The Myth of Donald Trump's Mental Illness: Don't medicalize political judgments.

Author:Sullum, Jacob
Position:BOOKS - Bandy Lee's "The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President" and Jeffrey A. Schaler, Henry Zvi Lothane, and Richard E. Vatz's "Thomas S. Szasz: The Man and His Ideas" - Book review

IS THE PRESIDENT of the United States mentally ill, or is he just an asshole? That is the puzzle posed by The Dangerous Case of Donald Trump:27 Psychiatrists and Mental Health Experts Assess a President. The question would have amused Thomas Szasz, the late psychiatric iconoclast whose legacy is considered in a new essay collection edited by Jeffrey Schaler, Henry Zvi Lothane, and Richard Vatz.

Szasz, who died in 2012 at the age of 92, spent his career calling attention to the ways in which "the myth of mental illness" (the title of his best-known book) muddles our thinking about troublesome people and problematic conduct. The sweeping, creeping medicalization of thought and behavior that Szasz decried is epitomized by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), which is where "mental health experts" look when trying to diagnose Trump (or anyone else).

The most promising label mentioned by the contributors to The Dangerous Case of Donald Trump, edited by Yale psychiatrist Bandy Lee, is "narcissistic personality disorder." According to the DSM-5, the latest edition of that psychiatric bible, the symptoms of this condition include grandiosity, attention seeking, self-centeredness, "exaggerated self-appraisal," condescension, feelings of entitlement, lack of empathy, and relationships that are "largely superficial and exist to serve self-esteem regulation."

That seems like a pretty accurate summary of the president's personality. But what is gained by calling this collection of traits a "mental disorder" (and implicitly a disease, since psychiatrists are medical doctors)? Diagnosing Trump is a rhetorical trick that allows his opponents to medicalize questions about his competence, temperament, and policies, giving experts like Lee special authority to render political judgments that are supposedly beyond the ken of laymen.

"Possibly the oddest experience in my career as a psychiatrist has been to find that the only people not allowed to speak about an issue are those who know the most about it," Lee writes in the introduction. "How can I, as a medical and mental health researcher, remain a bystander in the face of one of the greatest emergencies of our time, when I have been called to step in everywhere else?"

Lee is alluding to the "Goldwater rule," which bars members of the American Psychiatric Association (APA) from diagnosing at a distance public figures whom they have not personally examined. It is so named because it was created in response to psychiatric critiques of 1964 Republican presidential nominee Barry Goldwater--in particular, a Fact article in which APA members described the candidate as "a dangerous lunatic," a repressed homosexual, a self-hating half-Jew, a paranoid schizophrenic, and "a mass-murderer at heart," just like "Hitler, Castro, Stalin and other known schizophrenic leaders."

Lee says she objects not to the Goldwater rule itself but to an excessively broad interpretation of it that prohibits psychiatrists from bringing their expertise to bear on an orange-haired menace who poses an existential threat to humanity. The truth that she and her colleagues are capable of revealing, she says, "could be the key to...

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