialized experts to tell us what we can plainly see. It is plainly visible every day that Donald Trump is pressured to act out and defend himself against the painful threats posed by feelings of guilt, shame, inferiority, and helplessness, and that it is these defenses that produce his aberrant attitudes and actions. We should trust our intuitions and credit our own ability to analyze Trump’s personality and the irrational ways that it manifests itself.
Michael Bader is a psychologist and psychoanalyst in San Francisco. He is the author of "More Than Bread and Butter: A Psychologist Speaks to Progressives About What People Really Need in Order to Win and Change the World" (Blurb, 2015).